关于本科生医学免疫学启发式教学的探讨

针对医学免疫学理论抽象、逻辑性强、学生感觉枯燥难懂的特点,介绍了启发式教学及其实施的三个阶段,同时指出该教学方式具有效激发学生的学习兴趣,培养独立思考和创新意识,提高教学质量的作用.     

Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients

Background: Laparoscopic common bile duct (CBD) exploration is a well-established treatment option in dedicated centers. However, few data are available on the results in elderly patients. Methods: The outcome after laparoscopic CBD exploration in elderly patients (age <70 years) was compared with that in a concurrent control group of younger patients (age, <70 years). Results: There were 77 elderly patients in group A and 207 younger patients in group B. American Society of Anesthesiology (ASA) III and IV patients and prior abdominal operations were more frequent in group A (p <0.001). Two patients from each group underwent conversion to open surgery. There was no significant difference frequency of use between the transcystic and choledochotomy approaches, although the latter tended to be more frequent in the group A because of larger stones, (group A 53.4%; group B, 37.6%). Minor and major morbidity (group A, 12%; group B, 13.6%), rate of recurrent stones (group A, 1.3%; group B, 1.9%), and mortality (group A, 1.3%; group B, 0%) were not significantly different between the two groups. The single death in group A involved a patient with acute toxic cholangitis who underwent emergency surgery after multiple failed attempts at endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy performed elsewhere. No CBD stenosis was observed at follow-up assessment. Conclusions: Elective laparoscopic CBD exploration is safe and effective. It may become the standard of care in both elderly and younger patients.     

对妇幼保健机构档案管理工作的探讨

妇幼保健机构的档案是发展妇幼保健事业的重要信息资源和依据,是妇幼保健机构长期积累的宝贵财富.多年来,档案资料在妇幼保健机构的各项决策部署、具体工作实施、妇幼疾病防治等工作中发挥了不可替代的资源优势作用.随着妇幼保健事业的日益发展,档案工作必将显示出越来越重要的作用.但由于种种因素的影响,妇幼保健机构档案管理工作在一定程度上还处于被动局面,不同程度地影响了档案工作为妇幼保健工作和社会服务功能的发挥.当前,档案工作必须紧紧围绕妇幼卫生事业新时期的新任务、新特点、新要求,以"服务全局工作,促进事业发展"为宗旨,改革不适合妇幼保健机构档案管理工作发展的旧模式,不断探讨新思路和新方法,更好地为妇幼保健工作和经济发展服务.＃     

胆源性胰腺炎胆总管探查的指征分析

目的 探讨胆源性胰腺炎胆总管探查的指征。方法 回顾性分析我院两阶段胆源性胰腺炎胆总管探查的病例资料：1995年-1999年间的46例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸。2001年-2006年间的30例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸，并经过磁共振胰胆管成像（MRCP）筛检确认。结果 第一阶段术中探查及术后T管造影示无结石28例，占60．8％（28/46）。第二阶段术中探查及术后T管造影示无结石7例，占23．3％（7／30）。结论 根据B超显示胆总管扩张及黄疽而行胆总管探查的阴性率高（P〈0．05），胆源性胰腺炎应严格掌握胆总管探查指征，MRCP可无创性地显示胆总管系统，有助于胆源性胰腺炎是否行胆总管探查的决定。     

腹腔镜胆总管探查T管引流术后胆漏的发生原因及对策

目的:探讨腹腔镜胆总管探查T管引流术后胆漏的发生原因、预防方法及处理措施。方法:对395例腹腔镜胆总管探查T管引流术后21例胆漏患者的临床资料进行回顾性分析。结果:胆管切口漏胆13例,其中4例经术中常规放置的腹腔引流管引流自愈,9例联合内镜乳头切开和鼻胆管引流治愈。术后T管早期滑脱4例和常规拔T管4例均导致胆汁性腹膜炎,经再次手术置T管和腹腔引流管治愈。结论:腹腔镜胆总管探查T管引流术后胆管切口漏胆、术后T管早期滑脱和T管瘘道形成不全是胆漏发生的主要原因,保持或建立通畅的腹腔引流和胆管引流是治疗胆漏的主要处理措施。     

Familiar social and nonsocial stimuli and the kitten's response to a strange environment

The effectiveness of the mother, a littermate, and the home environment were compared in alleviating the distress shown by kittens which had previously been placed alone in a strange environment. Tests were conducted on the same kittens at 2, 4, 6, and 8 weeks of age. In the intact group of mother and kittens in the home environment scarcely any cries were heard. But when the kittens were placed alone in the strange environment, the frequency of cries was greatly increased. When the mother or a littermate was present, however, the frequency of cries was reliably reduced. In contrast, when kittens were placed alone in the home environment, the frequency of cries was not reliably reduced. Although the frequency of cries decreased as the kittens grew older, the relative effectiveness of the mother's or littermate's presence in reducing the frequency increased with age, whereas the home environment did not reliably reduce the frequency at any age. These findings indicate that separation from accustomed companions was a more powerful cause of distress than separation from accustomed physical surroundings, and that being alone in familiar as well as strange settings can evoke distress in the young cat.     

Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy

Background/Purpose Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC. Methods Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed. Results These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14–37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12–99 months) after LC. Conclusions Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC.     

Technical aspects in the laparoscopic management of complicated common bile duct stones

The management of common bile duct (CBD) stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of last century, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) has become the mainstream treatment for CBD stones and gallstones in most medical centers around the world. However, in certain situations, ERCP cannot be feasible because of difficult cannulation and extraction. ERCP can also be associated with potential serious complications, in particular for complicated stones requiring repeated sessions and additional maneuvers. Since our first laparoscopic exploration of the CBD (LECBD) in 1995, we now adopt the routine practice of the laparoscopic approach in dealing with endoscopically irretrievable CBD stones. The aim of this article is to describe the technical details of this approach and to review the results from our series.     

Evidence for an interaction of opioid and noradrenergic locus coeruleus systems in the regulation of environmental stimulus-directed behavior

The roles of opioid and noradrenergic (NE) dorsal bundle systems in an animal's response to particular environmental stimuli were examined in a multicompartment exploration chamber. The opiate antagonist naloxone (NAL) produced a stereospecific increase in environmental stimulus interaction, while the opiate agonist morphine induced a NAL-reversible reduction in stimulus contact. Thus, a specific opioid role in environmental stimulus-directed behavior is indicated. Several reports suggest inhibitory actions of opioids on NE locus coeruleus (LC) activity. Consistent with these reports, we observed that 6-hydroxydopamine (6-OHDA) lesions of the NE dorsal bundles of the LC produced a morphine-like reduction in stimulus contact. Naloxone, which increased stimulus interaction in sham-lesioned rats, had no effect in dorsal bundle lesioned animals. These findings indicate an interaction between opioid and LC systems in the regulation of environmental stimulus-directed behavior.