Blunt hepatic injury: minimal intervention is the policy of treatment

BACKGROUND: Many publications recommend nonoperative treatment for stable blunt hepatic injury patients. Unstable hemodynamic status is the only indication for surgery. When operation is indicated, controversies exist regarding which operative procedure will be more beneficial to the patients. The purposes of this study are to compare the results of operative and nonoperative management of patients with blunt hepatic injuries and to identify the optimal surgical approach when surgery is indicated. METHODS: Different prospective protocols of treating adult blunt hepatic injuries were conducted. From 1992 to 1993 (group I), urgent surgery would be performed in the presence of hemoperitoneum. The policy shifted to aggressive nonoperative approach between 1996 and 1997 (group II). The patients from each period were divided into three subgroups. Group A included the patients who received nonoperative treatment in either period. Group B consisted of the patients who received surgery in the first period and nonoperative management in the second period. Group C included the patients who were operated on in either group. Comparisons were made between matched groups. RESULTS: Groups IA and IIA patients had minor injuries and could be successfully treated nonoperatively. The results of groups IB and IIB were similar concerning hospital stay, morbidity, and mortality. Transfusion requirements of group IIB patients were significantly higher (2.2 vs. 1.1 units,p = 0.01) than those of group IB. However, 25 (58%) celiotomies of group IB patients were nontherapeutic. When surgery was indicated, group IC patients had significantly higher liver-related mortality (14 of 49 vs. 3 of 55, p = 0.002). Anatomic resection was performed more frequently in that period. CONCLUSION: Nonoperative treatment significantly decreased the rate of nontherapeutic laparotomy but carried the risks of higher transfusion requirements and delaying operation. When surgery was indicated, the policy of minimal intervention positively affected the patients' outcomes. The goal of surgery should be hemorrhage control rather than resection of the injured liver tissues.     

重组人类表皮生长因子在超声乳化白内障摘除术后的应用

目的　观察重组人类表皮生长因子 (rh EGF)滴眼液对超声乳化白内障术后泪膜的疗效。方法　随机选择两组超声乳化白内障术后患者 ,A组 (74只眼 )术后给予 rh EGF眼液 ;B组 (87只眼 )术后给予赋形剂。分别于术后第 1天、7天、15天、30天进行干眼症状、角膜荧光素染色、泪膜破裂时间 (BU T)及泪液分泌试验观察加以比较 ,并进行统计学分析。结果　术后第 7天两组患者的干眼症状、BU T、泪液分泌量及角膜荧光素着色均有好转 (P<0 .0 1) ,两组间差异无显著性 (P>0 .0 5 ) ;而术后第 15天、30天 A组各项检查结果均有反复 ,与术后第 1天比较差异无显著性 (P>0 .0 5 ) ,B组各项检查结果反复较小 ,与术后第 1天比较 ,差异有显著性 (P<0 .0 5 )。结论　 rh EGF滴眼液对超声乳化白内障术后泪膜的修复有促进作用。     

Disseminated tuberculosis presenting as multiple hepatosplenic microabscesses and pancytopenia in a teenage boy.

Disseminated tuberculosis usually occurs in immunocompromised hosts. Involvement of bone marrow, liver, and spleen is infrequent. A previously healthy 15-year-old boy presented with body weight loss, prolonged fever, neck lymphadenopathy, pancytopenia, and hepatosplenic microabscesses within the recent month and was transferred to our hospital. Bone marrow studies showed hypocellular marrow. Based on his clinical manifestations, hemophagocytic syndrome was initially suspected. Pancytopenia resolved after administration of intravenous immunoglobulin but caseous necrosis and/or positive acid-fast stain were subsequently demonstrated in the lymph node biopsy and sputum. Cultures from these 2 specimens grew Mycobacterium tuberculosis. Fever continued in a low-grade pattern even under antituberculous therapy with rifampin, isoniazid, pyrazinamide and ethambutol. Five months after admission, fever subsided after splenectomy and liver wedge resection. Microscopic examinations of both the liver and spleen showed mycobacteria-related granulomatous inflammation and caseating necrosis. This report suggests that tuberculosis infection should be considered in the differential diagnosis in patients with prolonged fever, pancytopenia and hepatosplenic abscesses.     

