现代医院院长的角色与定位

现代医院的建设与发展，离不开先进、准确、合理的医院定位与医院院长定位。一个医院院长的定位准确与否，关乎医院未来发展的成败得失与进退。院长定位的合理有利于提高医院发展过程中的自我监控能力和反思能力，及时纠正医院发展中的失误。     

反复发生高原肺水肿37例

我院地处西藏山南地区 ,驻地海拔 370 0ｍ ,自1997年至今共收治高原肺水肿 185例 ,其中 37例均属 2次以上发病 ,最多 1例是第 7次发生高原肺水肿。现分析如下。1　临床资料1 1　一般情况　 37例中 ,男 34例 ,女 3例 ;年龄2 342岁 ,平均 31 6岁。世居西藏高原 4例 ,高原生活 8年以上回内地居留 1个月以上重返高原 33例。所有病例均符合中华医学会第 3次全国高原医学学术讨论会推荐的诊断标准[1] 。1 2　临床表现　患者大多数表现为头昏、头痛、胸闷、气短 ,少数伴有呼吸困难、咳嗽、咯粉红色泡沫痰 ,其中高原红细胞增多症 (ＨＡＰＣ) 2例 ,并…     

局部晚期宫颈癌CT图像引导下适形调强后程推量的临床研究

目的：观察利用三维适形调强技术（Intensity modulated radiotherapy,IMRT）、采用5Gy×5f分割模式对于局部晚期宫颈癌患者盆腔外照射后残留病灶局部推量的治疗效果及并发症发生。方法：33例局部晚期宫颈癌患者在完成盆腔外照射及同期DDP化疗后,行CT模拟定位扫描,定位前及每次治疗前均进行膀胱灌注以控制膀胱的充盈程度,勾画子宫颈、宫旁及阴道侵犯区域以及2cm阴道组织、子宫体下段2/3为CTV-boost,CTV-boost加5、15mm为PTV-boost,设计并执行7野三维适形调强计划,处方剂量为5Gy/f×5f,2f/w。结果：1年总生存率、无病生存率、盆腔控制率分别为82%、76%、79%,其中15mm PTV边界组的1年盆腔控制率为90%。结论：对于不能进行腔内后装治疗的部分局部晚期宫颈癌患者,采用5Gy×5f分割模式的三维适形调强技术进行后程推量可达到根治效果,1年内未见严重直肠、膀胱并发症出现,远期疗效及并发症正在进一步观察中。     

西藏高原地区超声心动图对房间隔瘤合并下腔静脉瓣残留的诊断分析

目的 探讨西藏高原地区房间隔瘤(ASA)合并下腔静脉瓣(EV)残留的超声表现及其临床意义。方法 回顾性分析藏族成人经胸超声心动图诊断的ASA合并EV残留12例,总结其超声声像图特点。结果 ASA全部发生在房间隔卵圆窝处,Olivares-Reyes A分型标准Ⅰ型瘤样回声膨向右心房侧4例；Ⅱ型膨向左心房侧7例；Ⅴ型随心动周期左右心房摆动1例。瘤体膨出高度 (2.10±1.7)cm；瘤体基底直径(3.90±3.3)cm；瘤壁厚度(0.28±0.03) cm。EV残留来源于下腔静脉右心房入口处上缘,舒张期长度(4.40±2.7) cm；厚度(0.29±0.07)cm。结论 西藏高原地区由于环境因素影响ASA和EV的发病率高,超声诊断简便、直观、准确,可作为首选诊断方法。因其临床诊断参考价值大,超声检查结果均应以报告。     

肝炎疫情报告订正原因调查

疫情报告是传染病管理工作的基础 ,其准确与否关系着传染病管理工作的质量。为了给传染病管理提供全面、准确、及时的信息 ,为制订、修改传染病防治规划提供参考 ,现将传染病管理过程中搜集的有关肝炎疫情报告订正原因资料整理报告如下。1　资料及方法1.1　资料　 1990年 1月～ 2 0 0 0年 7月的肝炎疫情报告卡及个案调查资料。1.2　方法　依据肝炎疫情订正报告卡 ,结合日常走访工作记录 ,进行综合整理分析。2　结果本次共搜集有完整资料的肝炎订正疫情 12 6例。订正原因主要有 :复查病例重复报告 33例 ,占 2 6 .19% ;住址或姓名不准确而流失…     

三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.     

