疤痕子宫再次分娩146例临床分析

我院1988年1月～1992年12月分娩总数4232人，其中疤痕子宫再次分娩者146例，阴道试产成功52例，现分析报告如下。临床资料本组146例，前次剖宫产术后跟本次分娩时间＜2年者2例，占1．36％；2～4年者56例，占38．36％；＞4年者88例，占6027％。再次剖宫产分娩94例，占64．38％，     

重型颅脑损伤285例治疗研究

目的 总结和分析重型颅脑损伤的救治经验。方法 统计本院6年重型颅脑损伤的病人总数、发病率及病因并分析其治疗效果。结果 1995年至2001年共收治重型颅脑损伤病人285例，GCS 3－5分76例，死37例，占48．7％；GCS6－8分209例，死亡44例，占21．1％。结论 早期诊断、早期治疗是提高重型颅脑损伤救治成功率的关键。积极防治脑水肿、颅高压及严重并发症可以减少病死率、致残率。     

原发性脑出血患者医院感染23例临床分析

目的 对我院1997年1月至2000年12月的3年间住院治疗的原发性脑出血患者108例进行医院感染回顾性分析。结果 并发医院感染23例，医院感染发生率为21．30％，其中以下呼吸道感染最多见。占39．13％；第二位为泌尿道，占26．08％；感染性腹泻和口腔感染各占17．39％；皮肤和软组织感染占13．04％；手术切口感染占0．09％；败血症占0．09％，其中5例为混合感染。结论 原发性脑出血患者医院感染发生率高，医院应高度重视医院感染规范管理，尽可能把脑出血并发医院感染控制到最低限度，以提高原发性脑出血病人治愈率。     

儿童感染性眼病的细菌培养分析

目的 了解儿童感染性眼病的病原及耐药性特征。方法 取500例儿童眼分泌物标本进行细菌学培养、鉴定和耐药分析。结果 阳性标本347例,阳性率69．4％,其中革兰阳性菌245例占70．6％,革兰阴性菌87例占25．0％,真菌15例占4．4％。所有菌株对红霉素耐药性最高达80．8％,对喹诺酮类抗生素敏感性最高为92．0％～94_8％。结论 对于儿童感染性眼病应首先在滴药前做早期细菌培养和耐药分析,选用合适抗生素以防止耐药菌株的增加。     

34例胃平滑肌肿瘤的临床诊断与治疗

目的探讨胃平滑肌肿瘤临床误诊的原因及早期治疗原则。方法收集医院1988—2006年34例胃平滑肌肿瘤患者的临床资料，进行回顾性分析。结果34例患者中，术前诊断明确者7例（占21％），误诊27例（占79％）；33例行局部或胃大部切除术，仅1例行根治术并淋巴结清扫术，但5年随访无一例因肿瘤复发而死亡，5年生存率为68．4％。结论及时、准确地诊断胃平滑肌肿瘤，并采取正确的治疗方法能提高疗效、降低死亡率。     

新生儿病理性黄疸342例临床研究

目的：了解新生和病理性黄疸的病因及特点。方法：对该院于1997年9月－1999年5月间收治的342例新生儿病理性黄疸进行分析。结果：葡萄糖醛酸转移酶（G－6PD）缺陶症占36．84％，ABO溶血病占19．88％，感染性黄疸占12．57％头颌面肿4．39％，地中海贫血占3．80G－6PD缺陷合并其他疾病（复合性黄疸）16．67％不明原因5．85％。各组黄疸依生后出现的天数平均为ABO溶血病2．37天，头颌面肿2．93天，复合性黄疸2．95天，G－6PD缺陷症3．21天，不明原因3－4天，地贫4．08天，感染性黄疸4．40天。血清胆红素值在各组间无明显差异。结论：深圳地区由于某些遗传性溶血病的发病率较高，使该病的病因比例构成与北方地区有差别。     

