宫颈涂片和宫颈照像技术对宫颈癌筛查的比较

目的:评价宫颈照像技术在宫颈癌筛查中的作用.方法:对194例宫颈病变专科门诊的患者,前瞻盲法,专人分组同时进行宫颈涂片、宫颈照像、阴道镜下取活检.宫颈涂片应用Autocyte液基薄层法,TBS分类报告;宫颈照像仪(Mediscope KCSG-1)的报告按1995年NTL修订分类;以组织病理学为金标准,比较两种筛查方法.结果:阳性预测值、阴性预测值、漏诊率、误诊率、特异度、灵敏度,统计学显示两组间P值均＜0.01.宫颈照像在生育年龄妇女的特异性高(99.30%),阳性预测值高(95.65%),但漏诊率相对高(56.86%).宫颈涂片漏诊率明显偏低(11.76%),灵敏度高(88.24%),但特异性(75.52%)低于宫颈照像(99.30%),误诊率增高(22.48%).结论:在宫颈癌筛查中细胞病理学占主导地位,宫颈照像可以作辅助手段.     

Nongonococcal urethritis. A clinical review

The rising incidence of nongonococcal urethritis (NGU) and the risk of potential complications attributed to chlamydial carriage are of great concern to public health officials. Recognition of Chlamydia trachomatis as a serious, sexually transmitted pathogen has come more recently, and this agent may be responsible for many cases of epididymitis, prostatitis, pelvic inflammatory disease, Reiter's syndrome, infant pneumonia, and possibly other complications. This review describes the clinical manifestations of NGU compared with gonococcal urethritis and the means of diagnosis and management in the patient and his sexual partners. The chlamydial etiology of NGU and other possible etiologies are also discussed.     

国际临床试验注册概述

临床试验是进行医学研究的重要手段,目前为止,只有部分临床试验在不同性质的注册机构进行了注册。临床试验注册能够避免临床研究中的各种偏倚以及由于重复研究而造成的浪费,有利于开展循证医学研究,进而促进人类健康事业的进步。因此,临床试验进行注册的重要性和必要性已日益显现。本文就临床试验注册的定义、原因、要求、内容、历史与现状进行了概述,并详细介绍了重要的国际临床试验注册机构。通过分析临床试验注册的历史与现状,提出未来的临床试验注册将趋向于透明化、强制性和综合性的方向发展。     

糖尿病临床治疗研究的历史回顾

本文并非系统分析或汇总分析,而是回顾糖尿病临床治疗的历史。特别是涉及糖尿病并发高血压、并发高脂血症的临床研究,对临床医师可以有如下的启迪:如何从我们日常遇到的常见病、多发病中去发现问题、研究问题?前人已做了多少研究?每项研究解决了什么问题?正在进行什么样的研究?我们能结合自己的医疗实践做些什么?     

Is there a role for screening by cervicography in Australia?

A review of published studies that have evaluated cervicography as a screening-test for the presence of cervical cancer is presented. Significant problems with the use of cervicography at a population level can be anticipated, in particular, a high proportion of women with uninterpretable test-results and an unacceptably-low positive predictive value. Colposcopy was unable to distinguish adequately the true status of many women with suspicious cervicograms; half the women with a cervicogram that was suggestive of cancer and an abnormal result by colposcopy had normal or benign histological findings. The impact of cervicography on the morbidity and mortality of cervical cancer is unproved. On current evidence, cervicography would not appear to be suitable for use as a screening-test, either as a replacement for, or as a supplement to, the Papanicolaou smear-test.     

Herbal antioxidant in clinical practice: A review

Antioxidant-the word itself is magic. Using the antioxidant concept as a spearhead in proposed mechanisms for staving off so-called "free-radical" reactions, the rush is on to mine claims for the latest and most effective combination of free-radical scavenging compounds. We must acknowledge that such "radicals" have definitively been shown to damage all biochemical components such as DNA/RNA, carbohydrates, unsaturated lipids, proteins, and micronutrients such as carotenoids (alpha and beta carotene, lycopene), vitamins A, B₆, B₁₂, and folate. Defense strategies against such aggressive radical species include enzymes, antioxidants that occur naturally in the body (glutathione, uric acid, ubiquinol-10, and others) and radical scavenging nutrients, such as vitamins A, C, and E, and carotenoids. This paper will present a brief discussion of some well- and little-known herbs that may add to the optimization of antioxidant status and therefore offer added preventive values for overall health. It is important to state at the outset that antioxidants vary widely in their free-radical quenching effects and each may be individually attracted to specific cell sites. Further evidence of the specialized nature of the carotenoids is demonstrated by the appearance of two carotenoids in the macula region of the retina where beta-carotene is totally absent.     

Calcitonin. A review of experimental and clinical investigations

In 1962 Copp proposed the existence of a hypocalcaemic hormone. Subsequent studies have shown him to be right.     

