卫生体制改革的目标与政策选择--国际卫生体制改革的经验与教训

引入市场机制,采取分权、分级与分类管理等政策与措施是当今国际卫生体制改革中的主流特点,由于各个国家的社会经济体制与卫生保健制度不同,这些改革政策与措施所产生的影响与效果也各具特色.因此,在深化我国卫生体制改革的进程中,借鉴国际卫生体制改革的经验与教训具有一定的现实意义.     

Pneumatization of perpendicular plate of the ethmoid bone and mucocele]

OBJECTIVE: To find out the prevalence of pneumatization of perpendicular plate of the ethmoid bone, and to discuss the diagnosis and management of perpendicular plate mucocele (nasal septal mucocele). METHODS: The CT data from 32 patients with septal deviation were reviewed, and an unusual case of perpendicular plate mucocele was reported. RESULTS: Six cases (6/32, 18%) were found to have pneumatization of perpendicular plate of the ethmoid bone, with 2 located in the anterior portion (frontal-septal pneumatization), and 4 located in the posterior portion (spheno-septal pneumatization). A patient with perpendicular plate mucocele was treated by the technique of marsupialization under nasal endoscope. This patient was followed-up for 10 months without recurrence. CONCLUSION: As a kind of variation of nasal septum, the clinical significance of pneumatization of perpendicular plate should be emphasized. We reported the first case of perpendicular plate mucocele, originated possibly from the pneumatization of perpendicular plate of the ethmoid bone. Marsupialization under endoscope was considered to be the initial management for this unusual disease.     

Acute fulminant invasive fungal sinusitis]

OBJECTIVE: To discuss the clinical presentation, diagnostic criterion and treatment principle of acute fulminant invasive fungal rhinosinusitis (AFFS). METHODS: Six patients were diagnosed as AFFS based on history, nose, especially eye symptoms with or without fever, sinus CT and MRI, endoscopic and cytological findings in the nasal cavity. Surgical debridement was performed on 5 of 6 biopsy proven AFFS patients, one of them being amputated of the orbital content. With the original disease controlled simultaneously, 4 of 5 patients were prescribed with systemic amphotericin B or liposomal amphotericin B (1 case) and one with Itraconazole orally. One patient had not been involved with any of the anti-fungi measures. RESULT: Mucor (Zygomycetes) was identified on culture in 1 patient, Rhizopus species in 2, Aspergillus in 1, Alternaria in 1 and mixed Mucor and Rhizopus in 1. All patients were proved of tissue invasion histopathologically through biopsy. One patient died without any anti-fungi therapy on the 7th admission day, 3 patients survived for 88 days, 32 and 6 months respectively and died of original diseases (diabetes 1, leukaemia 2). One patient survived 9 months and lost for follow-up, 1 patient survived 11 months after treatment. CONCLUSION: A high index of suspicion and early endoscopic investigation through nasal cavity with fungal investigation should highly be strengthened for recognition of this disease. MRI findings should be considered as, or even more, important as that of CT scan on the early diagnoses. Extensive and aggressive surgical debridement, prompt and enough dosage of antifungal therapy intravenously, together with serious controlling of the underlying disease, all take important roles in the complete control of the disease.     

前庭水管扩大综合征患者的人工耳蜗植入术

目的 评价前庭水管扩大综合征患者人工耳蜗植入术的安全性和可行性。方法 1995年5月1日～2002年6月1日因双耳重-极重度感音神经性聋在北京协和医院接受人工耳蜗植入术的患者312例中诊断为双耳前庭水管扩大者10例(3．2％)，其中语前聋7例，语后聋3例。回顾性分析这10例患者的临床资料。结果 10例患者人工耳蜗电极植入顺利，8例耳蜗底回开窗时发生轻度井喷，迅速用颞肌筋膜牢固封闭圆窗制止井喷。全部患者术后未出现脑脊液漏、颅内感染、面瘫、中耳炎等并发症。开机6个月时8例患者具有开放性言语识别力，已进入普通学校(幼儿园、小学、大学)就读。另2例语前聋的幼儿视觉强化测听听阈达40dB HL，与其他无内耳畸形的全聋儿童术后效果差异无显著性。全聋前语言能力较好的5例患者术后语言能力明显好于语前聋的患者，语言交流基本听不出聋人特有的语音特征。另5例患者语言均有不同程度的进步。结论 尽管前庭水管扩大患者在人工耳蜗植入术中可能出现井喷，但术后未出现并发症且听力-言语康复效果好，因此重-极重度聋的前庭水管扩大综合征患者行人工耳蜗植入术是安全可行的。     

