全反式维甲酸治疗慢性粒细胞白血病慢性期病人

由于ATRA在APL的显著作用,人们注意到ATRA在其它血液病方面的潜在抗白血病作用,但目前为止ATRA在CML慢性期的作用无人报导。本文研究了ATRA间歇给药治疗Ph~+CML慢性期病人。 材料和方法:18例Ph~+CML慢性期病人男女各9例,中位年龄58岁,诊断到治疗时间平均为21个月,用α-IFN和/或Hu或Bus治疗的15例,未用的3例,当病人WBC>10×10~9/L,用Hu2g/d口服;WBC<10×10~9/L,停Hu,立即用ATRA80mg/m~2.d,tid.po。每隔1周连续7天,总共12疗程(1疗程=用药1周,间歇1周)。WBC>50×10~9/L和/或PLT<1500×10~9/L,停用ATRA。12疗程后WBC<10×10~9/L,PLT<500×10~9/L,Hb>11g/dl,脾触不清时进行细胞遗传学检查。ATRA剂量的     

腹壁带状疱疹误诊急腹症14例分析

腹壁带状疱疹易被误诊为急腹症 ,而延误治疗甚至造成不必要的手术 ,现就我们于 1990 - 0 1～ 2 0 0 1- 12共误诊的 14例 ,分析如下。1　临床资料本组男 8例 ,女 6例 ,年龄 39～ 82岁 ,平均 6 4.5岁 ,大于 6 0岁者 9例。右上腹疼痛 3例 ,右下腹疼痛 5例 ,右侧腹及腰部疼痛 3例 ,左上腹疼痛 3例 ,伴腹胀感 4例 ,伴恶心呕吐 2例 ,低热3例 ,尿频尿急感 1例。初诊时全组均有不同程度的腹部压痛 ,有局限性腹肌紧张者 2例。血常规 WBC>10 .0× 10 9/ L ,N0 .75 ,WBC<5 .0× 10 9/ L ,N>0 .70 9例。 8例行 B超检查 :2例提示胆囊炎、胆石症 ;3例…     

恙虫病误诊18例分析

我院近 3a来共收治恙虫病 6 5例 ,其中误诊或不能及时诊断者 18例 (占 2 7.8% ) ,现分析如下。1　临床资料本组男 8例 ,女 10例 ,年龄 10～ 6 5岁 ,平均 4 8岁 ,青壮年多见 ,儿童 2例 ,其中农民 15例 ,城镇居民 3例。发病时间在 6～ 9月份。本组主要以发热、畏寒、头痛、四肢酸痛、疲乏、结膜充血、淋巴结肿大、皮肤溃疡或焦痂为主要临床表现 ,详见表 1。本组血 WBC<4 .0× 10 9/ L 5例 ,≥ 4 .0～ 2 5 .0× 10 9/ L 13例 ,尿蛋白 (+～ ) 7例 ,尿 RBC(+) 3例 ,尿管型 (+) 3例。肝功能检查 ,总胆红素 >2 5 μmol/ L 3例 ,AL T升高者 10…     

急性心肌梗死并白细胞增高98例临床分析

1996年 3月～ 1999年 10月 ,我院收治急性心肌梗死并白细胞增高患者 98例 ,报告如下。1　临床资料1.1　一般资料　 98例均经心电图及酶学检查确诊为急性心肌梗死 ,其中男 70例 ,女 2 8例 ;年龄 38～ 79岁 ,平均 6 2岁。以急性心肌梗死后 3天白细胞计数结果分为 3组 ,A组 6 2例9× 10 9/ L≤ WBC≤ 15× 10 9/ L;B组 2 8例 15× 10 9/ L≤WBC≤ 2 0× 10 9/ L ;C组 8例 WBC>2 0× 10 9/ L。1.2　结果　 98例急性心肌梗死患者白细胞数与病情关系 ,见表 1。表 1　 98例急性心肌梗死白细胞增高程度与病情关系 (例 )分组例数 一般心律失常…     

成人急性白血病生存10a以上15例分析

现将我院成人急性白血病生存 10 a以上的 15例分析如下。1　临床资料1.1　一般资料　本组男 10例 ,女 5例。年龄 16～ 5 8岁 ,其中16～ 4 0岁 12例 ,>4 0岁 3例。平均年龄 2 7.3岁。类型 :按 FAB分型 ,M1 1例 ,M2 4例 ,M33例 ,M53例 ,L1 1例 ,L2 1例 ,L32例。WBC(2 .2～ 92 )× 10 9/ L,平均 11.4 4× 10 9/ L。 Hb4 5～ 90 g/ L,平均 6 9.6 g/ L。PL T2 0～ 10 0× 10 9/ L,平均 4 2 .9× 10 9/ L。脑脊液检查 ,确诊后即做脑脊液检查 ,同时鞘内注射甲氨蝶呤 10mg,氟美松 5 mg。以后急性非淋巴细胞白血病 (AML) ,6～ 8周1次 ,做 …     