四环素鞘膜内注射治疗鞘膜积液163例报告

我院于1988年以来，在门诊应用四环素溶液鞘膜囊内注射治疗非交通性睾丸（精索）鞘膜积液163例，取得较好的效果，报告如下。1．一般资料：本组共163例，年龄最小3岁，最大63岁。为了比较疗效，我们分为20岁以下，20～40岁，40岁以上3个年龄段总结，20岁以下IOg例占66．7％，20～40岁30例占18．4％，20岁以上24例占147％；病程最短的3年，最长的1例达44年；抽液量8～525ml。2．方法：2．l药液浓度：为Ic％四环系溶液，随配随用，1988～199o年用生理盐水溶解，注射后病人均诉疼痛较剧，需止痛处理，199o年下半年后改用2％利多卡因溶解，解…     

感染性心内膜炎20例诊治体会

目的探讨感染性心内膜炎的临床特点及诊治体会,以期提高感染性心内膜炎的诊治水平。方法对本院收治的20例感染性心内膜炎患者进行回顾性分析。结果20例患者中,血培养阳性率为60．0％,经超声心动图检查发现赘生物者占85．0％。14例患者经治疗后病情好转。结论基础心脏病史感染性心内膜炎的常见病因．医疗诊断技术的广泛应用增加了感染性心内膜炎发生的概率;血培养和超声心动图检查可提高感染性心内膜炎的确诊率;采用抗生素或者尽早手术治疗可提高治愈率。     

内镜下消化道息肉诊断与摘除的体会

1988年5月～1993年10月，作消化道内镜检查6798例，共发现息肉267例，其中226例作息肉摘除术，效果良好。报告如下。临床资料本组226例中，男133例，女93例，男女之比1．43：1。年龄12～80岁，40岁以上占572％。上消化道息肉67例，摘除息肉72颗。大肠息肉159例，摘除息肉335颗。息肉直径＜0．5cm占251％，0．5～1．0cm占50．1％，1．1～2.0cm占174％，2．1～3．0cm占5．2％，＞3·ocm占3．2％。382颗息肉送病理检查，腺瘤性息肉占37．2％，增生性息肉占25．O％，炎性息肉占285％，幼年性息肉占8．4％，血吸虫虫卵性息肉占2．9％。142颗腺癌…     

256例围产儿尸检死因分析

为降低围产儿死亡率，研究围产地的死因，作者对1985年1月～1994年12月间我院孕满28周至出生7天的256例死亡围产儿尸检分析，报告如下。临床资料围产期死亡尸检256例，其中新生儿死亡98例（38．28％），死产34例（1．28％），死服124例（48．44％）。男138例，女118例，男：女一1．17：1。98例新生儿中，早产儿和足月儿各49例，生后1小时内死亡31例（31．63％），生后1～24小时内死亡43例（43．88％）。死因：256例中，缺氧IOS例（占42．19％），非感染性肺疾患98例（占38．28％），致死性畸形25例（占9．77％），颅内出血13例（占5OS％）…     

托拉塞米治疗急性脑出血后脑水肿疗效分析

目的观察托拉塞米治疗急性脑出血后脑水肿的疗效。方法将50例急性脑出血后脑水肿患者完全随机分为观察组和对照组,各25例。在改善脑代谢、控制血压、控制血糖等对症支持治疗基础上,观察组给予托拉塞米20mg和20％甘露醇125ml,2种药物每6小时交替静脉用药;对照组给予呋塞米20mg和20％甘露醇125ml,用法同观察组。然后逐渐延长用药间隔时间。入院后第1—7天通过颅内压监护仪观察颅内压的变化;治疗14d后,观察2组患者神经功能缺损改善情况及监测电解质的变化。结果观察组治疗14d后,神经功能缺损基本痊愈8例（32．0％）,显著进步14例（56．O％）,进步3例（12．0％）;对照组基本痊愈5例（20．0％）,显著进步11例（44．0％）,进步8例（32．0％）,恶化1例（4．0％）;观察组神经功能缺损改善明显优于对照组,差异有统计学意义（P〈0．05）。观察组治疗第1—7天颅内压明显低于对照组,电解质紊乱发生率明显低于对照组[12．O％（3／25）比40．0％（10／25）],差异均有统计学意义（P〈0．05或P〈0．01）。治疗后观察组总有效率明显高于对照组[92．0％（23／25）比72．0％（18／25）],差异有统计学意义（P〈0．05）。结论托拉塞米治疗急性脑出血后脑水肿效果好,且电解质紊乱等并发症发生相对较少。     

