茎突多层螺旋CT扫描技术探讨

目的:探讨茎突高分辨率CT扫描时改变螺距及准置器宽度对图像质量的影响。方法:将我院50例茎突高分辨率CT扫描患者按准置器宽度为0.75mm和1.5mm分为2组,分别改变螺距0.5~0.8mm后进行扫描。对全部横断扫描图像及VR三维重建后处理图像进行分析评价。结果:多层螺旋CT扫描图像质量优良,能较好地显示正常茎突的细微结构以及异常茎突(过长),准置器宽度为1.5mm时,用同一螺距扫描比准置器宽度为0.75mm时的曝光时间更短,X线剂量当量更低,而图像质量无明显下降。结论:通过调整CT扫描螺距及准置器宽度和采用三维(VR)技术能替代X线平片的检查方法,直观、诊断准确。改变准置器宽度同时改变螺距,能减少X线剂量当量,降低患者的辐射剂量,同时能提供较好质量图像。     

高职护生生化教学方法的探讨

生物化学是一门重要的医学基础理论课，教学中长期以来一直被认为是抽象、难懂和内容多、难记忆的学科。笔者在多年的教学实践中探讨一些生物化学的教法，如巧用导语，鉴赏学科美，恰当应用多媒体课件，注重教学过程等。     

Contact granulomas of the larynx

Ten cases of intubation granulomas and eight cases of contact granulomas not related to intubation were reviewed for the purpose of clinical analysis and pathological investigation. Granulomas were located primarily at the vocal process of the arytenoid cartilage. Additionally, 58 hemilarynges obtained from 37 cadavers with intubation granulomas were evaluated grossly and histopathologically. The intubation granulomas had no side predilections. All eight contact granulomas occurred in males and had a higher incidence of recurrence (three of eight cases) despite complete removal with laser surgery. In an attempt to explain recurrences of these contact granulomas, all three cases were studied clinically and pathologically. Results indicated that they recurred in singers and vocal abusers, and presumably resulted from the continued hammering of one vocal process against the other. Analysis also demonstrated that vocal rehabilitation was essential prior to or immediately after removal of the granuloma to prevent its recurrence. Pathological evaluation of the contact granulomas revealed focal ulceration and a covering of necrotic tissue with desquamating epithelium. The propria mucosa was edematous and infiltrated by chronic inflammatory cells and neutrophils forming focal granulation tissue in a stroma containing proliferated capillaries. Pathological features around local ulcerations were typical of a secondary granuloma while underlying arytenoid cartilage was partially necrotic.This paper was adapted from an extraordinary meeting of Colloquia and Workshops on Laryngeal Disorders, Johns Hopkins Medical Institutions, Baltimore, Md., USA, 10–12 September 1992     

千金子炮制品中秦皮乙素含量的测定

目的：探讨炮制对千金子中秦皮乙素含量的影响。方法：以秦皮乙素为对照品,应用薄层扫描法对千金子生品及５种不同炮制加工品进行了含量测定。结果：千金子经不同炮制方法加工炮制后,除冷霜外,秦皮乙素的含量无有所下降。结论：建立了千金子秦皮乙素的含量测定方法,千金子制霜入药,以冷霜为宜。     

Performance and standards for the process of head and neck cancer care: South and West audit of head and neck cancer 1996-1997 (SWAHN I). South and West Regional Cancer Organisation Tumour Panel for Head and Neck Cancer

Evidence suggests wide variation in cancer care between different hospitals in the UK. To establish bench-marking data, we designed a prospective, 1 year regional study comparing key performance measures with established standards for the 28 hospital Trusts in the South and West of England involved in head and neck cancer care. 566 sequential patients with a newly-diagnosed head and neck cancer were included. Numbers referred and treated per hospital Trust were 1-58 and 1-65 respectively. 59% of patients received a pretreatment chest X-ray (standard 95%). 45% of patients were seen in a multidisciplinary clinic pretreatment (standard 95%), and this was proportional to the frequency of clinics held (P<0.0001). Median number of cases treated per surgeon was 4 (1-26), and by radiotherapist was 10 (1-51). Times between parts of the process of oral cancer care were closer to the standards than those for laryngeal cancer. Two patients were entered into a clinical trial. One had a quality-of-life score. Thus, in 1996-1997, in the South and West of England, there were major discrepancies between actual performance and established standards in many fundamental aspects of head and neck cancer care. Re-audit is essential to determine if the implementation of the Calman-Hine report has resulted in improvements.     

