THE RISK OF OCCUPATIONAL LEAD EXPOSURE

We conducted a field survey on 53 workers in a battery factory, 52 solder workers, and 50 embroidery workers (control group). The average air lead levels at the workplaces of these three groups were 0.578 mg/nt, 0.0015 mg/m:3 and 0.006 mg,iml respectively. Clinical and biochemical studies re vealed that the workers in Shanghai Navigation Battery Factory were affected somewhat by the toxic effects of lead. The solder workers showed no signi- ficant abnormalities compared with the control group. A significant dose-response relationship ex isted between air lead levels and toxic effects. The early clinical manifestations observed were dysfunction of the central nervous system, dyspcpsia, joint pain, and myalgia in the extremities. A positive association was observed between the prevalences of fatigue, mild abdominal pain, and joint pain and the blood lead (PbB), urine lead (PbU), and zinc protoporphyrin (ZPP) levels. The symptomatic threshold values for PbB, PbU, and ZPP were 30 u.g/dl, 0.045 mg/'I, and 40 Ug/dl, respectively Although the PbB, PbU, 6-aminolevulinic acid dehydratase (ALAD), free erythrocyte protoporphyrin (FEP), and ZPP levels could be used as criteria of lead exposure, the measurement of ZPP is the first- choice screening test for a preventive monitoring program. The motor and sensory conduction velocities in the median nerve were slower in the exposure group than the control group (p<0.05). Conduction velocity and intensity of lead exposure were not significantly correlated. No apparent effects on behavioral func tion were observed among the solder workers.     

NP方案与XD方案治疗应用蒽环类药物治疗失败的乳腺癌的疗效观察

目的 观察诺维本联合顺铂(NP方案)与多西紫杉醇联合希罗达(XD方案)治疗应用蒽环类药物治疗失败的乳腺癌的疗效及不良反应.方法 将64例应用蒽环类药物治疗失败的乳腺癌患者随机分为两组,NP组34例,治疗方法:NVB25 mg/m2,静脉输注,第1、8天;DDP25 mg/m2,静脉输注,第2、3、4天.每21 d为1个治疗周期.XD组30例,治疗方法:DOC 75 mg/m2,静脉输注,第1天;XELODA 1275 mg/m2,口服,每日2次,第1～14天.两组均以21 d为1个治疗周期,每例至少完成2个周期.结果 NP方案总有效率(41.2%)与XD方案总有效率(50.0%)差异无统计学意义(P>0.05);两组不良反应均以粒细胞减少、恶心呕吐为主,经对症处理后可耐受.结论 NP方案与XD方案对治疗应用蒽环类药物治疗失败的乳腺癌患者均有较好疗效,可选择应用.     

OCCUPATIONAL CONTACT DERMATITIS IN MANUFACTURE OF VANILLIN

Of 105 employees investigated, 53 (50.5% ) cases of occupational contact dermatitis were observed. Most of the patients work at nitrition-condensation (NC) and packing sections. The clinical feature was the same as non occupational contact dermatitis. The results of the survey and patch tests on human show ed that the p-nitri-dimethylaniline hydrochloride (p-NDMAH), sodium nitrite (SN) and the mechanical irritation of vanillin dust were attributable factors for the dermatitis at the NC and the packing sections. Guinea pig tests showed that p-NDMAH and SN were the skin sensitizers. The former was also a skin irritant at >10 concentration. Vanillions was neither irritant nor sensitizer. Cross-sensitization exists between SN and p-NDMAH. It appears that nitroso group (-NO) plays a major role in inducing sensitization of p-NDMAH and SN.     

中晚期鼻咽癌放化疗与化放疗的疗效比较

目的 探讨中晚期鼻咽癌放疗后加定期化疗的远期疗效。方法 １８４例中晚期鼻咽癌病人中,９１例放疗后定期化（放化组）,９３例放疗前后化疗（化放组）,放疗：用＾６０Ｃｏ加深部Ｘ线照射鼻咽、颅底和颈部三个区域,鼻咽剂量７０～７６Ｇｙ,颈部根治量６５～７０Ｇｙ,残留病灶追加１０Ｇｙ。化疗：放化组放疗后用顺铂（ＤＤＰ）加５－氟脲嘧啶（５－Ｆｕ）方案（ＰＦ方案）化疗２～６疗程;化放组放疗前先用ＰＦ方案化疗１～２     

胃静脉曲张的介入治疗

目的：评价介入治疗在胃静脉曲张治疗中的应用价值。方法：采用经皮经门静脉闭塞术（ＰＴＯ）或球囊阻塞下静脉逆行闭塞术（ＢＲＴＯ）对９例胃静脉曲张破裂或可能破裂的患者进行治疗，其中ＰＴＯ４例、ＢＲＴＯ５例。结果：有效率１００％、止血率１００％、静脉曲张闭塞率５６％，无严重并发症。结论：ＰＴＯ及ＢＲＴＯ操作简单、有效率高，是治疗胃静脉曲张的首选方法。     