玉露散加味临床治疗小儿泄泻150例体会

目的探讨在祖国医学理论的指导下辨证施治，运用玉露散加味临床治疗小儿泄泻（火泻）。方法通过对近几年临床积累的小儿泄泻（火泻）病例150例（男93例，女57例）进行临床资料综合分析。结果临床150例病例中，服用1剂痊愈21例，占14％；服用2剂痊愈97例，占65％；服用3剂痊愈29例，占19％；服用4剂痊愈3例，占2％。结论玉露散加味对临床因湿热蕴结尤以热盛所致的小儿泄泻（火泻），能达到清热泻火，利水渗湿的治疗作用，疗效佳，为治泻选方提供范例。     

锂对染铅大鼠海马胆囊收缩素和神经元型一氧化氮合酶神经元的保护作用

目的 探讨锂对染铅大鼠海马胆囊收缩素（CCK）和神经元型一氧化氮合酶（nNOS）神经元的保护作用及其与动物学习记忆功能变化的关系.方法 通过测量体重,利用反映学习记忆功能的Y迷宫法和ABC免疫组化法,研究饮用含0.2 g/L醋酸铅（PbAc）水和含不同剂量（3、30、300、3 000mg/kg）氯化锂（LiCl）饲料喂养的大鼠体格发育情况、学习记忆能力以及海马不同亚区CCK和nNOS阳性神经元数目的变化.结果铅染毒组大鼠体重增加少于对照组大鼠,差异有统计学意义（P＜0.05）,Y-迷宫学会次数多于对照组大鼠,差异有统计学意义（P＜0.05）;其海马各区CCK和nNOS阳性神经元数明显减少,差异有统计学意义（P＜0.05）.铅＋LiCl（3、30、300mg/kg）组体重增加多于对照组大鼠,差异有统计学意义（P＜0.05）;Y-迷宫学会次数少于对照组大鼠,差异有统计学意义（P＜0.05）,海马各区CCK阳性神经元数明显增加,差异有统计学意义（P＜0.05）.铅＋3 000mg/kg LiCl组大鼠Y-迷宫学会次数多于对照组大鼠,差异有统计学意义（P＜0.05）;海马各区CCK阳性神经元数明显少于对照组,差异有统计学意义（P＜0.01）;与铅染毒组比较,差异无统计学意义（P＞0.05）.结论 铅可损伤大鼠学习记忆能力,影响大脑海马CCK和nNOS阳性神经元的数目.较低剂量的锂对铅引起的学习记忆损伤和海马CCK阳性神经元的变化有一定保护作用.     

基于混合正态模型的糖尿病住院病人医疗保险设计

目的提出一种基于混合正态模型来拟合糖尿病住院病人风险损失规律的精算方法.方法采用EM算法对混合正态风险模型进行参数估计;采用Kolmogorov-Smirnov检验对混合正态风险模型的拟合优度进行检验;采用随机抽样模拟和t检验法比较随机样本指标与模型参数之间的差异;采用逐步判别分析方法,对随机保单进行分类与甄别;设计保险条款,作为保险双方有约束力的合同.结果由训练样本拟合得到四元混合正态模型;模型的拟合精度很高（P=0.99701）;按μi＋1.645σi可得到4种保险等级下的总保费;样本指标与模型参数之间的差异无统计学意义.结论 本文设计的面向糖尿病住院病人的医疗保险,可根据投保人因糖尿病住院风险损失额划分成4种类型保单持有者,并由此厘定出4种不同等级的保险费,因而体现了高风险损失应承担高额保险费的保险原则,有利于投保人根据自身情况选择保单类别.     

粗羊毛脂中胆甾醇的分离与精制研究

目的:以粗羊毛脂为原料提取胆甾醇.方法:改进实验流程,以混合溶剂量、混合溶剂比及配合物提取时间为条件,采用正交实验优选胆甾醇提取工艺.结果:确定最佳条件为混合溶剂量120ml,混合溶剂比12:1,配合物提取时间30min.结论:工艺合理,稳定可行.     

提高病原生物学实验教学效果探讨

病原生物学是医学微生物学和人体寄生虫学合二为一的新学科,有其自身的特点,使这两门课程有机地组合确实有一定的难度。就目前存在的某些问题进行讨论,认为可从提高师资队伍的素质,有机组合教学内容,培养学生学习主动性,利用现代化的教学手段,改进实验考核方法等方面提高教学质量。     

重症急性胰腺炎46例护理体会

目的探讨提高重症急性胰腺炎(SAP)患者抢救成功率的护理体会。方法总结了2001年3月￣2006年1月46例SAP患者的监测和护理。结果本组患者有39例经积极治疗痊愈,2例转化形成胰腺假性囊肿手术后治愈,5例抢救无效死亡。结论促进胃肠道功能恢复,对呼吸、循环、神经系统、肝肾功能等重要脏器进行有效支持,同时控制感染,做好心理护理,能有效提高SAP患者的治愈率。