三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

目的 分析CT图像为基础三维适形放疗联合顺铂同期化疗对晚期宫颈癌患者疗效及副反应情况.方法 回顾分析2007-2008年本科收治的181例Ⅱa～Ⅳa期宫颈癌患者资料,其中年龄32～82岁(中位数50岁).放疗采用以CT图像为基础的三维适形放疗和三维192Ir后装照射技术,同期联合顺铂单药每周化疗方案.结果 随访中位数34个月,随访率为92.2%.全组患者3年总生存率为73.4%、无瘤生存率为70.4%、盆腔控制率为91.3%.肿瘤直径≥4 cm和＜4 cm者总生存率分别为66.9%和86.4%(χ2=6.29,P=0.012).RTOG分级急性胃肠道副反应1、2级发生率分别为40.0%、45.0%,泌尿系副反应l、2级发生率分别为19.9%、4.4%.RTOG分级晚期下消化道副反应3+4级发生率为4.9%.结论 以CT图像为基础三维适形放疗和三维192Ir后装照射技术联合顺铂同期化疗对局部晚期宫颈癌患者疗效较好,并对降低晚期严重副反应的发生有益.

Abstract：

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.     

超声心动图对房间隔瘤合并下腔静脉瓣残留的诊断分析

正房间隔瘤和下腔静脉瓣残留均属于先天性心脏异常。西藏地区高寒缺氧是各种先天性心脏异常的高发区,但超声诊断房间隔瘤合并下腔静脉瓣残留却鲜见报道。本组回顾性分析我院经胸超声心动图诊断的房间隔瘤合并下腔静脉瓣残留的超声表现,旨在为临床提供更多的诊断参考。     

超声心动图对高原地区藏族老年性房间隔瘤的诊断分析

目的:探讨西藏高原地区藏族老年性房间隔瘤(ASA)的超声表现。方法: 回顾性分析西藏高原地区超声诊断ASA 20例，总结其超声声像图特点。结果: ASA全部发生在卵圆窝处，瘤样回声膨向右心房侧9例，占45%；膨向左心房侧10例，占50%，1例随心动周期左右摆动，占5%，分属Olivares-Reyes A分型标准的Ⅰ型、Ⅱ型和Ⅴ型。Ⅰ型瘤体突出平均高度为(1.33±0.40) cm，基底直径(2.1±0.4) cm；Ⅱ型瘤体突出平均高度为(0.85±0.22) cm，基底直径(1.5±0.3) cm。结论: 西藏高原地区老年性ASA多发生在卵圆窝处，超声检查可作为ASA首选检查方法。     

高原习服过程中青年人心电轴的变化

在高海拔地区 ,移居人群在高原习服过程中 ;心血管系统会出现代偿性改变 ,而心电图也会发生相应的变化。作者在对高原地区某部 3 90名青年人进行体检时发现 ,入藏 2～11年的部分青年人心电图有不同程度的电轴右偏现象 ,现将情况报道如下。1　对象和方法1.1　对象　 1999- 0 7～ 2 0 0 0 - 0 6对驻地海拔为 3 5 0 0～ 4 5 0 0 m的 3 90名男性青年人进行正常体检 ,年龄 2 0～ 2 8(平均2 5 .4 )岁 ,入藏时间 2～ 11年。追溯既往史所有受检者移居前心电图均示正常 ,无心电轴右偏史。1.2　方法　用日产 CARDIOFAX- 5 15 1型单导心电图机作常…