吡拉西坦对高血压脑出血术后患者的影响

目的:探讨吡拉西坦对高血压脑出血术后患者的影响。方法:选取2010年1月—2011年12月中国医科大学附属第四医院收治的高血压脑出血患者共160例,以随机抽样法分为实验组和对照组,其中实验组采用20%吡拉西坦氯化钠注射液治疗,对照组采用20%甘露醇注射液治疗。结果:实验组中度脑水肿发生率明显较高(P<0.05),而对照组重度脑水肿发生率明显较高(P<0.05);实验组患者的意识清醒情况明显多于对照组(77.50%vs.62.50%,P<0.05);治疗3个月后实验组巴氏指数(BI)、简明精神状态检查量表(MMSE)评分均明显高于对照组(P<0.05);2组不良反应发生率差异具有统计学意义(P<0.05)。结论:吡拉西坦注射液可代替甘露醇用于高血压脑出血术后降低颅内压,且其具有对脑的保护及促醒作用,不良反应少,在临床上值得推广应用。     

乌司他丁对大鼠创伤性脑水肿后 NF-κB 及 IL-1β 表达的影响

目的通过观察大鼠创伤性脑水肿后脑组织中核转录子-κB （NF—κB）及白介素-1β（IL-1β）的变化,探讨乌司他丁（UTI）在大鼠创伤性脑水肿过程中对脑组织的保护作用及其机制。方法将30只健康成年SD大鼠随机分为正常对照组、创伤性脑水肿组及UTI干预组,每组10只。并于伤后8、24、72采用免疫组化法及血清ELISA法检测脑组织NF—κB和IL-1β的水平。结果创伤性脑水肿组和UTI组脑水肿部位NF—κB的活性和IL-1β的水平均较对照组明显升高（P〈0．01）,且于24h达到最高值,于72h时有所下降;UTI组各时间点与创伤性脑水肿组比较差异均有统计学意义（P〈0．01）。结论乌司他丁对大鼠创伤性脑水肿引起的脑损伤具有明显的脑保护作用,通过抑制NF-κB和IL-1β信号传导通路是乌司他丁脑保护作用的重要机制之一。     

Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1988). III. Secular changes in susceptibility]

Sensitivities to various antibacterial and antibiotic agents of strains of Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Serratia marcescens and Pseudomonas aeruginosa isolated from patients with urinary tract infections (UTIs) in 9 hospitals during June to November 1988 were compared with those in the same period of previous year according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in sensitivities of E. coli, Proteus spp., Citrobacter spp. and S. marcescens. The sensitivity of Klebsiella spp. to cephems decreased in complicated UTI without indwelling catheter and increased in complicated UTI with indwelling catheter. The sensitivity of Enterobacter spp. to third generation cephems decreased in complicated UTI with indwelling catheter. Sensitivities of P. aeruginosa to aspoxicillin and cefsulodin increased. The number of resistant strains to new quinolones increased slightly.     

