喉鳞状细胞癌全喉切除术后复发和颈部转移

目的：探讨喉鳞状细胞癌全喉切除术后的复发和颈淋巴结转移特点。方法：回顾分析108例因喉鳞状细胞癌行全喉切除手术的病例资料。结果；108例喉鳞状细胞癌患者有48例出现颈淋巴结转移，有8例局部复发，局部复发者预后差。48例出现颈淋巴结转移者中，有18例颈淋巴结转移发生于全喉切除手术之前，30例颈淋巴结转移发生于全喉切除手术之后。声门上型喉鳞状细胞癌比声门型容易发生颈淋巴结转移（P〈0.01），T3和T4期患者比T2期患者容易发生颈淋巴结转移（P〈0．01）。结论：颈淋巴结转移是喉鳞状细胞癌患者的常见现象，外科医师应警惕喉鳞状细胞癌颈淋巴结的高转移特性，并制定合适的治疗方案。对晚期和声门上型喉鳞状细胞癌应进行密切的术后随访。     

喉癌部分喉切除术后复发的挽救治疗效果分析

目的探讨喉癌部分喉切除术后复发患者的有效治疗方法。方法回顾分析我院1999年1月~2005年10月收治的喉癌部分喉切除术后肿瘤复发并行挽救治疗的26例临床资料。结果 26例首次术后至复发时间平均22个月,均行挽救治疗,术式包括全喉切除、根治性颈淋巴结清扫、支撑喉镜复发癌局部切除、喉次全切除加选择性颈淋巴结清扫、发声重建术等,11例同时行术后放疗,3例单纯行放疗。治疗后有4例再复发,均行第3次手术,其中1例行第4次手术。随访5年,挽救治疗后总体3年生存率57.69%(15/26),5年生存率34.62%(9/26)。结论喉癌部分喉切除术后复发患者以局部复发为主,目前挽救性治疗仍以全喉切除为主,患者预后差。     

垂直部分喉切除术治疗声门型喉癌临床分析

目的：评价垂直部分喉切除术治疗声门型喉癌的效果。方法：1996～2001年共行垂直部分喉切除术治疗声门型喉癌25例。其中单纯手术治疗12例。手术加术前术后放疗9例。手术加术后放疗4例。新声门重建采用甲状软骨外软骨膜修复15例。刨面直接对合重建声带6例。游离皮片移植2例。带蒂胸骨舌骨肌修复2例。结果：术后拔管率为100％。有较好的发声和吞咽功能。3年、5年、8年生存率分别为92％、80％及72％。死于局部复发3例。死于远处转移1例。非肿瘤死亡3例。结论：垂直部分喉切除术是治疗喉癌的有效术式。手术切除范围和修复方法的合理选择可进一步提高疗效。保留良好的发声和吞咽功能。     

一例喉切除、颈淋巴组织清扫术患者脑压的监测

一例喉切除、颈淋巴组织清扫术患者脑压的监测周姝梅，李佐强东北地区是喉癌高发区，以声门上型喉癌为主，约占８０％。［１］声门上型喉癌，由于其淋巴系统的解剖特点，较易发生颈淋巴结转移，转移率可达５０％～６２％。临床研究表明：单纯全喉切除的５年生存率为５２．...     

环上喉部分切除喉功能重建31例远期疗效分析

目的 评价环上喉部分切除喉功能重建术的远期治疗效果。方法 回顾性分析31例接受该术式的T2～T3期喉鳞癌患者的临床资料，其中声门型23例，声门上型8例。行环舌骨会厌固定术22例，环舌骨固定术9例，同期行功能性颈廓清术13例。结果 3年生存率93．5％(29／31)，5年生存率83．9％(26／31)。拔管率为93．5％(29／31)。30例恢复了正常吞咽，全部病例均能利用新喉发音。结论 环上喉部分切除喉功能重建术既能彻底切除肿瘤，又能较满意地恢复喉的三大基本功能；正确掌握适应证是手术成败的关键；合理处理颈部淋巴结是提高3，5年生存率的重要环节。     

64例声门上型喉癌的区域性颈淋巴结清扫术的研究

目的：探讨区域性颈淋巴结清扫术治疗声门上喉癌的作用。方法：64例声门上型喉癌N0病例，根据颈淋巴结引流的特点，进行选择性区域性颈淋巴结清扫术，随访分析5年的临床效果。结果：64例声门上型喉癌N0病例发现24例有颈淋巴结转移，转移率为37．5％，行区域性颈淋巴结清扫术治疗五年生存率为75．5％。结论：声门上型喉癌N0颈部的治疗可采用选择性区域性颈清扫术，治疗效果与传统性全颈清扫相似。同时具有创伤小，手术时间短的优点，具有一定的临床运用价值。     

近似全喉切除术治疗T_3、T_4期喉癌的康复疗效

目的探讨彻底切除病变并用残喉组织重建声瘘管的方法。方法总结９８例喉癌近全喉切除术（ＮＴＬ）喉侧切开径路，从健侧进入喉腔，可彻底切除病变，便于保留尚未受累的残喉组织，以重建声瘘管。结果随访５年以上的７４例，术后５年生存率和５年无癌生存率分别为７９％和７１％。结论近似喉切除术（ＮＴＬ）可以克服其他术式的缺欠，有助于提高喉切除的肿瘤疗效和功能疗效，进一步改善患者术后生存质量。     

喉癌术后细菌学分析及切口的护理

从1988年12月至1989年12月,我们结合临床,对74例喉癌术后病人的切口局部及气管内分泌物标本,进行了连续动态的细菌学检测,现分析如下。一般资料本组观察74例,其中男性47例,女性27例,年龄最大76岁,最小34岁,平均年龄58.6岁;喉癌分型:声门型25例,声门上型25例,声门下型3例,下咽癌2例,喉癌术后复发9例。采用术式:喉全切除发音重建术17例,喉部分切除并一侧颈廓清术11例,全喉切除30例,声带切除7例,喉癌术后双侧颈廓清术6例,单侧颈廓清术3例;术后切口愈合时间最长15天,最短6天,平均7.6天;术后切     

喉部分切除术的护理配合

喉部分切除术是治疗喉癌的一种手术方式。适用于声门癌、声门上下癌以及其他各种喉癌及下咽癌治疗后复发癌、声门闭合不全导致长期误吸。其目的是为广泛切除喉癌，同时保留喉的呼吸、发声和吞咽功能。我院从2003～2005年行喉部分切除共10例，现将手术配合介绍如下。     

乳腺癌术后胸壁局部复发的治疗及其预后

我科１９８６．１～１９９５．１２共收治了１３７２名乳癌患者，１１１６名得到随访。其中明确诊断为复发或转移者２２３例，有４０例为单纯胸壁局部复发，临床无远转移迹象。肿瘤病理类型为：浸润性导管癌３４例，髓样癌２例，浸润性导管癌＋粘液腺癌２例，恶性叶状囊肉瘤１例，粘液腺癌１例。胸壁肿瘤复发距首次手术治疗时间３～１１２月，平均３０．４±３３．１月。除去８例未治外，其余均接受了治疗。接受治疗者１，３，５年生存率为５９．４％，４０．６％及２１．９％．未接受治疗者生存７．６±４．０月，７１．４％在１２月内死亡。本文对影响乳腺癌术后胸壁局部复发及预后的因素进行了讨论。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.