Treatment of congenital cystic adenomatoid malformation-does resection in the early postnatal period increase surgical risk?

OBJECTIVE: The recent development of fetal ultrasonography has allowed for an increasing number of prenatal diagnoses for congenital cystic adenomatoid malformation (CCAM). However, the appropriate surgical timing of these patients has not been studied as of yet. The aim of this study is to suggest a safe strategy for the treatment of CCAM by identifying the relationship between the timing of surgery and postoperative outcome. METHODS: Between 1987 and 2003, 40 patients (28 males, 12 females) underwent surgical resection for CCAM. The mean age was 38.6+/-9.1 (2 days-13 years) months. CCAM was diagnosed by prenatal ultrasonography in eight patients. Early operations were performed in four out of the eight. Operation was deferred until 2-12 months of age for the remaining four patients. RESULTS: Type I CCAM was found in 20 patients, type II in 20 and no patient exhibited type III. Five patients had associated pectus excavatum anomaly. There were no cases of operative mortality. Seventeen minor postoperative complications developed in 16 patients (40.0%): prolonged chest tube drain in 10, wound infection in 4, and 1 case of pneumonia, empyema and pleural space, respectively. The average hospital stay was 11.8 (6-29) days. During the mean follow-up period of 67.5 months, one patient died of accidental aspiration 7 months after operation during the postoperative recovery course of Ravich operation for pectus excavatum. The remaining patients reported doing well with normal physical activity. All five patients who underwent surgery at the age of under 1 month did not exhibit increased postoperative morbidity. CONCLUSIONS: We concluded that surgery for CCAM could be safely performed in all age groups with satisfactory long-term outcomes. It is suggested that early elective surgical correction can be recommended for a patient whose diagnosis was made in utero.     

神经节细胞胶质瘤恶变及其差异表达基因分析

目的探讨神经节细胞胶质瘤恶性进展的分子变化,为进一步研究分子病因奠定基础。方法取同一患者不断恶化的3次手术标本,行cDNA微阵列检测,分析在不同阶段持续存在的差异表达基因。结果初发(WHO II级)、复发(WHO III级)和再发(WHO IV级)的标本与正常脑组织相比,差异表达基因共19条,其中下调者16条,上调者3条。在下调的基因中,功能明确者有抑制RAF1/MEK/ERKs激酶通路激活的磷酸酰乙醇胺结合蛋白,抑制肿瘤血管增生、侵袭,调控细胞凋亡的碳酰还原酶;抑制c-myc基因表达的肺库否样因子;参与人DNA切除修复的多聚酶ε。结论神经节细胞胶质瘤恶变过程中持续存在的分子变化,以抑制肿瘤增殖基因表达下调为主,其中RAF激酶抑制蛋白、DNA多聚酶ε和碳酰还原酶是参与细胞信号传导和DNA损伤修复等具重要功能的基因,值得进一步研究。     

刍议基层医院急诊工作对护理管理的要求

急诊室是基层医院工作的窗口，护理管理在急救工作中起着至关重要的作用。因此，基层医院对急诊护理管理提出了完善管理制度，各种物品、药品、器材做到“四定三及时”；急诊科设置集中，标志醒目；根据工作特点，严格要求护士；合理安排班次，保证充足的人力资源；加强护士急救技术和心理素质的培训，提高护理质量；不断提高护理管理者的自身素质等要求。     

Elevated concentrations of CRF in the locus coeruleus of depressed subjects.

Research evidence that corticotropin-releasing factor (CRF) plays a role in the pathophysiology of major depressive disorder (MDD) has accumulated over the past 20 years. The elevation of lumbar cerebrospinal fluid (CSF) concentrations of CRF decreased responsiveness of pituitary CRF receptors to challenge with synthetic CRF, and increased levels of serum cortisol in MDD subjects support the hypothesis that CRF is chronically hypersecreted in at least the endocrine circuits of the hypothalamic-pituitary-adrenal (HPA) axis and may also involve other CRF brain circuits mediating emotional responses and/or arousal. One such circuit includes the excitatory CRF input to the locus coeruleus (LC), the major source of norepinephrine in the brain. Furthermore, there are now reports of decreased levels of CRF in lumbar CSF from MDD patients after symptom relief from chronic treatment with antidepressant drugs or electroconvulsive therapy. Whether this normalization reflects therapeutic effects on both endocrine- and limbic-associated CRF circuits has not yet been effectively addressed. In this brief report, we describe increased concentrations of CRF-like immunoreactivity in micropunches of post-mortem LC from subjects with MDD symptoms as established by retrospective psychiatric diagnosis compared to nondepressed subjects matched for age and sex.     

