Brain stem tuberculoma in adult patients: Diagnosis and treatment

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.     

温阳健心灵口服液治疗充血性心力衰竭的临床与实验研究

以煎剂形成筛选治疗CHF的处方，发现温阳益气方改善泵血功能的效果优于单纯益气和养阴益气的处方。根据前方制备的温阳健心灵口服液保持了原煎剂的疗效，并被毒理学试验证明毒性极低。动物药效学及临床试验发现该药不仅能改善心衰犬和病人的左室收缩功能，还能改善其舒张功能。除此，它还具有利尿作用和使PAWA、SVR和PVR下降的作用，这也是它抗心衰的机理之一。90例的临床观察（疗程2周）表明该药总有效率、近期治愈率和显效率分别达88．9％、7．4％和18．5％，其效与开搏通组无明显差异。     

神经梅毒的临床特征与诊断分析

目的：分析神经梅毒的分型和临床特征及提供早期诊断依据。方法：回顾性分析经临床和实验室检查确诊的18例神经梅毒病人的有关临床资料。结果：神经梅毒的临床特征包括：(1)急性、亚急性起病为主；(2)临床以间质型，尤其是以脑卒中起病常见，症状元特异性；(3)血清学检查以梅毒螺旋体血凝试验(TPHA)及快速血浆反应素试验(RPR)特异性较高；(4)脑脊液检查表现为压力增高(42．9％)、蛋白增高(81．2％)及细胞数增高(56．3％)；(5)头颅CT、MRI表现与高血压、动脉硬化所致脑梗死不同，为多发、散在病灶。结论：神经梅毒早期误诊率高，临床表现与分型密切相关，实验室及影像学检查是诊断的重要依据。     

优立新治疗急性细菌性感染的临床观察

优立新与头孢噻肟随机对照治疗呼吸道和泌尿道感染４０例，临床有效率各为１００％和９５％（Ｐ＞０．０５），细菌阴转率各为９４，１％和１００％（Ｐ＞０．０５）。无显著性差异。优立新共治疗３０例，临床有效率和细菌阴转率分别为１００％和９６％。两药副反应均轻微。无因副反应而停药。在优立新治疗病例中，有２例出现皮疹。另２例为肝功能ＡＬＴ和ＡＳＴ暂时性轻度增高。     

Epidemiology and clinical manifestation of HIV infection in Northern Zaire

1275 patients were evaluated for HIV-1+2 seroprevalence and its association with clinical symptoms of HIV infection. Of 667 apparently healthy subjects, 8.2% had anti-HIV-1 antibodies. In 465 patients with clinical signs of AIDS, 39.4% were seropositive. 143 patients with miscellaneous symptoms had positive predictive values for HIV infection between 67% (vaginal ulcerations) and 20% (profound pyogenic abscesses). The WHO definition for AIDS had a specificity of 78.3%, a sensitivity of 72.2% and a predictive value of 61.6%.     

碰撞癌的临床影像学表现及病理分析

目的:探讨碰撞癌的临床影像学表现、发病机制与病理特点。方法:回顾性分析20例碰撞癌的临床影像学资料并结合文献复习,总结其患病率、发病年龄、性别比、好发部位、临床影像学表现、治疗手段、病理特点。结果:碰撞癌罕见,好发年龄大于58岁,男性发病多见,好发部位为食管-贲门,食管-胃底等。临床表现无特殊,术前影像学检查多不能明确诊断,术后病理诊断是唯一的确诊方法。治疗以手术为主,辅以化疗或放疗。病理特点为同一宿主同一部位或器官2个不同类型肿瘤的结合,瘤组织间没有移行和混合,有各自的转移途径,碰撞癌以鳞癌和腺癌的碰撞为主。结论:碰撞癌是一种罕见的恶性肿瘤结合,临床特点有待进一步总结,影像学综合诊断有助于提高其确诊率。     

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.     

活动性结核标志物'H-多肽的实验与临床研究

本题研究是经免疫学途径直接检测人体感染结核菌的情况，为现代结核病的实验诊断、临床监测、流行病调查提供了一个全新的检验指标。作者首先发现了一种仅存在于活动性结核病患者体液中的蛋白成份—活动性结核标志物（ＡｃｔｉｖｅＴｕｂｅｒｃｕｌｏｓｉｓＭａｒｋ—ＡＴＭ）１Ｈ—多肽；并为之创立了独特的检测方法，经四年多临床１９４６０例样本调查中确定了ＡＴＭ的临床价值。将ＡＴＭ检测与ＯＴ皮试、酶联免疫ＥＬＩＳＡ、ＤＮＡ探针、ＰＣＲ基因扩增技术及典型病例组患者行Ｘ线计算机断层摄影（ＣＴ）、磁共振像（ＭＲＩ）等多组对比试验中，实验与临床研究资料分析证明：ＡＴＭ检测的总敏感度为８６．０６％、特异度９６．２４％、准确度９３．４５％、诊断效率为８２．８２％、批内ＣＶ１．２％、批间ＣＶ２．０％、Ｐ＜０．０５。经ＮＭＲ光谱分析结构含有ＣＣＨ２官能团。     

浅谈临床教师的角色素养及道德要求

探讨了临床教师的角色特征;认为临床教师的角色要求与现实状况之间存在反差;据此就其原因进行了分析。提出要强化临床教师的角色意识;在教学实践中自觉加强对其角色素养的自我锻炼和培养。     

Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain

Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.