老年人自发性气胸的临床分析

目的探讨老年人自发性气胸的诊断及治疗,以提高老年人自发性气胸的诊治水平。方法回顾性分析我科1996年2月3日～2006年2月23日我科89例老年人自发性气胸的诊治经过。结果老年人自发性气胸的临床症状易被原发病掩盖,其临床特点有:(1)临床表现多不典型,症状以紫绀、气急多见,无明显胸痛;(2)以继发性气胸为多;(3)老年自发性气胸并发症、伴发病多;(4)肺复张时间长,负压吸引效果差;(5)交通型和张力型在老年自发性气胸当中较为多见;(6)易误诊;(7)由于基础疾病存在,肺功能差,发生气胸后易出现肺部感染、呼吸衰竭等并发症,死亡率高。结论老年人各器官储备功能差,肺功能差,同时多并存基础疾病,老年人自发性气胸后易出现肺部感染、呼吸衰竭等并发症,死亡率高,早期诊断和积极合理的治疗是降低老年人自发性气胸病死率的关键。     

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

OBJECTIVE: To describe the dieting histories of bariatric surgery candidates. RESEARCH METHODS AND PROCEDURES: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. RESULTS: Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. DISCUSSION: Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.     

不同微生物诱导家蝇幼虫表达抗菌肽的特性

研究不同微生物诱导家蝇幼虫表达的抗菌肽特性.用3种不同的病源菌通过针刺感染的方法诱导家蝇幼虫表达抗菌肽,通过Sephadex G25分离,用Hult mark改进法和抑菌圈测定法作抑菌试验,用毛细管电泳（CE）分析不同微生物诱导得到的抗菌肽样品差异,检测抗菌肽的热稳定性和酸碱耐受性.发现不同微生物诱导产生的家蝇抗菌肽具有广谱抑菌性,但不同样品对不同病源菌抑菌活性有差异,不同测定抑菌效果的方法对抑菌结果有影响,各种抗菌肽样品CE蛋白谱具有明显不同.抗菌肽样品都具有热稳定性和酸碱耐受性.说明不同微生物诱导产生的家蝇抗菌肽类型以及抗菌肽含量与诱导源有关,抗菌肽为家蝇幼虫体内固有成分,诱导增加了抗菌肽的表达量同时刺激新抗菌肽的产生.用志贺氏菌、金黄色葡萄球菌、鼠伤寒沙门氏菌诱导家蝇幼虫可产生较多含量高活性好的抗菌肽.     

康莱特联合化疗药物增敏的最佳时机的实验研究

目的:寻找康莱特联合化疗药物健择和顺铂的最佳时机。方法:采用MTT比色的方法。结果:康莱特对人肺腺癌95D的生长有抑制作用和化疗增敏作用;康莱特先于健择,顺铂加入对95D的抑制最强。结论:康莱特先于健择或顺铂加入优于两药同时加入。     

老年人急性心肌梗塞的临床特点

目的：研究60岁以上老年人急性心肌梗塞的临床特点。方法：对86例老年人急性心肌梗塞资料进行临床分析,并与同期255例小于60岁的急性心肌梗塞病人进行对比。结果：老年急性心肌梗塞患者女性的比例较60岁以下者明显增多(P＜0.01),老年无痛性心肌梗塞比例(30.5%)明显增多(P＜0.05),并发症心力衰竭(P＜0.01)、心律失常(P＜ 0.05),死亡率(P＜0.01)也明显增多。结论：老年人无痛性急性心肌梗塞多见,并发症发生率、死亡率高,应予重视。     

Bilateral Hematogenous Pseudomonas aeruginosa Endophthalmitis After Lung Transplantation

Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.     

1992～2001年海南省结核病防治工作情况分析

目的　分析海南省结核病防治工作现状和经验。方法 根据全省各市(县)上报的结核病报表和有关总结材料,分析结核病现状、防治对策及效果。结果 海南省应用现代结核病控制策略以来,1992～2000年共检查可疑肺结核病患者192077例,查痰48670例,查痰率25.3%。发现并登记活动性肺结核病人31822例,其中涂阳病人22946例,涂阳新登记率从1992年12.8/10万上升到2000年48.4/10万。至2001年12月止,共治愈了21625例涂阳病人,总治愈率达94.2%。结论 海南省结核病疫情严重,近10年来经过应用现代结核病控制策略,取得显著成效,证明该策略是控制结核病流行最有效的技术措施。     

