心脏传导的变异性裂隙现象

在连续３６１例患者心内电生理检查中，发现４例有心脏传导的裂隙现象。其特点表现为激动传导方向上远端平面相对不应期（ＲＲＰ）长，程序刺激中先出现传导延缓，随后近端平面也进入ＲＲＰ使传导变为延缓，激动经过近端平面延缓传导后，到达远端平面时其已脱离了ＲＲＰ，使已经在远端传导延缓的情况变为传导正常，与经典的裂隙现象相比，这种裂隙现象的发生机制，与心内电图的表现均有不同，暂定名为变异性裂隙现象。     

自血光量子疗法治疗高粘滞血症30例疗效观察

采用自血光量子疗法治疗高粘滞血症３０例，男２１例，女９例。其中伴发冠心病者７例，高血压病６例，肺心病６例，脑血栓５例，糖尿病４例，脑出血，多发性肺囊肿、药物性皮疹、肺炎各１例，单纯高粘滞血症８例。另设健康对照组３０例。经一疗程治疗，比较患病组治疗前后全血粘度、红细胞聚集指数及红细胞压积均明显降低。本文结果表明自血光量子疗法对高粘滞血症有明显疗效，     

Rural Hospital Inpatient Surgical Volume: Cutting-edge Service or Operating on the Margin?

Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services. Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis-related group (DRG) weights were used to measure complexity of rural surgical cases. Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume-outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them. The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services--and these are considerable--but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionalization of complex surgery are likely to enhance the convenience and safety of surgery for rural citizens.     

Geographic Benefit from Decentralized Medical Education: Student and Preceptor Practice Patterns

The performance of area health education center (AHEC)-stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCH)/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980-1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non-Colorado doctors were more often practicing in rural (non-metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non-MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs.     

膀胱移行细胞癌分级诊断的研究中三种定量分析方法的评价

应用ＨＩ－ＣＩ真彩色病理图像分析仪对８６例移行细胞癌的核形态，ＤＮＡ量和ＡｇＮｏＲｓ颗粒进行了定量分析。三种方法分别和综合作分级判别分析。分级结果与ＷＨＯ分级结果对比并分析他们与预后的关系。结果证明，三种定量方法在膀胱癌分级诊断中都是比较客观而有价值的方法。１级癌的判别效果最好，一致率为９０．９％～１００％。各种方法分级与ＷＨＯ一致率以形态定量法较好，为８６．０％，ＡｇＮｏＲｓ为７７．９％，ＤＮＡ为７６．７％。对预后估计的价值以ＡｇＮｏＲｓ法最好，ＤＮＡ法次之。三种方法综合分级判别可稍提高分级诊断一致率，达８８．４％。     

Duchenne型肌营养不良症105例临床分析及其发病机制的探讨（附4例肌纤维膜冷冻断裂电镜检查）

报告１０５例Ｄｕｃｈｅｎｎｅ型肌营养不良症（ＤＭＤ），其中男１０３例，女２例。年龄４～１９岁，平均６５岁。３２例有阳性家族史。文中对ＤＭＤ的临床表现，血清酶、肌肉病理、组织化学、电镜检查等特点进行了讨论。对其中４例骨骼肌进行肌纤维膜冷冻断裂电镜检查。结果表明，本病肌膜的Ｅ面和Ｐ面的膜蛋白颗粒密度降低，与２例正常骨骼肌相比有显著性差异，支持本病发病机理中的“膜缺陷”学说。     

海南文昌汉族人群中两种葡萄糖-6-磷酸脱氢酶基因突变的研究

目的:分析海南文昌人群中葡萄糖-6-磷酸脱氢酶基因1376G→T、95A→G突变。方法:应用硝基四氮唑蓝定量法进行G6PD缺乏症的筛查,用等位基因特异PCR检测1376G→T、95A→G突变。结果:在358位海南文昌汉族人中,发现G6PD缺乏症患者20例,其中9例患者有1376G→T突变,3例患者有95A→G突变。结论:1376G→T、95A→G突变是文昌人群中常见的突变。     

长泰乐口服液治疗成人急性感染性腹泻45例临床观察

长泰乐生物保健口服液是一种新型腹泻治疗药物，用该药治疗感染性腹泻４５例，与用氟哌酸治疗的对照组比较，结果表明疗效相近，且比后者使用安全。我们认为该药可代替抗生素用于治疗感染性腹泻轻、中型患者，尤其适用于老年、孕妇和儿童。对非感染性腹泻有良好的治疗前景。     

Infantile depression,nonorganic failure to thrive,and DSM-III-R: A different perspective

A controversy exists regarding the classification of nonorganic failure to thrive within the psychiatric nomenclature. There are a number of DSM-III-R diagnoses that may be applied to NOFTT, including Reactive Attachment Disorder of Infancy (RADI) and Major Depressive Disorder (MDD). The behaviors characteristic of NOFTT are symptomatic of depression, and are similar to those exhibited by infants with anaclitic depression as well as those of the adult with depression. The correspondence of the behaviours of NOFTT and the DSM-III-R criteria for Major Depression are reviewed, as are the conceptual and therapeutic reasons to view NOFTT infants as suffering from Depression.     

Evaluation of Tissue-Engineered Skin (Human Skin Substitute) and Secondary Intention Healing in the Treatment of Full Thickness Wounds after Mohs Micrographic or Excisional Surgery

BACKGROUND: Human Skin Substitute (Apligraf, Organogenesis, Inc., Canton, MA) is a bi-layered tissue-engineered living biological dressing developed from neonatal foreskin. It consists of a bovine collagen matrix containing human fibroblasts with an overlying sheet of stratified human epithelium containing living human keratinocytes. Human Skin Substitute (HSS) appears to be immunologically inert, and has shown usefulness in the treatment of chronic and acute wounds. OBJECTIVE: Primary objectives were to evaluate the safety and efficacy of HSS in the treatment of full-thickness wounds in a prospective case series. Secondary objectives were to determine the rate of complete wound reepithelialization, incidence of complete wound healing, pain at wound site, overall cosmetic outcome, and patient satisfaction. METHODS: Fourteen patients were enrolled in the study, of which 12 were evaluable. HSS was applied in a blinded fashion to 6 of the patients immediately following Mohs or excisional surgery for skin cancer. The remaining 6 patients were allowed to heal by secondary intention. Both groups were evaluated at weekly appointments until complete reepithelialization occurred. During each evaluation, wound quality was assessed through the Vancouver Burn Scar Assessment Scale by the investigator and an independent blinded dermatologist. The investigator, blinded observer, and patient further evaluated the cosmetic outcome of the wound through the use of a Visual Analog Scale over a 6-month period. RESULTS: HSS patients and secondary intention patients were equivalent in comorbid factors such as pain, erythema, edema, exudate, infection, or hematoma between the groups. The incidence of complete wound healing at 6 months was 100% for both groups. Both groups also appeared to heal at similar rates, as defined by the complete reepithelialization of the wound. HSS patients ultimately resulted in more pliable and less vascular wounds as defined by the Vancouver Burn Scar Assessment Scale. Patient satisfaction with cosmetic outcome in both groups was positive at 6 months. CONCLUSIONS: HSS appears to be a safe, well-tolerated biological dressing with equivalent comorbid factors to secondary intention healing. HSS, however, seems to produce a more pliable and less vascular scar than those developed through healing by secondary intention. HSS also appears to produce more satisfactory cosmetic results when compared to secondary intention healing.