长耽典籍若谈蔗饴——谈"功夫在医外"

文学素养的提高、医籍经典的研读,对培养医学大家具有重要意义.本文首先举例说明悟经典著作之精髓,临床才能得心应手,其次阐述古代文字和文化知识的重要性,再次谈及孙思邈、李时珍、岳美中等的著述中所论对典籍学习的重要性,最后从<左传>旁及古文化知识学习要有目的、有选择.     

恶性冬眠瘤的临床病理和免疫组化及超微结构观察

目的：了解恶性冬眠瘤独特的临床病理和免疫组化及超微结构变化。方法：收集2例恶性冬眠瘤和4例粘液性脂肪肉瘤的临床资料,所有标本光镜常规切片观察,免疫组化染色检测CKp,SMA,RMA,MyOD1,S100,PCNA,p53。冬眠瘤和粘液性脂肪肉瘤各1例取新鲜组织做透射电镜观察。结果：恶性冬眠瘤与粘液性脂肪肉瘤有显著的组织学、免疫组化和超微结构的不同;例1与腺泡状软组织肉瘤的组织学和免疫组化改变相似,唯有超微结构不同。例2免疫组化与有腺泡样结构的肉瘤不同。结论：恶性冬眠瘤的诊断主要靠超微结构的观察和免疫组化染色。     

Growth, puberty and obesity after treatment for leukaemia

Final height, body proportions, pubertal growth and body mass index were studied retrospectively in 142 survivors of acute lymphoblastic leukaemia (ALL). Treatment consisted of combination chemotherapy and cranial irradiation (18 or 24 Gy). Significant standing height loss and disproportion, with a relatively short back, was seen in both radiation dose groups. Girls were more severely affected than boys. Pubertal growth was adversely affected, with a reduction in peak height velocity in both sexes. Puberty occurred early in girls but at the normal time in boys. Nearly half the group were obese at final height, with no significant difference in incidence between the sexes. The relative roles of cranial irradiation and chemotherapy in the disturbance of growth, puberty and body composition observed in survivors of childhood ALL remain unclear. The aetiology is almost certainly multifactorial, with radiation-induced growth hormone insufficiency, early puberty, steroids and chemotherapy all having a role.     

Renal transplantation and osteoporosis

A cross sectional study assessed the bone mineral density (BMD) of 20 young adult patients who received a renal transplantation in childhood. The BMD of the lumbar spine, mainly trabecular bone, and of the total body, mainly cortical bone, were measured and expressed as an SD score. Fourteen patients (70%) had a BMD SD score of the lumbar spine below -1, of whom six patients were below -2. Fifteen patients (75%) had a BMD SD score of the total body below -1, of whom seven patients were below -2, Both trabecular and cortical bone appeared to be involved in the osteopenic process. The cumulative dose of prednisone was inversely correlated to both lumbar spine and total body BMD SD score. In a multiple regression analysis the cumulative dose of prednisone appeared to be the only factor with a significant effect on BMD SD score. Most young adult patients who had received a renal transplantation in childhood had moderate to severe osteopenia. Corticosteroid treatment played a major part in the development of osteopenia in these patients.     

窒息新生儿血清肝功能和心功能的变化及其临床意义

目的了解窒息新生儿血清肝功能和心功能的变化,有助于指导临床对窒息新生儿重要脏器损害的严重程度的判断,指导临床积极治疗。方法检测60例窒息新生儿(轻度窒息48例、重度窒息12例)的血清总胆红素(Tbil)、直接胆红素(Dbil)、谷丙转氨酶(ALT)、总胆汁酸(TBA)、肌酸激酶同工酶(CK-MB),并设40例正常新生儿作为对照。结果窒息后新生儿Tbil出现下降(P<0.05),并随着窒息程度加重下降愈明显(P<0.05);ALT、TBA、CK-MB出现升高(P<0.05),并随着窒息程度加重升高愈明显(P<0.05)。结论Tbil、ALT、TBA和CK-MB的变化反映肝功能和心功能损害情况,窒息时新生儿肝功能和心功能应予以保护,以减轻窒息对于新生儿重要脏器的损害。     

大鼠注射重组腺病毒Ad-HGF后血清中抗腺病毒抗体的检测

目的观察大鼠重复给与携带肝细胞生长因子基因的重组腺病毒（recombinant adenovirus carrying hepatocyte growth factor gene，Ad-HGF）后，血清中抗腺病毒抗体的出现时间及消失规律。方法大鼠给与不同剂量的Ad-HGF共14次，利用病毒中和反应（细胞病变效应及绿色荧光方法）观察血清中抗腺病毒抗体。结果手术及正常对照组和实验组动物给药7次前血清处理的细胞均出现明显细胞病变效应及强荧光。之后各剂量组动物血清均对腺病毒有不同程度的中和作用，停药后13周到14周抗体水平很低或已不存在。同时观察到动物性别及给药剂量大小无差异。结论大鼠肌注Ad-HGF7次后，动物血清中可检测到抗腺病毒抗体，停药后13周或14周抗体基本消失，此结果对Ad-HGF的实际应用具有指导意义。     

