微波扁桃体凝固手术分析

目的 探索微波在扁桃体疾病中的治疗作用.方法 采用CYⅢ电脑微波对120例扁桃体肥大、慢性扁桃体炎进行微波凝固术,然后就术后情况进行分析.结果 术中出血病例仅占12.50%,术后仅8.33%的患者出现疼痛,术后24小时内白膜全部形成,所有患者2周内白膜脱落.结论 微波扁桃体凝固术疗效可靠,值得推广.     

干扰素栓联合微波治疗宫颈糜烂的临床观察

目的观察干扰素栓(奥平栓)联合微波治疗宫颈糜烂的临床效果。方法对160例诊断为中重度宫颈糜烂(均经细胞学检查排除宫颈上皮内瘤变及早期宫颈癌)的病人随机分成两组,研究组80例,在微波治疗后应用干扰素栓塞入阴道深处,对照组80例,微波治疗后未用任何药物。观察两组病人物理治疗后宫颈糜烂面愈合情况、术后阴道排液持续时间、术后创面出血发生率及不良反应。结果两组病人宫颈糜烂面愈合情况术后两个月比较,研究组痊愈70人(87·50%),总有效率98·75%,对照组痊愈58人(72·50%),总有效率91·25%,差异均有显著性(p<0·05);术后叁个月比较,研究组痊愈77人(96·25%),总有效率100%,对照组痊愈68人(85·00%),总有效率95·00%,差异均有显著性(p<0·05)。两组病人术后阴道排液持续时间比较,研究组比对照组短,差异有显著性(p<0·05)。两组病人术后创面出血发生率比较,研究组比对照组低,差异有极显著性(p<0·01),研究组少部分病人用药期间觉轻微不适。结论干扰素栓在微波治疗宫颈糜烂术后作为促进创面愈合药物,对促进术后糜烂面的愈合,缩短阴道排液时间及降低术后创面出血发生率,作用效果显著,值得在临床上推广使用。     

鼻窦内窥镜下微波治疗妊娠期鼻出血

目的:探讨鼻窦内窥镜下微波凝固术在妊娠期鼻出血的应用价值。方法:回顾性分析76例妊娠期鼻出血患者经鼻窦内窥镜下微波凝固术治疗的临床资料。结果:76例患者一次性治愈73例,治愈率达96%。结论:鼻窦内窥镜下微波凝固术具有视野清晰,止血准确,对正常组织损伤小,操作方便,术后不需填塞鼻腔,可减少并发症,值得推广使用。     

特居乐用于不孕患者宫腔镜刮宫术后的临床效果观察

目的:了解宫腔镜下刮匙刮除术治疗不孕患者子宫内膜异常后应用炔雌醇左炔诺孕酮片(商品名:特居乐)的临床效果。方法:对有指征的不孕不育患者行宫腔镜检查,子宫内膜异常患者86例,均行宫腔镜下刮匙定点刮除术,研究组50例术后当日即开始模拟自然周期口服炔雌醇左炔诺孕酮片,同时注射广谱抗生素预防感染,对照组36例仅注射与研究组相同的广谱抗生素治疗。比较两组患者术后出血天数、排卵期子宫内膜厚度及形态、卵泡发育及排卵情况、术后月经来潮时间、月经量、随访6个月内妊娠例数。结果:研究组术后出血天数与对照组比较显著减少(P<0·05),随访6个月内妊娠例数显著增加(P<0·05),研究组术后82%月经来潮时间无明显提前或延迟,58%月经量无明显增多或减少;对照组38·89%月经来潮时间明显延迟、月经量明显减少,两组差异显著(P<0·01,P<0·05)。研究组术后排卵期子宫内膜厚度72%为0·6~1·4cm,并有三线征;对照组41·67%子宫内膜厚度偏薄,30·56%子宫内膜厚度偏厚,未恢复典型"三线征",两组差异显著(P<0·01,P<0·05)。研究组术后66%卵泡发育达1·8~2·5cm并正常排卵,8%LUFS形成,对照组分别为72·22%和2·78%,但两组比较差异无显著性(P>0·05)。结论:宫腔镜下刮匙定点刮除术治疗子宫内膜息肉、内膜增殖、单纯性增生及宫腔粘连、子宫内膜炎后,及时短期应用炔雌醇左炔诺孕酮片,有助于减少患者术后出血,维持正常内膜厚度和状态,不影响卵泡发育及排卵,有助于调节月经周期,提高妊娠率。     

腹腔镜在诊治输卵管梗阻性不孕症中的应用

目的探讨腹腔镜在输卵管梗阻性不孕症诊治的临床应用价值。方法对84例输卵管性不孕患者在腹腔镜下行美兰通液,直视判断输卵管通畅程度,根据输卵管通畅程度决定手术治疗方案,判断术后输卵管通畅效果,术后所有患者随访。结果盆腔无粘连者21例(25·0%),盆腔轻度粘连者18例(21·4%),盆腔中度粘连者19例(22·6%),盆腔重度粘连者26例(31·0%),术前通畅率分别为95·2%、72·2%、42·1%、11·5%,术后通畅率分别为95·2%、88·9%、94·7%、42·3%,分别为57·1%,66·7%,36·8%,3·8%。结论应用腹腔镜技术能早期、直观、准确地明确输卵管性不孕症并予以针对性治疗,可减少误诊率,提高术后妊娠率,值得临床应用和推广。     

