眼球破裂伤相关因素分析

目的 观察眼球破裂伤的致伤原因、常见部位、视力预后。方法 眼科住院眼球破裂伤51例的回顾性总结分析。结果 眼球破裂伤的首要致伤因素是打架斗殴(占43％)、其次工伤(占20％)、家庭休闲和旅游误伤(占17％)，交通事故(10％)，其他(10％)。眼球破裂伤的常见部位是上方角膜缘(占45％)，颞侧、鼻侧角膜缘和肌止点后巩膜(各占15％)。经过治疗，Ⅰ度破裂伤7／13获得0．02以上视力，Ⅱ度破裂伤9／20保留光感以上视力，Ⅲ度破裂伤1／18保留光感视力。结论 打架斗殴是眼球破裂伤首要致伤因素，常见伤口位置是上方角膜缘，眼球破裂伤的预后和损伤程度密切相关。     

Health status,work limitations,and return-to-work trajectories in injured workers with musculoskeletal disorders

BACKGROUND: The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury. METHODS: A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. RESULTS: One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). CONCLUSIONS: There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.     

Long-term follow-up of patients with persistent/recurrent,isolated haematuria: A Hungarian multicentre study

A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least 6 months at the beginning of observation. The duration of follow-up was 2–5 years in 201, 5–10 years in 119, 10–15 years in 19, and over 15 years in 2 cases. Of these patients 47.8% became symptom-free. In 18.4% the haematuria remained isolated; in 13.8% it was combined with proteinuria over 250 mg/day more than 2 years later. The occurrence of associated proteinuria increased progressively with time. It was 8.6% between the 3rd and 5th years, and 37.0% after the 5th year. Renal biopsy was performed because of the symptoms of glomerular disease in 47 cases at an average time of 12 months following the appearance of proteinuria. Proteinuria appeared after a 2–5, 5–10, 10–15 and more than 15 years follow-up period in 16, 23, 6, and 2 patients respectively; 14 of them had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (creatinine clearance: 10–50 ml/min per 1.73 m²) and 0.3 (creatinine clearance: < 10 ml/min per 1.73 m²). Mortality was 0.58%. Most of the patients who developed severe azotaemia had persistent microscopic haematuria at the beginning. The prevalence of hypertension was only 1.2%. The time of its appearance was above 5 years in 2 and below 5 years in 2 cases. All these patients had chronic glomerulonephritis. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2–15 years after onset. All of these had hypercalciuria. Our findings suggest that symptoms of isolated haematuria may last for a longterm period and need systematic control. When proteinuria and/or hypertension is associated with haematuria a worse prognosis can be expected.Participating paediatric hospitals and university departments: Second Department of Paediatrics, I. Semmelweis Medical University of Budapest (M. Visy); Department of Paediatrics, University Medical School of Pécs (V. Jászai); Department of Paediatrics, A. Szent-Györgyi Medical University of Szeged (I. Haszon, S. Túri); County Children's Hospital, Miskolc (Á. Vissy); P. Heim Children's Hospital, Budapest (Z. Czirbesz); County Children's Hospital, Györ (Zs. Szelid); Buda-Children's Hospital, Budapest (I. Ferkis); I. Apáthy Hospital, Budapest (J. Kisbán); János Hospital, Budapest (I. Marosváry); Hospital of Hungarian State Railway, Budapest (J. Fehér); L. Madarász Hospital, Budapest (F. Kalmár); South Pest Hospital, Budapest (G. Halász); County Children's Hospital, Pécs (E. Kolman); County Children's Hospital, Gyula (P. Sipos); County Children's Hospital, Szolnok (I. Jaksics); County Children's Hospital, Debrecen (Á. Miskolczi); County Children's Hospital, Tatabánya (I. Kiss); County Children's Hospital, Eger (M. Frank, E. Ladányi); County Children's Hospital, Nyíregyháza (E. Bujdosó); County Children's Hospital, Szombathely (M. Andics); Kerepestarcsa Hospital, Budapest (M. Marcell); Komárom Hospital, Komárom (J. Kecskés)     

40岁以上高龄妊娠与分娩结局分析(附56例临床报告)

目的 探讨40岁以上妊娠妇女对分娩的影响.方法 回顾性分析1995年12月～2005年12月分娩的40岁以上孕妇56例及同期妊娠的18～34岁孕妇100例,后者为对照组.结果 高龄组不孕史、习惯性流产和子宫肌瘤发生率高于对照组(P＜0.01或P＜0.0 5);高龄组剖宫产率(78.6%)比对照组(38%)高(P＜0.01).但两组的新生儿出生体重、新生儿窒息、新生儿畸形和围生儿死亡率则没有明显差异(P＞0.05).结论 40岁以上妇女妊娠的并发症及剖宫产率增高,但只要重视和加强管理,积极预防和治疗合并症,母儿预后较好.     

1341名医学生心理健康水平调查分析

目的 了解医学生心理健康状况,为今后有针对性地在我校开展心理健康教育及心理咨询活动提供参考依据.方法 按分层整群抽样的方法抽取被试,采用大学生人格问卷(UPI)进行比较.结果 57.94%的学生存在不同程度的心理健康问题.男生心理健康状况优于女生,男、女生之间差异有统计学意义(p＜0.01).2004级学生与2005级学生UPI总分比较,两者差异无统计学意义.结论 医学生心理问题不容忽视.应结合医学生的自身特点和性别心理差异,进行不同的心理健康教育.     

临床随访研究

目的探讨目前国内临床随访的情况。方法通过电子检索查阅中国期刊网历年文献。并对每篇文献进行从随访形式，随访时间，随访资料和主要指标进行总结。结论目前国内随访工作正在开展，但尚需统一管理及完善。     

Tacrolimus with Mycophenolate Mofetil (MMF) or Sirolimus vs. Cyclosporine with MMF in Cardiac Transplant Patients: 1-Year Report

The most advantageous combination of immunosuppressive agents for cardiac transplant recipients has not yet been established. Between November 2001 and June 2003, 343 de novo cardiac transplant recipients were randomized to receive steroids and either tacrolimus (TAC) + sirolimus (SRL), TAC + mycophenolate mofetil (MMF) or cyclosporine (CYA) + MMF. Antilymphocyte induction therapy was allowed for up to 5 days. The primary endpoint of >/=3A rejection or hemodynamic compromise rejection requiring treatment showed no significant difference at 6 months (TAC/MMF 22.4%, TAC/SRL 24.3%, CYA/MMF 31.6%, p = 0.271) and 1 year (p = 0.056), but it was significantly lower in the TAC/MMF group when compared only to the CYA/MMF group at 1 year (23.4% vs. 36.8%; p = 0.029). Differences in the incidence of any treated rejection were significant (TAC/SRL = 35%, TAC/MMF = 42%, CYA/MMF = 59%; p < 0.001), as were median levels of serum creatinine (TAC/SRL = 1.5 mg/dL, TAC/MMF = 1.3 mg/dL, CYA/MMF = 1.5 mg/dL; p = 0.032) and triglycerides (TAC/SRL = 162 mg/dL, TAC/MMF = 126 mg/dL, CYA/MMF = 154 mg/dL; p = 0.028). The TAC/SRL group encountered fewer viral infections but more fungal infections and impaired wound healing. These secondary endpoints suggest that the TAC/MMF combination appears to offer more advantages than TAC/SRL or CYA/MMF in cardiac transplant patients, including fewer >/=3A rejections or hemodynamic compromise rejections and an improved side-effect profile.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.