肺隔离症的外科诊治临床分析

目的 总结肺隔离症的临床特点、诊断及外科治疗经验.方法 回顾性分析2000年7月至2009年1月经手术治疗15例肺隔离症患者的临床资料.结果 肺隔离症的术前诊断率为93.33%(14/15);术前均行胸部CT平扫+增强,其中9例加行血管三维成像.12例叶内型隔离肺行肺叶切除术,3例叶外型隔离肺行局部切除术.术中发现异常供血动脉14例来源于胸主动脉,1例来源于腹腔干.全部患者手术顺利,无围手术期死亡.结论 肺隔离症的误诊率较高,胸部增强CT薄层扫描+血管三维成像有利于肺隔离症的诊断.手术是治疗肺隔离症安全、有效的方法.     

肺隔离症的诊断及外科治疗17例临床分析

目的对肺隔离症的分类、诊断、临床特点及外科治疗进行临床分析总结。方法回顾性临床分析经手术和病理证实为肺隔离症的17例临床资料。自2000年1月~2012年7月共发现肺隔离症17例。术前诊断为肺隔离症11例,支气管扩张2例,肺囊肿综合征2例,支气管肺癌1例,纵隔肿瘤1例。11例术前螺旋增强CT和CTA发现异常供血动脉而确诊。结果均行手术切除,术后病理确诊。恢复顺利,无手术死亡,随访14例,均生活良好,未见复发。结论本病常于青年时发病,临床表现无特异性。胸部增强CT是临床上最主要的术前检查方法。手术治疗肺隔离症效果满意,胸腔镜手术在肺隔离症的诊断与治疗方面具有优越性。     

儿童肺隔离症的X线和CT诊断

目的探讨儿童肺隔离症的X线和CT影像学特征。方法搜集经手术与病理证实的儿童肺隔离症10例,所有病例都摄有胸部正侧位片,4例行平扫及增强扫描。结果X线表现为肺内肿块6例,囊性病变4例;CT检查4例均表现为肺内肿块影,且现异常动脉供血。结论胸部平片是诊断肺隔离症的方法,可提供本病的重要线索。CT增强扫描由于能够显示异常供血动脉和评价肺实质改变,是肺隔离症的最佳影像学检查手段。     

肺隔离症的流行病学调查及临床诊断治疗分析

目的探讨肺隔离症的流行病学、病因、诊断和治疗方法。方法查阅1998年1月-2007年12月本院心胸外科18例手术明确诊断的肺隔离症患者的住院病历,对患者的性别、年龄、临床特点等进行归类并分析。结果1998年至今我院共治疗18例肺隔离症,其中叶内型16例(88.9%),叶外型2例(11.1%)。术前确诊该症5例(27.8%),主要通过影像学诊断。全组病例均行肺叶切除术,无手术死亡。结论肺隔离症临床发病率低,无特异性临床表现,易误诊和漏诊。通过结合X线、CT及主动脉逆行造影等检查资料,发现异常的主动脉供血血管是明确诊断的关键。手术是目前主要的治疗方法。     

肺隔离症的诊治体会(附5例分析)

目的：探讨肺隔离症的诊断及治疗。方法：复习文献并总结我院确诊的5例隔离症患者的临床表现、X线、螺旋CT血管造影等检查特点及治疗预后情况。结果：5例均为叶内型。均经手术证实并切除隔离肺组织，预后良好。结论：肺隔离症临床表现无特异性，胸片表现为下肺囊性或实质性阴影。螺旋CT血管造影可显示隔离肺及异常动脉血供及静脉回流，为首选无创检查方法。手术治疗预后良好。     

合理应用影像学检查诊断腰椎间盘突出症

目的比较评价X线平片、椎管造影、CT、MRI影像学检查诊断要椎间盘突出症的价值.方法经手术证实,临床资料齐全的腰椎间盘突出症病人100例,均有X线平片、椎管造影、CT、MRI资料片.共检出126个病变部位,其中112个经手术证实.结果112个经手术证实的病变中,椎管造影、CT、MRI为中央型28例,外侧型为64例,混合型20例.结论X线平片的诊断敏感性虽不如CT、MRI高,但X线即简便经济,辐射剂量又少,应为诊断椎间盘突出症的首选方法.椎管造影诊断符合率和CT、MRI结果基本一致,不受设备限制,对基层医院可以作为一种常用方法.     

外伤性支气管断裂11例诊治体会

目的 探讨外伤性支气管断裂的诊断及治疗.方法 11例外伤性支气管断裂患者术前均经胸部CT或支气管镜检查确诊,在全身麻醉双腔管插管静脉复合麻醉下行手术治疗,9例行支气管断裂处组织切除端端吻合术,另2例因断裂延伸到上叶支气管,且上叶纤维化和/或严重挫裂伤,遂行上叶袖式切除术.结果 除1例合并重度颅脑损伤患者术后3d死亡外,其他患者均治愈.结论 对支气管断裂患者,术前应尽可能进行胸部X线、CT、支气管镜检查,尽快明确诊断,及时行气管重建术,可获得满意疗效.     

MSCT血管成像对肺隔离症的诊断价值

目的 探讨多层螺旋CT血管成像对肺隔离症的诊断价值。方法 回顾性分析经病理和(或)临床证实的肺隔离症患者15例的胸部CT平扫、增强及最大密度投影(MIP)、多平面重组(MPR)、容积再现(VR)等重建图像,分析本病在MSCT检查中的特征性影像学表现。结果 15例病变均为叶内型,11例位于左肺下叶,4例位于右肺下叶。多层螺旋CT血管成像证实15例病变的供血动脉,均来源于胸主动脉,有11例为单支血供,4例为双支或多支血供。结论 MSCT血管成像各种后处理技术能很好地显示肺隔离症的供血动脉,并且安全、无创,为肺隔离症的定性诊断及以及术前确诊提供了可靠的依据,可作为诊断肺隔离症的首选检查方法。     

放射CT技术在肺段隔离症诊断中的应用价值

目的:探讨放射CT技术在肺段隔离症诊断中的应用价值.方法:选择2015年03月—2017年03月这一时间段我院收治的40例肺段隔离症患者为分析对象,使用放射CT技术进行诊断,同时以X线平片进行检查,观察并比较两种方法对患者的诊断效果.结果:CT检查准确率97.5%高于X线平片的92.5%,但两者存在的差异不大(P>0.05);37例患者属于肺叶内型,2例患者属于肺叶外型;10例为实性病灶,15例为囊性病灶,14例为囊实性病灶;23例患者主动脉供血存在异常;有10例患者肺气肿病变.结论:放射CT技术在肺段隔离症诊断中有着良好的应用价值,值得推广.     

CT平扫与X线平片诊断腰椎间盘突出症结果及准确度比较

目的:探讨CT平扫和X线平片检查对腰椎间盘突出症(LDH)的诊断价值.方法:回访我院78例经手术后确诊为腰椎间盘突出症的患者X线平片和CT平扫情况进行分析和对比.结果:CT平扫LDH确诊74例(94.9％),明显高于X线平片确诊53例(67.9％),差异具有统计学意义(P＜0.05).结论:X线平片可用于腰腿痛患者的初步检查,费用小,可显示腰椎骨质改变;CT平扫确诊率高,可准确分型,为手术治疗以及后期康复治疗提供有效指导.     

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.