The rights and wrongs of intentional exposure research: contextualising the Guatemala STD inoculation study

In its recent review of the US Public Health Service Sexually Transmitted Disease Inoculation Study, conducted in Guatemala from 1946 to 1948, the Presidential Commission for the Study of Bioethical Issues identified a number of egregious ethical violations, but failed to adequately address issues associated with the intentional exposure research design in particular. As a result, a common public misconception that the study was wrong because researchers purposefully infected their subjects has been left standing. In fact, human subjects have been exposed to disease pathogens for experimental purposes for centuries, and this study design remains an important scientific tool today. It shares key features with other types of widely accepted research on human subjects and can be conducted ethically, provided certain safeguards are implemented. That these safeguards were not implemented in Guatemala is what made that study wrong, rather than the fact of intentional exposure itself. To preserve public trust in the clinical research enterprise, this conclusion ought to be stated explicitly and emphasised.     

性病防治所和综合医院皮肤性病科性病患者求医行为研究

目的　比较性病患者选择性病防治所和综合医院皮肤性病科求医行为差别,探讨患者采取不同求医行为因素和丰富求医行为研究内容。方法　按事先拟定的结构式问卷,在知情同意前提下,对北京３９０例性防所性病患者、５５例综合医院性病患者进行个人访谈。结果　性病知识得分越高、首诊知道设有性病防治所者,倾向于选择性防所,就近就医倾向于选择综合医院皮肤性病科。结论　性病防治所、综合医院皮肤性病科在性病高危人群及一般人群中的知晓度是影响患者就诊不可忽视的因素,性病防治所由于它们在治疗和控制性病中的特殊地位,是确定卫生资源的重要条件之一。     

Iatrogenic nerve injuries

Thirty-one examples of iatrogenic peripheral nerve injuries have been collected from a review of the case records of one neurological referral centre over a 7-year period. The clinical details are described to call attention to the special care needed with the management of patients subjected to certain invasive procedures.     

医源性梗阻性黄疸

梗阻性黄疸由于胆道机械性梗阻所致 ,而该机械性因素是在医疗诊治活动中产生的 ,胆道受到该机械性因素阻塞、损伤发生胆道狭窄或梗阻 ,而导致的梗阻性黄疸称之为医源性梗阻性黄疸。1　 病因1 )胆总管残余结石。由于胆囊泥沙样、小结石患者在开腹手术或腹腔镜手术切除胆囊时 ,没有结扎胆囊管 ,盲目的牵引胆囊或挤压胆囊 ,不慎将胆囊或胆囊管中的结石挤于胆总管中 ,造成胆道的梗阻。2 )胆道损伤。多发生在胆囊切除术后 ,其原因有 :①解剖变异 ;②局部炎性粘连 ,胆囊体部、胆总管或右肝管粘连紧密 ,在分离过程中误将胆总管或右肝管当做胆囊管结…