女性睡眠呼吸暂停低通气综合征临床特点

OBJECTIVE: To realize the characteristics of symptoms and polysomnography in women with sleep apnea-hypopnea syndrome (SAHS) compared with that of male patients. METHODS: The symptoms and polysomnography were compared between men and women with SAHS and among mild (5 to 19 events/h), moderate (20 to 39 events/h), severe (> or = 40 events/h) of female patients. RESULTS: Female patients were older than that of male(51.1 +/- 11.2 yr versus 43.9 +/- 10.1 yr). The mean body mass index(BMI) for women was (27.8 +/- 3.9) kg/m2 and (28.1 +/- 3.8) kg/m2 for men. Women with higher AHI snored more severely, and female had a lower apnea hypopnea index (AHI) and apnea index (AI) but higher hypopnea index (HI) than did male. In addition, the respiratory events during non-rapid eye movement for men were significantly higher than that for women. CONCLUSION: Female patients are older than male but not more adipose. SAHS and respiratory events during NREM sleep are less severe in women.     

A foreign body embedded in the mobile tongue masquerading as a neoplasm

Foreign bodies in a mobile tongue are rarely presented to the laryngologist, because such bodies are commonly lodged superficially and are easily removed by the patients themselves or by general practitioners. Thus, it is rare that a foreign body totally embedded in the mobile part of the tongue presents as an enlarged tongue mass. We have described a 64-year-old female with a 3-month history of an enlarged mass in the anterior right tongue. Physical examination showed a mass located in the anterior right tongue, with intact mucosa and normal color. A benign tongue neoplasm was considered first. However, a fish bone totally embedded in the mobile tongue with granuloma formation was encountered during the incisional biopsy operation. Complete removal of the foreign body with granuloma was achieved under local anesthesia. There was no neuromuscular or neurosensory deficit of the tongue in the follow-up period of 2 years. Although an embedded foreign body in the mobile tongue is a rare condition, it should be considered in the work-up of a patient with an enlarged tongue mass, with or without a history of swallowing a foreign body.     

钙离子拮抗剂治疗阿尔茨海默氏病的现状

目的：介绍钙离子(Ca2 )拮抗剂治疗阿尔茨海默氏病(AD)的机制和研究进展。方法：查阅近年来国内外相关献。结果：应用Ca2 拮抗剂(如尼莫地平等)治疗AD，可促进受伤神经的再生和感觉运动功能的恢复，并有较好的临床疗效。结论：Ca2 自体平衡失调学说为AD发病机制中的重要组成，应用Ca2 拮抗剂治疗AD具有良好的前景。     

注射用通脉灵质量标准研究

目的：对注射用通脉灵进行质量标准的研究。方法：采用薄层层析法对处方中药材进行了定性鉴别，并采用分光光度法对总黄酮进行了含量测定，采用比色法对总皂苷进行了含量测定。结果：薄层色谱分离效果好，两种方法回收率RSD均小于3％。结论：该方法较简单，重现性好，可作该制剂质量控制标准。     

HPLC法测定阿奇霉素的血药浓度

目的 :建立阿奇霉素血药浓度的测定方法。方法 :采用HPLC紫外检测法 ,岛津CLC CN分析柱 ,流动相为 0 1mol·L-1磷酸二氢钠 甲醇 乙腈 ( 85∶7∶8,,V/V/V) ,pH 3 0～ 3 5 ,流速 1mL·min-1,柱温 4 0℃ ,检测波长 2 10nm ,灵敏度 0 0 0 3AUFS ,提取液为氯仿 正己烷 ( 3∶2 ,V/V) ,以峰面积外标法定量。结果 :阿奇霉素血药浓度线性范围 5 0～ 5 0 0 0 μg·L-1,平均回收率( 10 0 9± 2 7) % ,日内RSD 1 2 %～ 4 3% ,日间RSD 2 8%～ 6 8%。结论 :本法简便 ,分析速度快 ,灵敏度较高 ,重复性好 ,基本能适用于临床血药浓度测定及药动学研究。     

帕司烟肼介入凝胶体外抗结核活性及安全性研究

目的 观察帕司烟肼凝胶体外抗结核作用和支气管介入的安全性。方法 手工法、仪器法分别测定帕司烟肼及其凝胶的最小抑菌浓度和最小杀菌浓度及家兔经支气管介入的安全性试验。结果 帕司烟肼凝胶对H37Rv标准株、牛型结核分枝杆菌、草分枝杆菌MIC值分别为0．1、0，1、0．4mg／L，MBC值分别为0，2、0．2和1．6mg／L；帕司烟肼凝胶与帕司烟肼单体MIC、MBC值无显著差异；动物实验表明该药应用安全。结论 帕司烟肼凝胶具有与帕司烟肼单体相同的抗结核菌药效，卡波姆基质不影响帕司烟肼的抗菌活性；以卡波姆为基质的帕司烟肼凝胶应用安全。