住院医师临床技能评估方法探讨

该文总结了安徽省立医院住院医师培训情况,提出了必须引入实践性考核作为住院医师临床技能考核的主要方式。根据临床技能评价的项目,制定了内科、外科、影像科住院医师临床技能评估指标体系,确立了临床技能考核的原则,并组织实施。这种评估方法能全面考核住院医师的临床技能,但在新的医疗形势下,需建立相关配套措施来保证实施。     

Axonal transport of dopamine D1 receptors in the rat brain

Binding of a specific dopamine D₁ receptor antagonist,¹²⁵I-SCH 23982, was measured in rat brain sections by quantitative autoradiography at various time intervals, following a knife cut through the striatonigral pathway. Twenty-four hours after lesioning, accumulations of D₁ receptor binding sites were found in sagittal sections both rostral and caudal to the lesion site. No other regions studied (caudate-putamen, nucleus accumbens, olfactory tubercle, and substantia nigra pars reticulata) showed any change in D₁ receptor binding 24h after the lesion. In brain sections obtained 10 days after lesioning, only the substantia nigra pars reticulata had a significant decrease in D₁ receptors ipsilateral to the lesion. These findings suggest the possibility of a presence of bidirectional axonal transport of D₁ receptors in rat striatonigral pathway.     

Neuroradiological features of intracranial and intraorbital meningeal haemangiopericytomas

The neuroradiological features of six intracranial and one intraorbital haemangiopericytomas (HP) are reviewed. CT was performed before and after IV contrast medium in 5 patients. In 2 patients MRI was performed before and after contrast medium; in another, only unenhanced images were obtained. Five patients were studied by selective external and internal carotid artery angiography. Women constituted 5 of the 7 patients, and the mean age was 50.5 years, thus the sex and age distribution did not differ from that of typical meningiomas. Contrary to previous reports, calcification was present in two of the intracranial HP, and bone erosion was clearly seen in one intracranial HP and the orbital lesion. On MRI the tumours showed no differences from angioblastic meningiomas. All 6 intracranial HP were aggressive; all recurred following treatment and extracerebral metastasis occurred in one case.     

外刊速览

中国私立医院风头正劲——华尔街日报作为一家大律师事务所的高级合伙人,庄先生说,他可以很轻松地花7万美元买一辆进口宝马(BMW)车,或1．2 万美元买块Jaeger-LeCoultre金表。但去年,当这位律师患上偏头痛时,他却不得不排着长队,忍受着粗暴的服务,到固营医院去看病。而费用仅仅是6美元。因为是有钱人,庄先生没有透露他的全名。他说宁愿多花点钱,也希望享受到方便舒适的医疗服务。去年底,他     

Pseudodissection of the coronary artery: A variation caused by interventional tools

During PTCA immediate decisions often must be made on the basis of a less than optimum data set. We present a combination of factors which produce an incorrect perception of a coronary artery dissection. This potential must be understood by the interventionalist to avoid misdiagnosis and inappropriate therapeutic maneuvers. © 1993 Wiley-Liss, Inc.     

Cyclic guanosine 3'3' monophosphate concentrations in pre-eclampsia: effects of hydralazine

Objective To elucidate the role of the L-arginine: nitric oxide pathway in pregnancy and pre-eclampsia.
Participants Pregnant women (nulliparous, age < 25 years). Normotensive pregnancy (   n = 22  ) was defined when blood pressure remained at levels of < 120/80 mmHg and there was no proteinuria. Women with pre-eclampsia (   n = 22  ) had blood pressure measurements of > 140/90 mmHg and proteinuria of > 300 mg/l. Nonpregnant normotensive women (   n = 22  ) were studied as controls.
Study Design Blood samples were taken for measurements of ionised calcium, atrial natriuretic factor, cyclic guanosine 3'5'monophophate (GMP), arginine and asymmetric dimethylarginine. Urine samples were collected for determination of cyclic GMP excretion. Cyclic GMP concentrations were also determined in 12 women with severe pre-eclampsia before and after treatment with hydralazine.
Results L-arginine, asymmetric dimethylarginine and atrial natriuretic factor were not different in any group. Cyclic GMP concentrations in plasma [0.94 (SD 0.23) nM] as well as in urine [50.1 (SD15.7)μM] were increased significantly (   P < 0.05  ) in normal pregnancy compared to nonpregnant controls [plasma mean 0.46 (SD 0.12) nM and urine mean 18.4 (SD 10.3) μM], but not in the pre-eclampsia group [plasma mean 0.48 (SD 0.10) nM and urine mean 24.1 (SD 14.5) μM]. Concentrations of cyclic GMP in plasma and urine increased significantly (   P < 0.05  ) in women treated with hydralazine.
Conclusions The differences in cyclic GMP concentrations may reflect differences in nitric oxide production. Hydralazine increases cyclic GMP concentrations in severely pre-eclamptic women. This action could explain the antihypertensive effect of hydralazine.     

儿童感觉统合失调及其影响因素的调查分析

目的 研究儿童感觉统合失调与学习障碍及环境因素的关系。方法 采用感觉统合评定量表和学习障碍(PRS)筛查量表，分别对755名学龄儿童进行检测、分析。结果 感觉统合严重失调率为13．25％；感觉统合正常与失调儿童的学习障碍有统计学差异(P＜0．005)；其中在LD儿童中感觉统合失调率占63．51％；感觉统合失调与母孕期的情绪、是否足月顺产、出生后的喂养方式、居住环境、孩子1岁内有无高热、家长对孩子的态度及期待等因素有关(P＜0．05)。结论 儿童感觉统合失调与环境因素、学习障碍有一定的关系。