全层缝合在预防阑尾炎术后切口感染中的应用

目的：探讨全层缝合在预防阑尾炎术后切口感染的治疗效果。方法：将皮肤、皮下组织、腹外斜肌腱膜全层褥式缝合(腹膜不予缝合)。结果：56例患者无一例感染，也未发现近期并发症。结论：此方法对预防切口感染有较好疗效，且能缩短手术时间，操作简单，建议值得临床应用。     

267株烧伤感染细菌的调查分析

目的：回顾性分析1995年1月至2003年12月间本院烧伤科细菌分布和菌种耐药情况，以指导临床合理用药。方法：收集烧伤病人创面分泌物、血液、痰液及静脉导管末端行普通细菌培养，统计细菌分布情况及常用药物的敏感性。结果：9年来共检出19种267株细菌．其中铜绿假单胞菌和金黄葡萄球菌占83．14％，并有逐渐增加的趋势。铜绿假单胞菌以亚胺培南、头孢哌酮／舒巴坦和多粘菌素B最敏感；氨曲南亦较敏感，且敏感性呈逐渐上升趋势。金黄色葡萄球菌以万古霉素最敏感．呋喃妥因、利福平次之，青霉素类和大部分头孢菌素则高度耐药。结论：目前烧伤感染仍以铜绿假单胞菌和金黄色葡萄球菌为主．防治该两种细菌感染是抗烧伤感染的主要任务。     

SKALP/elafin gene polymorphisms are not associated with pustular forms of psoriasis

Psoriasis is a multifactorial skin disease characterised by epidermal abnormalities and infiltration by lymphocytes and polymorphonuclear leukocytes (PMN). Skin-derived antileukoproteinase (SKALP), also known as elafin, is a potent inhibitor of human leukocyte elastase and proteinase 3, two PMN-derived proteinases implicated in tissue destruction and leukocyte migration. We have shown that, at least at the protein level, SKALP is significantly decreased in lesional skin of patients with pustular psoriasis compared with plaque-type psoriasis. This finding raised the possibility that SKALP could be one of the candidate genes for pustular forms of psoriasis. We therefore performed single strand conformation polymorphism (SSCP) analysis on the SKALP gene to screen for mutations/polymorphisms in the exons of 30 patients with plaque-type psoriasis, 15 patients with pustular psoriasis and 48 healthy controls. In exon 1 a polymorphism was detected at position + 43 relative to the translation start site, resulting in a substitution of threonine for alanine in the signal peptide. In the promoter region a dinucleotide repeat polymorphism was identified. Both polymorphisms were not associated with pustular psoriasis, or psoriasis in general. Our data indicate that the decrease in SKALP activity in pustular psoriasis is not caused by mutations in the coding region of the gene, and that there is no allelic association between pustular psoriasis and SKALP gene polymorphisms.     

经阴道、会阴超声诊断直肠肿瘤的临床价值

目的探讨经阴道、会阴超声诊断直肠肿瘤的临床价值。方法直肠灌水后经阴道、会阴超声检查直肠肿瘤病人28例,并与正常人20例,直肠腔内超声16例对照,同时5例肿瘤作了标本超声检查。结果 28例患者中,26例检出直肠肿瘤28个,其部位在距肛门口2.5～15cm范围内,2例经阴道、会阴超声未发现肿瘤。直肠灌水后经阴道会阴超声检查可直观显示肿瘤的形态,与标本超声显示一致;其病理分期的符合率分别为80.8％。发现淋巴结肿大5例。尤其对高位直肠肿瘤或肿瘤致直肠严重狭窄的病例或Miles手术后,更具有价值。结论经阴道、会阴超声可作为直肠肿瘤检查的补充方法。     

Establishing priorities for European collaboration in communicable disease surveillance

Background: Several collaborations in communicable disease surveillancehave developed between European Union member states. Involvementin these activities takes time and money. It is vital that collaborationsare established in areas most likely to be beneficial. An exercisewas undertaken to inform national surveillance centres and theEuropean Commission as to priority areas for the developmentof collaborations. Methods: A modified Delphi exercise was undertakenamongst the heads of centres with responsibilities for surveillanceat national level in the member states of the EU. Participantsdeveloped, agreed and ranked criteria for developing collaborations.A list of communicable diseases and syndromes was then rankedusing a Likert-type scale. Three rounds were undertaken. Betweenrounds, scores and a ranking were fed back showing where participantshad ranked items, compared to the overall mean and rank distribution.For the third round participants were asked to use a categoricalscale, nominating six or ten high priority disease areas. Results:Response rates were 87.5% for round 1, 44% round 2 and 87% round3. The low round 2 response rate appeared to be because respondentsdid not wish to alter their rankings. The six high priorityareas were outbreaks of gastroenteritis/food poisoning, CID/otherslow virus infections, serious imported diseases, legionellosis,antimicrobial resistance and tuberculosis. When participantsgave ten high priority areas meningococcal disease, travel advice,vaccination/immunization and influenza were also included. Thefinal lists were accepted at the meeting of participants. Conclusions:The process was successful in developing both a priority listand consensus.     

The effects of nisoldipine on the total ischaemic burden: the results of the ROCKET study

This study was designed to examine the effects of nisoldipine(relative to placebo), a new dihydropyridine calcium entry blockingagent, in the treatment of silent ischaemia in conventionaldoses. A total of 409 patients with proven coronary artery diseasewere screened and of this 64 had at least six episodes or atotal duration of 30 mm of ST segment depression (1 mm lastingat least 1 min) over 48 h. Fifty-two patients ultimately completeda randomized double-blind cross-over study comparing nisoldipine5 mg twice a day, nisoldipine 10 mg daily and placebo. There was a reduction in the ST segment integral and numberof episodes of ST segment depression when compared to placeboon treatment with nisoldipine 5 mg twice a day and nisoldipine10 mg daily. However, the confidence limits were wide and crossedthe no-treatment effect line. In addition, the nisoldipine dosesneither affected the circadian distribution of ischaemic episodesnor caused an alteration of the workload achieved either atpeak exercise or at 1 mm ST segment depression measured 24 hafter nidoldipine 10 mg or 12 h after nisoldipine 5 mg. We conclude that frequent silent ischaemia in patients withproven coronary artery disease is relatively uncommon, it accountsfor approximately 16% of patients with positive exercise. Inthese patients nisoldipine, given as 5mg twice a day and 10mg daily, showed no significant therapeutic effects, eitheron the frequency or severity of silent ischaemia. New formulationsof slow release nisoldipine are consequently being developedso that a fuller 24 h therapeutic profile may be obtained.     

体外受精—胚胎移植术后异位妊娠29例临床分析

目的 :探讨体外受精 -胚胎移植后异位妊娠的发生率及高危因素。方法 :对我院 1998年 9月～ 2 0 0 3年 3月接受体外受精 -胚胎移植后发生的异位妊娠 2 9例进行回顾性分析。结果 :异位妊娠发生率为 5 .8%。 2 9例异位妊娠中有 19例术前存在输卵管病变。结论 :体外受精 -胚胎移植术后发生异位妊娠的高危因素是输卵管病变、继发性不孕 ,年龄、子宫位置、移植术过程的困难程度等亦与之有关