雪卡毒素中毒13例剖析

目的:探讨雪卡毒素中毒的原因、临床表现、治疗和预防。方法:分析13例中毒病人的临床资料并综合文献资料进行分析。结果:病人进食有毒海鱼肉后1.5～7h,表现以急性胃肠炎为主的消化系统症状及以温度感觉倒错为主的神经系统症状。经过解痉、止痛、补充血容量,纠正失水、补充电解质等对症处理,均治愈出院。结论:雪卡毒素多存在于部分深海鱼的体内,中毒后出现消化、神经、心血管系统症状,以温度感觉倒错具有特征性。病程1～5周,预后良好,短期内可复发。     

雪卡毒素中毒患者的心血管系统临床表现

目的:探讨雪卡毒素(ciguatoxin)中毒患者的心血管系统临床表现特点.方法:对86例雪卡毒素中毒伴有心血管系统临床表现患者的临床资料进行数理分析.结果:伴心血管系统临床表现的雪卡毒素中毒患者占24%(86/358).病人进食含雪卡毒素的鱼或鱼汤后约3～16 h出现心血管系统的症状,主要表现为心悸、胸闷等,部分病人的血压、心率上升,部分病人则下降;心肌酶谱未出现明显异常;86例均出现心电图异常,79例(92%)表现为窦性心动过缓、窦性心动过速、室上性期前收缩、室性期前收缩,7例(8%)表现为Ⅰ度房室传导阻滞及Ⅱ度Ⅰ型房室传导阻滞,未见明确的ST-T改变;心脏超声检查均未见明显异常.病程1～2周,预后良好.结论:雪卡毒素只是损害心脏的传导系统,而对心肌本身无明显的损害.     

雪卡毒素集体中毒的急救护理

目的探讨雪卡毒素集体中毒的护理和预防方法.方法根据雪卡毒素的临床表现,重点观察消化、神经、心血管系统症状,对症施以护理.结果44例雪卡毒素中毒的患者治疗3～14 d后,均全愈出院,无严重并发症发生.结论做好市民的宣教对阻止和预防雪卡毒素中毒起关键作用.     

雪卡毒素集体中毒的急救护理

目的探讨雪卡毒素集体中毒的护理和预防方法。方法根据雪卡毒素的临床表现，重点观察消化、神经、心血管系统症状，对症施以护理。结果44例雪卡毒素中毒的患者治疗3～14d后，均全愈出院，无严重并发症发生。结论做好市民的宣教对阻止和预防雪卡毒素中毒起关键作用。     

15例雪卡毒素中毒的护理

目的总结雪卡毒素中毒的护理及预防要点。方法对本院收治的15例雪卡毒素中毒患者进行救治护理及预防中毒的指导。结果15例患者均痊愈出院,平均住院时间为5.3d;随访1个月,所有患者均无不适反应。结论迅速诊断、有效地治疗,针对雪卡毒素中毒出现的消化系统、神经系统、心血管系统损害做好护理,加强健康教育及心理护理对患者康复至关重要。     

雪卡毒素中毒２５例分析

目的：探讨雪卡霉素中毒的原因,临床表现、治疗和预防。方法：分析２５例中毒患的临床资料并结合献资料。结果：雪卡毒素广泛存在热带、亚热带深海鱼中,其中石斑鱼、鲈鱼最常见,是鱼类通过食物链获得,中毒后经２－１０h潜伏期,出现以急性胃肠炎为主的消化道症状和心血管症状,２－３d后伴有特征性、较持久的温度感觉倒错。结论：中毒后以温度感觉倒错为特征,预后良好,病程２－３wk,为避免中毒,建议勿食用重１.5kg以上的深海鱼,特别是鱼头和内脏。     

急性雪卡毒素中毒的神经电生理特点

目的 探索急性雪卡毒素中毒早期周围神经的运动感觉传导速度变化特点。方法 对51例急性雪卡毒素中毒患者有四肢及身体其他部位感觉异常的病人进行正中神经及胫神经的感觉、运动传导速度检查，其中9例进行了三叉神建的感觉传导速度及瞬目反射及神觉诱发电位检查。结果 正中神经的感觉传导速度异常率为31．4％，胫神经为54.9％。下肢多于上肢（P〈0.001）。运动神经传导速度及三叉神经感觉传导速度、瞬目反射及视觉诱发电位未发现异常。结论 急性轻度雪卡毒素中毒以四肢远端感觉障碍为主，下肢多于上肢，早期可出现感觉传导速度改变。     

雪卡毒素中毒42例临床分析

目的：探讨雪卡毒素中毒的原因、临床表现和治疗。方法：收集42例雪卡毒素中毒病人的临床资料并综合文献资料进行分析。结果：病人进食有毒鱼肉后1～12h出现神经、消化、心血管系统症状，神经系统症状持续1～3周，并以温度感觉倒错、双下肢麻木、疼痛最具有特征性。结论：雪卡毒素多存在于部分深海鱼的体内，中毒后出现神经、消化、心血管系统症状，以温度感觉倒错双下肢麻木、疼痛具有特征性，预后良好。     

34例砷中毒患者的临床救治与护理

砷及其化合物可由呼吸道、消化道及皮肤吸收而进入人体。砷的毒性作用是砷离子与体内酶蛋白分子结构中巯基和羟基结合，使酶失去活性。临床主要表现为急性胃肠炎，周围循环衰竭；神经精神症状；中毒性肝损害等。我院2005年11月收治了34例因食用含有砷化物的水而出现砷化物中毒症状患者，现将救治措施与护理体会报道如下。     

西加中毒（附5例报告）

目的：探讨西加中毒的诊断、治疗和预防。方法：分析５例西加中毒病人的临床资料。结果：中毒病人临床表现为急性胃肠炎，伴有明显痛温觉障碍。给予对症及支持疗法，预后良好，无后遗症。结论：西加中毒为进食有毒深水海鱼引起的，以痛温觉障碍及急性胃肠炎为特征的，非细菌性食物中毒。预防措施为勿食大量深水海鱼，特别卵巢等内脏。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.