肿瘤化疗病人行PICC置管的护理探讨

目的 探索肿瘤患者从外周静脉植入中心静脉导管(PICC)的方法及需要注意的护理问题.方法 总结81例肿瘤患者行PICC置管的操作方法,分析围PICC置管术期的护理措施.结果 严格遵守操作规程,认真做好PICC置管术期的护理,可延长PICC导管的使用寿命,方便病人治疗,减少并发症.结论 经外周静脉穿刺置入中心静脉导管,近年来被广泛应用于临床,特别对于需要反复多次进行静脉化疗的肿瘤患者,PICC置管是安全可靠的选择.     

PICC置管在肿瘤化疗中的应用与护理

目的：探讨经外周静脉置入中心静脉导管术(PICC)在肿瘤化疗中的应用与护理。方法选择60例肿瘤患者,给予PICC置管静脉化疗,观察其治疗和护理效果。结果置管成功率为100%。60例患者全部顺利完成化疗。导管留置时间35~182d。导管留置期间发生静脉炎4例,穿刺点出血5例,导管堵塞2例,导管移位2例。结论PICC置管具有创伤小、留置时间长、并发症少、维护简便和避免反复静脉穿刺等优点,是一种良好的静脉化疗通道。     

外周静脉穿刺置入中心静脉技术中的体会

外周静脉穿刺置入中心静脉(PICC)是指从外周静脉进行穿刺插管,导管尖端要在上腔静脉下1/3处或上腔静脉与右心房的链接处,上静脉管径粗而且血流量大,可以迅速稀释高浓度或刺激性强的化疗药物从而不损伤血管,故特别适用于行化疗的患者。唯一允许护士操作的穿刺技术就是PICC,此技术操作简单,成功率高,保留时间长,并发症少,可以更好地保护血管,避免反复穿刺,但是因穿刺针粗,穿刺时存在疼痛、紧张引起血管痉挛问题。为了解除送管中血管痉挛,我选择了局部用药的方法。从2013年5月~12月,我给69例肿瘤患者行PICC置管术。患者全部置管成功,穿刺时疼痛明显减少,6例患者穿刺中痉挛立即解除,行大剂量化疗后无1例发生药物外渗及导管并发症,保证化疗顺利完成。     

喜辽妥联合镇痛灸治疗静脉炎的临床观察

<正>经外周置入中心静脉导管(PICC)是一种从外周静脉导入且末端位于中心静脉的深静脉置管技术,临床护理中主要适用于需长期输液及输注化疗药物等情况,不仅能解除反复静脉穿刺带给患者的痛苦,还能保护外周静脉[1]。但我们在临床中发现PICC存在一些并发症,如穿刺失败、脱落、静脉炎等。特别是在输注化疗药物时,由于化疗药物浓度高、刺激性强,操作不当可致局部软组织及血管内皮损伤,从而引起给药静脉及临近组织出现红、肿、热、痛、血管硬结等化学性静脉炎,严重影响患     

PICC的护理及并发症的原因分析和处理

目的探讨应用外周中心静脉置管(PICC)的护理体会及并发症的防治.方法对150例PICC置管患者的护理进行回顾性分析,总结其并发症的原因及防治.结果 150例患者中1次性置管成功142例,成功率94.7%.发生静脉炎2例,导管堵塞5例,静脉血栓1例,导管相关感染1例,并发症发生率总计6%.结论 PICC提供了安全可靠的静脉通路,减少对患者的疼痛刺激,值得临床推广应用.强化置管及使用操作者的护理技能培训,严格操作规程,可以减少静脉炎、堵管和感染等并发症,延长PICC留置时间,保证治疗完成,减少患者痛苦.     

浅谈PICC在肿瘤化疗中的护理体会

目的：探讨PICC导管在肿瘤化疗中的护理体会。方法选择本院肿瘤内科2012年7月~2013年12月诊治的100例应用PICC置管化疗治疗的肿瘤患者,并对其临床资料及护理措施进行统计分析。结果本文所有入组的100例患者,其中56例为胃癌患者,20例患者为乳腺癌,24例患者为结直肠癌。所有入组的患者均穿刺成功,置管保存时间为35~180d。其中有4例患者发生了化疗性静脉炎,3例患者的导管出现阻塞现象,93例患者对其所接受的治疗及护理服务表示满意。结论 PICC穿刺成功率高,安全性强,导管可长时间保留,具有较高的临床应用价值。肿瘤患者使用PICC置管术可以用来缓解其疼痛感,以及降低其化疗所产生的不良毒副反应,同时可以确保化疗药物顺利注入患者体内,从而有利于整个化疗治疗过程的实施。     

