显微镜下手术切除脑干海绵状血管瘤的临床分析

目的 探讨显微镜下手术切除脑干海绵状血管瘤的指征、入路及术中要点.方法 回顾性分析26例脑于海绵状血管瘤患者的临床资料及手术效果.结果 26例患者中肿瘤全切除17例,次全切除8例,大部分切除1例.术后2例昏迷,自主呼吸未恢复,自动出院.术后随访8～42个月,7例肿瘤次全切除患者未恢复至术前状态,17例肿瘤全切除患者生存状态良好,定期复查头颅MRI,未见肿瘤确切复发.结论 对具备手术适应证的脑干海绵状血管瘤,应采取外科手术切除,病灶争取全切除,复发率低,治疗效果满意.     

肝血管瘤的诊断和治疗(附47例报告)

目的 探讨肝血管瘤诊断和治疗方法的合理选择,评价肝血管瘤手术治疗的风险性.方法 回顾性分析47例肝血管瘤患者的临床资料.36例患者具有各种不同程度的非特异性腹部症状或体征.B超、CT和磁共振成像(MRI)三种方法诊断准确率分别为44.7%、84.2%和100.0%.结果 16例患者行肝血管瘤挖除术,27例行常规肝叶或肝段切除术,1例行肝右动脉结扎加碘油栓塞术,3例患者实施了右半肝联合左外叶切除术以及肝段切除联合血管瘤挖除术.术后并发症发生率为25.5%(12/47).多变量Logistic回归分析示术中失血量和术中有无输红细胞(≥2 U)是术后并发症发生的独立风险因素(P=0.0280,P=0.0013).结论 肝血管瘤是常见的肝脏良性肿瘤,临床表现缺乏特异性;B超、CT和MRI是诊断肝血管瘤的主要手段,MRI的诊断准确率最高,对本病的诊断具有特殊意义;手术切除是肝血管瘤最理想的治疗方法,手术指征应从严把握.术中出血量和术中有无输红细胞(≥2 U)是影响肝血管瘤术后是否发生并发症的重要风险因素.     

直视下绑扎加栓塞治疗肝海绵状血管瘤的手术配合

目的探讨绑扎加栓塞治疗肝海绵状血管瘤的手术配合减少手术并发症的发生.方法对22例肝海绵状血管瘤患者,在剖腹直视下行肝海绵状血管瘤周围绑扎加栓塞治疗的患者回顾性总结.结果通过良好的手术配合显效率达76.19%,有效率达100%.结论良好的手术配合能尽量减少手术并发症的发生,从而使手术达到预期的效果.     

外伤性脑外积液手术治疗指征与方法

目的 :探讨外伤性脑外积液手术治疗的指征及术式选择。方法 :总结采用不同方法手术治疗的 2 7例患者临床症状与体征、CT及MRI等影像学特征、积液蛋白含量测定等临床资料。结果 :行积液—腹腔分流术 16例 ,钻孔外引流 6例 ,囟门穿刺闭式外引流 3例 ,囟门穿刺抽液 2例。痊愈 2 5例 ,放弃治疗 2例。结论 :手术指征主要取决于积液量及病人的临床症状与体征 ,方法则取决于质 (积液的成分 )、蛋白含量高或混有血液者 ,行外引流或经囟门抽吸 ;相反 ,则应行腹腔分流术     

肝血管瘤的治疗(附47例报告)

目的：总结手术、肝动脉栓塞及硬化剂注射等方法治疗肝血管瘤的效果，为临床选择合理的肝血管瘤治疗模式提供参考。方法：回顾性分析我院近10年所收治的47例（58个肝血管瘤）病人的临床资料，总结治疗经验和体会。结果：其中，肝切除术24例，血管瘤剜出术16例，无死亡及重大并发症发生，仅有右侧胸腔积液和膈下积液各1例（2／40）。7例病人行介入下肝动脉栓塞治疗，治疗后病变大都明显缩小，无死亡及并发症发生。结论：手术治疗是一种安全有效的手段，对于弥散分布或部位特殊的病变可选择肝动脉栓塞，超声引导下硬化剂注射疗效不肯定。     

肝血管瘤的诊断和治疗（附47例报告）

目的探讨肝血管瘤诊断和治疗方法的合理选择，评价肝血管瘤手术治疗的风险性。方法回顾性分析47例肝血管瘤患者的临床资料。36例患者具有各种不同程度的非特异性腹部症状或体征。B超、CT和磁共振成像（MRI）三种方法诊断准确率分别为44．7％、84．2％和100．0％。结果16例患者行肝血管瘤挖除术，27例行常规肝叶或肝段切除术，1例行肝右动脉结扎加碘油栓塞术，3例患者实施了右半肝联合左外叶切除术以及肝段切除联合血管瘤挖除术。术后并发症发生率为25．5％（12／47）。多变量Logistic回归分析示术中失血量和术中有无输红细胞（≥2U）是术后并发症发生的独立风险因素（P=0．0280，P=0．0013）。结论肝血管瘤是常见的肝脏良性肿瘤，临床表现缺乏特异性；B超、CT和MRI是诊断肝血管瘤的主要手段，MRI的诊断准确率最高，对本病的诊断具有特殊意义；手术切除是肝血管瘤最理想的治疗方法，手术指征应从严把握。术中出血量和术中有无输红细胞（≥2U）是影响肝血管瘤术后是否发生并发症的重要风险因素。     

