1000例白鼻毛调查

在1000人中统计白鼻毛发生率为36.4%,白发为26.1%,白须为7.5%,白眉为3.3%,白睫为1.6%。我们认为白鼻毛比白发等作为衰老的一项指标更有其代表性。白鼻毛发生率:男性(53.4%)高于女性(13.4%),知识分子(60.8%)高于工人(26.3%)及农民(26.4%),日本人高于中国人,差异显著。     

持续压力超负荷对兔左心室细胞凋亡的影响

OBJECTIVE: To study the effect of chronic pressure overload on the apoptosis of the left ventricle myocytes in rabbits. METHODS: Rabbit models of chronic pressure overload-induced heart failure were prepared in which dynamic changes of apoptotic myocytes in the left ventricle were observed by way of terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. RESULTS: Only a few apoptotic cells was observed in the sham-operated group, while in the experimental group, the apoptotic left ventricle myocytes significantly increased after operation, presenting a peak level between day 3 and day 7. Seven days after the operation, the apoptotic myocytes began to decrease and till day 14, the apoptotic cell number had been smaller than that measured on day 1. When signs of heart failure set in, the apoptotic myocytes were again increased (P<0.001). CONCLUSION: During chronic pressure overload, myocyte apoptosis in the left ventricle is elevated at the early stages and undulates subsequently, with the peak occurring before hypertrophy is obvious.     

Same-Day Upper and Lower Inpatient Endoscopy: A Trend for the Future

Performance of same-day upper and lower endoscopy has many potential advantages, as it may reduce costs, shorten hospital stay, and expedite patient care, but its feasibility, efficacy, and potential have not been carefully defined. We report here our experience with a group of 87 patients who underwent same-day upper and lower endoscopy (174 procedures) over a 2-yr period at a tertiary care VA Hospital, compared with an alternate-day upper and lower endoscopy group of 50 patients (100 procedures) over the same time period. Most patients were elderly males. Common indications for endoscopy were occult or overt gastrointestinal bleeding, previous or concomitant history of pertinent pathology (i.e., polyps, ulcers), abdominal pain, diarrhea, or other symptoms, abnormal radiological studies, and iron deficiency anemia. Both groups required similar amounts of intravenous sedation. There were no complications in either group. In both groups, common positive findings were inflammation (i.e., colitis, esophagitis), benign neoplasms, diverticulae, peptic ulcer, and cancer. In both groups, only 2-6% had negative upper and lower endoscopy, whereas either one procedure was negative in 25% and 18% of cases, respectively. We conclude that the practice of same-day inpatient upper and lower endoscopy is feasible, has excellent diagnostic yield, even in the elderly, and carries no increased risks. When indicated, the practice of same-day upper and lower endoscopy should be encouraged.     

Biomechanical evaluation of spinal stability after disc injury in a porcine model

The biomechanical effects of disc injury on flexion-extension were investigated in nine fresh porcine functional spinal units. Under 12 N-m in extension and 6 N-m in flexion, the range of motion among intact specimens were 23.11 degrees -33.29 degrees (mean = 26.07 degrees , SD = 3.25 degrees ), which shifted to 28.04 degrees -38.46 degrees (mean = 31.69 degrees , SD = 3.50 degrees ) when discs were injured. Similarly, the neutral zones among intact and disc injured specimens were 4.88 degrees -12.75 degrees (mean = 9.32 degrees , SD = 2.60 degrees ) and 9.50 degrees -24.43 degrees (mean = 16.80 degrees , SD = 4.69 degrees ) respectively. To obviate the differences between tested specimens, the changes of neutral zone and the range of motion after disc injury were normalized and expressed as ratios as compared to the same items before disc injury. The neutral zone ratio ranged from 1.29 to 3.18 (mean = 1.87, SD = 0.55, p < 0.01). For range of motion, it ranged from 1.13 to 1.42 (mean = 1.22, SD = 0.09, p < 0.01). The change of flexibility coefficient, however, was statistically insignificant in either flexion or extension. The model presented defines the range of motion, the neutral zone as well as the flexibility coefficient under a specific load. It suggests that major spinal instability can be elicited by a minimum flexion-extension moment, as reflected by a profound change of the neutral zone, after disc injury.     

Passive exercise system: effect on muscle activity, strength, and lean body mass.

