The Truth About Health Care: Why Reform is not Working in America

Social controls and the medical profession. Edited by Swazey, J.P., and Scher, S.R. (Oelgeschlager, Gunn, &; Hain, Publishers, Inc., Boston, Massachusetts, 1985), 268 pages, $27.50.     

Truth telling, placebos, and deception: ethical and legal issues in practice

The issue of truth-telling is very complex. There is variance among patients in the amount of information they want to be told and variance among professionals in the amount of information they want to tell. Truth is conditioned by our knowledge limits and understanding. Technological advances in health care have made this arena even more complex. Placebos have been viewed traditionally as a kind of benign deception. Few studies have looked at treatments and tests as placebos. There are many myths associated with placebos and placebo therapy. There are five primary theories for withholding the truth or promoting deception with patients. Ethical and legal principles generally support veracity and the concept of a duty to tell the truth. One of the remaining issues is whether the placebo effect can be achieved without deception.     

奇台红豆草品种的特征特性研究

奇台红豆草品种为经50年引种、筛选,试验生产所形成红豆草地方品种,本文叙述了该品种的特征、特性、经济性状、栽培技术要点和利用,为该品种的大面积推广应用提供了科学依据。     

生化指标及小肠上皮细胞膜结构在热应激中的变化规律

目的 研究TxB2、PGFIa、PRL、CORT、TSA等生化指标及小肠上皮细胞膜结构在热应激中变化的规律。方法 应用生化、酶学、放免法检测相关的生化指标。采用冷冻蚀刻技术,定量分析大鼠小肠上皮细胞膜内微粒的数量及分布状况。结果 热应激动物体温迅速上升;受检生化指标明显异常;小肠上皮细胞膜,核膜EF面及PF面的膜内微粒数量均有明显减少和异常分布,且累及范围较为广泛,负荷能加重其异常改变的程度;热暴露停止4—24h上述各项指标无明显恢复迹象。结论(1)热应激能迅速破坏小肠上皮细胞的膜性结构,其程度与受热时间长短,体温高低呈反比。(2)可导致对机体有害的TxB2大量释放,对机体有保护作用的PGFIa水平降低,以及与继发损伤有关的CORT持续上升和TSA的异常增高,最终导致全身系统,多器官,多种细胞成分的广泛受损;(3)受热停止4～24h,上述各项指标均无明显恢复迹象,迟发性损伤明显。     

类风湿性关节炎首次发病四肢大关节(附102例临床X线分析)

本文收集我院102例资料较为完整的单独发病于四肢大关节而无小关节改变的类风湿性关节炎,分析其临床及X线表现,提出首次大关节肿痛而无小关节症状就医者,应考虑类风湿性关节炎存在的可能。     

^99Tc^m—植酸钠显像在猪辅助性肝移植中的应用

目的 观察^99Tc^m-植酸钠显像在猪辅助性肝移植中的应用价值。方法 将供肝右叶移植于受体右肝下,建立猪辅助性肝移植模型,动脉血供相同,部分缩窄宿主门静脉控制门脉血流量。根据缩窄程度不同分A（缩窄1／3）、B（缩窄1／2）、C（无缩窄）3组。术后通过^99Tc^m-植酸钠显像检测两肝血流量,判断肝功能,并与组织学检查结果相对照,观察两肝存活情况在^99Tc^m-植酸钠显像中的表现。结果 ^99Tc^m-植酸钠显像提示A组两肝血流均衡、充足,B组移植肝及C组宿主肝血流充足,B组宿主肝及C组移植肝血流量明显降低;组织学检查见肝血流充足者无萎缩,血流量低者肝萎缩。结论 ^99Tc^m-植酸钠显像能准确反映辅助性肝移植后两肝存活情况及功能状况。     

硝酸甘油介入99Tcm-MIBI SPECT心肌显像对PTCA决策的影响

目的评价硝酸甘油(NTG)介入99Tcm-甲氧基异丁基异腈(MIBI) SPECT心肌显像对心肌梗死患者行经皮冠状动脉腔内成形术(PTCA)决策的影响.方法 51例心肌梗死患者PTCA前1周内行99Tcm-MIBI静息和NTG介入心肌显像,术后2～3个月内复查静息心肌显像,并进行对比分析.结果 51例患者共141个心肌灌注异常节段,其中术后74个节段心肌血流灌注改善,治疗有效率为52.48%.术前NTG介入显像表现为可逆性缺损79个节段,术后84.81%(67个)节段心肌灌注改善,其中有明显填充的58个节段,术后全部灌注改善.NTG介入显像表现为不可逆性缺损的62个节段,有11.29 %(7个)节段术后心肌灌注改善.NTG介入显像检测心肌存活的准确性为86.52%.结论 NTG介入99Tcm-MIBI SPECT心肌显像对患者行PTCA起重要的决策作用.     