肝血管瘤的介入治疗

目的 :探索肝血管瘤的最佳栓塞治疗方案 ,分析比较不同栓塞方法的疗效 ;方法 :45例肝血管瘤患者被分为两组 ,A组 1 6例 ,用平阳霉素碘化油乳剂进行栓塞 ,B组2 9例 ,用平阳霉素碘化油乳剂加明胶海绵微粒进行栓塞 ,比较两组治疗效果 ;结果 :所有病人经栓塞治疗后 6个月开始行CT扫描检查 ,A组中瘤体缩小 5例 ,保持稳定 1 1例 ,B组中瘤体缩小 2 0例 ,保持稳定 9例 ,两组统计学检验差别有显著性 (P <0 .0 5) ;结论 :平阳霉素乳剂治疗肝血管瘤有效 ,而平阳霉素乳剂加明胶海绵微粒的混合性栓塞效果更好     

致极疗法刍议

致极疗法在外科疾病，特别是疑难及危急疾患的治疗中起着出奇制胜的作用。本疗法就是对一主证被他证干扰而不够显露，影响了对主证作逆反处理时，顺从了主证的偏性，并使其达到致极的程度，然后或同时反其道行之，以求阴平阳秘，力争病愈的一种疗法。其理论根据源于“重阴必阳，重阳必阴”及“微者逆之，甚者从之”之说。笔者对本疗法作了确切的阐述，并附有若干专家的治验。     

CURRENT STATUS OF DISULFIRAM THERAPY

The effectiveness of disulfiram is linked to the disulfiram-ethanol reaction in the treatment of Alcohol Dependence Syndrome. However disulfiram therapy is associated with various adverse effects and needs a structured and supervised after care program. Relapse rate is very high once disulfiram therapy is discontinued. Keeping these factors in mind disulfiram therapy is used less often today than previously.KEY WORDS: Alcohol Dependence Syndrome (ADS), Adverse drug reaction (ADR), Disulfiram (Antabuse), Disulfiram-ethanol reaction (DER)Disulfiram (antabuse) is used in alcohol rehabilitation because it inhibits aldehyde dehydrogenase and consequently causes the disulfiram-ethanol reaction (vomiting, vertigo, anxiety, cardiovascular effects) after ingestion of alcoholic beverges. However, adverse effects on the central nervous system (psychotic reaction, acute organic brain syndrome, catatonia) may appear as a direct result of the drug itself [1].Although it has been suggested that the effectiveness of disulfiram is only as a placebo, there is evidence for the effectiveness being linked to the disulfiram ethanol reaction (DER) due to the pharmacological action and the operant conditioning model. Hepatitis following use of disulfiram has been reported in many studies. There is a close temporal relationship between the occurrence of symptoms and disulfiram intake. Fulminating hepatitis is a rare but potentially fatal adverse reaction that may occur after the use of disulfiram. Disulfiram toxicity may present different clinical aspects: (1) Cytolytic hepatitis with fatal ovulation in 30% of cases (fulminant hepatitis). (2) Severe optic neuritis. (3) Peripheral neuropathy. (4) Encephalitis [2].Enghusen et al (1992) in their study of Adverse Drug Reaction (ADR) to disulfiram treatment have reported 1 per 2000 treatment year mainly of hepatic neurological, skin and psychiatric reaction in decreasing order of frequency and death 1 per 25000 treatment year [3]. Reports to the WHO collaborating center for Industrial Drug monitoring in Uppsala, Sweden, showed the same ADR profile, although with a higher rate of neurological and psychiatric and a lower rate of hepatic reaction. The latency time from the start of treatment to the manifestation of the ADR differed according to organ. Hepatitis occurred with a distinct peak after 2 months of treatment, skin reaction after 2 weeks and the rate of neurological ADR increased with duration of therapy. Obviously the use of disulfiram as therapeutic agent is not without danger, and it should be attempted only under careful medical supervision. Patient must be warned that as long as they are taking disulfiram, the ingestion of alcohol in any form will make them sick and may endanger their life. Patients must learn to avoid disguised forms of alcohol such as cough syrups, sauces, fermented vinegar and even after shave lotion and back rubs.Murthy KK (1997) in his study of 52 patients of Alcohol Dependence Syndrome on 250 mg disulfiram twice daily after food showed 6 patients developed psychotic symptoms with mood disorder [4]. Psychiatric complications appear to be more common with the use of disulfiram in India than in Western Countries [5].However, there are other studies that add weight to the evidence that disulfiram is not a drug with high incidence of adverse effects [6]. Larson FW et al (1992) reported that in treatment of alcohol dependence, disulfiram is most useful in conjuction with a structured, supervised, aftercare program [7]. The effectiveness of supervised disulfiram therapy was confirmed in a multicentric British study in which supervised disulfiram therapy was compared with vitamin ‘C’ in a sample of chronic alcoholics who had relapsed. The result clearly favoured the disulfiram group with significant reduction in several measures of drinking behaviour including the level of GGT in the disulfiram group compared to no reduction in these measures in the vitamin ‘C’ group. A review of controlled clinical trials with disulfiram concluded that there is unopposed evidence for its effectiveness [8].Comments:

• 1.Pharmacological benefits of disulfiram in the treatment of alcoholism have yet to be clearly demonstrated [9].
• 2.Disulfiram is used in the treatment of alcohol dependence. Its main effect is to produce an unpleasant and potentially dangerous reaction in a person who ingests even a small amount of alcohol while taking disulfiram. However, because of the risk of severe and even fatal disulfiram - alcohol reaction, disulfiram therapy is used less often today than previously. Many clinicians have stopped routinely prescribing the agent, partly in recognition of the dangers associated with the drug itself: mood swings, rare instances of psychosis, the possibility of an increase in peripheral neuropathies and a potentially fatal hepatitis [10].
• (3)Disulfiram can be viewed as a drug with a moderate record of adverse effects. Alcohol dependence, for which it can be helpful treatment, is associated with a high morbidity and mortality [5].
• (4)Relapse rate is very high, Helander A (1998) reported 80% of his patients returned to drinking very soon on discontinuation of disulfiram therapy [11].
• (5)Disulfiram is an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage.
• 6.Disulfiram is not a cure for alcoholism. When used alone without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect in the drinking pattern of the chronic alcoholic.

     

慢性外阴营养不良综合治疗观察

应用中西药膏剂对外阴病灶部位涂擦、中药煎剂清洗外阴、免疫制剂病灶部位多点注射的方法对４２例慢性外阴营养不良患者进行综合治疗与观察。经统计学处理，结果表明：病变面积越小、病程越短、年龄越小者，其疗效越佳。有效率达８０．９５％，明显高于对照组。此方法在目前众多治疗慢性外阴营养不良的方法中，不失为一种值得推广的好方法。     

邮政分拣作业对工人健康影响的调查研究

本文对６９名女性信件分拣作业工人的慢性肌肉骨胳损伤和心理生理功能进行了调查，并测量了作业场所人机学参数。结果表明：分拣作业者，肩、腰、背和手腕部不适感阳性率较高，作业者身体尺寸参数与工作架及坐椅尺寸参数不匹配。作业后作业者临界闪烁融合频率和视度值较作业前显著降低（Ｐ＜０．０５或０．０１），而简单反应时作业后显著长于作业前（Ｐ＜０．０５）。结果提示邮政分拣作业是一种视需性、单调性和重复性运动作业，作业过程中存在着姿势紧张问题，邮政分拣作业对作业者的身心健康存在着不良影响。     

视觉电生理检查在职业眼病鉴定中的意义

目的:探讨视觉电生理检查在职业眼病鉴定中的意义.方法:对两年中进行职业眼病鉴定的150例(均为双眼)进行分析.视觉电生理检查主要是进行视网膜电图和视觉诱发电位的检查.结果:主观视力以及临床体征与视觉电生理检查结果相一致的有42例(占28%),不一致者为106例(占71%),有两例无法判定(占1%).结论:视觉电生理检查在职业眼病的鉴定中有重要的意义.     

护理专业学生实习前艾滋病KAP和职业防护教育效果分析

目的 对护理专业学生赴医院临床实习前进行职业防护教育,根据教育前后的职业防护知识尤其是艾滋病KAP调查结果,及时调整教育内容和教育方法,必要时对护理专业学生进行强化培训,为有效开展职业防护教育课程提供理论依据.方法 将艾滋病相关知识纳入职业防护教育计划,用问卷法对203名学生在职业防护技能强化培训前后分别进行艾滋病KAP问卷调查.结果 教育后护理专业学生对艾滋病相关知识知晓率有明显提升(P＜0.05),如在教育前对传播途径的知晓率达到88.18％,教育干预后达到95.07％;对感染艾滋病的非危险因素的知识知晓率较低,如通过泳池传播教育前为52.22％,教育后为92.61％;对AIDS患者的态度不容乐观,如和AIDS病人正常交往,教育前,45.32％,教育后为88.67％;对将来从事其护理工作有恐惧,健康教育前从事该病护理的意愿分别为49.75％,健康教育后为99.51％.结论 经过系统的职业防护知识教育后,学生能基本掌握艾滋病相关知识,对ADIS患者的态度改善,对以后从事该类病人的护理工作意愿也逐步增强.但护理专业学生对艾滋病病人的恐惧甚至歧视的态度依旧不容乐观,仍有约12％的人不愿与AIDS患者正常交往,应将艾滋病知识教育作为护理专业学生实习前职业防护技能培训的必修内容.