山东省德州地区已婚育龄妇女弓形虫筛查状况分析

目的:了解已婚育龄妇女弓形虫感染情况以及探讨弓形虫的感染途径、感染与不良生育的关系。方法:于1998年12月～2000年12月采用ELISE方法对1042例育龄妇女进行了TOX-IgM的筛查及有关情况调查。结果:本市已婚育龄妇女TOX-IgM平均感染率为12.18％,正常妊娠组及不良生育组显著高于未孕组(P<0.05);郊区妇女高于市区妇女(P<0.05);有动物接触史及有生食习惯的妇女显著高于无接触史及生食习惯者(P<0.05)。结论:TOX感染是引起不良生育的重要原因之一。建议育龄妇女孕前孕期加强TOX筛查工作,以及早诊治;加强健康教育,改变不良生活习惯;加强水源、粪便等卫生管理。     

老年急性重症胆管炎的外科治疗(附76例分析)

目的：探讨老年急性重症胆管炎(ACST)的外科治疗。方法：总结60岁以上老年ACST76例，根据病程分段统计手术后并发症率和死亡率。结果：病程在1天以内手术者，并发症率为10．0％，死亡率为0；1～3天手术者，并发症率为21．9％，死亡率为6．3％；3天以上手术者，并发症率为64.3％，死亡率为28．8％。三组之间比较有显著差异(P＜0．01)。结论：老年人ACST治疗上应早期手术，解除胆道梗阻，建立通畅的胆道引流；手术应简捷，尽量缩短手术时间。     

体重对腰椎后路开窗减压手术疗效的影响

目的对不同体重老年腰椎管狭窄患者行单纯腰椎后路开窗减压手术,并评价其治疗效果。方法回顾性分析1996年12月～2002年12月间145例因老年腰椎管狭窄而采用单纯腰椎后路开窗减压手术治疗患者的病例资料,结合问卷调查患者对手术的满意程度,比较不同体重患者住院期间及术后症状改善情况,评估手术疗效。结果不同体重患者术后腰腿疼痛明显缓解、日常生活质量改善,患者对手术的满意率达67.59%。而且患者的各种统计数据表明,不同体重组之间差异无显著性意义(P>0.05)。结论体重在一定程度上影响老年腰椎管狭窄患者的手术治疗结果。单纯腰椎后路开窗减压手术,可以达到较为理想的治疗效果。     

Free flap reconstruction of the lower extremity in the elderly

Summary Over a four year period, thirteen patients over the age of 60 (mean 69 years) underwent reconstruction of lower extremity defects with free tissue transfers. Ten latissimus dorsi, one tensor facia lata, and two rectus abdominus free flaps were used. Despite significant risk factors which included previous tobacco use, hypertension, diabetes mellitus, and angiographic vessel abnormalities, ten of thirteen cases had successful outcomes. There was one acute flap failure secondary to arterial thrombosis. Four flaps had delayed healing, with one patient eventually requiring amputation secondary to persistent pain and wound drainage. This experience demonstrates that free flap reconstruction of lower extremity defects in the elderly patient is a reasonable alternative to amputation when other options are limited.From the Section of Plastic and Reconstructive Surgery at the Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA Requests for reprints: J. Fisher, M.D.     

Cyclic hormonal replacement therapy after the menopause: Transdermal versus oral treatment

Summary In an open, randomized, comparative, between-patient trial, 45 postmenopausal women were treated for 4 months with cyclical transdermal oestradiol 0.05 mg per day or oral conjugated equine oestrogens 0.625 mg per day, in both cases, plus, medroxyprogesterone acetate 10 mg per day on the last 8 days of each cycle. Similar relief from postmenopausal symptoms was obtained with both treatments. Post-treatment histological evaluation of the endometrium did not reveal neoplastic or hyperplastic change in any patient.Early follicular-phase plasma oestradiol levels were observed only after transdermal oestradiol. There was a significant reduction in serum total cholesterol and LDL cholesterol in both treatment groups, with no difference between treatments, whereas serum triglyceride levels were decreased only by transdermal oestradiol. Plasma calcium and phosphorus fell significantly and serum intact parathyroid hormone rose significantly, with no difference between the therapies. No significant changes were observed in clotting factors.Transdermal oestradiol appears to be an effective and safe hormonal replacement therapy, and this route of administration may be responsible for the more useful action of the drug on serum lipids and plasma oestradiol levels.     

