医源性胆管损伤的治疗进展

胆管损伤一直是普外科倍受关注的问题.随着人们对胆管损伤后果严重性认识的提高,并采取了许多积极有效的预防措施,使胆管损伤的发病率有所下降,并随着医学技术的发展和大量的临床实践总结使已经造成胆管损伤的患者在治疗方法和临床疗效上都有了很大改善.同时又面临许多新的困难.本文概述了医源性胆管损伤的治疗现状.     

Is Cerebral Microembolism in Mechanical Prosthetic Heart Valves Clinically Relevant?

BACKGROUND AND PURPOSE: High-intensity transient signals (HITS) are frequently detected by transcranial Doppler (TCD) ultrasound in patients with mechanical prosthetic heart valves (PHVs), but published data about their clinical relevance are controversial. This study was undertaken to determine the clinical relevance of HITS in patients with mechanical PHVs. METHODS: The authors prospectively studied patients with mechanical PHVs using TCD monitoring for microemboli detection with and without O2 inhalation. The cognitive testing of patients included the Mini-Mental State Examination, the Dementia Rating Scale, and MicroCog. RESULTS: The authors studied 36 patients (20 women, aged 58 +/- 13 years). HITS were detected in 72% of patients, with a nonsignificant increase of HITS rate in the aortic valve group (P = .07). There was no significant difference in HITS rate between asymptomatic and symptomatic patients. In a multiple linear regression model, HITS rate was predicted only by younger age (P = .024). No correlation was found between HITS rate and the cognitive performance of patients. There was a significant decrease in HITS rate after 100% O2 inhalation compared to baseline levels (32.8 +/- 40.2 vs 6.1 +/- 11.3, P = .011). Subgroup analysis in asymptomatic patients confirmed this finding (P = .017), but in symptomatic patients, decreased HITS rate was not statistically significant (P = .18). CONCLUSION: Only age was a significant predictor of HITS in patients with mechanical PHVs. The lack of association between HITS, clinical symptoms, and cognitive functioning suggests that most of these signals represent harmless epiphenomena, and only HITS detected after O2 inhalation have any clinical relevance.     

Assessing the gain in efficiency due to matching in a community intervention study

COMMIT (Community Intervention Trial for Smoking Cessation) is a randomized study employing a matched pairs design. Pairs of communities were selected on the basis of their geographical proximity and were chosen to be matched on variables strongly expected to relate to the outcome variable, the smoking quit rate. However, quantitative information was not available to evaluate the efficiency gain from matching. We have used baseline smoking quit rates in the communities as a surrogate for the outcome measure to evaluate the gain in efficiency from the matching. Our method takes account of the possible imperfection of the surrogate as a representative of the true outcome. The method estimates an efficiency gain of at least 50 per cent using the matched design. We also evaluate the further gains in efficiency which would be made by using the baseline quit rate to balance the randomization.     

神经淋巴瘤病一例报告

神经淋巴瘤病(neurolymphomatosis,NL)是指非霍奇金淋巴瘤浸润周围神经系统,临床表现以周围神经损害为主,病理检查可以发现肿瘤细胞在神经组织浸润伴随有髓神经纤维轴索或髓鞘损害.本文报道1例通过神经活检证实的神经淋巴瘤病.     

厄贝沙坦氢氯噻嗪片对血压晨峰及左心室质量相关参数的影响

目的　对结缔组织病 (CTD)伴间质性肺疾病 (ILD)患者进行治疗研究。方法　 13例CTD伴ILD患者治疗半年后复查。结果　 12例患者血沉 (ESR)下降 ,肺功能、一氧化碳弥散量 (DLCO)、PO2 有明显改善 ,且P <0 .0 5。胸片检查 :1例毛玻璃样改变和 1例斑片网格状阴影基本消失。 1例网格状阴影形成蜂窝状影。HRCT检查 :9例毛玻璃样改变中 ,7例有改善 ,2例形成索条蜂窝样改变 ;2例胸膜下结节和 2例胸膜边缘不规则消失 ;3例小叶间隔增厚消失。其余的网状、索条、蜂窝状和肺大泡基本无改变。 1例SLE患者因合并肺部感染而死亡。结论　对急性ILD早期强的松或强的松加免疫抑制剂治疗 ,对慢性ILD可不予特别治疗。对ILD合并肺部感染者 ,要严格掌握激素用量 ,同时加强综合治疗     

Analysis of dietary fat, calories, body weight, and the development of mammary tumors in rats and mice: a review

We have extracted from the literature data from 100 animal experiments, involving 7838 rats and mice, which compared the effects of different levels of dietary fat and/or calorie intake on the development of mammary tumors. Both higher calorie intake (P less than 0.0001) and higher fat intake (P less than 0.0001) independently increased mammary tumor incidence in Sprague-Dawley rats and in mice, as judged from analyses combining ad libitum feeding experiments and restricted feeding experiments. The effect of fat was two thirds the magnitude of the calorie effect in both Sprague-Dawley rats and mice. In ad libitum feeding experiments, a modest but significant (P less than 0.0001) average increase in body weight was found in animals fed high fat diets. However, these differences in body weight did not correspond to differences in mammary tumor incidence. The effect of log body weight on the log odds of tumor incidence was not significant (P = 0.16), while dietary fat intake significantly increased tumor incidence (P less than 0.0001). The collection of animal experimental data supports the hypothesis that, in mammary tumor development, there is a specific enhancing effect of dietary fat, as well as a general enhancing effect of calories.     

Cultural systemic therapy on the kibbutz: Community and family-based treatment of anorexia nervosa

A cultural approach to therapy assumes that community organization and social ideology can contribute to the genesis and maintenance of mental health problems, and also to their resolution. Cultural systemic therapy applies this insight to all relevant levels of the family-community ecosystem. This is demonstrated by focusing on the treatment of anorexia nervosa in the Israeli kibbutz. We analyze the confluence of cultural characteristics with the anorectic syndrome and then illustrate in a case study of how these characteristics can be employed in therapy. Two particular interventions are delineated to document the powerful impact that can be achieved when this approach is applied to severe and long-term disorders: the establishment and ongoing collaboration with an expanded community/family team and a home confinement program.     

可调温式输液加热器的研制

自行设计并制作可调温式输液自控加热器,包括外壳、加热器、自动温控装置、电源4部分,能够满足患者对不同输液温度的要求,并且结构简单,制作成本低,使用方便.