长方体定位血肿排空法联合尿激酶与地塞米松救治65例高血压丘脑出血效果观察

目的探讨长方体定位血肿排空法联合尿激酶与地塞米松救治高血压丘脑出血的临床疗效及意义。方法回顾性总结采用长方体定位置软管血肿排空法联合尿激酶与地塞米松救治65例高血压丘脑出血,通过复查颅脑CT观察血肿的体积以及血肿周围脑水肿的变化,结合临床神经功能分级予以分析。结果本组24小时内血肿清除超过95％的19例（29．2％）,48小时内血肿清除超过95％的42例（64．6％）术后1月GOS4．5分48例（73．8％）,死亡1例（0．15％）。结论长方体定位血肿排空法联合尿激酶与地塞米松救治高血压丘脑出血定位准确、安全快捷、操作方便;同时能缩短血肿清除时间,减少出血后脑水肿反应。     

The changing pattern of Crohn's disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007)

Aliment Pharmacol Ther 2011; 33: 1133–1142

Summary

Background Crohn’s disease incidence rates have stabilised in industrialised countries since the 1980s. Conversely, a continuing increase in childhood‐onset Crohn’s disease incidence has been reported. Aim To confirm trends in inflammatory bowel disease (IBD) incidence in northern France over an extended time period (1988–2007) with a focus on childhood‐onset Crohn’s disease. Methods The IBD patients recorded in the EPIMAD registry between 1988 and 2007 were included. Standardised incidence rates were calculated for Crohn’s disease and ulcerative colitis in the entire population, and separately according to age. Evolution of phenotypes at diagnosis was also studied. Results A total of 12 084 incident IBD cases (7428 Crohn’s disease and 4656 ulcerative colitis) were recorded. Crohn’s disease incidence rates increased from 5.2 cases/100 000 persons in 1988–1990 to 6.7 in 2006–2007 (+29%), stabilising after a peak at 7.1 in 1997–1999. Crohn’s disease incidence rates in the 10–19‐year age category increased by 71%, from 6.5 (1988–1990) to 11.1 (2006–2007). The frequency of initial ileo‐colonic localisation increased from 52.9% in 1988–1990 to 68.6% in 2006–2007 (P < 0.0001). Ulcerative colitis incidence rates decreased during the same period. Conclusions From 1988 to 2007, Crohn’s disease incidence increased by 29% in northern France and by 71% in the 10–19‐year‐old age group. Consequently, studies on Crohn’s disease risk factors should focus on the population under 20 years of age.     

Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2002). III. Secular changes in susceptibility

The bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa) isolated from patients diagnosed as urinary tract infections (UTIs) in 13 institutions in Japan were supplied between August 2002 and July 2003. The susceptibilities of these bacteria to various antimicrobial agents were examined. The bacteria were divided into 2 groups consisting of uncomplicated UTIs and complicated UTIs (with and without indwelling catheter) based on their isolation origins. The results were compared with those obtained between 1993 and 2001. The drug sensitivity of S. aureus in this year was similar to those in up to the previous year and S. aureus showed the best susceptibility to vancomycin. The drug sensitivity of E. faecalis in this year also was similar to those in up to the previous year. The drug sensitivity of E. coli in this year was generally good except penicillins and was similar to those in up to the previous year. Among cephems, cefozopran (CZOP) and cefpirome (CPR) showed the highest potency (MIC90: < or = 0.125 microg/mL). An antibacterial activity of cefotiam (CTM) was similar to it in 10 years ago and was fine (MIC90: < or = 1 microg/mL). The sensitivity of E. coli to carbapenems and carumonam (CRMN) also was good like to CZOP. However, the sensitivity of the complicated UTIs group to quinolones decreased after 2000 and was suggested to develop the resistance to the drug. The drug sensitivity of Klebsiella spp. in this year also was similar to those in up to the previous year. The bacteria showed good susceptibility (MIC: < or = 0.125 microg/mL) to cefmenoxime (CMX), CPR, cefixime (CFIX), flomoxef (FMOX), and CZOP among cephems. The drug sensitivity of P. aeruginosa was generally low. Most of the bacteria were little sensitive to cephems except CZOP and ceftazidime (CAZ). The sensitive bacteria to CZOP and ceftazidime (CAZ) were observed to be 26.8% (15/56 strains) and 39.3% (22/56 strains) in complicated UTIs group, respectively. The sensitivity profile of P. aeruginosa to the other tested drugs was not much different from that in up to the previous year. However, the sensitivity of the bacteria to carbapenems tended to decrease after 2000, and the low sensitive strains (MIC: > or = 256 microg/mL) were detected at 22.2% (2/9 strains) in the uncomplicated UTIs group and 3.6% (2/56 strains) in the complicated UTIs group.     

