经直肠超声下的前列腺低回声区及其临床意义

目的评估经直肠超声下的前列腺低回声区及其临床意义。方法1999年8月～2004年8月，共438例患者接受了经直肠超声引导前列腺系统穿刺活检术。活检点数为6～13点。如果经直肠超声检查发现前列腺的低回声区，亦加取该区部位的活检。将低回声区、等回声区的活榆结果进行比较。结果总的癌检出率为25．6％（112／438）。112例前列腺癌患者中，有低回声区者75例，占67％，无低回声区者37例，占33％。本组总共取得3504个活检点，取自低回声区者636个。636个低回声区中癌区163个，占25．6％，非癌区473个，占74．4％。腺体中有或无低回声区检出前列腺癌的可能性相当，为25．2％（75／298）和26．4％（37／140），差异无统计学意义（P〉0．05）。结论多数前列腺癌可发现低回声区，但多数低回声区并非前列腺癌。腺体中有无低同声区对前列腺癌的检出率相当。     

肌肉注射与静脉输注哌替啶术后止痛效果的比较

[目的]通过观察两种不同给药方式的止痛效果,探讨骨科病人术后应用哌替啶止痛的良好途径。[方法]采用视觉模拟评分法判断病人持续缓慢静脉输注哌替啶与肌肉注射哌替啶的术后疼痛情况,并进行比较。[结果]静脉输注哌替啶疼痛程度比肌肉注射哌替啶疼痛程度明显降低,用药总量减少近1倍,且静脉输注哌替啶避免了术后剧烈疼痛的发生以及血管吻合术因疼痛而产生的血管危象,提高了病人休息的质量。[结论]骨科手术后采用持续缓慢静脉输注哌替啶预防性用药是一种有效、适用的止痛方法。     

现代医学200词——147、社区康复

所谓社区康复的“社区”一词尚没有明确的定义。其范围是小的群体、大城市、县，也有以国为单位的。另方面，关于康复历史上虽提出了很多概念，但现在暂时一致采用1982年“联合国残疾人世界行动计划”的定义，即康复是尽可能使躯体和心理达到社会的最适机能水平，旨在提供改变个体人生的手段，且限定在一定时间的过程。但与康复的4个方面，即依据医学、社会、职业、教育的专门领域的概念相异，统一还相当困难。     

Cross-neutralisation of Australian brown and tiger snake venoms with commercial antivenoms: Cross-reactivity or antivenom mixtures?

Recently it has been suggested that the Australian snake antivenoms made by CSL Ltd. are in fact not truly monovalent and may contain antibodies to other snake venoms because the horses are injected with multiple snake venoms. It is unclear to what extent various monovalent antivenoms can neutralise the effect of other venoms, whether this is due to a mixture of antibodies or true cross-reactivity, and whether this has any clinical significance. We aimed to study the immunological and functional properties of brown snake (Pseudonaja spp.) antivenom (BSAV) and tiger snake (Notechis spp.) antivenom (TSAV) against their respective venoms using enzyme immunoassays (EIA) and in vitro clotting studies. There was significant overlap between the two antivenoms with both TSAV and BSAV being detected by EIA on brown snake venom (BSV)-coated and tiger snake venom (TSV)-coated wells, respectively. In a competition EIA, increasing amounts of immunoaffinity-purified hen anti-brown antibodies (IgYp) mixed with TSAV reduced TSAV measured on TSV-coated wells. Both BSAV and TSAV prevented the clotting activity of both venoms. IgYp also prevented the clotting activity of TSV, suggesting true cross-reactivity. The cross-reactivity of TSAV and BSAV with BSV and TSV, respectively, was likely due to each being a mixture of anti-brown and anti-tiger antibodies, but there was partial cross-reactivity demonstrated by the effect of IgYp. Single-polyvalent antivenom for brown snake and tiger snake may be feasible in the future.     

