上消化道肿瘤伴出血的治疗

上消化道肿瘤是引起上消化道出血的常见病因之一，约占所有上消化道出血病因的２％～３％。良性肿瘤中以食管、胃及十二指肠息肉或息肉病最常见，此外，平滑肌瘤、腺瘤或神经纤维瘤等也可引起上消化道出血。恶性肿瘤中以胃癌最常见，依次还有食管癌、十二指肠癌、胃和十二...     

以贫血为首发症状的食管裂孔疝9例分析

【目的】 探讨以贫血为首发症状的食管裂孔疝患儿的临床特点及诊治要点。 【方法】 对9例贫血为首发症状的食管裂孔疝患儿的临床资料进行分析。全部患儿进行了血常规、血清铁、铁蛋白、总铁结合力检测,行胸片、上消化道造影检查。 【结果】 9例均符合缺铁性贫血诊断标准。就诊时血红蛋白值为(52±12)g/L,铁蛋白值为(3.0±1.8)ng/mL,血清铁值为(2.7±1.8)μmol/L,总铁结合力值为(87.21±5.78)μmol/L。所有患儿均无“呕吐、呕血、黑便”等消化道症状。胸片检查疑诊、消化道造影证实食管裂孔疝。8例给予手术治疗,1例家属拒绝手术出院。 【结论】 缺铁性贫血为婴幼儿常见病,诊断时需重视缺铁性贫血的病因诊断,尤其是一些先天性胃肠道畸形,如食管裂孔疝;对此类患儿可行胸片筛查,手术是治疗成功的关键。     

小儿慢性咳嗽的诊断探讨

[目的]探讨小儿慢性咳嗽的病因及分布特点，为临床诊断慢性咳嗽提供依据。【方法】参考ABChang推荐的儿童慢性咳嗽诊断流程，并辅以诱导痰细胞分类检查，对慢性咳嗽的病因进行分类，并针对病因进行特异性治疗。【结果】用此方法对门诊61例慢性咳嗽患儿进行分析，其中咳嗽变异性哮喘(cough variant asthma，CVA)占54．1％(33／61)，鼻后滴漏综合征(postnasal drip syndrome，PNDS)占24．6％(15／61)，支原体感染占8．2％(5／61)，双病因8．2％(5／61)，病因未明4．9％(3／61)，经过针对病因的特异性治疗，有91．6％(56／61)患者咳嗽症状明显减轻或消失。【结论】儿童慢性咳嗽常见病因有咳嗽变异性哮喘、鼻后滴漏综合征、支原体感染，针对病因治疗是临床疗效的关键。     

儿童慢性腹泻61例临床分析

目的探讨儿童慢性腹泻的病因、临床表现、诊治及预后。方法选择1997年8月至2007年8月在本院住院的61例慢性腹泻患儿为研究对象。本组患儿除腹泻外,伴发热、腹痛、呕吐,合并贫血,营养不良,伴不同程度脱水,水、电解质紊乱及代谢性酸中毒等。采用回顾性分析法对患儿的一般资料、临床表现、实验室检查结果、病因及预后等进行研究。结果61例患儿的实验室检查结果中,大便正常为34例（55．7％）,异常为27例（44．3％）。其中,大便细菌培养均呈阴性（100．0％）,乳糖呈阳性为14例（23．0％）,肠道菌群失调为13例（21．3％）,真菌菌丝感染呈阳性为3例（4．9％）,寄生虫阿米巴感染呈阳性为3例（4．3％）,轮状病毒感染呈阳性为1例（1．6％）。血清免疫学指标测定结果显示,28例行血清免疫球蛋白检测的患儿中,15例（53．6％）异常;24例行CD系列检测的患儿中,7例（29．2％）异常。电子结肠镜及病理学检查结果显示,27例（44．3％）发现黏膜病变,其中溃疡性结肠炎为3例（4．9％）,克罗恩病为10例（16．4％）,非特异性结肠炎为6例（9．8％）,淋巴组织增生性肠炎为1例（1．6％）,过敏性结肠炎为3例（4．9％）,息肉合并感染为4例（6．6％）。其他检查结果包括钡剂灌肠、全消化道X射线钡餐检查,胃镜、腹部超声检查、放射性核素美克尔憩室检查等,结果显示,胃炎为6例,十二指肠球炎为3例,小肠淋巴管扩张症为1例,小肠炎为4例,结肠炎为9例,右下腹占位病变为1例,肠息肉合并感染为4例,左肾上腺占位为2例。另外,进行剖腹探查的3例患儿中,2例确诊为肿瘤（1例为神经母细胞瘤,1例为节细胞神经瘤）,同时行肿瘤切除术;1例确诊为克罗恩病。本组61例患儿中,56例（91．8％）明确腹泻病因,5例（8．2％）未明。其伴随病构成情况依次为炎症性肠病、感染性肠炎（真菌感染、阿米巴感染）、非特异性肠炎、息肉合并感染、乳糖不耐受、抗生素相关性腹泻、过敏性腹泻、免疫缺陷病、肿瘤（神经母细胞瘤和节细胞神经瘤）、获得性免疫缺陷、小肠淋巴管扩张症、肠易激综合征、先天性乳糖酶缺乏。本组患儿21例治愈,39例好转,1例死亡（弥漫性腹膜炎伴感染性休克）。结论小儿慢性腹泻临床表现多样化、病因及发病机制复杂、治疗困难。对其应加强检查手段,及早明确病因,尽快治疗。     

