60例中老年白内障患者手术临床效果分析

目的分析白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗糖尿病性白内障的疗效及并发症。方法选择2005年1月-2007年12月期间确诊为糖尿病的白内障60例（73眼），40眼Ⅱ～Ⅲ级核，采用超声乳化白内障吸除后房型人工晶体植入术；33眼Ⅳ～Ⅴ级核，采用现代白内障囊外摘除后房型人工晶体植入术。结果术后视力均有不同程度的提高，其中54眼（73.97％）术后1周裸眼视力≥0．4。术中术后主要并发症经处理对术后视力元影响。结论采取恰当的术式，白内障现代囊外摘除人工晶体植入术和超声乳化白内障吸除人工晶体植入术治疗糖尿病性白内障疗效肯定。     

两种手术治疗白内障手术并发症对比分析

本文总结隧道小切口白内障摘除人工晶体植入术和超声乳化白内障摘除人工晶体植入术，并对两组术后并发症进行3～28个月的观察对比，结果如下。     

前房型人工晶体植入18例临床分析

报告18例18眼前房型人工晶体植入术，均植入双侧“S”型弹性襻，术后平均观察15个月，效果好。前房型人工晶体植入术，植入路径短操作在虹膜前，可见度广，操作简单容易，作为后房型人工晶体植入术的补充，或后房人工晶体植入术失败的补救措施，有其应用价值。     

高龄白内障患者人工晶体植入术

目的：评估80岁以上老年人行人工晶体植入手术的疗效和对手术的承受力。方法：对119例80岁以上高龄白内障患者实施人工晶体植入术，其中后房型人工晶体植入术108例，前房型人工晶体植入术8例，青光眼小梁切除及后房人工晶体植入术3例。80％以上病例有全身多系统疾病，以高血压、冠心病最多。结果：111例术后视力有不同程度提高，其中视力≥0．3为69只眼（58．9％），术后眼部并发症不高于一般老年人，仅有8例（6．7％）术后视力无提高。结论：人工晶体植入术是矫正高龄白内障患者最佳方法。如果处理恰当，高龄老年人均能承受手术。     

晶体半脱位白内障手术治疗的临床探讨

【目的】探讨治疗白内障晶体半脱位的有效方法。【方法】分别对32例（32只眼）晶体半脱位白内障患者行PHACO人工晶体植入术（23只眼）和小切口ECCE人工晶体植入术（3只眼）及超声乳化白内障吸除联合前部玻切悬吊式人工晶体植入术（6只眼），术后观察和总结患者的视力变化情况、人工晶体的位置及手术并发症。【结果】全部患者术后视力均有提高。正常瞳孔下3只眼可见人工晶体上缘，散瞳后5只眼人工晶体偏住，均无复视症状发生；术中和术后均无严重并发症发生。【结论】只要具有熟练的手术技巧，选择最佳手术方式，手术治疗晶体半脱位白内障可取得良好效果。     

超声乳化白内障吸出术联合人工晶体植入对先天性晶体半脱位视功能的改善

目的 观察超声乳化联合人工晶体植入术对先天性晶体半脱位患者术后视功能的改善。方法 1999—05／2002—01哈尔滨医科大学第一临床医学院眼科收治先天性晶状体半脱位患者65例(75眼)，行超声乳化联合人工晶体植入术，术中应用连续环形撕囊技术，并使用灌注抽吸系统清除皮质，囊袋内植入人工晶体。结果 术后矫正视力≥4．6者42眼，4m(0．08)以下者12只眼，4．0～4、5者21只眼。结论 超声乳化联合人工晶体植入术的应用于先天性晶体半脱位手术，提高了患者的视功能。     

619例囊外白内障摘除并后房型人工晶体植入术的护理

６１９例囊外白内障摘除并后房型人工晶体植入术的护理天津医学院世界人工晶体中国天津培训中心（３００００１）谭黎手术显微镜下囊外白内障摘除合并后房型人工晶体植入术，是我国近几年开展的新的手术方法。因术后一般不戴眼镜即可获得良好视力，目前已被越来越多的白内...     

白内障人工晶体植入术后眼内炎的临床分析与预防措施

目的 控制人工晶体植入术后医源性感染的发生。方法 对近半年来的480例白内障人工晶体植入术的病人进行统计，并对术后发生眼内炎的病例进行临床分析。结果 2例发生医源性感染，细菌培养分别是铜绿假单孢菌和表皮葡萄球菌。经抗感染治疗，1例无效，行左眼内容物挖除术，1例眼内炎得到控制，治愈后患者出院。结论 必须加强围手术期的管理，严格遵守消毒灭菌原则，杜绝白内障人工晶体植入术后医源性感染的发生。     

人工晶体术后迟发性葡萄膜炎3例

白内障人工晶体植入术后常发生不同程度的术后炎症反应，多数经治疗后在1周内逐渐消退和消失。但也有后房型人工晶体植入术后，早期的炎症反应消退一段时间后又突然复发，甚至表现为较严重的全葡萄膜炎即为迟发性葡萄膜炎反应。这是一种严重的术后并发症，对患术后视力构成严重威胁。作在2000年1月至2004年12月发现了3例白内障人工晶体植入术后迟发性葡萄膜炎。现报道如下。     

白内障超声乳化并人工晶体植入术的术后护理

白内障超声乳化并人工晶体植入术的术后护理大连市第二人民医院（１１６０１１）沈连香洪汝清丛晶１临床资料我科自１９９６年６月至１１月应用超声乳化进行各类白内障晶体超声乳化并人工晶体植入术共１１４例，１２９只眼。其中老年性白内障７３例，８１只眼；糖尿病性...     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.