Perioperative risk factors for posterior ischemic optic neuropathy

Background:

Infarction of the optic nerve posterior to the lamina cribrosa, called posterior ischemic optic neuropathy (PION), is a condition that can result in profound bilateral blindness. Cases of PION treated at this institution and those described in the literature were analyzed to identify clinical features that profile those individuals at risk of PION in an attempt to identify major contributing factors that could be addressed prophylactically to enable effective prevention.

Study Design:

Salient clinical features in seven cases of PION diagnosed at the Doheny Eye Institute between 1989 and 1998 are compared with 46 cases of PION reported in the literature.

Results:

In the Doheny series there were six men and one woman aged 12 to 66 years (mean, 47 years). Five patients were status-post spine surgery, one was status-post knee surgery, and one had a bleeding stomach ulcer. Vision loss was simultaneously bilateral in six of seven patients (85.7%) and was apparent immediately after surgery. There were no abnormal retinal or choroidal findings including diabetic retinopathy, in any of the patients. Notable contributing factors were blood loss in all seven patients, ranging from 2,000 to 16,000 mL, with a drop in hematocrit of 9.5% to 19% (mean, 14%), and intraoperative systemic hypotension in all patients. Facial edema was a factor in three of six spine surgery patients (50%). Patients reported in the literature had a mean age of 50 years and were also predominantly men (34 of 46, 74%) who underwent spine surgery (30 of 46, 65.2%).

Conclusions:

Middle-aged men undergoing spine surgery with prolonged intraoperative hypotension and postoperative anemia and facial swelling are at risk of developing PION from hypovolemic hypotension. Avoiding or immediately correcting these contributory factors can reduce the incidence of PION.     

The risk of stroke following coronary revascularization -- a population-based long-term follow-up study

OBJECTIVE: To study the incidence and risk factors of stroke after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). DESIGN: During 1983-1992, coronary revascularization procedures (n = 2160) were recorded in patients aged 35-64 years as part of the population-based FINMONICA Myocardial Infarction Register. The FINMONICA Stroke Register and National Hospital Discharge Register were used to ascertain subsequent stroke events in such patients. RESULTS: During the average follow-up of 5.83 years, 155 patients (7.2%) had a stroke. The cumulative incidence of stroke was 1.55% in the first year after revascularization and varied between 0.8 and 1.4% during subsequent years. In Cox proportional hazard models the relative risk of stroke was 3.01 (p = 0.0007) for a previous stroke, 2.61 (p = 0.0001) for diabetes mellitus, 2.15 (p = 0.007) for low income (compared with high income), 2.06 (p = 0.03) for male sex, and 1.43 (p = 0.02) for a 10-year increment in age. CONCLUSION: The incidence of stroke during the first year after revascularization was five times higher than among the age- and sex-matched general population. Patients with a previous stroke, diabetes mellitus, advanced age, male sex and low socioeconomic status need special attention because of increased risk of stroke after CABG or PTCA.     

北京市儿童青少年女性青春期性征发育流行病学研究

摘要 目的：了解北京市6~18岁学龄女生青春期第二性征发育现状,以及人群性早熟发生率。方法：利用2004年北京市儿童代谢综合征调查（BCAMS）总样本中9 778名6~18岁中小学女生的青春期发育数据，用概率单位回归法计算月经初潮、乳房、阴毛不同发育时期的中位年龄。8岁前乳房或阴毛发育达Tanner II 期（B2,P2），或10岁前月经初潮者被定义为性早熟。结果：9 778名6~18岁中小学女生中城市人口5 040人，占总样本51.5%。北京市学龄女生月经初潮年龄平均为 （12.1±1.1）岁，城市女生（11.9±1.1）岁，农村女生（12.5±1.1）岁；女性第二性征开始发育年龄（总体/城市/农村）分别为，乳房：（9.5±1.2）岁/（9.3±1.1）岁/(9.6±1.2）岁；阴毛:(11.1±1.1）岁/(10.8±1.1）岁/(11.4±1.1）岁。城市女生月经初潮、乳房和阴毛发育均显著早于农村女生。月经初潮早发生率为0.79%，城市高于农村（1.03%：0.55%；x2=6.93，P<0.01）；乳房、阴毛早发育率分别为2.91%和0.22%。1962~1982年期间，北京女生月经初潮年龄平均每10年提前0.7岁（8.4个月）；近10年平均提前0.43岁（5.2个月）。结论：北京市城区女生青春期第二性征发育明显早于郊区县女生。月经初潮年龄提前的长期变化趋势依然存在，但近10年这一趋势趋于减缓。     

中国呼吸治疗师的培养现状

就我国目前呼吸治疗师的培养现状和成长背景进行了分析,并对其发展前景进行了展望。     

生物蛋白胶预防屈肌腱粘连的临床研究

目的评价生物蛋白胶对屈肌腱吻合术后防止粘连及功能恢复的作用。方法84例屈肌腱吻合术后涂以生物蛋白胶（生物蛋白胶组），80倒不辅予任何处理（对照组）。术后随访2～14个月，观察手功能恢复情况。结果生物蛋白胶组和对照组的手功能恢复优良率分别是80．9％，62．5％。结论生物蛋白胶对防止屈肌腱粘连有良好疗效     

