沙培林腔内注射对乳腺癌改良根治术后皮下积液的疗效

目的:观察沙培林腔内注射治疗乳腺癌改良根治术后皮下积液的疗效及安全性。方法:选择行乳腺癌改良根治术后发生皮下积液患者60例,随机分为观察组和对照组,每组30例。观察组行抽净积液后腔内注射沙培林混合液,3h后抽净药液,再用绷带加压包扎积液创面;对照组仅以50%葡萄糖腔内注射,其余步骤相同。观察两组皮下积液改善的效果以及发热和局部皮肤坏死等不良反应。结果:治疗前两组积液量差异无统计学意义(164.45±36.22ml vs 172.41±45.37ml,P0.05);第一次治疗后和第二次治疗后,观察组积液量均少于对照组(55.43±36.29ml vs 132.31±41.65ml,18.39±15.47ml vs 69.42±38.75ml;P0.05),积液完全消失时间(3.22±0.64天vs11.84±1.83天)明显短于对照组(P0.05)。两组发热率均为3.33%(1/30),差异无统计学意义(P0.05),均未发生皮肤坏死事件。结论:局部腔内注射沙培林可很快减少乳腺癌改良根治术后皮下积液,且使用方便、安全。     

乳腺癌的根治术皮下积液的防治

目的:探讨乳腺癌术后皮下积液的防治方法。方法:回顾在院2004年～2007年12月收治女性乳腺癌患者146例,比较腋窝多孔单管负压引流加压包扎法(A组)与腋窝,胸壁双负压引流加压包扎法(B组),乳腺癌改良根治术后皮下积液的发生率。结果:A组皮下积液12例(16.4%),B组皮下积液3例(4.1%)②。两组皮下积液发生率有显著性差异。结纶:乳腺癌改良根治术后双负压引流加压包扎法有助于减少皮下积液的发生率。     

外科方法处理乳腺癌合并糖尿病患者术后皮下积液的临床效果

目的探讨以外科方法处理乳腺癌合并糖尿病患者术后皮下积液的临床应用效果。方法选取2017年1月至2018年12月本科室收治的女性乳腺癌合并糖尿病患者60例,均接受改良根治术,符合ⅡA～ⅢA期(T2K-3N0-1M0),根据所住院的区域分为干预组和对照组,各30例。对照组在接受改良根治术后,伤口加压包扎,肩部制动,常规糖尿病饮食指导并控制血糖。干预组在对照组的基础上,于术后2 d应用外科方法及早干预处理局部积液腔;比较2组患者术后5 d引流液量、拔管时间、术后接受辅助化疗的最佳时间、是否因皮下积液再次手术引流。结果通过外科方法处理的干预组患者术后5 d引流液量、拔管时间、术后接受辅助化疗最佳时间、再次手术引流例数比较,差异均具有统计学意义(P 0. 05)。结论对于乳腺癌合并糖尿病患者应用外科方法将铜绿假单胞菌注射液通过引流管通道注入术后创面腔隙内,使手术后的局部创面产生良性的无菌性炎症,可促进术后创面快速愈合,同时缩短拔管时间,患者术后接受辅助化疗的最佳时间得以保证,减轻患者的精神心理压力。     

真空负压引流在乳腺癌改良根治术中的应用

目的:研究真空负压引流装置在乳腺癌改良根治术中的应用效果.方法:收集江苏省苏州市立医院东区乳腺癌患者140例,随机分为实验组和对照组,各组70例.实验组应用真空负压引流装置,对照组使用传统的负压引流.对比两组皮下积液、皮瓣坏死、切口感染情况及拔管时间.结果:实验组皮下积液及切口感染发生率显著低于对照组,差异有统计学意义(P＜0.05).实验组拔管时间早于对照组,差异有统计学意义(P＜0.05).结论:乳腺癌改良根治术后使用真空负压引流装置可减少术后并发症的发生率,提高患者的舒适度,值得推广.     

乳腺癌改良根治术术后引流管拔管时间的选择

目的 探讨乳腺癌改良根治术术后患者较为合适的拔管时间.方法 采用分割χ2检验,回顾性分析744例乳腺癌改良根治术术后引流管的拔除时间与拔管后皮下或腋窝积液发生的情况.结果 拔管时间为5～7天组拔管后皮下或腋窝积液发生率最低(10.18%),且与合并组积液发生率差异有统计学意义(χ2=13.209,P<0.001),其余各组组间差异无统计学意义(P>0.05).结论 乳腺癌改良根治术术后5～7天是最佳的拔管时间,可有效预防因引流管本身刺激而形成的积液.     

缓释型氟尿嘧啶植入剂应用于乳腺癌改良根治的安全性

背景:如何寻找更好的药物剂型、给药途径,使高浓度的药物直接作用于局部,并提高药物对局部靶组织的选择性、延长药物作用时间,对预防乳腺癌局部复发有重要意义。目的:探索在乳腺癌改良根治术中应用氟尿嘧啶植入剂的临床安全性,探寻预防乳腺癌局部复发的新途径。方法:63例乳腺癌改良根治术患者,TNM分期:Ⅰ+Ⅱ期35例,Ⅲ期28例,随机分为植入剂组32例及对照组31例,植入剂组在肿瘤下方,腋窝、锁骨下血管区域、胸大小肌之间多点喷撒氟尿嘧啶植入剂,总剂量为600mg,每点处小于100mg,观察应用植入剂后,切口有无感染裂开,8d后的皮下积液情况,皮瓣坏死、患肢水肿、拆线天数及血红、白细胞、肝肾功能情况。结果与结论:植入剂组与对照组在切口感染裂开、皮下积液量、患肢水肿、拆线天数及血红细胞计数等方面差异无显著性意义(P0.05),两组治疗后,血白细胞计数、谷丙转氨酶、肌酐均较治疗前有明显增加(P0.05),但是两组之间差异无显著性意义(P0.05)。结果提示乳腺癌改良根治术中应用氟尿嘧啶植入剂是安全可靠的,是乳腺癌术后局部化疗的有效途径。     