颅面联合入路切除颅眶鼻沟通瘤

本文报告了颅面联合入路成功切除颅眶鼻沟通瘤5例,包括上颌窦腺鳞癌及胚胎型横纹肌肉瘤各1例,嗅神经母细胞瘤2例,分化好的软骨肉瘤1例。重点讨论了手术方法,眼球保留及颅底修复等问题。     

东莨菪碱对大鼠下丘脑室旁核精氨酸升压素的影响

目的 观察东莨菪碱对大鼠下丘脑室核精氨酸升压素的影响。方法 以不同浓度Ｓｃｏｐ推挽灌流大鼠下丘脑室旁核 结果 扣留出液中精氨酸升压素含量随推挽时间延长而增多。结论Ｓｃｏｐ可促进ＰＶＮ释放内源性ＡＶＰ，这对了解Ｓｃｏｐ抗休克的机理有重大的意义。     

钩体基因疫苗对豚鼠延髓原癌基因表达的影响

我们的研究已表明，赖型０１７株钩体外膜疏水蛋白ＯｍｐＬ３９是稳定的免疫原，在此我们分别用ＯｍｐＬ３９与钩体死菌苗和生理盐水对照免疫豚鼠，研究ＯｍｐＬ３９的免疫保护作用和免疫机理，对ＯｍｐＬ３９的抗原特异性刺激引起中枢原癌基因（Ｃｆｏｓ基因）表达进行了观察。结果表明，ＯｍｐＬ３９在豚鼠体内能产生高效价的阳性抗体，免疫保护率为１００％。在ＯｍｐＬ３９对中枢Ｃｆｏｓ基因表达的影响中，我们观察到ＯｍｐＬ３９免疫的豚鼠较空白和死菌苗组Ｃｆｏｓ表达明显少于死菌苗组和空白对照组（ｐ＜００５）。提示ＯｍｐＬ３９能特异性地抑制Ｃｆｏｓ基因的表达，减轻强毒钩体对动物体内的病理损伤，有较死菌苗强的免疫保护作用。     

肾移植前后男性性生活状况比较

目的 :探讨肾移植前后男性性生活质量的变化。　方法 :将 86例男性肾移植病人分为低年龄组 (2 5～ 35岁 ,35例 )、中年龄组 (36～ 45岁 ,2 9例 )、高年龄组 (46～ 5 5岁 ,2 2例 ) 3组 ,分别调查病人患病前后、肾移植术后性生活能力、频率、性生活满意程度等性生活状况。　结果 :86例病人患病前均有性生活能力 ,患病后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 2 8.6 %,13.8和 9.1%。肾移植术后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 88.6 %、75 .9%和 6 3.6 %。　结论 :肾移植术后的性生活质量明显好于患病后 ,年龄越轻、恢复的越理想。     

成本核算在医院管理中的应用和进展

目前,我国医疗总费用的增长速度大大超过了国民经济和财政收入的增长速度[1]。卫生经费投入不足,药费居高不下,政府、企业不堪重负,医疗制度改革势在必行。成本核算是医院经济管理的基础工作,核算工作的深度和层次直接影响医院成本管理的成效。1医疗成本核算的概念医疗成本是卫生服务过程中所发生的物化劳动和活劳动耗费的总和。它由以下6大类成本构成:劳务费、业务费、公务费、原材料费、固定资产折旧费和管理费。医疗成本核算是按照《医院财务制度》有关成本费用开支范围的规定,核算医院在医疗服务过程中所支出的物质消耗、劳务报酬以及有…     

经尿道等离子双极汽化电切(TUPKVP)治疗前列腺增生症580例

目的:探讨经尿道等离子前列腺双极汽化电切术(TUPKVP)治疗前列腺增生的效果。方法:回顾性分析580例良性前列腺增生(BPH)患者行TUPKVP的临床资料。结果:中转开放手术2例,切除前列腺组织10~80 g,平均32.5 g。手术时间25~150 min,平均60 min,术中输血10例,无电切综合征(TURS)发生。术后随访2~36个月,患者最大尿流率升高,IPSS症状评分值降低,排尿通畅,疗效好,并发症少。结论:TUPKVP出血少,手术安全,疗效确切,是治疗前列腺增生的有效方法。