536例大肠癌误诊误治分析

大肠癌误诊误治较为普通。从总结经验教训出发，本文对确诊前曾发生过误诊误治的５３６例大肠癌进行详尽的分析。本组病例５３６例，曾７１９次先后被误诊为３２种疾病，其中误诊为“痔”“痢疾”“肠炎”“肠梗阻”等最为常见，误诊为其它疾病也时有发生，严重的影响其预后。在误诊原因上，除病人自误外，与医生责任心不强，询问病史不细，本行或未认真行有关检查，特别是直肠指诊检查和结肠内窥镜检查是分不开的。文章就今后如何减少误诊，提高早期诊断率，提出了５点措施，强调了直肠指诊和结肠内窥镜检查的重要价值。     

Gd-DTPA在MRI中的诊断作用

目的:探讨Gd-DTPA在MRI中的诊断作用。材料与方法:总结分析了被确诊的378例(402人次)患者应用Gd-DTPA增强检查后的效果。对肿瘤、感染、梗塞等病变的强化特点进行了讨论。结果:使用Gd-DTPA后,有23例平扫时误诊的病例得到了纠正,并发现了MRI平扫时未能发现的一些病变,诸如管内型听神经瘤、脑膜炎、脑(脊)膜的转移性病变等。但是,作者还同时发现即使在用了Gd-DTPA之后,仍有多种病变存在鉴别诊断上的困难。结论:合理使用增强检查,将有助于提高诊断的符合率。     

香菇多糖对肿瘤患者免疫状态的影响

对78例恶性肿瘤患者的免疫状态及其对化疗和化疗加香菇多糖治疗反应进行了检测。结果表明恶性肿瘤患者免疫状态显著低于正常对照组。单纯化疗时，患者自然杀伤细胞（NK）和大颗粒淋巴细胞（LGL）比率明显下降；而化疗加香菇多糖治疗时，则能促进免疫功能活性细胞增加。     

Q-tip pap smear: Should it be done routinely in patients who have developmental disabilities?

In some patients with mental retardation, a Q-tip pap smear obtained blindly from the upper vagina may be the only cytologic smear obtainable without subjecting the patient to heavy sedation or to examination under anesthesia. The efficacy of blind Q-tip smears has not been previously determined. Of 31 Q-tip smears obtained from patients with CIN, the Q-tip smear identified the abnormality in 10 (32%) patients. For those patients who will not submit to examination without anesthesia or sedation, routine screening with multiple smears, obtained on an annual basis has the potential to identify many cases of CIN which otherwise would not be identified at all, and in certain patients, this method outweighs the risks of heavy sedation or general anesthesia. Because of the greatly reduced sensitivity of the Q-tip pap, every effort should be made to help the patient and/or her family or guardian to understand the implications and risks of this method. However, if an examination under anesthesia is performed for other indications, a complete gynecologic examination and a direct smear should be obtained at that time.     

高等医学院校计算机基础知识无纸化考试研究

我国高等医学院校计算机基础知识的教学,近年来有了很大的发展,但对应的考试测评相对滞后.对此,我们对无纸化考试应具备的条件、环境、考生、试题要求和安全性等几个方面进行了研究.     

Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.     

火针刺血疗法的临床应用心得

目的:探讨火针刺血疗法在临床的应用价值。方法:对实践经验和临床资料进行分析。结果:火针刺血疗法疗效快无不良反应。结论:火针刺血疗法对寒凝血瘀证疗效较好。     

浙江省台州市路桥区从业人员乙肝病毒标志物检测的调查分析

目的：了解路桥地区2004年至2006年之间,从业人员健康人群HBsAg、HBsAb的阳性率及大、小三阳所占的比例。方法：对32 490人来体检的健康人群进行乙肝三系二对半检测,采用酶联免疫法（ELISA）测定HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,按不同性别、城区与乡镇之间、两年之间进行比较。结果：不同性别之间HBsAg、HBsAb的阳性率无显著性差异。城区与乡镇之间HBsAg、HBsAb阳性率有显著性差异。两年之间HBsAg的阳性率有下降趋势。大小三阳的比例在各组之间也各不相同。结论：健康人群的乙肝病毒携带率比例偏高,易感者多,相关部门应督促乙肝疫苗的注射,减少乙肝发病率。     

Sry监测体外扩增造血细胞植入效果的实验研究

目的：探讨Y染色体性别决定基因(Sry)作为评价和追踪造血细胞移植后植入状态检测指标的可行性。方法：根据Sry DNA序列设计引物及制备探针，然后进行PCR检测、斑点杂交和原位杂交．动态追踪经不同条件下体外扩增的纯系雄性小鼠BMMNC回输至雌性小鼠后的植入状态。结果：PCR结果显示在各移植组小鼠的骨髓有核细胞、脾细胞及外周血白细胞中均有Y染色体特异性序列的存在；斑点杂交结果显示在各回输组间并无明显差别，但用脾脏组织作原位杂交的结果则发现基质细胞支持扩增回输组的阳性颗粒数目与输注新鲜细胞组相似，但略少于雄性小鼠；而输注细胞因子扩增细胞实验组小鼠则明显少于雄性动物的阳性对照标本和基质细胞支持扩增回输组。结论：(1)经重复检测表明上述方法的重复性好，结果可信．可作为检测性别不同时造血干细胞移植效果的一种检测手段；(2)证实基质细胞支持下的体外扩增的造血细胞具有较好的植入能力。     

Surgical metabolism

Summary. Trauma, operative interventions, infection and other disturbances of homeostasis lead to a uniform reaction of the body, namely release and activation of hormones and cytokines. Profound alterations of substrate flow result, with mobilization of energy stores and degradation of structural and functional proteins of vital organs like the gut mucosa. Due to these reactions the energy demands of the organs are met and energy-consuming synthesis of substrates is indicated. Clinically, hypermetabolism, hyperglycemia, lipolysis and increased urea production with negative nitrogen balance can be observed. The metabolic reactivity is reached by an increased substrate cycling. To avoid negative consequences such as organ dysfunction, a rational situation-adapted substrate supply is warranted as well as reduction of catabolic stimuli and stimulation of anabolic factors. The metabolic care of the surgical patient is still a basic and important task.