There is little information concerning the effects of passive exercise training in healthy humans. This prompted an investigation to evaluate muscle activity and the associated changes in strength and lean body mass resulting from a passive exercise program. Twenty-eight healthy volunteers, aged 26 to 44 years, participated in this six-week study. Lean body mass changes were evaluated by tetrapolar bioelectric impedance measurements, strength changes by isokinetic strength evaluation, and muscle activity by surface EMG techniques. Reproducible muscle activity was recorded in all three muscles studied during two of three preselected exercises. This involuntary muscle activity was attributed to fusimotor and postural reflexes. No significant change (p greater than .05), however, occurred in muscle strength or lean body mass at the end of the six weeks. Lack of these physiologic changes in light of the documented muscle activity is attributed to insufficient training effect.     

Patient attitude towards waiting in an outpatient clinic and its applications.

Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management. This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic. Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise. The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed.     

脑梗塞患者血清脂蛋白（a）测定及其临床意义

应用酶标法测定58例脑梗塞患者和56例健康对照者血清脂蛋白(a)[LP(a)]含量,并同时测定了其他脂代谢指标,对其中26例脑梗塞患者还测定了血浆纤维蛋白溶解(简称纤溶)指标。结果表明脑梗塞组存在显著的脂代谢和纤溶功能紊乱。LP(a)含量增高,与所测脂代谢、纤溶指标无显著相关,是脑梗塞发病独立的危险因素。     

体外循环对瓣膜置换术病人血细胞胰岛素受体和红细胞ATP含量的影响

目的：观察体外循环（ＣＰＢ）对１０例瓣膜置换术病人全血细胞胰岛素受体和红细胞ＡＴＰ含量的影响。方法：利用放射配体结合试验，测定全血细胞胰岛素受体密度和亲和力；用高效液相色谱法测定红细胞ＡＴＰ含量，同时监测血糖和胰岛素浓度。结果：转流３０分钟，血细胞高亲和胰岛素受体（Ｒ１）密度明显增加（Ｐ＜０．０１），亲和力（Ｋ１）明显降低（Ｐ＜０．０１），低亲和胰岛素受体（Ｒ２）密度也明显增加（Ｐ＜０．０１），但亲和力（Ｋ２）变化不大（Ｐ＞０．０５）；停机３０分钟，上述变化有所恢复，但未到转流前的水平。转流３０分钟红细胞ＡＴＰ含量明显降低（Ｐ＜０．０１），并持续到停机后３０分钟，同时伴随血糖明显升高（Ｐ＜０．０１），胰岛素／血糖比值明显降低（Ｐ＜０．０１）。结论：ＣＰＢ可致血细胞胰岛素受体密度增加而亲和力下降，以及红细胞ＡＴＰ含量下降。     

Nephrectomy during operative management of retroperitoneal sarcoma

Background: Complete resection of a retroperitoneal sarcoma often requires removal of adjacent organs. In this study we evaluated the role of nephrectomy during operation for retroperitoneal sarcoma. Methods: Between July 1982 and July 1995, 75 of the 371 (20%) patients who underwent resection of retroperitoneal sarcoma at MSKCC underwent concommitant nephrectomy. Data concerning the reasons for nephrectomy, degree of sarcomatous renal involvement, and survival were retrospectively analyzed. Results: Fifty-four patients (72%) underwent nephrectomy during the initial resection, and 21 (28%) during a resection of a recurrent or persistent tumor. The most common reason for nephrectomy was total encasement by sarcoma (n=40; 53%), followed by dense adherence of the tumor to the kidney (n=21; 28%), and the direct invasion of the kidney by tumor (n=2; 3%). Pathology demonstrated an absence of kidney invasion in the majority of cases (55 of 75; 73%). Renal capsular invasion was present in 11 of 75 (15%), renal parenchymal invasion in 7 of 75 (9%), and renal vein invasion in 2 of 75 (3%) of cases. There were no significant differences in survival based on degree of sarcoma involvement of the kidney, tumor grade, or whether the resection was for primary or recurrent disease. The 53 patients who underwent a complete gross resection of all tumor had a significantly improved long-term survival compared to the 20 patients who did not (50% versus 20% DFS at 5 years, respectively; p<0.001). Conclusions: Decisions for concomitant nephrectomy during resection of retroperitoneal sarcoma should be based on whether this maneuver will provide a complete resection of all gross tumor, in which case the long-term disease-free survival of 50% is comparable to the reported 5-year survival of all patients with retroperitoneal sarcoma who are completely resected. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.