针状刀在急性化脓性胆管炎治疗中的应用

目的探讨经内镜针状刀乳头括约肌切开术(PST)治疗急性化脓性胆管炎的应用价值。方法对有结石嵌顿、炎性狭窄的乳头做常规逆行胰胆管造影术(ERCP)乳头插管失败后,进行针状刀电切,找到胆总管下端开口,成功后改用常规电刀切开或乳头气囊扩张,再行网篮取石、置管引流等。结果12例患者中11例取石成功,取石成功率为91.7%。结论乳头结石嵌顿、乳头炎性狭窄伴结石致急性化脓性胆管炎,在常规内镜乳头插管困难时,采用PST技术,患者可以得到有效的诊断和治疗。PST是内镜下治疗结石源性急性化脓性胆管炎的重要手段。     

内镜下治疗胆总管结石48例临床分析

目的：评价内镜下十二指肠乳头括约肌切开术、鼻胆管引流术治疗胆总管结石的疗效和安全性。方法：对48例胆总管结石的患者行常规内镜下逆行胰胆管造影,必要时行十二指肠乳头括约肌切开术、内镜下乳头气囊扩张术、鼻胆管引流术治疗。对其临床资料进行回顾性分析。结果：48例患者中,46例常规逆行胰胆管造影成功,成功率95．8％。另2例结石嵌顿于壶腹部行乳头开窗术取石成功;36例一次取尽结石,11例分2次取石成功,总成功率98％,1例取石失败。术后并发高淀粉酶血症10例,胆道感染4例,急性胰腺炎1例,无大出血、穿孔等严重并发症。术后平均住院6天。结论：经内镜下胆总管取石疗效好,创伤小、并发症少,术后恢复快。     

老年人胆总管结石的内镜治疗

目的：探讨老年人胆总管结石的内镜治疗的特点、疗效及随访结果。方法：回顾分析我院近5年来709例老年人胆。总管结石的内镜治疗及部分病人随访隋况。结果：本组709例ERCP全部成功，其中有57例深插管困难者采用十二指肠乳头剥脱开窗术而成功，所有病人均显示有胆总管结石，合并胆囊结石198例；其中单发结石345例，2枚结石211例,3枚以上结石153例，取石网篮直接取石372例，碎石后取石302例，应急碎石20例,未取结石直接于胆总管放置塑料支架15例。一次取尽结石569例，放置鼻胆管引流后二次取石125例。37例术中乳头括约肌电切时发生渗血，经局部喷洒去甲肾上腺素、局部黏膜下注射1：10000肾上腺素或局部电针电凝后出血停止，有15例术后48h于十二指肠乳头切口发生出血，10例给予黏膜下注射1：10000肾上腺素，5例给予钛夹止血。63例术后出现一过性淀粉酶升高而无腹痛，26例发生术后轻症胰腺炎，1例并发重症急性胰腺炎，均给予禁食、抑制胰液分泌抑制胰酶活性、抗炎补液等治疗后痊愈。有9例并发胆管炎，给予抗炎对症治疗，所有患者均痊愈出院。对其中498例病例随访6月～24月，有32例（6．43％）结石再发而再次内镜治疗。结论：老年胆总管结石患者内镜治疗安全有效，并发症发生率低。     

急性化脓性胆管炎的内镜治疗58例报告

目的　探讨急性化脓性胆管炎的急诊内镜治疗方法。方法　对 62例患者急诊行内镜治疗 ,其中包括逆行胰胆管造影 (ERCP)、鼻胆管引流 (ENBD)和 /或乳头括约肌切开 (EST)及取石术。结果　 58例成功治疗 ,取石 52例、6例引流后择期手术 ,54例患者急诊治疗后症状明显缓解 ,无严重的并发症与死亡。结论　内镜下治疗急性化脓性胆管炎安全、有效、微创 ,具有较大的临床应用价值     

内镜微创治疗胆总管结石

目的探讨经十二指肠镜治疗胆总管结石的临床疗效。方法对305例胆总管结石患者进行经内镜十二指肠乳头括约肌切开术,并通过网篮套石、机械性碎石网篮取石,球囊套石等方法排除胆总管结石。结果其中299例胆总管结石患者成功施行EST,289例完全排除结石,通过胆汁查到109例华支睾虫卵确诊并治愈,同时并发的急性胆管炎或急性胆源性胰腺炎也得到治愈。随诊5年,复发胆管结石67例,其中并华支睾虫感染者胆道结石29例复发,再次或多次内镜治疗成功。结论内镜十二指肠乳头括约肌切开术能有效治疗胆总管结石及其并发症,且创伤轻微,并发症少。华支睾虫感染是结石成因之一,内镜通过查胆汁易于发现,治疗及预防华支睾虫感染可减低胆石复发。     