海绵窦侵袭型垂体瘤磁共振诊断系统及其相关因素分析

目的：探讨MR对海绵窦侵袭型垂体瘤的诊断价值，寻求建立一套海绵窦侵袭型垂体瘤的MR诊断系统。方法：选取手术中已经确诊的39例海绵窦侵袭型垂体瘤，同期162例非侵袭型垂体瘤做对照，应用计算机分析冠状位MR上肿瘤与海绵窦的关系。包括海绵窦形态的改变、窦内间隙的改变以及肿瘤与颈内动脉海绵窦段的关系等。将相关的各个类型均做为拟诊标准分别计算各自的灵敏度(Se)、特异度(Sp)、阳性预告值(PV )、阴性预告值(PV-)。依据医学统计学原理中的判别分析法进一步系统分析MR图像对于是否海绵窦侵袭型垂体瘤的诊断意义。结果：肿瘤包绕颈内动脉≥70％确诊侵袭的意义最大(PV ，100％)，肿瘤超过颈内动脉外侧连线的诊断意义也较高(PV ，86．1％)；如果肿瘤包绕颈内动脉的角度不到20％、肿瘤未超过颈内动脉内侧连线以及海绵窦内侧间隙未出现肿瘤则可以排除海绵窦侵袭的存在。同时应用判别分析法建立了一个海绵窦侵袭型垂体瘤及非海绵窦侵袭型垂体瘤的统计学判别计量数值表。从而完善了海绵窦侵袭型垂体瘤MR图像诊断系统。结论：通过系统分析垂体瘤加RI的表现，能够比较准确的确立海绵窦侵袭型垂体瘤的诊断。     

儿科治疗急性上呼吸道感染应用抗菌药物现状分析

目的 调查儿科门诊治疗急性上呼吸道感染(URI)的抗菌药物应用现状，分析滥用的原因，提出避免滥用的对策。方法 于2002年3—6月，随机抽查本院儿科门诊就诊病历607份，就诊次数1000例次，对在治疗URI过程中抗菌药物的应用情况进行统计、分析。结果 本院儿科门诊1000例次就诊病人，诊断为URI病人862例次，占就诊人次的86．20％；URI抗菌药物使用819例，使用率95．01％；使用二联以上抗菌药物357例，占抗菌药物使用的43．59％；治疗URI常用抗菌药物，前三位为头抱一代、青霉素类、头孢二代。结论 URI为儿科门诊常见病，多为病毒感染引起，因此进行合理使用抗菌药物的再教育和提高医生诊疗水平可减少门诊抗菌药物的滥用。     

MRI findings on healing process of vertebral fracture in osteoporosis

The healing process of vertebral fracture was investigated in 37 senile osteoporotic patients on serial magnetic resonance imagings (MRIs), including enhancement study with gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA). The healing process was classified retrospectively into six categories in terms of the changes and recovery of T1 and T2 signal intensity and in terms of the local vascularity. Two types of damage foci were identified, and, in each type, three patterns of healing were noted. In the partial collapse type, the focus of damage in the fractured vertebral body was located near the cranial or caudal endplates; in the total collapse type, the focus was located at the center of the body. In each of these two types, fracture healing was smooth, belated, or resulted in nonunion. In the partial collapse type, vertebral fractures healed smoothly (smooth pattern) in 8 cases, belatedly (belated pattern) in 11, and resulted in nonunion (nonunion pattern) in 5. In the total collapse type, vertebral fractures healed smoothly (smooth pattern) in 6 cases, belatedly (belated pattern) in 4, and resulted in nonunion (nonunion pattern) in 3. The percent height of the anterior wall, central portion, and posterior wall was defined to allow accurate calculatation of the collapse of the fractured vertebral body. Chronological changes in the vertebral body height were investigated. Progressive collapse of the vertebral body was minimal in the smooth pattern cases, and most severe in the nonunion pattern cases. Statistical analysis indicated that prediction of the course of the fracture was difficult only with the height of the fractured vertebral body in acute phase. Enhancement study with Gd-DTPA showed that, in fractures with favorable prognosis, the ischemic area in the body tended to be smaller from the beginning, and restoration of vascularity was prompt. On the contrary, in fractures with unfavorable prognosis, the ischemic area was wider, and restoration of vascularity was poor.     

单味柴胡及舒肝健脾汤对正常小白鼠血浆、肝脏及丘脑的环核苷酸的影响

本文介绍用疏肝解郁药物柴胡及舒肝健脾汤水煎液,给正常小白鼠灌胃,观察药物对小白鼠血浆、肝脏及丘脑环核苷酸的影响。柴胡煎液组与对照组比较,仅肝脏的 cAMP/cGMP比值降低;舒肝健脾汤组与对照组比较,前者血浆、肝脏和丘脑的 cAMP 及肝脏、丘脑的 cAMP/cGMP比值,均显著降低(P<0.05或<0.01);而cGMP改变不大。