新型隐球菌脑膜炎的诊断探讨及文献复习

目的:探讨新型隐球菌脑膜炎(CNM)的临床特点及诊断方法。方法:对18例CNM患者的临床资料进行回顾性分析并文献复习。结果:18例患者均经病原学确诊。大部分CNM患者为亚急性起病,临床表现无特异性,误诊率高,首诊误诊率为72％,其中误诊为结核性脑膜炎的占69％。结论:脑脊液中找到新型隐球菌是诊断该病的重要依据,多种快速检测手段结合可提高早期诊断率。     

Effects of bimatoprost 0.03% on ocular hemodynamics in normal tension glaucoma.

PURPOSE: The aim of this study was to investigate the effects of bimatoprost 0.03% on ocular hemodynamics in patients with normal tension glaucoma (NTG). METHODS: Twenty-two (22) patients with NTG were consecutively recruited. After basic eye examination and diurnal intraocular pressure (IOP) measurement, color Doppler imaging was used to measure the peak systolic and end diastolic velocities and resistive index of the central retinal, lateral posterior ciliary, and medial posterior ciliary arteries. Patients received bimatoprost 0.03% for 4 weeks, and these measurements were then repeated. The worse eye of each NTG patient was used in the statistical analysis. RESULTS: Bimatoprost 0.03% significantly reduced mean IOP from 15.1 +/- 3.8 mmHg at baseline to 12.0 +/- 2.9 mmHg after treatment in our sample of NTG patients (P < 0.001). No significant changes in blood velocities or resistance indices were observed in the retrobulbar vessels after the 4-week treatment. CONCLUSIONS: Topical bimatoprost 0.03% significantly reduced IOP in our NTG patients without causing significant hemodynamic changes in the retrobulbar vessels.     

外科学教学中的审美教育

医学审美教育是医学生全面素质教育不可分割的组成部分,笔者结合长期外科教学实践,阐述了在外科学教学中运用医学美学原理对外科学的美进行开发和挖掘,使医学生在熟练掌握外科学基本理论和基本技能的同时,潜移默化地接受美的教育,美的熏陶,更能激发他们对外科学的热爱和兴趣,达到全面提高医学生整体素质的目的。     

凯时治疗慢性重型肝炎患者疗效观察

目的探讨凯时即前列地尔脂微球载体制剂（Lipo-PGE1）治疗慢性重型肝炎的疗效。方法将84例慢性重型肝炎患者随机分成两组，对照组予综合治疗及对症治疗，治疗组在该基础上加用凯时10μg溶于5％葡萄糖注射液250ml中静脉缓慢滴注，1次/d，疗程为4周。结果治疗组对慢性重型肝炎的疗效优于对照组（P〈0．01），肝功能改善优于对照组（P〈0．01）。结论Lipo-PCEI是一种治疗慢性重型肝炎安全、有效的药物。     

64层CT下肢动脉成像技术研究

目的探讨64层CT下肢动脉成像强化质量的对比剂注射方式。方法前瞻性地选择60例疑诊下肢动脉病变的病人,利用64层螺旋CT行下肢动脉CT血管成像。采用不同的扫描和重建参数,应用370mgI/100ml浓度的对比剂100ml团注或采用先70ml的对比剂后50ml的0.9%生理盐水用双筒高压注射器分别以4.0ml/s的注射速度团注入肘静脉,应用对比剂追踪触发扫描方式待腹主动脉CT阈值达120HU时延迟7s开始扫描;利用MIP和VR方式重建CTA图像;对比不同参数和不同对比剂应用方式的CT血管成像图像质量。结果最佳的扫描与重建参数为准直64×0.6mm,螺距1.5,层厚1.0,重建间隔50%;最佳的对比剂应用方式为(浓度为370mgI/100ml)对比剂70ml、生理盐水50ml以4.0ml/s注射速度按先后顺序团注。结论选择合适的准直、螺距以保证适当的扫描速度,选择合适的对比剂浓度、用量和注射速度以保证血管内足够的对比剂峰值浓度及峰值持续时间,此二者是64层CT下肢动脉成像成功的关键。     