国产长效皮下埋植避孕剂的临床应用

1992年我院用国产长效皮下埋植避孕剂(左旋18-甲基炔诺酮),对600例育龄妇女进行皮下埋植,经1年随访,结果显示:国产长效皮下埋植剂的避孕效果达100％。600例中10例因出现月经异常而终止使用,其持续使用率为98.33％,获得了与进口长效皮下埋植避孕剂相同的效果。     

人脑桥内部的动脉供应和毛细血管构筑

采用血管灌注和透明切片,在立体解剖显微镜下对30例脑桥内部动脉的分群,经行分支和供应范围进行了观察。并应用图像分析系统测算了脑桥内部主要神经核团和纤维束的毛细血管密度。脑桥内部前正中群有三组长动脉,分别由脚间窝下端,基底沟中部和盲孔处穿入,这些动脉在向脑桥被盖部经行和分布的过程中,可形成多级直角分支,使之呈“垂柳状”外观。脑桥内部的毛细血管构筑,在透明切片上,可显示出神经结构的轮廓。其中上橄榄核的毛细血管密度最高,小脑上脚的毛细血管密度最低。     

梭曼中毒动物中枢神经系统病变与惊厥的关系

用神经组织学方法观察了兔、猫、狗、猴梭曼中毒急救治疗后CNS的病理变化.结果表明,CNS病变程度随着惊厥持续时间的延长而加重,抗惊剂可以保护CNS免受损伤.不同种动物梭曼引起的CNS病变基本相似,均为神经细胞的缺血性改变.主要病变包括大脑皮质、丘脑、海马、小脑和脊髓的神经细胞尼氏体溶解、核浓缩和细胞表面结痂.由于CNS病变与惊厥有密切关系,因此梭曼中毒后必须应用抗惊剂.     

Evaluation of hypothesis testing for comparing two populations using NONMEM analysis

In a simulation study of inference on population pharmacokinetic parameters, two methods of performing tests of hypotheses comparing two populations using NONMEM were evaluated. These two methods are the test based upon 95% confidence intervals and the likelihood ratio test. Data were simulated according to a monoexponential model and, in that context, power curves for each test were generated for (i)the ratio of mean clearance and (ii)the ratio of the population standard deviations of clearance. To generate the power curves, a range of these parameters was employed; other pharmacokinetic parameters were selected to reflect the variability typically present in a Phase II clinical trial. For tests comparing the means, the confidence interval tests had approximately the same power as the likelihood ratio tests and were consistently more faithful to the nominal level of significance. For comparison of the standard deviations, and when the volume of information available was relatively small, however, the likelihood ratio test was more able to detect differences between the two groups. These results were then compared to results on parameter estimation in order to gain insight into the question of power. As an example, the nonnormality of estimates of the ratio of standard deviations plays an important role in explaining the low power for the confidence interval tests. We conclude that, except for the situation of modeling standard deviations with only sparse information, NONMEM produces tests of significance that are effective at detecting clinically significant differences between two populations.Partial support from the Upjohn Company, NIH-BRSG SO RR 07066, and the Burroughs Wellcome Foundation.     

Virtual real-time digital processing of hemodynamic data

At present, the majority of cardiac catheterization laboratories acquire and store hemo-dynamic data in analog form. To examine the possibility of performing complex analysis of digital data during the catheterization procedure, we examined whether virtual realtime digital (fast Fourier) analysis improves the accuracy of clinical data. We compared digital filtering of fluid manometry during right heart catheterization with 10-Hz and 250-Hz analog filters. Using the simultaneously acquired micromanometry as the “gold standard,” we found that analog filtering is associated with a greater error and time delay than digital filtering. This study demonstrates that digital hemodynamic data analysis performed during cardiac catheterization can improve the quality of data obtained during right heart catheterization, with the results available within seconds. More extensive use of computers in the cardiac catheterization laboratory may be useful for both clinical and research purposes. © 1992 Wiley-Liss, Inc.     

离子对提取比色法测定复方制剂中氨基比林的含量

复方制剂中氨基比林与溴甲酚绿形成稳定的离于对，用氯仿萃取后在４１６．８ｎｍ处测定吸收度．回收率为９９．８０％，相对标准偏差为０．９２％（ｎ＝５）。方法简便快速，结果准确可靠。