特发性腹膜后纤维化并发肾积水

目的:探讨特发性腹膜后纤维化(IRF)并发肾积水的临床特征.方法:报告12例IRF并发肾积水患者的临床资料.12例均以腰、腹痛为首发症状.B超均发现肾积水及输尿管病变,3例发现腹膜后肿块.腹部CT均发现腹膜后肿块,对肿块的大小和部位均能明确.术前诊断准确率为83.3%.10例行输尿管松解 大网膜包裹或腹腔移位术,1例逆行置人输尿管支架管,1例肾穿刺造瘘.后2例情况好转后,仍行手术治疗.结果:10例随访无复发,1例因同侧肾积水复发行二次治疗,1例因对侧肾积水而行二次手术.结论:腰、腹痛患者应考虑到特发性腹膜后纤维化的可能;B超对肾积水敏感,腹膜后肿块依赖腹部CT检查,两者联合应用有利于诊断.输尿管松解 大网膜包裹或腹腔移位术是主要的有效的治疗手段.单侧腹膜后纤维化患者,随访应同时注意对侧发病的可能.     

OFA/C三联抗幽门螺杆菌治疗的临床观察

目的:探讨一种安全有效价廉的根治幽门螺杆菌(Hp)的治疗方案。方法:2005年4月至2007年4月符合标准病例64例,随机分为治疗组33例[男性19例,女性14例,平均年龄(45.2±6.5)岁],对照组31例[男性25例,女性6例,平均年龄(41.3±8.5)岁]。采用OFA/C方案:奥美拉唑(Omeprazole)、呋喃唑酮(Furazolidone)和阿莫西林克拉维酸钾(Amoxicillin/ClavulanicAcid)三联治疗,与用奥美拉唑、阿莫西林(Amoxicillin)及甲硝唑(Metron-idazole)方案进行比较。结果:治疗组显效达28/33(84.85%),有效达2/33(6.06%);对照组显效达19/31(61.29%),有效达6/31(19.35%),二者间统计学差异有显著性(P<0.05)。人均医疗费用治疗组(180±40)元;对照组(1494±201)元,差异有统计学意义(P<0.01)。治疗组出现2/33(6%)例轻度不良反应,对照组出现5/31(16%)例轻度不良反应,差异无统计学意义(P>0.05)。结论:用OFA/C方案治疗幽门螺杆菌具有疗效显著、不良反应轻微、费用少的优点。     

Treatment with dextromethorphan improves endothelial function,inflammation and oxidative stress in male heavy smokers

Summary. Background: Dextromethorphan (DM) is reported to reduce the inflammation‐mediated degeneration of dopaminergic neurons. Objective: The goal of this study was to test if DM can improve the endothelial dysfunction and inflammatory markers in heavy smokers. Patients and methods: Forty habitual smoking healthy male volunteers (mean age, 31.5 ± 1.4 years) were randomly given either DM (120 mg day^?1) or a placebo for 6 months. We determined endothelial function using the brachial artery diameter changes in flow‐mediated dilatation (FMD) and measured their inflammatory and oxidative markers. A sex‐and‐age matched non‐smoking group (n = 20) was compared as normal parameters. Results: Habitual smokers showed impaired baseline endothelial function in FMD (smoking vs. non‐smoking: 6.3 ± 1.8 vs. 10.2 ± 2.3% respectively, P < 0.01). Without change in smoking behavior, lipid and metabolic parameters, a significant increase in FMD was found in the DM‐treated group (32%), accompanied by a decrease in high‐sensitivity C‐reactive protein (hs‐CRP), phospholipase A₂, matrix metalloproteinase‐3, interleukin 6 (IL‐6) and tumor necrosis factor‐α receptor II (TNF‐α RII) (all P < 0.05), but unchanged in von Willebrand factor (VWF)and plasminogen activator inhibitor‐1 (PAI‐1). An increase in plasma glutathione peroxidase and a decrease in spot urinary excretion of 8‐epi‐prostaglandin F_2a were found in DM‐treated smokers. Conclusions: Our study suggests that a 6‐month treatment with DM can improve endothelial function and attenuate vascular oxidative stress and inflammation markers in habitual smokers.     

胃液血液中β2微球蛋白测定对胃癌的临床意义

目的测定胃癌、消化性溃疡患者胃液、血液中β2微球蛋白含量,以慢性浅表性胃炎作对照,了解其临床意义.方法用放射免疫法测定28例胃癌、40例消化性溃疡、44例慢性浅表性胃炎患者胃液和血液中β2微球蛋白含量.结果胃癌组患者胃液和血液中β2微球蛋白含量显著高于消化性溃疡和慢性浅表性胃炎患者(P＜0.01).结论测定胃液和血液中β2微球蛋白含量对胃癌有一定的辅助诊断价值.     

大鼠烫伤后下丘脑室旁核β-内啡肽的变化及δ受体的作用

目的　探讨大鼠烫伤后不同时间下丘脑室旁核β 内啡肽水平的变化和阿片δ受体的作用。　方法　在大鼠背部 2 0 %体表面积Ⅲ度烫伤后不同时间 ,采用放射免疫分析法测定下丘脑室旁核 β 内啡肽免疫活性物质含量的变化 ;通过下丘脑室旁核微量注射δ受体激动剂DPDPE或其拮抗剂ICI174 86 4后心功能指标和存活时间的变化 ,探讨δ受体在大鼠烫伤休克中的作用。　结果　 (1)大鼠烫伤后 1、2、4h ,下丘脑室旁核 β 内啡肽免疫活性物质的含量显著升高 (P <0 .0 1) ;(2 )与对照组比较 ,给予ICI174 86 4后不同时间 ,动物平均动脉压、左心室内压最大上升速率与各自伤前基础值的比值显著升高 ,给予DPDPE则显著降低。但无论给予ICI174 86 4或DPDPE ,心率比值的变化相差不显著 ;(3)ICI174 86 4组动物的平均存活时间明显长于DPDPE组 (P <0 .0 1)。　结论　下丘脑室旁核 β 内啡肽的过量增加是促使休克加重和加快死亡的原因之一 ,该处δ受体可能起了重要的介导作用 ;拮抗δ受体的作用有利于对抗烫伤休克 ,延长存活时间。     