Pediatric lupus versus adult lupus role of the laboratory

Systemic lupus erythematosus (SLE) is the archetypical immunologic disease. Approximately 20% of patients present in the first two decades of life. This article highlights some of the differences between pediatric and adult onset lupus.Children are defined as different from adults on the basis of age. Lupus presents with different gender ratios based on hormonal or pubertal status with more significant skewing toward female patients in the childbearing years. Female patients in the childbearing years appear to have a higher relative risk for mortality. Despite this, children have greater disease severity at onset based on the number of patients who present with significant organ inflammation, the amount of corticosteroids required and the abnormalities in lupus serologies including autoantibodies and low complements. Children present frequently with congenital and acquired complement defects. Children have an increased risk of infections that can be confused with lupus. They have a higher risk of serious pneumococcal infection and may have less protection from vaccinations received at the time of disease onset.The clinical immunology laboratory is critical in the diagnosis and treatment of pediatric SLE. The rapid analysis and transfer of laboratory results can be life saving for the child with suspected new onset lupus. The laboratory is also helpful in determining disease activity through analysis of immunologic trends over time in pediatric lupus patients. This is especially important in the noncompliant adolescent patient who has a correlation between disease activity and lupus serologic tests. Finally, the clinical immunology laboratory is an important tool for better understanding of the immunologic phenomena associated with lupus and of disease pathophysiology.     

肝移植围手术期出凝血功能障碍的防治

目的　探讨肝移植围手术期出凝血功能障碍的防治。方法　回顾性分析我院 2 0 0 2年 6月～ 2 0 0 3年 12月施行的 6 1例肝移植病例。结果　 6 1例肝移植术前肝功能ChildC级 35例 (5 7 4 % ) ,ChildB级 2 6例 (4 2 6 % ) ,ChildC组的患者术中凝血指标 (INR)的变化程度大于ChildB组 (P <0 0 5 )。与凝血有关的并发症中大出血 5例 (8 2 % ) ,肾衰 6例 (9 8% ) ,肝动脉血栓形成 5例 (8 2 % ) ,手术开展两阶段对比 ,第二阶段主要因限制了大量凝血药及血制品的使用 ,并发症明显减少。结论　掌握好不同时期、不同患者出血和血栓形成的平衡是防治肝移植围手术期出凝血功能障碍的关键     

遗传性压力易感性周围神经病临床神经电生理检测的意义

目的探讨遗传性压力易感性周围神经病（hereditary neuropathy with liability to pressure palsies，HNPP）的临床神经电生理改变。方法对1个HNPP家系的先证者及5例家系患者进行神经传导速度检测，并对先证者进行病理组织学检查。结果先证者正中神经、尺神经、腓肠神经感觉神经传导速度（SCV）均减慢；正中神经、尺神经、腓总神经运动神经传导速度（MCV）均减慢。病理结果提示腊肠样结构改变（部分有髓神经纤维的髓鞘出现显著增厚，符合髓鞘肥厚性周围神经病的病理改变，提示HNPP）。共检查家系中5例患者的36条神经。感觉神经传导检测结果：30条神经SCV异常。其中正中神经异常率12／12；尺神经异常率10／12；腓肠神经异常率8／12。感觉纤维最易累及的神经为正中神经，其次为尺神经、腓肠神经。正中神经SCV平均减慢35．1％，平均37．7m／s；尺神经SCV平均减慢31．6％，平均39．7m／s；腓肠神经SCV平均减慢19．4％，平均38.6m／s。受损程度以正中神经最重，其次为尺神经、腓肠神经。运动神经传导检测结果：运动神经诱发电位潜伏期延长者21条。所查神经远端MCV异常率24／36，其中尺神经异常8条。正中神经异常7条，腓总神经异常9条。减慢的尺神经沟下至腕部MCV平均39．7m／s，减慢31．6％；减慢的正中神经平均50，0m／s，减慢11，3％；减慢的腓总神经平均39．3m／s，减慢21．2％；尺神经沟上至沟下异常率75．0％，平均40m／s，平均减慢34，4％；腓骨小头上下异常率33．3％。减慢的MCV平均35，3m／s，平均减慢31％。运动纤维最易累及的神经为腓总神经，其次为尺神经、正中神经。结论HNPP患者可伴有大部分神经传导障碍，可靠的神经电生理检查是诊断HNPP的重要依据，在无症状的HNPP患者及其家属也可出现神经传导障碍。在HNPP患者，嵌压处神经更易受损。