复方碘酊消毒液中和剂试验研究

复方碘酊消毒液是含有20 g/L碘和1 g/L三氯羟基二苯醚的酒精溶液,为选择出合适的中和剂,采用化学中和法的悬液定量试验和滤膜冲洗及中和剂加滤膜冲洗法进行了试验研究。结果,硫代硫酸钠、硫代乙醇酸钠、吐温80、卵磷脂及其复方中和剂经悬液定量试验法和滤膜冲洗法,均不能中和复方碘酊消毒液对试验菌的残留作用。采用中和剂加滤膜冲洗法证明,用含5000 mg/L硫代硫酸钠+5000 mg/L吐温80+2000 mg/L硫代乙醇酸钠的磷酸盐缓冲液作为中和剂,均可有效去除复方碘酊消毒液对试验菌的残留作用;各中和剂及其中和产物对试验菌及培养基无不良影响。结论,选择复方碘酊消毒液的中和剂,不适宜用悬液定量试验法;宜采用滤膜过滤冲洗法。     

Pulmonary Lophomonas blattarum infection in patients with kidney allograft transplantation

The aim of the study was to analyse the clinical manifestation and management of pulmonary Lophomonas blattarum infection in four allograft transplantation recipients retrospectively. Four patients with pulmonary L. blattarum infection were diagnosed by using Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) examination. Their clinical manifestation and management are summarized. Four cases of pulmonary L. blattarum were found during the period from the second month to the third month after transplantation. Concurring infection by other pathogens was found in three of them. Common initial symptoms included fever (>38 degrees C) without cough and breathlessness. Lower lobe shadowing could be found on chest X-ray. Body temperature decreased to the normal range in three patients and to 37.5 degrees C in the other one, after intravenous injection of metronidazole and tapering immunosuppressant. Radiological examination confirmed improved health condition of the patients afterwards. Two patients received repeated FOB and only dead L. blattarum was found. Pulmonary L. blattarum infection in allograft transplant recipients carry relatively obscure initial symptoms. Possible L. blattarum infection needs to be screened in post-transplantation pulmonary infection patients with similar symptoms, especially in those who respond poorly to anti-infection treatment. Microscopic examination of BAL fluid can help to identify pulmonary L. blattarum infection and metronidazole is an ideal treatment choice.     

原发性食管间质瘤的诊断和治疗(附2例报告和国内文献复习)

目的探讨原发性食管间质瘤（esophageal stromal tumor,EST）的临床特征及外科治疗方法。方法总结2例EST的外科手术资料，并对国内同类病例进行文献复习和讨论。结果本组2例EST均行手术切除，随访无复发。迄今国内个案报道8例EST，结合回顾性病理文献资料不足50例，经手术切除者，随访1年以上均无复发。结论EST是一种少见病，免疫组化检测是确诊方法，手术切除是主要治疗手段。     

孕期宣教对孕妇影响的调查与分析

[目的]了解孕期宣教对孕妇在保健知识方面的需求性,孕期检查的必要性及心理健康状况、分娩方式选择方面的影响。[方法]采用自制问卷调查表对1500例孕妇进行调查,其中接受孕期宣教1000例,未接受孕期宣教500例。[结果]孕期宣教对孕妇在保健知识的需求性和孕期检查的必要性上,在心理健康状况和对分娩方式的选择上有显著影响(P<0.005)。[结论]开办孕妇学校对孕妇实施针对有效的孕期宣教和保健指导是必要的。     

真菌源性CD::UPRT联合基因治疗脑胶质瘤的实验研究

目的研究5-FC/CD：：UPRT联合基因治疗策略对胶质瘤细胞C6的杀伤效应。方法扩增yCD：：UPRT融合基因并构建含yCD：：UPRT基因的重组表达载体；载体转染包装细胞PT67,所获重组病毒转染胶质瘤细胞C6,筛选并鉴定阳性转基因克隆；用MTT法检测不同浓度5-FC对CD：：UPRT转基因细胞的杀伤效应。结果PCR法扩增出全长CD：：UPRT基因,经测序证实序列正确,重组逆转录病毒表达载体pLXSN-yCD：：UPRT经双酶切获目的条带,载体转染包装细胞获重组逆转录病毒(滴度达3．5×10~6CFU/ml)并转染C6,经筛选获得转基因阳性克隆C6-yCD：：UPRT细胞株,检测显示该细胞株有效表达目的基因。当5-FC终浓度≥10μmol/L时,实验组与对照组的细胞增殖力出现显著差异(P＜0．01),5-FC作用96h后电镜观察到凋亡小体。结论5-FC/yCD：：UPRT联合基因治疗策略对胶质瘤细胞C6有明显的杀伤作用。