Correlations between bone mineral density and demographic, lifestyle, and biochemical variables in community-dwelling Japanese women 69 years of age and over

Introduction A few epidemiologic studies have comprehensively attempted to identify risk factors for low bone mineral density (BMD) in elderly Asian women. The purpose of this study was to identify demographic, lifestyle, and biochemical factors correlated with BMD in elderly Japanese women 69 years of age and over.Methods The study design was cross-sectional. The subjects were 583 ambulatory women aged 69 years and over, and their average age was 74.3 (SD 4.4) years. Predictor variables were age, reproductive history, anthropometric indices, grip strength, calcium intake, lifestyle information, and serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D (1,25(OH)₂D), osteocalcin (OC), and undercarboxylated osteocalcin (ucOC) values. The outcome variable was forearm BMD measured with a DTX-200 osteometer.Results Simple linear regression analyses showed that BMD was significantly positively associated with body height, weight, body mass index, grip strength, serum albumin concentration, and “housework,” and negatively associated with age, years since menopause, age at menarche, number of children, serum 1,25(OH)₂D concentration, serum OC concentration, and ucOC concentration. The stepwise multiple regression analysis showed that weight (β=0.00316, SE=0.00028, R²=0.180), age (β=−0.00321, SE=0.00050, R²=0.108), log-transformed serum OC (β=−0.0445, SE=0.0064, R²=0.053), log-transformed serum 1,25(OH)₂D (β=−0.0401, SE=0.0074, R²=0.050), “farmwork” (β=0.00904, SE=0.00426, R²=0.005), and serum 25(OH)D concentration (β=0.000281, SE=0.000120, R²=0.003) were significantly associated with BMD.Conclusion It was concluded that body weight is a major predictor of forearm BMD among the factors measured in this study in independent Japanese women 69 years of age and over and that serum 1,25(OH)₂D concentration may be associated with cortical BMD. Maintenance of body weight is very important for maintaining BMD in this population, unless a large weight aggravates obesity-related diseases. A follow-up study is needed to confirm these findings.     

长沙地区孕妇CMV感染状况及其临床追踪观察

研究了７７例长沙地区孕、产妇的宫颈排毒（ＣＭＶ）情况及母、婴的免疫状态，并对宫颈排毒及ＣＭＶ一ＩｇＭ阳性的母亲所生小孩进行临床追踪。结果显示：孕妇宫颈排毒率为４．５％，抗ＣＭＶ－ＩｇＧ和抗ＣＭＶ－ＩｇＭ阳性率分别为７７％和１３％，５９例脐血ＣＭＶ－ＩｇＭ阴性。宫颈排毒的３例其抗体检测抗ＣＭＶ－ＩｇＧ均阳性，抗ＣＭＶ－ＩｇＭ仅一例阳性。作者认为，对妊娠期活动性ＣＭＶ感染的诊断，仅检测抗ＣＭＶ－ＩｇＧ和抗ＣＭＶ－ＩｇＭ抗体滴度仍不足，尚须结合病毒分离和其它检测手段。     

Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” United States, 1998–2001 Birth Cohorts

ABSTRACT: Background: The percentage of United States’ births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full‐term (37–41 weeks’ gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998–2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006)     

167例老年人心力衰竭的循证治疗实践

目的:探讨老年人充血性心力衰竭(CHF)的循证医学(EBM)标准化治疗。方法:167例确诊为CHF的住院患者,年龄60￣90岁,平均(74.38±6.84)岁,按照循证医学的基本原理,在病因、诱因和改善心衰症状的基础上,强调能改善预后的神经内分泌拮抗剂的应用。结果:本组167例CHF患者,显效96例(57.5%),有效62例(37.1%),总有效率94.6%,死亡9例(5.4%)。神经内分泌拮抗剂践行率分别为:ACEI类119例(71.3%),β受体阻滞剂69例(41.32%),醛固酮拮抗剂88例(52.7%);随访6￣36个月,平均(16.25±9.30)个月;107例(67.7%)再入院1￣5次,院外死亡6例。结论:按照EBM原理对老年CHF患者制定的个体化治疗方案,效果理想。在老年CHF患者中,神经内分泌拮抗剂践行率较低,可能是再住院次数多的原因之一。