大明胶囊对大鼠心肌梗死预防性保护作用的研究

目的观察大明胶囊对大鼠心肌梗死的预防性保护作用。方法对大鼠预防性给予大明胶囊1wk后,结扎其左冠脉前降支造成心肌梗死。通过测量心肌梗死面积,观察心肌酶学指标、病理形态学和组织超微结构的改变,评价大明胶囊对心肌梗死的预防性保护作用。结果心梗染色面积和心肌酶学指标显示(与模型组相比),大明胶囊灌胃后心肌梗死面积减少(P<0.05),乳酸脱氢酶(LDH)和肌酸激酶(CK)的含量降低(P<0.05)。心肌形态学和超微结构显示,大明胶囊减轻了左冠脉前降支结扎所造成的心肌损伤。结论通过心梗面积、心肌酶学指标、形态学和超微结构的观察,大明胶囊能预防性保护心肌梗死所造成的损伤。这提示大明胶囊可能应用于心肌梗死治疗。     

Gefitinib treatment for non-small cell lung cancer -- a study including patients with poor performance status.

BACKGROUND AND PURPOSE: Gefitinib is effective in the treatment of advanced non-small cell lung cancer (NSCLC). However, most studies have only investigated patients who have good performance status or are evaluable. This study evaluated the efficacy of geftinib in a consecutive series of patients with NSCLC. METHODS: The treatment response of all gefitinib-treated NSCLC patients from November 2001 to September 2003 at a single medical institute was retrospectively evaluated. All patients receiving at least 1 dose of gefitinib during the study period were included. RESULTS: A total of 66 NSCLC patients were treated, including 22 patients with Eastern Clinical Oncology Group performance status 3 or 4. No prior chemotherapy had been given in 14 patients because of their personal preference or poor general condition. The duration of treatment ranged from 1 day to 19.3 months (median, 2.5 months). The partial remission rate was 15.2% and the stable disease rate was 25.8%. The median survival for all patients was 5.9 months and the 1-year survival rate was 27.9%. Symptom improvement and response correlated well to survival. Female gender, non-smoking status, and performance status of 0-2 were associated with better survival. The disease control rate was 22.7% in patients with performance status of 3-4. CONCLUSIONS: Gefitinib can be recommended for the treatment of advanced NSCLC in patients for whom standard chemotherapy is not an option. Further study is required to determine the optimal selection criteria of patients and the timing of starting therapy.     

男性精液携带阴道加德纳菌对配偶的影响

目的:进一步了解男性生殖道感染阴道加德纳菌(Gv)与配偶之间的互感率。方法:取男性精液携带Gv者的配偶阴道分泌物进行Gv套式PCR法检测。结果:随机抽取102例男性精液携带Gv者的配偶中,共检出Gv阳性者89例,阳性率为87.3%。结论:Gv是性接触传播的病原生物之一。     

冠心病合并代谢综合征患者的临床特征与冠状动脉病变程度的关系

目的分析冠心病合并代谢综合征患者的临床特征和冠状动脉病变特点。方法回顾性分析本院175例冠心病患者的临床资料及冠状动脉造影结果,按照ATPⅢ诊断标准分为代谢综合征组和无代谢综合征组,以冠状动脉病变积分评价其病变程度。结果175例中89例(50.9%)合并代谢综合征。代谢综合征组的体重指数、腰围、总胆固醇、甘油三酯、尿酸、空腹血糖、餐后2h血糖、糖化血红蛋白、稳态模型的胰岛素抵抗指数及心肌梗死的发生率均显著高于无代谢综合征组,而高密度脂蛋白胆固醇水平显著低于后者;其冠状动脉多支病变发生率(65.1%比45.4%,P<0.01)及冠状动脉病变总积分均显著高于无代谢综合征组(7.5±3.6比6.4±3.3,P<0.05);代谢综合征组中合并糖尿病患者的冠状动脉病变总积分也高于无糖尿病患者(8.0±3.7比6.3±3.5,P<0.05)。相关分析显示,冠状动脉病变程度与患者的腰围、总胆固醇、甘油三酯、糖化血红蛋白、空腹血糖及餐后2h血糖水平呈明显正相关(P<0.05),与高密度脂蛋白胆固醇呈负相关(P<0.01)。结论冠心病患者中合并代谢综合征较为普遍,且合并代谢综合征患者的冠状动脉病变呈多支性、狭窄程度更高,应进行全面心血管危险因素防治,以改善预后。     

乌鲁木齐市562例汉族青少年(牙合)特征调查分析

目的：探讨乌鲁木齐市汉族青少年的（牙合）特征。方法：按随机化原则和整群分层抽样方法抽取562例11～19岁乌鲁木齐市汉族学生，并制取牙颌石膏模型，观察磨牙关系、覆盖分布情况、覆（牙合）分布情况及咬合异常和中切牙间隙的分布情况。结果：磨牙Ⅰ、Ⅱ、Ⅲ、Ⅳ类关系构成分别为72．95％、14．06％、12．46％、0．53％。前牙覆盖（0～4mm）者构成为82．21％，前牙反（牙合）者构成为5．52％，前牙覆（牙合）（〈1／3牙冠）者构成为59．07％，前牙开（牙合）者构成为1．60％，后牙反（牙合）者构成为lO．10％，锁（牙合）者构成为9．96％。结论：在乌鲁木齐汉族青少年人群中异常咬合关系分布较高。应予以足够重视。