National Poisons Information Centre in a developing Asian country--the first year's experience

The National Poisons Information Centre (NPIC) in Sri Lanka was established in January 1988. It received 353 enquiries in the first year of which 37% concerned pesticide poisoning. More than half the instances were of self-poisoning; consistent with the high suicide rate in the island. Over a quarter of poisoning episodes were among 19-25 year olds. Follow-up of enquiries showed 31 (9%) deaths. Collaboration with developed countries helped in the formation of the NPIC, fulfilling a long felt need among doctors in the island.     

慢性酒精中毒伴发癫痫发作临床分析

目的··:探讨慢性酒精中毒伴发癫痫发作的临床特点及转归。方法··:对1988年1月 -1999年12月间住院病人中 ,17例慢性酒精中毒伴发癫痫患者的饮酒情况、临床表现和脑电图等实验室检查资料进行回顾性分析。结果·· :17例患者的平均饮酒史22.3a±s7.51a;平均饮酒量345.52g·d-1±s109.63g·d-1;酒精中毒的精神症状以幻觉 (7例 )和妄想症 (4例 )为主 ;癫痫发作多出现在戒酒后48 -96h之间 (7例 ,占41.8 % )和饮酒量加大时 (5例 ,占29.4 % ) ,饮酒量无变化时的比例也很高 (4例 ,占23.5 % ) ;癫痫发作表现为全身强直 -痉挛发作 (16例,94.1 % ) ;脑电图异常者8例(8/14) ,脑萎缩6例 ;经治疗 ,13例 (76.5 % )痊愈;3(17.7%)明显好转 ;1例 (5.9 % )好转。结论·· :慢性酒精中毒可伴发癫痫,其发生与饮酒史、饮酒量、突然停酒及酒精对大脑的损伤有关 ;癫痫症状严重 ,近期治疗效果好。     

The Changing Pattern of Imported Malaria in the Academic Medical Centre, Amsterdam

Background: Since 1988, the incidence of malaria imported into the Netherlands has been stable, but the population groups have remarkably changed.
Methods :The records of all patients with malaria in the Academic Medical Centre, Amsterdam, between October 1991 and December 1994 were analyzed.
Results: Of the 286 patients, 149 (52%) were Dutch citizens and 114 (40%) were originally from malaria endemic areas (92 immigrants, 22 asylum-seekers), whereas between 1979 and 1988 these figures were 85 and 15%.The remaining 23 (8%) patients were 11 children born in the Netherlands to immigrants, 10 foreigners from nonmalarious areas, and 2 for whom the origin is unknown. Plasmodium falciparum was found in 197 (69%) patients, mostly acquired in subSaharan Africa; P. vivax(61 patients, 21%) was mainly acquired in Asia. Two vivax infections proved to be chloroquine-resistant. The compliance with the malaria chemoprophylaxis was poor: only 38% (30/80) of the Dutch citizens and 8% (4/52) of the settled immigrants and children were fully compliant. Severe complicated falciparum malaria developed in 18 (10%) patients, two of whom died. The majority of the falciparum cases were treated with halofantrine or sulfadoxine-pyrimethamine. Artemisinin was used in two.
Conclusions: Among the patients with imported malaria, settled immigrants and their (nonimmune) children constitute a growing number. Compliance with chemoprophylaxis is decreasing in Dutch travelers and remains poor in the immigrants. Quinine was increasingly used both as initial treatment for severe falciparum malaria as well as in patients with nonsevere malaria who were nauseated or vomiting.