A review of subclavian steal syndrome with clinical correlation

Subclavian 'steal' phenomenon is a function of the proximal subclavian artery (SA) steno-occlusive disease, with subsequent retrograde blood flow in the ipsilateral vertebral artery (VA). The symptoms from the compromised vertebrobasilar and brachial blood flows constitute the subclavian steal syndrome (SSS), and include paroxysmal vertigo, drop attacks and/or arm claudication. Once thought to be rare, the emergence of new imaging techniques has drastically improved its diagnosis and prevalence. The syndrome, however, remains characteristically asymptomatic and solely poses no serious danger to the brain. Recent studies have shown a linear correlation between increasing arm blood pressure difference with the occurrence of symptoms. Atherosclerosis of the SA remains the most common cause. Doppler ultrasound is a useful screening tool, but the diagnosis must be confirmed by CT or MR angiography. Conservative treatment is the initial best therapy for this syndrome, with surgery reserved for refractory symptomatic cases. Percutaneous angioplasty and stenting, rather than bypass grafts of the subclavian artery, is the widely favored surgical approach. Nevertheless, large, prospective, randomized, controlled trials are needed to compare the long-term patency rates between the endovascular and open surgical techniques.     

进行性播散型组织胞浆菌病22例临床分析

目的探讨进行性播散型组织胞浆菌病（PDH）的临床特点、诊断及治疗效果。方法回顾性分析中南大学湘雅医院诊治的PDH患者22例的临床资料。结果PDH的临床表现主要有发热（100％,22／22）,肝、脾肿大（45．5％,10／22）,淋巴结肿大（68．2％,15／22）,消化道症状（45．5％,10／22）,呼吸系统症状（45．5％,10／22）。实验室检查示血、尿常规异常,血生化检查示白蛋白降低16例（76．2％）。人院误诊9例,诊断不明2例。9例经骨髓涂片检查确诊,13例经病理活组织检查确诊。22例患者中,19例患者给予抗真菌药物治疗,其中13例治愈,6例好转。放弃治疗2例,要求出院1例。结论PDH临床表现复杂,通过骨髓涂片、病理组织切片进行病原学检查是确诊的依据。两性霉素、伊曲康唑、伏立康唑及氟康唑治疗有效。     

不明原因发热90例临床分析

目的：探讨不明原因发热（ fever of unknown origin , FUO）的病因分布及临床特点,减少误诊率。方法回顾性分析2008年1月-2011年10月于大连医科大学附属第二医院血液科住院的90例FUO患者的临床资料,包括病史、症状、体征,实验室检查,影像学检查及病理检查。采用独立样本t检验,比较不同病因相关生化指标的差异。结果90例患者中81例确诊,确诊率90％。病因包括：感染性疾病43例占53．1％,其中结核14例,占感染性疾病首位;恶性肿瘤10例占12．3％,其中非霍奇金淋巴瘤5例,血管免疫母细胞性T细胞淋巴瘤4例;结缔组织病10例占12．3％,其中成人Still’s病5例占50％;其他疾病18例占22．2％,其中噬血细胞性淋巴组织细胞增生症（hemophagocytic lymphohistiocytosis ,HLH）11例,占61．11％;未确诊病例9例占9％。结论感染性疾病是本组FUO患者的主要病因,其中结核所占比例最高。此外噬血细胞性淋巴组织细胞增生症,非霍奇金淋巴瘤也常见。     

A review of the safety and clinical utility of contrast echocardiography

There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. Unfortunately, the use of contrast echocardiography has not taken off as expected. The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution’s experience in using it and elaborate on the clinical indications of contrast echocardiography.     

不明原因发热90例临床分析

目的　探讨不明原因发热(fever of unknown origin, FUO)的病因分布及临床特点,减少误诊率。　方法　　回顾性分析2008年1月—2011年10月于大连医科大学附属第二医院血液科住院的90例FUO患者的临床资料,包括病史、症状、体征,实验室检查,影像学检查及病理检查。采用独立样本t检验,比较不同病因相关生化指标的差异。　结果　　90例患者中81例确诊,确诊率90%。病因包括：感染性疾病43例占53.1%,其中结核14例,占感染性疾病首位;恶性肿瘤10例占12.3%,其中非霍奇金淋巴瘤5例,血管免疫母细胞性T细胞淋巴瘤4例;结缔组织病10例占12.3%,其中成人Still’s病5例占50%;其他疾病18例占22.2%,其中噬血细胞性淋巴组织细胞增生症（hemophagocytic lymphohistiocytosis,HLH)11例,占61.11%;未确诊病例9例占9%。　结论　　感染性疾病是本组FUO患者的主要病因,其中结核所占比例最高。此外噬血细胞性淋巴组织细胞增生症,非霍奇金淋巴瘤也常见。