胃十二指肠肿瘤出血

消化道出血最多见于胃、十二指肠溃疡，其次是肝硬变引起的胃底或食管曲张静脉破裂，两者约占80％，胃十二指肠肿瘤引起的大出血约占5％，主要见于胃癌，其次是恶性淋巴瘤、平滑肌瘤，表癌等。     

小儿上消化道出血55例病因分析

本文作者分析报道了小儿上消化道出血患者55例．经胃肠X线钡餐透视和纤维胃镜检查，结合临床表现综合分析，其病因十二指肠球部溃疡25例，占45．5％；胃溃疡9例(复合性溃疡2例)，占16．4%；浅表性胃炎5例，占9．0％；胃窦炎2例，占3．6%；病因未明14例，25．5%．并对55例上消化道出血患儿的病因作了分析，为临床治疗提供了依据．     

100例小儿上消化道出血病人的护理

通过本文100例小儿上消化道出血患者采用日本富士能EG-250PE电子胃镜检查。结果胃溃疡42例42％，浅表性胃炎合并十二指肠球炎31例31％，浅表性胃炎合并胆汁返流1例1％，十二指肠球部溃疡16例16％，食道炎4例4％，十二指肠多发性息肉2例2％，食道息肉2例2％，食道裂孔疝2例3％的护理报告。结论小儿上消化道出血的主要原因与小儿消化系统疾病密切相关。必要时行小儿电子胃镜检查可及早明确诊断治疗。这些患者尽管当时情况紧急，但护理得好，抢救治疗及时。疗效满意。     

小儿慢性咳嗽病因及其与肺炎支原体感染的关系

【目的】　探讨小儿慢性咳嗽的病因及其与肺炎支原体 (mycoplasmapneumoniae ,MP)感染的关系 ,为临床治疗提供依据。　【方法】　对 94例慢性咳嗽患儿进行病因分析 ,并测定肺炎支原体IgM抗体 (MP IgM )水平。 　【结果】　 94例慢性咳嗽患儿确诊为反复呼吸道感染 41例 (4 3 .6% ) ,咳嗽变异性哮喘 3 3例 (3 5 .1% ) ,慢性鼻窦炎 14例 (14 .9% ) ,其它 6例 (6.4% )。全部病例MP IgM抗体阳性 5 1例 ,占 5 4.3 %。MP感染组 5 0例 (98.0 % )胸片异常 ,而非MP感染组 2 9例 (70 .7% )胸片异常 ,两者差异有非常显著性 (χ2 =13 .968,P <0 .0 0 1)。　【结论】　反复呼吸道感染、咳嗽变异性哮喘和慢性鼻窦炎是小儿慢性咳嗽的主要病因 ,肺炎支原体感染与小儿慢性咳嗽关系密切 ,临床上应加以重视。     

基层儿童智力低下的病因初探

【目的】了解我国某农村地区儿童智力低下的病因,探索在基层开展智力低下(mental retardation,MR)病因诊断的可行性。【方法】对山西省吕梁地区2800个儿童进行智力筛查,MR确诊儿童进行体格检查、尿液筛查,问卷调查,部分患儿给予尿液色谱/质谱、染色体检查。【结果】共确诊237个MR患儿,男女比例为2.29∶1;其中MR病因明确者47例(19.8%),有重要诊断线索者81例(34.2%),病因不明者109例(46.0%);72名MR患儿同时伴有先天畸形,以耳发育畸形、小头畸形、多(少)指(趾)畸形为主,MR伴发畸形患儿倾向出现一些染色体病的面征:如丑陋面容、宽眼距等;33个有重要诊断线索MR患儿的染色体检查正常。【结论】在基层地区,结合病史、家族史、身体检查,可以对一部分MR患儿完成初步病因诊断,染色体检查仍是一些MR患儿的首选检查。     

氩离子凝固术在内镜治疗中的疗效观察

目的探讨氩离子凝固术（APC）在消化系统疾病内镜治疗中的应用及疗效。方法均采用内镜下APC术治疗620例患者。结果350例直径〈5mm消化道息肉病变全部消除；直径〉5mm息肉43例，38例治愈，5例黑斑息肉病患者缓解：94例非静脉曲张性消化道出血病人中，89例成功止血，止血成功率94．6％；122例疣状胃炎患者治疗后1月复查胃镜，116例病灶消失，治愈率95．08％。11例Barret食管患者，2例于治疗后1年在原来部位出现柱状上皮化生黏膜岛，1年根除率为82％。结论APC术可广泛用于消化道息肉、消化道非食管胃底静脉曲张性出血、Barret食管、疣状胃炎等疾病的内镜介入治疗，尤其对广基（直径〈5mm）扁平息肉、疣状胃炎疗效显著，且简便易行、安全、创伤及痛苦小，有较高的临床应用价值。     

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.