儿童脉络丛乳头状癌的影像诊断

目的探讨脉络丛乳头状癌的CT、MR影像学特点,以提高诊断水平。资料与方法搜集5例经手术病理证实的脉络丛乳头状癌的临床影像学资料进行回顾性分析。结果5例瘤体在CT、MRI上均呈乳头状或分叶状,位于颞顶叶及侧脑室三角区,超出脑室边缘向脑实质内生长,周围有明显水肿灶,伴不同程度脑积水。2例有点状钙化,1例中心部有陈旧性出血,1例大囊变。增强扫描,4例瘤体实体明显强化。结论脉络丛乳头状癌的CT、MRI表现具有一定特点,有助于临床诊断,最终确诊依靠病理和免疫组织化学检查。     

不同化学发光分析系统检测丙型肝炎病毒抗体的性能评价

目的 评价罗氏Cobas e601及雅培Architect i2000两种化学发光免疫分析系统检测抗-HCV的分析性能和一致性.方法 按照CLSI推荐的方法对两台分析仪检测抗-HCV的精密度、检出限、阴阳性符合率等性能进行验证试验;两台仪器分别检测120例有反应性血清样本及30例无反应性样本,用Kappa检验评价检测结果的一致性.结果 两台仪器的精密度良好;检出限均为0.3NCU;阴阳性符合率为100％;两个分析系统检测抗-HCV总体符合率为70.67％,无反应性、e601 S/CO≥15.0、i2000 S/CO≥6.0样本结果的符合率为100％,e601 S/CO为1.01 ～5.0和i2000 S/CO为1.01 ～2.0样本结果的符合率为0和44.4％:经统计分析κ=0.35在Kappa系数区段中一致性程度属于弱(κ=0.35,P＜0.05).结论 两个分析系统检测抗-HCV的分析性能均良好,适用于临床标本的常规检测,对于两台仪器检测结果不一致的样本,尤其是e601 S/CO 1 ～ 15及i2000 S/CO 1～6的样本,建议进行补充实验(RIBA,NAT)来明确诊断.     

局部注射糖皮质激素引起骨关节损伤2例报告

肾上腺糖皮质激素应用于临床已有40年历史。因其具有抗炎、抗毒、抗过敏、抗休克和免疫抑制等方面的作用,对于某种疾病具有明显的疗效,在临床上应用较广。但如不能严格掌握适应症、禁忌症、剂量、次数、疗程、间隙时间以及注射部位,滥用会给患者带来严重不良后果。我们近期收治了2例糖皮质激素局部注射致胫骨平台内缘发生坏死的病例,现报告如下。     

我院三年制护生共情特点的调查分析

目的探讨三年制护生共情的特点。方法以2006级三年制护理专业328名护生为研究对象,采用人际反应性指针(台湾修订版)测量,进行t检验分析。结果男女护生在"身心忧患"维度差异有统计学意义;学生干部与非学生干部在"观点取替"、"幻想力"维度差异有统计学意义;家住城市和家住农村的护生在"同情关怀"维度差异有统计学意义;独生子女与非独生子女在"身心忧患"维度差异有统计学意义。结论护生人际反应性指针在不同因素方面存在一定的差异。     

Arnold-Chiari畸形的手术治疗--MRI对中远期疗效的评价

目的通过对比不同术式的术后临床及MR影像效果，探讨Arnold-Chiari畸形的最佳手术方案。方法复习1992年至2002年在我院手术治疗的214例Arnold-Chiari畸形病例的临床及MR影像资料、手术记录，通过与术后1a至10a的随访结果相比较，分析各种术式的临床效果与影像学效果。结果MRI所见与临床效果高度一致。临床效果：轻、中度畸形组病例分别采用术式1(后颅窝减压成形术)、术式2(后颅窝减压成形术 小脑扁桃体切除术)的短期、中期、长期有效率均为100％。重度畸形组病例采用术式3(术式2 脊髓空洞一蛛网膜下腔分流术)的短期有效率为92．2％，中期有效率为97．1％，长期有效率为96．4％。影像效果：术式1的中、长期有效率为100％；术式2的中期有效率为100％，长期有效率为94．4％；术式3的中期有效率为95．7％，长期有效率为91．6％。结论对Arnold—Chiari畸形的手术治疗应根据影像显示的畸形程度采取相应的术式。彻底的后颅窝减压是影响疗效的最关键因素。对巨大的广泛性脊髓空洞病例，在后颅窝减压及小脑扁桃体切除的同时行脊髓空洞一蛛网膜下腔分流是安全、有效的治疗手段。术前畸形复杂、严重，年龄大、病程长是效果不佳的主要原因。     

农村老年人疾病经济风险现状与对策分析

农村老年人是一个疾病经济风险较大,而自身抗风险能力却很弱的群体。长期以来,在我国广大农村地区,由于卫生资源不足,医疗保障制度能力分担能力有限,导致农村老年人群疾病经济风险问题难以有效地解决。因此,应在研究农村老年人疾病经济风险现状的基础上,探讨解决农村老年人疾病经济风险问题的可行办法。     

上泪小管侧壁吻合治疗下泪小管断裂

Raupp于1881年首先报告泪小管吻合术[1]，随着技术的改进，尽管支撑管各不相同[2，3]，但效果均良好，特别是显微镜下泪小管吻合术[4]，更提高了泪小管断裂的治愈率。我院自1995年至今收治5例下泪小管断裂，均获满意效果，现报告如下。临床资料：5例均为下泪小管断裂，自上泪小管冲洗证明上泪小管均未受累，右眼3例，左眼2例，均为男性，年龄最大64岁，最小25岁，平均48．2岁。方法：备带钢丝的硬膜外导管（以下均称导管），长约5－6cm2根，头部制成圆钝的盲端。术前用0．5％地卡因棉片麻醉上下泪小点，约5分钟，用泪点扩张器扩张上下泪点…     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.     

部分板层角膜移植治疗真菌性角膜炎

目的：探讨部分板层角膜移植术治疗真菌性角膜炎的适应证及临床效果。方法：对临床确诊的23例（23只眼）中浅层真菌性角膜炎患者用新鲜尸眼角膜供体行部分板层角膜移植术。结果：23例患者22例治愈,21例植片透明,成功率91．3％,随访2－10个月,植片全部透明。矫正视力0．3－0．8,2例复发。结论：部分板层角膜移植术是治疗中浅层真菌性角膜炎的有效方法。