甲状腺肿块的诊治及手术指征

目的：分析研究甲状腺肿块的临床诊断、治疗以及手术指征。方法：抽取近年来在我院收治的患有甲状腺肿块的病人140例,对其相关临床资料给予回顾性分析。在140病人患者采取临床手术治疗一共有166次,在166次临床手术当中包括有一侧腺叶次全部切除、一侧腺叶次全部切除加上峡部切除、双侧腺叶次全部切除、患病一侧甲状腺叶加上峡部加上颈部淋巴结清扫手术,它们依次为99例、31例、17例、19例。结果：本文140例手术没有1例住院手术死亡,手术书以后并发症包括有切口出血、喉头水肿、切口感染、四肢抽搐以及声嘶,它们依次为1例、2例、1例、2例、5例。结论：外科手术是治疗甲状腺肿块的首选方法,其中以甲状腺叶次全部切除手术是治疗甲状腺良性结节的最佳手术方式,对甲状腺恶性结节必须要采取根治手术。     

肝段叶切除联合手术治疗肝内胆管结石的临床研究

[目的]结合临床实践经验,探讨肝段叶切除联合手术治疗肝内胆管结石的临床疗效。[方法]2007年1月～2009年12月期间,我院共收治肝内胆管结石患者84例,以此为研究对象,采用总结回顾分析法,将患者的病例资料、临床治疗资料等搜集整理,并与经治医师、责任护士共同探讨病例,探讨肝段叶切除联合手术治疗肝内胆管结石的临床疗效。[结果]本次研究中,患者均行肝段叶切除手术。其中41例行左外叶或左半肝叶切除,13例行右肝段切除,19例右半肝切除。其中行高位胆管切开整形28例及胆管空肠Roux-en-Y吻合35例;行肝断面扩张胆管、肝门胆管分别与空肠作双口吻合7例,U管引流2例和T管引流20例,16例患者手术后道镜取石。本组患者手术后,经过B超、造影检查后有肝内胆管结石残留19例,其中9例患者为左外叶及左半肝结石,8例患者为右后叶及右半肝结石,14例患者为全肝结石。并发的症状为:切口感染7例,肺部感染9例,膈下感染4例,胆瘘2例,上消化道出血2例,胸腔积液2例,肝功能衰竭1例,无手术死亡病例。[结论]为患者实施进行肝段叶切除治疗不仅将肝管结石彻底去除,同时也切除了恶变的胆管,彻底的消除了病根,防止了病情复发的可能性,提高了治疗效果。肝段叶切除联合手术治疗是目前治疗肝胆管结石的最好治疗方法,值得临床推广应用。     

腹腔镜下肝血管瘤切除手术配合及效果评价

目的总结腹腔镜下肝血管瘤切除的手术配合要点。方法对2007年1月-2011年12月湖南省人民医院25例腹腔镜下肝血管瘤切除术患者的临床资料进行回顾性分析。结果 25例腹腔镜下肝血管瘤切除手术均成功,肝血管瘤完整切除,未发生破裂,术中未出现大出血等情况。所有患者术后未发生出血、胆漏,术后5-7天出院。出院后随访3-24个月,25例患者均未出现并发症,能正常工作和生活。结论腹腔镜下肝血管瘤切除术的合理严谨的手术配合是提高手术治疗效果、减少术后并发症的重要一环。     

肝内胆管结石手术方式的选择--附56例报告

目的探讨外科手术治疗肝内胆管结石的最佳术式.方法全组患者采用高位胆管或Ⅰ～Ⅲ级胆管切开取石,对肝内孤立性结石加作肝实质切开取石,右肝叶结石并肝实质纤维化者采用亚肝段切除,左肝萎缩或左肝管多发性结石则同时加作左肝或左肝外叶切除,纠正解除胆管狭窄原位整形,选择病例作各种胆肠吻合等方法;对56例肝内胆管多发结石病人进行其临床观察及跟踪随访.结果 56例病人均经手术治愈出院,无严重并发症发生;切口感染5例,切口脂肪液化2例,经理疗和换药治愈;结石复发9例,复发率为16.07%,偶有胆管炎发作2例,占3.57%.结论对肝内胆管结石应根据各种不同情况选择不同术式、方法治疗方能取得良好的临床疗效.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.