^99Tc^m—RBC显像诊断小肠出血

目的：探讨^99Tc^m-RBC显像诊断小肠出血的临床价值。方法：对64例小肠出血患者行^99Tc^m-RBC显像并与病理检查结果进行比较。结果：^99Tc^m-RBC显像诊断小肠出血阳性率95．3％，定位诊断率84．4A％，特异性88．5％。结论增加捕捉时机是提高^99Tc^m-RBC显像定位诊断小肠出血的有效方法。     

The United Nations: The embarrassment of international law

The United Nations should be working towards an international community living in peace under the aegis of international law. Although progress was made in its early years, notably in decolonization, with its membership increased from 50 to 189, major inequalities remain between its nations and their peoples. The Security Council, and in particular its five permanent members (P5), has been guilty of double standards in enforcing international law. Investment should create prosperity and not increase demand for arms. Independent oversight of the UN, and particularly the Security Council, by civil society is needed. If the legitimacy of the UN is to be restored, the Security Council should become more representative, the power of the General Assembly should be restored and the role of the International Court of Justice should be increased. All members of the UN, especially the P5, must respect international law as enshrined in the UN Charter and Conventions.     

The legal significance of clinical guidelines in The Netherlands

In The Netherlands the use of clinical guidelines has increased rapidly. To a growing extent, judges also refer to them. Although they are not regarded as legal rules, clinical guidelines do play various roles in judicial decision making. In attaching importance to clinical guidelines, judges sometimes speak about the qualities they look for. Scientific credibility, the prestige of the developing organisation, the way they come about, positiveness, clarity, carefulness and cognizability are mentioned. However, the importance attached to clinical guidelines by the courts does not endanger clinical autonomy. Except for one very instructive incident, Dutch judges have shown respect for clinical autonomy.     

覆膜支架在治疗食管狭窄中的应用

目的：探讨食道覆膜支架在治疗食管狭窄等疾病的临床疗效。方法：在X线监视下对73例食管狭窄的患者置入覆膜金属食道支架。结果：本组71例食管狭窄的患者一次性成功置入支架,2例患者置入支架时由于技术原因支架移位,经胃镜取出移位支架,再次置入后成功。结论：食道覆膜支架置入术治疗食管狭窄,是一种简便、安全、有效的治疗方法。     

臂部双蒂皮瓣的应用解剖学研究

在52侧经红色乳胶灌注的成年尸体上,对臂部双蒂皮瓣的血管和神经进行了观察和测量.该皮瓣实质是臂后侧皮瓣及臂内侧皮瓣的联合应用.故此皮瓣具有上述两皮瓣的特点,皮瓣上、下两蒂十分恒定,适用于下颌部皮肤的大面积缺损及半侧面部皮肤大面积缺损的修复等.     

CT在肝脏炎性假瘤诊断中的价值

目的：探讨ＣＴ在肝脏炎性假瘤诊断中的价值。方法：１６例经手术或病理证实的肝脏炎性假瘤均作平扫及增强扫描,１０例采用动态增强扫描,６例为螺旋ＣＴ多期扫描。结果：ＣＴ平扫表现均为低密度灶,边界不清,增强动脉期扫描病灶无强化,门脉期和延迟期扫描１３ 例可见到周边环形强化;２ 例为整个病灶轻度到中度不均匀强化;１例为病灶中心结节状强化。另外１６ 例中有９例可见到病灶内纤维分隔形成。结论：ＣＴ动态增强扫描和螺旋ＣＴ多期扫描可充分反映病灶的血供特点和病理特征,在肝脏炎性假瘤的诊断和鉴别诊断中具有很大价值。