经外周静脉穿刺中心静脉置入术导管异位的影响因素

目的探讨经外周静脉穿刺中心静脉置入术(PICC)发生导管异位的相关因素,提出针对性的干预措施,以减少导管异位的发生。方法回顾性分析2016年1月至2018年12月在重庆市急救医疗中心神经外科行PICC的167例患者的临床资料,统计PICC导管异位情况,对可能引起导管路径异常的相关影响因素进行统计学分析。结果本组167例PICC患者中,导管异位16例(9.58%)。多因素logistic回归分析结果显示,气管切开(OR=1.569)、机械通气(OR=1.598)、经头静脉穿刺(OR=1.985)、患者意识障碍(OR=1.866)、送管次数大于2次(OR=1.265)、锁骨下静脉置管史(OR=1.632)是神经外科患者PICC导管异位的危险因素。结论神经外科有高危因素的患者行PICC置管时,建议首选经贵要静脉路径穿刺置管,肘正中静脉次之,同时应根据患者个体情况,给予针对性的干预措施,减少PICC导管异位发生率。     

应用MELODIE输液泵经PICC导管行时辰化疗在治疗中的渗液原因分析与对策

目的探讨MELODIE输液泵经PICC导管行时辰化疗时的渗液原因及护理对策。方法回顾3例MELODIE输液泵经PICC导管行时辰化疗时的渗液患者的临床资料，分析其原因并采取相应的处理。结果60例MELODIE输液泵经PICC导管行时辰化疗时有3例出现输出管压力盘处渗液，发生率为5%。行观察，得出渗液原因与患者的活动方式、肢体位置及导管置入部位有关，通过加强健康宣教、改变患者体位及改变导管置入部位的方式，控制MELODIE输液泵时辰化疗时的渗液。结论通过治疗护理观察，对MELODIE输液泵时辰化疗渗液情况进行分析和制定实施相应对策，能很好解决MELODIE输液泵时辰化疗渗液情况。     

肿瘤患者行PICC置管的临床观察与护理研究

目的分析研究PICC导置管对肿瘤患者的临床治疗效果,并结合临床观察分析PICC导置管成功实施的关键需要有效的导管护理措施,才能进一步实现患者治疗过程中良好的静脉通路。方法选取我院2013年10月~2014年6月收治的80例肿瘤患者为研究对象,对其采用外周导入中心静脉PICC置管,通过置管给患者进行给药,详细观察患者的病情以及长期置管的临床效果。结果插管率97.5%;长期置管观察患者病情没有误伤动脉、血管,保持静脉通路;无药物外渗现象;实现长期给患者顺利的输液治疗。结论对肿瘤患者采用PICC置管可以有效的保护血管,在临床上取得较好的护理效果,值得推广和应用。     

原发性肺癌患者经PICC置管后发生并发症的危险因素分析

目的探究原发性肺癌患者经外周中心静脉(PICC)置管后发生并发症的危险因素。方法选择2018年12月～2019年12月于我院进行PICC置管的158例原发性肺癌患者作为研究对象,根据是否发生PICC置管后并发症分为并发症组(18例)和无并发症组(140例)。回顾性分析患者临床资料,包括性别、年龄、TNM分期、基础疾病、置管前D-二聚体水平、置管静脉、化疗药物、置管时间、治疗方式等,分析原发性肺癌患者经PICC置管后并发症发生的危险因素。结果多因素Logistic回归分析显示,置管前D-二聚体水平、肿瘤分期及化疗药物依托泊苷的应用是原发性肝癌患者PICC置管后并发症发生的独立危险因素。结论置管前D-二聚体水平、肿瘤分期及化疗药物依托泊苷的应用是原发性肝癌患者PICC置管后并发症发生的独立危险因素。在患者PICC置管前需提前筛查D-二聚体水平,同时密切观察肿瘤晚期患者置管侧血管情况,在输液过程中减少肢体制动,适当活动肢体,对预防PICC相关性静脉血栓的发生具有重要作用。     

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.