民办高校大学新生SCL—90量表测评分析

目的：了解民办高校大学一年级新生心理健康状况。方法：采用临床症状自评量表(SCL—90)，对中国信息大学一年级全体新生进行心理测量，并对1132个有效样本进行了比较分析。结果：①被试SCL—90测查中度或中度以上的心理问题检出率16．70％，男生检出率为16．15%，女生检出率为17．62％，男女生无显性差异；②不同群体比较：干部、知识分子家庭子女、高收入家庭及低收入家庭子女心理问题发生率较高；③按各种标准分类，不同群体被试的排在前几位的心理问题几乎均为人际关系敏感、强迫症状和抑郁，敌对症状也较为突出。结论：民办高校大学新生心理问题检出率较高，应予关注。     

银杏叶片改善高原移居者脑一体功效能力的对比研究

目的 探讨药物提高和改善高原移居者脑-体作业能力的作用。方法选择驻海拔3700m10个月的某部士兵10人,于服药前、负荷运动前后、服药15d负荷运动前后4个不同阶段采用DDX200型电脑心理生理测试仪进行缺失记忆,左右手及左右脚交叉动作频率的测验,进行服药前后与负荷运动前后的总次数、正确与错误次数的比较。结果服用银杏叶片15d,运动前后缺失记忆在相同时间操作时限内(10s),错误次数(7.0±2.3,8.0±2.8)与服药前运动前后相同时段比较错误次数(11.0±2.7,16.0±2.1),显著减少(P<0.01或P<0.05)。服用银杏叶片15d,运动前后在相同的操作时限内(10s)左右手交叉敲击动作频率正确次数54.0±7.0,52.0±5.1。错误次数11.0±5.3,11.0±5.6与服药前运动前后比较正确次数23.0±6.4,20.0±0.9,错误次数18.0±4.1,19.0±5.4比较,正确次数显著增多(P<0.01),错误次数显著减少(P<0.01)。服用银杏叶片15d,运动前后在相同的操作时限内(10s),左右脚交叉动作频率正确次数为57.0±5.7,50.0±6.9,错误次数7.0±2.4,8.0±3.1与服药前运动前后正确次数34.0±6.8,29.0±5.4,错误次数13.0±4.3,15.0±4.5比较相差非显著(P<0.01或P<0.05)。结论口服银杏叶片15d能显著提高和改善高原移居者脑-体作业效率和能力。     

Effect of Modified Sinisan (四逆散) on Anorectal Manometry of the Constipation Predominant Type of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) of theconstipation predominant type is a functionalintestinal disease characterized by abdominaldistress or pain, changed habit of defecationand abnormal defecation. Its pathogenesishas not been totally clarified yet. This re search is to explore the mechanism of pa tients with IBS of the constipation predomi nant type through the determination of ano rectal pressure via anus and better efficacyhas been obtained in the study by modify…     

年轻妇女宫颈癌临床特征分析

目的分析35岁以下年轻妇女宫颈癌的发病趋势、临床特征变化等.方法对1998年-2003年我院收治的67例年轻宫颈癌患者（研究组）的临床资料进行回顾性分析,并随机选择同期有完整随访资料的82例年龄大于35岁的宫颈癌患者作对照组,分析两组资料间临床特点、病理及预后之间的差异.结果 1998年-2003年6年间年轻宫颈癌的构成比呈现逐渐上升趋势,分别为11.11%、13.63%、15.21%、17.28%、20.89%、23.58%;研究组以接触性出血为主要临床表现,占79.10%（53/67）,与对照组的40.24%（33/82）比较有显著性差异（P＜0.01）;初诊时67例患者中30例（44.77%）曾在基层医院以宫颈炎、宫颈糜烂行对症治疗,12例（17.91%）以月经紊乱行调经治疗,1例术前诊断为子宫肌瘤,术后病检证实为宫颈癌;病理特点研究组内生型比率较对照组明显增高,二者比较有显著性差异;病理类型及组织类型上二者无明显差异,均以鳞癌为主（97.01%、95.21%）,但术后淋巴病理检查显示对照组淋巴转移率高于研究组,有显著性差异.结论年轻宫颈癌患者的构成比呈现明显上升趋势,宫颈癌年轻化趋势明显;年轻宫颈癌临床症状较为隐匿,容易漏诊和误诊.