胃癌腹腔脱落细胞检查及临床意义

腹膜转移是胃癌常见的转移形式。为在肉眼可见转移前发现亚临床的转移现象,自1981年3月至1982年4月,我们共对胃癌病人142例进行了腹腔脱落细胞检查及临床随诊,发现有腹腔脱落细胞阳性者76例(53.5％)。5年随诊结果发现,腹腔脱落细胞阳性者无一例生存>3年;而腹腔脱落细胞阴性的66例中生存5年者有11例。可见,腹腔脱落细胞检查,对胃癌的诊断,治疗和预后判断有一定价值。     

健康教育在青光眼患者中的应用及效果

目的探讨健康教育在青光眼患者中的应用,并评价其实施效果。方法利用个体指导、健康处方、集体授课的形式,采取讲授、示范和操作的方法,对84例青光眼患者进行疾病知识、眼压监测、饮食、生活、运动等方面的健康教育。结果实施健康教育前患者知识掌握的优良率为28.6%,而实施健康教育后为80.9%,(P<0.05);实施健康教育后学会控制不良情绪、自我监测眼压、眼球按摩、正确使用降眼压眼水的人数比以前增多(P<0.05)。结论健康教育能提高青光眼患者的疾病知识水平和自我护理水平及监查依从性。     

肝移植术后血管胆道并发症的介入治疗

目的:评价介入治疗对肝移植后胆道、血管并发症的价值。材料和方法:18例肝移植患者接受了介入治疗。其中肝动脉狭窄8例,行肝动脉造影及溶栓治疗;下腔静脉及肝静脉狭窄2例,行内支架置入术;胆瘘及胆道狭窄8例,行PTCD治疗。结果:胆道并发症8例,PTCD治疗后症状消失;肝动脉狭窄8例,溶栓后肝动脉完全开放6例,1例血流部分开放,1例肝动脉血流未恢复再次肝移植治疗;下腔静脉及肝静脉狭窄2例内支架置入术后下腔静脉梗阻及肝肿大症状消失。结论:介入治疗是治疗肝移植后胆道血管并发症的有效方法。     

未破裂脑动脉瘤的治疗选择

未破裂脑动脉瘤的处理存在争议。由于其自然史尚未完全明确,因此最佳的治疗策略也不清楚。目前对未破裂脑动脉瘤处理的共识包括观察、显微手术夹闭和血管内治疗。用于随访已知未破裂脑动脉瘤的方法学也有争议,可能取决于经治医生的偏好。大多数动脉瘤由神经外科医师和介入神经放射科医师处理,但未破裂动脉瘤通常是由神经科医师在对患者进行其他神经系统疾病的筛查时首先发现的。因此,关于何时对患者进行筛查和如何对未破裂动脉瘤采取最佳处理的知识将对其日常医疗实践有直接的影响。未破裂动脉瘤经常导致包括缺血事件、癫和头痛在内的其他神经系统症状,这些症状可能促进更积极的干预治疗。由于缺乏设计完善真正基于人群的研究或随机试验,因此目前的最佳处理必须以现有文献和每例患者当时的具体情况为根据。     

Randomized placebo-controlled trial comparing montelukast and cetirizine for treating perennial allergic rhinitis in children aged 2–6 yr

Leukotriene receptor antagonists (LTRAs) were recently added to the method of treating allergic rhinitis (AR). However, in children under 6 yr old, there has been no study about its efficacy in treating AR. We aim to compare the clinical efficacy of montelukast, cetirizine and placebo in the treatment of children from 2 to 6 yr old with perennial allergic rhinitis (PAR), to see if there are any significant differences. Sixty children were selected and treated with montelukast, or cetirizine, or placebo once daily. The efficacy of the three agents was compared with the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Total Symptom Score (TSS) by diary. In addition, we also examined serum IgE, serum eosinophil cationic protein (ECP), blood eosinophil counts, nasal airway resistance (NAR) and eosinophil percentage in nasal smears. The results revealed that both montelukast and cetirizine were significantly efficacious compared with placebo in NAR, eosinophil percentage in nasal smears, PRQLQ, TSS and all symptom items except nasal itching, throat itching and tearing. For nasal itching, only cetirizine was significantly efficacious. On the other hand, for night sleep quality, montelukast was significantly superior to cetirizine.     

鼻出血的急诊处理特点及并发症的预防

针对不同鼻出血的病因特点,采取相应的治疗措施,能缩短出血时间,减少出血量,避免并发症的发生。     

Nucleotide changes around the splicing acceptor of intron 24 in the factor VIII gene and its impact on splicing.

Nucleotide 6724 of the factor VIII gene harbors a polymorphism of low frequency. A report from Taiwan claimed that 97.9% of the 83 alleles examined were of the A nucleotide at this position, which is quite different to the data from Western populations. Furthermore, this nucleotide is the start of exon 25, located in juxtaposition to the splicing acceptor of intron 24. We wonder if the nucleotide change at this location might have any effect on the splicing process of pre-mRNA. Using genomic DNA with direct sequencing of the polymerase chain reaction-amplified intron 24/exon 25 junction site, we found that 59 of the 60 patient samples were of the GTG sequence at nucleotides 6724-6726. The polymorphism is similar between populations in Taiwan and Western countries. The sequence of intron 24 around the splicing acceptor was always TCCAACTCTATTGCCCTCAG (-20 to -1), except for one hemophiliac patient who had a mutation in which the absolute consensus AG doublet of the intron 24 splicing acceptor changed to the AA dinucleotide. Owing to the mutation, exon 24 was erroneously spliced to exon 26, and exon 25 was skipped. This finding further testifies to the importance of the invariant AG dinucleotide in the example of the factor VIII gene.     

医务人员年度考核相关问题探讨

如何做好医务人员年度考核,是各级领导和组织人事部门必须研究的课题。本文对医务人员年度考核中相关问题:如考核标准单一、纯定性考核或纯量化测评等,进行了分析,结合医院工作特点,对解决上述问题进行了一些探讨。提出要敢于打破平均分配优秀等次名额的做法,根据不同的考核目的、考核对象及其工作性质,设计不同的考核标准体系,并采用定性考核和量化测评相结合的考核办法的设想。其目的是通过探讨,起到抛砖引玉的作用。