体内金属物质对热疗影响的实验研究

目的 确定金属物质是否会引起热积聚，损伤内脏局部组织，以明确恶性肿瘤热疗的适用范围。方法 家猪麻醉后腹部切开，植入金属夹和金属吻合钉，给予深部热疗。内生场热疗系统Ⅰ号机220V，500MA；Ⅱ号机220V，600MA，加温20分钟。金属区域、深部组织、直肠置热电偶测温探头，每分钟测温1次。结果 植入金属部位温度较肛温高3～7℃，较深部组织温度高2～6℃，脏器局部组织受损。结论 体内金属物质明显聚热损伤内脏组织，不宜行热疗。     

Naltrexone metabolism and sustained release following administration of an insoluble complex to rhesus monkeys and guinea-pigs

Both the release and the metabolism of naltrexone have been evaluated after intramuscular administration of a sustained release [15,16-3H2]naltrexone aluminium tannate complex in guinea-pigs and rhesus monkeys. In both species, measurable excretion of radioactivity was obtained for greater than 50 days and complete recovery of the dose was obtained in the guinea-pig. The radioactivity excretion rate-time profile differed in the two species with guinea-pig yielding a continuously declining rate and monkey yielding a peak at 5 days. In selected monkey urine samples (days 4, 17-20 and 49-52) subjected to t.l.c., evidence was obtained for the presence of naltrexone, beta-naltrexol and 2-hydroxy-3-O-methyl-beta-naltrexol, mostly as glucuronide and/or sulphate conjugates. The t.l.c. data also suggest that in monkey a naltrexone metabolite builds up relative to naltrexone over the 52 day release period.     

Effect of inspiratory time on tidal volume delivery in anesthesia and intensive care unit ventilators operating in pressure control mode

STUDY OBJECTIVE: To compare the effect of inspiratory time and lung compliance on tidal volume (Vt) delivery in anesthesia and intensive care unit (ICU) ventilators operating in pressure control mode. SETTING: Respiratory research laboratory of a tertiary care medical center. DESIGN: Two anesthesia ventilators with pressure control capability (Narkomed 6000, Drager Medical, Inc, Telford, Pa, and the Datex-Ohmeda Aestiva 5, Datex-Ohmeda, Inc, Madison, Wis) and one critical care ventilator (Puritan Bennett 7200, Puritan-Bennett, Pleasanton, Calif) were studied under varying inspiratory time and lung compliance conditions using a mechanical lung model. INTERVENTION: Each ventilator was set to pressure control mode at a fixed inspiratory/expiratory (I/E) ratio. The respiratory rate (RR) was varied between 6 and 28 breaths per minute. Lung compliance and inspiratory time settings were set to simulate clinical conditions known to affect anesthesia ventilator performance. MEASUREMENTS: Inspiratory flow, Vts, and peak airway pressures were measured using the on-board monitor for each ventilator, and confirmed with the Bicore CP-100 pulmonary mechanics monitor (Bicore Monitoring Systems, Inc, Irvine, Calif). To assess differences in inspiratory flow between ventilators, airway pressures were continuously monitored during inspiration. MAIN RESULTS: Increasing RRs caused delivered Vts to decrease for all ventilators. However, decreases in Vts were significantly larger for anesthesia than for ICU ventilators. At a lung compliance of 0.02 L/cm H(2)O and set Vt of 700 mL, Vt delivery for the Puritan Bennett 7200 ventilator remained at 88% of baseline, but decreased to 76% for the Aestiva 5 when RRs were increased from 6 to 28 breaths per minute (P < .0025). Airway pressure tracings demonstrated a slower increase in inspiratory airway pressure for the Aestiva 5 than for the other ventilators. CONCLUSION: Differences in inspiratory flow delivery between ICU and anesthesia ventilators can cause differences in Vt delivery when the pressure control mode is used at high RRs. These differences can significantly impact the perioperative care of critically ill patients requiring ventilatory support.     

Analyzing and developing effective instructional behaviors for allied health educators

This article discusses interaction alaysis, a procedure for objectively recording and analyzing the verbal interchange between instructors and students, which can aid instructors in setting goals for improving their instruction. The following questions are addressed: Why should instructors study their own behaviors? What conditions are necessary for studying one's teaching behaviors? What is interaction analysis? How does one implement interaction analysis? How does one interpret the results of interaction analysis? What does research indicate about interaction analysis? The authors mention the well-known Flanders System of Interaction Analysis, and outline the use of a simpler system, the System for Coding Interaction with Multiple Phases (SCIMP), developed by Townsend.     

Inpatient admissions for interventional radiology: philosophy of patient management

As an alternative to performing interventional radiology on inpatients under the care of internists and surgeons, the authors have established a cardiovascular radiology admitting service for well-screened, elective patients. The patients are admitted under the care of a cardiovascular radiology fellow and a staff physician. From April 1982 to December 1983, 133 patients were admitted to the service. Patients are cared for in a surgical ward or in an intermediate unit, as determined by the clinical situation. Advantages of this approach include a broader patient referral base, improved rapport with clinical colleagues and patients, improved follow-up data, and rapid evaluation and treatment, resulting in short hospital stays. The major disadvantages involve the commitment of time and staff necessary to provide quality care. The concept of the interventional radiologist in the role of admitting physician has important implications in terms of negotiations for additional financial compensation, commensurate with the skill and time required for performing these procedures and caring for the patient.     

Re-hospitalization after diagnosis of diabetes varies by gender and socioeconomic status in urban African-American and Latino young people

Abstract: Purpose: To examine risk factors for re‐hospitalization after diagnosis of diabetes mellitus amongst urban minority children. Methods: Families of insulin‐treated African‐American and Latino patients aged < 18 yr at diagnosis (n = 216) were interviewed about sociodemographics and other characteristics, on average 5.9 yr after diagnosis. Results and conclusions: About 60% of respondents were re‐hospitalized at least once for diabetes‐related reasons (n = 128). Half of those questioned had Medicaid or no health insurance at all; 23% fit criteria for a non‐autoimmune, type 2 diabetic phenotype. Those who avoided re‐hospitalization were more likely to have been seen initially at a tertiary care facility, to have private health insurance, and to be males. They had, on average, 2 yr shorter duration of diabetes at the time of interview. Risk for re‐hospitalization was not associated with age at diagnosis, ethnicity, diabetic phenotype, or source of care during the past year. In multivariate analysis, predictors of re‐hospitalization were gender [odds ratio (OR) 1.98 for females vs. males (95% confidence interval (CI) = 1.05–3.72)], duration of diabetes [OR = 1.46 per yr (95% CI = 1.36–1.57)], initial ascertainment at a community hospital [OR = 5.44 vs. tertiary care facility (95% CI = 2.61–11.29)] and having Medicaid or no insurance [OR = 2.73 (95% CI = 1.42–5.24)], compared with those with another type of health insurance. There is a high risk of re‐hospitalization after the initial diagnosis of diabetes among insulin‐treated minority children, particularly the uninsured and those on Medicaid, in part related to duration of disease and where the initial treatment occurred.