肾移植受者血清C-反应蛋白动态变化及意义

目的　观察肾移植受者血清 C-反应蛋白 (C- reactive protein,CRP)的动态变化 ,探讨 CRP与急性排斥的关系。方法　以透射比浊法检测 6 0例肾移植受者术前和术后不同时间血清中 CRP浓度 ,并同时检测尿素氮 (Bun)、肌酐 (creatine,Cr)的水平 ,以 5 0例健康献血者作对照。结果　肾移植受者术前 CRP水平 (2 .5 9± 0 .5 5 ) m g/L 与正常对照组 (2 .18± 0 .5 7)mg/L 相比 ,差异无显著性 (P>0 .0 5 ) ,而术后 1d CRP明显升高至 (2 0 .2 1± 4 .87) mg/L,并于第 2天达峰值 (2 9.30± 6 .4 4 )mg/L,第 4天开始下降 ,至第 8天恢复至接近术前水平 (8.0 2± 1.30 ) m g/L,CRP的总体变化趋势与肾功能改善基本一致 ,发生急性排斥者的 CRP均有一个明显上升过程 ,应用免疫抑制剂冲击治疗后大部分迅速下降。结论　血清 CRP动态变化与急性排斥反应的发生及免疫抑制剂冲击治疗的效果密切相关     

XE-2100定量检测网织红细胞的研究

目的 :评价SysmexXE - 2 10 0 (以下简称XE - 2 10 0 )定量分析网织红细胞RET的性能。方法 :以XE -2 10 0定量分析RET ,并将 73例测定结果与SysmexSE - 95 0 0及目视计数法进行比较。结果 :XE - 2 10 0测定RET低值 (2 86× 10 9/L)、中值 (4 3 12× 10 9/L)、较高值 (10 5 6 3× 10 9/L)、明显高值 (2 92 6 6× 10 9/L)标本批内重复性的变异系数 (CV)分别为 4 77%、 2 88%、 3 5 0 %、 2 0 0 %。XE - 2 10 0测定RET低值 (9 87× 10 9/L)、中值(5 6 37× 10 9/L)、高值 (12 8 0 6× 10 9/L)标本批间重复性的变异系数 (CV)分别为 4 6 6 %、 4 5 3%、 2 6 1% ,总重复性CV为 3 5 2 %。RET在 2 5 3× 10 9/L～ 2 6 8 70× 10 9/L范围内线性良好 (r =0 9992 )。XE - 2 10 0分析RET在标本采集后 4 8小时内结果稳定 ;XE - 2 10 0携带污染率为 0 2 3%。XE - 2 10 0、SE - 95 0 0与手工法测定RET结果之间有良好的相关性 ,r分别为 0 96 2 2和 0 94 71。受试者工作曲线分析显示 :受试者工作曲线下面积XE - 2 10 0为0 98和 0 94 ,而SE - 95 0 0为 0 92和 0 95。结论 :XE - 2 10 0测定RET具有简便、准确、精密度高、线性好可提供多参数等特点。     

足三里穴药物注射治疗化疗后白细胞减少的临床观察

为治疗化疗后白细胞减少 ,抽取化疗期间白细胞低于4.0× 10 9/L病人 6 8例 ,随机分为治疗组和对照组 ,治疗组采用足三里穴注射地塞米松和维生素B12 ,对照组采用鲨肝醇、利血升治疗。结果显示 :治疗组总有效率为 10 0 .0 0 % ,对照组为 35 .31% ,两组比较有显著性差异 (P <0 .0 0 5 ) ,且治疗组于 1个疗程后白细胞数上升至 6 .0× 10 9/L～ 8.4×10 9/L者为 2 4例 ,占70 .5 9%。提示足三里穴注射地塞米松和维生素B12 可明显提高化疗后白细胞计数     

脑脊液白细胞计数和蛋白浓度升高是儿童急性淋巴细胞白血病的独立危险因素

本研究的目的是了解测定儿童急性淋巴细胞白血病(ALL)的脑脊液(CSF)蛋白浓度和白细胞计数对患者中枢神经系统情况和预后是否能提供参考信息。作者研究随机儿童ALL患者160例,平均追踪72个月(25-143个月),CSF蛋白浓度为0.144.3g/L,平均0.26g/L,其中>0.45g/L者20例,5年存活率为18%,<0.45g/L者5年存活率为63%(P>0.05)。CSF白细胞计数为0-528×10~6/L,平均1×10~6/L,其中>10×10~6/L者10例,5年存活率为13%,其余患儿5年存活率为60%(P<0.001)。作者把患儿分为3组:Ⅰ组133例,CSF蛋白浓度≤0.45g/L,白细胞计数≤10×10~6/L,CSF中无原始淋     

苏州地区plt和MPV个体变化的调查

目的　调查苏州地区 10 6例健康成人血小板计数 (plt)和平均血小板容积 (MPV)在不同时间内的变化情况。方法　用自动BeckmanCoulterinc.的ModelSTKS计数仪和与仪器匹配试剂由专人检测。结果　 2 0 0 2年 5月份的plt为(172± 4 8)× 10 9/L ,9月份为 (14 5± 4 7)× 10 9/L(P <0 .0 0 0 1)。两次检查plt的平均值 ,9月份比 5月份降低了 14 % ;但从个体的变化情况看 ,减少率最大为 6 2 % (5月份为 16 5× 10 9/L ,9月份为 6 2× 10 9/L) ,增加率最大为 4 0 % (5月份为 99× 10 9/L ,9月份为 139× 10 9/L)。此外 ,MPV值也有变化。观察plt呈低值的血液涂片标本 ,巨大血小板或大型血小板的出现频率增高。结论　苏州地区健康成人plt和MPV值有个体变化。     

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.