乡镇中,小学教室噪声卫生防护距离的研究

本文对乡镇中，小学的交通噪声进行了调查研究，结果表明，在９：００～１６：４５时间内，中学的Ｌｅｑ值为８０ｄＢ（Ａ），Ｌ５０为７２ｄＢ（Ａ），小学的Ｌｅｑ值为８０５ｄＢ（Ａ），Ｌ５０为７３ｄＢ（Ａ）。文章还对不同距离的噪怕衰减情况进行统计分析，并制订出乡镇中，小学教室内噪声不超过５０ｄＢ（Ａ）防护距离为１２０米，不超过４５ｄＢ（Ａ）防护距离为２２０米。     

山莨菪碱防治甘油所致急性肾功能衰竭的实验研究

在１２９只ＳＤ大鼠的实验中动态观察了山莨菪碱对甘油所致急性肾功能衰竭时不同时期的Ｂｃｒ，ＢＵＮ，ｐＨ病理改变及死亡率的影响，结果表明：山莨菪碱能降低ＡＲＦ第５天大鼠死亡率以及Ｂｃｒ，ＢＵＮ水平。改善病理损害，对ＡＲＦ起到预防及治疗效果，山莨菪碱的预防效果优于治疗效果，预防是ＡＲＦ防治的关键，但山莨菪碱在治疗过程中要引起“冲刷综合征”导致洗脱性酸中毒，应引起注意。     

经肝动脉灌注^131 I-HAblSF（ab’）2治疗肝癌合并门静脉癌栓疗效分析

目的探讨经肝动脉灌注^131 I-HAbl8F（ab’）2治疗肝癌合并门脉癌栓的价值。方法8例合并门脉癌栓的晚期肝癌患者行经肝动脉超选择灌注^131 I-HAbl8F（ab＇）2临床治疗性试验，剂量：0．75mCi／kg。分析症状、卡氏评分、肝功能、AFP及肿瘤CT等影像变化，随访近期疗效。结果7例疼痛患者中，3例症状缓解。3例卡氏评分增加、4例稳定。6例AFP异常患者治疗后3例下降。全组病例用药后肝功能损害均无明显加重。1例无明显症状的弥漫型肝癌患者治疗后病灶减少；余7例中，瘤体增大5例、缩小2例，其中，PR2例，临床有效率28．6％。本组1例1年随访时生存。结论经肝动脉灌注0．75mCi／kg ^131 I-HAbl8F（ab＇）2对合并门脉癌栓的肝癌患者肝功影响小，对门脉分支癌栓患者有较好的疗效。     

原发性肝癌患者肝切除术前、后免疫细胞表型分析

目的研究原发性肝癌(PrimaryLiverCarcinoma,PLC)患者肝切除术前、后免疫细胞表型的变化。方法采用直接免疫荧光标记,流量血细胞计数法(FlowCytometry,FCM)检测方法,动态观察120例PLC患者肝切除术前后外周血T淋巴细胞亚群、NK细胞和HLA鄄DR含量变化。结果肝切除术前肝功能Child鄄PughB级、OGTTL型和术前施行肝动脉栓塞化疗患者外周血CD8+T细胞含量明显低于正常人组,CD4+/CD8+比值则较高(P<0郾05)。全部肝癌患者肝切除术前、后CD3+CD4+T细胞和NK细胞(CD3-CD16+CD56+)含量无明显差异。术后第1天、第3天、第7天和第2周外周血淋巴细胞CD3+CD8+含量明显低于肝切除术前和术后第3周(P<0.01);而CD4+/CD8+比值则显著高于肝切除术前和术后第3周(P<0郾01)。结论PLC合并肝硬变肝储备功能不足、术前肝动脉栓塞化疗和肝切除术可导致机体细胞免疫功能低下,PLC患者肝切除术前行肝动脉栓塞化疗的价值有待深入研究。     

双侧侧脑室外引流并脑脊液置换术治疗原发性脑室出血23例

我科自1995年1月至2005年1月共收治原发性脑室出血23例，经双侧侧脑室外引流并脑脊液置换术冶疗取得较好效果，现报道如下。     

Chronic obstructive pulmonary disease in Brazilian primary care: Diagnostic competence and case-finding.

AIMS: The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding. METHODS: 34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142). RESULTS: For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk. CONCLUSIONS: COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation.     

Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits

Background. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective. To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design. We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from 01 1998 to 10 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions. Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.     

超声抽吸法治疗下肢原发性淋巴水肿

目的观察超声抽吸法治疗下肢原发性淋巴水肿的疗效。方法为12例患者采用内超声脂肪抽吸机吸除淋巴水肿组织以降低患肢淋巴负荷，抽吸后结合持续弹力袜裤压扎。结果术后2周水肿即时消退明显，术后1年随访水肿消退，复发不明显。结论超声抽吸法治疗原发性淋巴水肿安全简便，结合弹性袜裤压扎可望取得较好的远期疗效。     

Prevalence of giardiasis among primary school children

Summary This cross-sectional study was conducted to investigate the prevalence of intestinal parasites among primary school children in Northern Jordan. Stool specimens were collected from 1100 children of both sexes from urban and rural schools. A questionnaire covering relevant informations was completed for each child. Wet mount preparation, formaline-ether concentration technique, and trichrome stain were prepared for the recovery and identification of parasites. Giardia lamblia was observed in 396 (36%) of the stool specimens examined. The infection rates were higher in the younger age group where several of them had diarrhoea and reported variable symptoms. The infection rates declined with age and children were asymptomatic. Rates were higher in children from the rural areas, from low income families, and it was higher in boys than girls.
Contaminated drinking water is suspected to be the major potential source of infection. The importance of the asymptomatic cases and the epidemiological factors contributing to the transmission in these areas are discussed.