内镜微创治疗胆总管结石

目的探讨经十二指肠镜治疗胆总管结石的临床疗效。方法对305例胆总管结石患者进行经内镜十二指肠乳头括约肌切开术,并通过网篮套石、机械性碎石网篮取石,球囊套石等方法排除胆总管结石。结果其中299例胆总管结石患者成功施行EST,289例完全排除结石,通过胆汁查到109例华支睾虫卵确诊并治愈,同时并发的急性胆管炎或急性胆源性胰腺炎也得到治愈。随诊5年,复发胆管结石67例,其中并华支睾虫感染者胆道结石29例复发,再次或多次内镜治疗成功。结论内镜十二指肠乳头括约肌切开术能有效治疗胆总管结石及其并发症,且创伤轻微,并发症少。华支睾虫感染是结石成因之一,内镜通过查胆汁易于发现,治疗及预防华支睾虫感染可减低胆石复发。     

治疗性经内镜逆行胰胆管造影术在急性胆源性胰腺炎中的应用

目的 探讨治疗性经内镜逆行胰胆管造影术(ERCP)对急性胆源性胰腺炎的治疗效果.方法 2009年11月至2011年4月行治疗性ERCP的23例急性胆源性胰腺炎患者,其中重症急性胰腺炎4例,轻症急性胰腺炎19例.对重症急性胰腺炎或考虑合并有化脓性胆管炎患者于发病72h内行急诊ERCP选择性插管以及内镜下十二指肠乳头括约肌切开术(EST)、内镜下鼻胆管引流术(ENBD),待病情稳定择期行内镜下胆管取石或外科手术治疗;对轻症急性胰腺炎患者行内科非手术治疗,待血淀粉酶明显下降后,行磁共振逆行胰胆管造影术(MRCP)评估胆总管梗阻情况,再行内镜下一次性取石.结果 23例患者内镜下插管成功率100％,其中ERCP选择性插管20例,EST 3例.并发胆道出血1例,经内镜下局部止血成功,并发ERCP术后高淀粉酶血症7例,无严重并发症和死亡病例.14例达临床治愈,9例于外科择期行腹腔镜胆囊切除术、胆管探查术、联合部分肝叶切除术.结论治疗性ERCP对急性胆源性胰腺炎的干预治疗是一种有效、安全的手段.     

肝内梗阻型急性化脓性胆管炎的诊断和治疗

肝内梗阻型急性化脓性胆管炎往往由肝内胆管结石嵌顿并闭塞肝内胆管所致，与一般肝外梗阻型化脓性胆管炎不同，该病合并症多，治疗较为复杂。本文回顾我院1996年7月至2003年1月52例该类病例，并对其诊断与治疗进行分析。     

EST与EST小切口联合EPBD治疗胆总管结石的前瞻性随机对照临床研究

目的：研究比较内镜乳头括约肌切开术（EST）与EST小切口联合内镜乳头括约肌球囊扩张术（EPBD）两种手术的临床指标,有利于对胆总管结石患者制定个体化治疗方案,对选择手术方式,控制手术质量,起到参考作用。方法：把经内镜逆行胰胆管造影（ERCP）证实的胆总管结石患者160例随机分为EST、EST小切口联合EPBD两组并进行手术,对两组患者的各项指标进行对比,统计分析。结果：两组患者的手术时间、手术费用有统计学差异（P<0.05）,结石清除率无统计学差异（P>0.05）。两组患者术后急性胰腺炎发生率无差异（P>0.05）,EST组更易并发出血和胆管炎。结论：EST小切口联合EPBD能够有效降低术后十二指肠乳头出血、胆管炎的并发症发生率,而其手术时间和费用相对增加。EST并发症的发生率相对较高,会引起住院时间和费用增加。故建议首选EST小切口联合EPBD治疗胆总管取石。     

胆囊颈部结石嵌顿并急性化脓性胆囊炎采用腹腔镜胆囊切除术治疗的临床观察

目的分析胆囊颈部结石嵌顿并急性化脓性胆囊炎采用腹腔镜胆囊切除术治疗的临床疗效。方法随机选取我院2013年1月至2014年1月收治的胆囊结石嵌顿并急性化脓性胆囊炎患者90例,根据患者就诊顺序编号分为治疗组(45例)和对照组(45例),治疗组行腹腔镜胆囊切除术,对照组行常规开腹手术,分析手术效果。结果治疗组手术时间、术中出血量均少于对照组(P0.05),并发症发生率小于对照组(P0.01)。结论腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎效果显著,具有切口小,并发症少等优点,值得作为治疗胆囊炎理想手术方法。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.