急性破裂出血动脉瘤弹簧圈栓塞治疗与脑血管痉挛

目的分析电解可脱卸弹簧圈(GDC)栓塞治疗急性破裂出血动脉瘤脑血管痉挛的发生及治疗。方法Hunt-HessⅠ～Ⅲ级并在发病后72h内进行GDC栓塞治疗的动脉瘤病人86例,症状性血管痉挛的诊断根据迟发性神经功能损害,并有TCD和/或脑血管造影的证据。结果共发生症状性血管痉挛17例(19.8%),血管痉挛的发生率和Hunt-Hess分级及Fisher分级有显著的相关关系,平均随访13个月,17例发生症状性脑血管痉挛病人中恢复良好12例,中度致残4例,重度致残1例。结论GDC栓塞治疗动脉瘤后症状性血管痉挛的发生率并不高于常规手术治疗;放置腰椎蛛网膜下腔持续引流可能对降低症状性脑血管痉挛的发生有积极意义。     

急性期川崎病患儿血清sIL-2R CRP IL-6 IL-8 TNF-α的变化

目的　探讨急性期川崎病 (KD)血清 s IL - 2 R、CRP、IL - 6、IL - 8、TNF-α的变化。方法　应用终点散射比浊法、双抗体夹心酶联免疫吸附法 (EL ISA)检测 30例急性期 KD患儿口服阿斯匹林和静脉注射丙种球蛋白前后血清 s IL-2 R、CRP、IL- 6、IL- 8、TNF- α的含量。结果　治疗前 s IL- 2 R、CRP、IL- 6水平高于对照组 (P<0 .0 1 ,P<0 .0 1 ,P<0 .0 5 ) ,治疗后 s IL- 2 R、CRP、IL- 6含量下降 ,与治疗前相比差异有显著性 (P<0 .0 5 ) ;IL- 8、TNF- α在治疗前后与对照组相比差异无显著性 (P>0 .0 5 )。结论　s IL- 2 R、CRP、IL- 6参与了 KD的疾病过程 ,阿斯匹林和大剂量静脉注射丙种球蛋白影响KD患者血清 s IL- 2 R、CRP、IL- 6水平 ,为治疗方案提供了依据。     

不同时间脑室注射脑源性神经营养因子治疗新生大鼠缺氧缺血性脑损伤效果的比较

目的　比较新生大鼠缺氧缺血性脑损伤后不同时间脑室注射脑源性神经营养因子 (BDNF)对脑损伤的影响。方法　 7d龄SD大鼠左侧颈总动脉结扎后行 8%低氧吸入 2 5h形成缺氧缺血性脑损伤 ,伤后 0、1和 4h分别向脑室注射0 5 μgBDNF ,观察对脑水肿、皮层和海马脂质过氧化物(MDA)水平和细胞凋亡的影响。结果　伤后即刻给予BD NF减轻脑水肿、防止MDA过量产生和细胞凋亡增加的效果最为显著 ,伤后 4h给予效果较差。结论　BDNF对新生大鼠缺氧缺血性脑损伤后的皮层和海马具有显著的保护作用 ,以早期应用效果较为明显     

当前医院信息化建设中存在问题与应对策略

目的研究医院信息化建设面临的难题并分析产生原因.方法通过剖析HIS建设中医院决策者的意识,计划,投入,提高对HIS建设的重大意义及其标准化,规范化,科学化的认识.结果针对HIS建设中存在的问题,结合我国医院的实际,提出应对策略.结论HIS建设是医院改革发展的必由之路,运行优良的HIS对医院管理、医疗质量、服务水平、效率效益至关重要,为构建数字化医院提供了平台.     

Recombinant human epidermal growth factor treatment of radiation-induced severe oral mucositis in patients with head and neck malignancies

Mucositis of the oral cavity and pharynx is a major dose-limiting factor in the application of radiotherapy (RT) to patients with head and neck cancer. Therefore, we evaluated the wound healing effect of human recombinant epidermal growth factor (rhEGF) in head and neck cancer and lymphoma patients with irradiation (with or without combined chemotherapy-induced oral mucositis). Patients at Asan Medical Center who had undergone definitive RT of the head and neck region with or without combined chemotherapy and who had developed severe oral mucositis (higher than the Radiation Therapy Oncology Group grade 3) were treated with topical rhEGF twice daily for 7 days. The evaluation of response with regard to oral mucositis was performed 1 week later. Of the 11 treated patients, three had nasopharyngeal carcinoma, three had carcinoma of the oropharynx, two had carcinoma of the oral cavity, one had carcinoma of the hypopharynx and two had lymphoma of the head and neck. Six patients received RT only, and five patients received concurrent chemoradiotherapy. All patients showed improvements in their oral mucositis after topical treatment with rhEGF in that the Radiation Therapy Oncology Group grade was significantly decreased ( P  = 0.0000). This finding suggests that rhEGF is effective and safe for the treatment of radiation-induced mucositis. Further studies are needed to determine the optimal dosage and fractionation schedule.