探讨静脉留置针管径大小对住院患者留置时间的影响

目的：探讨使用静脉留置针管径大小对住院患者留置时间长短的影响。方法对我院内科2013年3月~12月180例需静脉注射的患者,平均年龄(40±10)岁,穿刺部位及血管条件适合进行密闭式静脉留置针穿刺,选用BD公司生产的一次性18#、22#、24#三种型号的安全型静脉留置针,对留置时间进行观察。结果管径小的留置针(24#)留置时间比管径大(18#)的保留时间长。结论在临床中应该根据病情的需要及血管条件选择留置针的大小,在无特别需要情况下,选择较小的留置针以延长留置时间,减少患者的费用、减轻患者的痛苦。     

早期持续壁负压吸引对乳腺癌术后皮下积液预防作用的研究

目的：探讨早期持续壁负压吸引方式对乳腺癌术后皮下积液的预防作用,并为临床提供评价依据。方法选取2011年7月~2012年9月来我院就治的乳腺癌患者150例,所有患者均采取乳腺癌改良手术,根据患者手术后负压吸引的方式不同将其分为三组,分别命名为A组、B组、C组。结果 A、B、C三组比较发现C组采取术后持续壁负压吸引方式的患者乳腺癌术后皮下积液发生率最低,三组比较<0.05,有差异性显著,存在统计学意义。结论乳腺癌手术治疗后采取早期持续壁负压吸引的方式对皮下积液有较好的预防作用,值得在临床推广和使用。     

快速流程护理在乳腺癌改良根治术患者围术期的应用价值分析

目的探究快速流程护理在乳腺癌改良根治术患者围术期的应用价值。方法选取2018年3月～2019年3月在我院行改良根治术治疗的70例乳腺癌患者为研究对象,随机分为对照组和观察组,每组各35例。对照组围术期采用常规护理,观察组围术期采用快速流程护理。对比两组患者护理效果及生活质量。结果观察组患者的术后插管时间、住院时间均显著短于对照组,差异具有统计学意义(P0.05);干预前,两组患者各维度SCL-90得分无显著差异,手术后观察组患者强迫症状、抑郁、焦虑、敌对、偏执、恐怖、躯体化、人际交往、精神病性9个因子及总评分显著低于对照组,有统计学差异(P0.05);观察组患者术后3个月FACT-B评分明显高于对照组,差异具有统计学意义(P0.05);观察组患者术后并发症发生率显著低于对照组,差异具有统计学意义(P0.05)。结论快速流程护理干预可有效改善乳腺癌改良根治术患者的预后,提高患者生活质量,值得临床推广应用。     

优先精准解剖肾上腺中央静脉在后腹腔镜肾上腺肿瘤切除术中的应用

目的 探讨后腹腔镜优先精准解剖肾上腺中央静脉在肾上腺肿瘤切除术中的应用价值。方法 回顾性队列研究。纳入2014年3月—2018年10月徐州医科大学附属淮安医院行后腹腔镜肾上腺肿瘤切除患者76例,其中男41例、女35例,年龄33～67(42±11)岁,左侧42例、右侧34例。按手术方式不同分为两组,其中采用传统“三层面法”的患者纳入传统组(38例),采用术中优先精准解剖肾上腺中央静脉后再游离肾上腺的患者纳入精准解剖组(38例)。比较两组患者手术时间、术中出血量、腹膜后引流管留置时间、肠蠕动恢复时间、住院时间及术后并发症等。结果 两组患者年龄、性别构成、体质量指数(BMI)、肿瘤位置、肿瘤类型和平均直径等基线资料比较,差异均无统计学意义(P值均＞0.05)。两组患者均顺利完成手术,无中转开放手术者。患者术后均获得随访6~24(18.5±4.5)个月,未见肿瘤复发及转移。传统组手术时间、术中出血量、留置引流管时间、肠蠕动恢复时间和住院时间分别为(61.4±15.9)min、(66.84±19.25)mL、(3.6±0.6)d、(1.8±0.3)d、(7.9±2.1)d,精准解剖组分别为(66.2±13.7)min、(50.34±15.66)mL、(2.2±0.4)d、(1.7±0.3)d、(6.2±1.4)d。精准解剖组术中出血量、留置引流管时间、住院时间均少于传统组,差异均有统计学意义(t=4.099、11.396、3.990, P值均＜0.05);两组手术时间、术后肠蠕动恢复时间比较,差异均无统计学意义(P值均＞0.05)。两组患者在术后均未见肾上腺危象、皮下气肿、高碳酸血症等严重并发症发生。结论 后腹腔镜肾上腺肿瘤切除,术中优先精准解剖肾上腺中央静脉并结扎,具有出血少、手术视野清晰,安全性高,值得进一步深入研究。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.