纤维喉镜下微波治疗舌扁桃体肥大112例的疗效观察

目的观察纤维喉镜下微波治疗舌扁桃体肥大的效果。方法选择经保守治疗无效的咽部异物感患者112例，在纤维喉镜下行微波治疗舌扁桃体肥大术，选择4～6个治疗点，术后2周复诊。结果65例患者1次治愈，42例2次治疗后13例治愈，20例明显好转，9例稍有好转，5例无效，有效率95．5％。结论纤维喉镜下微波治疗舌扁桃体肥大，效果佳。     

宫腔镜、腹腔镜联合手术诊治输卵管性不孕症临床分析

目的:探讨宫腔镜、腹腔镜联合手术诊治输卵管性不孕的手术方式及应用价值。方法:对2000年3月~2006年7月住我院的100例因输卵管原因引起的不孕症患者采用宫腔镜、腹腔镜联合手术进行检查、诊断,并视术中的不同情况进行不同的手术方式治疗,术后6个月进行随访。结果:本组100例病人200根输卵管,发现病变149根,手术复通95根,复通率63·76%。壶腹部、伞部阻塞术后复通率(87·64%)明显高于间质部和峡部阻塞的术后复通率(22·22%、30·95%),差异有非常显著意义(P<0·0001)。术后≥6个月随访到的43例患者,有16例妊娠,妊娠率为37·20%。结论:宫腔镜、腹腔镜联合手术能同时对输卵管病变者进行诊断与治疗,创伤小、恢复快,手术成功率高,术后妊娠率较满意,是输卵管性不孕病人的首选治疗方法。     

腹腔镜与开腹保守手术治疗异位妊娠对比分析

目的:探讨腹腔镜保守性手术对有生育要求的异位妊娠患者的疗效及再次妊娠的影响。方法:回顾分析264例行保守性手术治疗的有生育要求的异位妊娠患者,其中通过腹腔镜手术136例,开腹手术128例。比较两组手术时间、术后输卵管通畅率、再次妊娠率。结果:腹腔镜组平均手术时间(45·47±17·24)min,开腹组平均手术时间(67·70±15·36)min(P<0·05)。腹腔镜组术后保留输卵管通畅率94·1%,受孕率71·3%,开腹组术后保留输卵管通畅率80·5%,受孕率66·4%(P>0·05)。腹腔镜组与开腹手术组比较手术时间短、恢复快,术后输卵管通畅率与再次妊娠率无显著差异。结论:腹腔镜手术更适用于年轻、有生育要求患者。     

宫腔镜与腹腔镜联合手术诊治不孕症142例临床研究

目的:探讨宫腔镜与腹腔镜联合手术在诊断、治疗不孕症的价值。方法:对2000年3月～2006年5月我院的142例不孕症患者住院进行宫腔镜与腹腔镜联合检查、诊断,并视术中的不同情况而选择不同的手术方式进行相应的治疗。结果:142例中发现输卵管病变95例、盆腔粘连61例、子宫内膜异位症34例、多囊卵巢24例、子宫肌瘤5例、卵巢肿瘤6例。共实施了332项操作:双侧输卵管插管通液术142例,输卵管成形术及造口术85例,子宫内膜异位症减灭术33例,多囊卵巢打孔术24例。统计比较原发性不孕者卵巢囊肿发生率(9·30%)高于继发不孕者(2·02%),差异有显著性意义(P<0·05);壶腹部、伞部阻塞术后再通率(84·71%)明显高于间质部和峡部阻塞者(7·14%、15·00%),差异有非常显著意义(P<0·0001)。术后随访到的65例患者妊娠率为27·69%,没有输卵管阻塞者的妊娠率(45·0%)明显高于输卵管阻塞者(20·0%),差异有显著意义。结论:宫腔镜与腹腔镜联合手术能集二者之长处,同时进行宫腔、盆腔疾病的诊断与治疗,创伤小、恢复快、手术成功率高,尤其适用于输卵管远端阻塞和盆腔粘连者,是不孕症重要的检查及治疗手段。     

扁桃体手术后严重出血19例临床分析

目的分析患者行扁桃体切除术后引起出血的原因及具体出血止血方式。方法选取我院1996年2月至2012年3月间19例施行扁桃体切除术后出现出血的案例资料。结果我院1996年2月至2012年3月间共对499例患者行了扁桃体切除手术,术后出现出血的患者有19例,出血率为3.81%。19位术后出血患者中,原发性出血18例,继发性出血1例,且均为单侧出血。9例采用局部压迫止血法,8例选择了微波局部止血法,而剩余2例则采用了缝扎止血。患者术后出血后,止血全部成功,恢复较好。结论引起扁桃体切除术后出血的原因是多方面的,既与患者本身因素有关,而且与手术过程中的技术因素、术后护理等均密切相关。若扁桃体切除术后出血,可对出血量、出血部位等情况综合分析,选择合适的止血方式。     

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.     

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.     

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.     

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.