顺氯氨铂(PDD)的毒付作用

自1969年发现 PDD 有强烈的抗癌活性后,国内外大量研究资料认为它具有抗瘤谱广,抗癌作用强,不引起交叉耐药的特点。在多种恶性肿瘤的治疗中取得了显著疗效。是一个颇有前途的新药。随着临床上使用剂量的增加和使用范围的扩大,其毒付作用也越来越引起重视,现加以概述。一、肾脏毒性PDD 具有严重的肾脏毒性,已成为临床上广泛使用的重要限制因素。毒性的发生与用药剂量有关,蓄积中毒后成为不可逆之肾损害。出现肾脏毒性时尿中有红细胞,白细胞与颗粒管型,血清肌酐     

经内窥镜激光止血治疗的进展

新式光导纤维内镜的应用使内镜的功能从单纯诊断向治疗方面扩展,目前国内外已广泛应用内镜治疗消化道出血。在出血病人内镜止血治疗的诸多方法中,激光止血具有安全实用,成功率高,出血复发率低的特点。在三种医用激光中,Nd∶YAG激光可产生巨大的能量和穿透力,成为有前景的内窥镜止血方法之一。为了提高止血效果,人们对传统Nd∶YAG激光止血方法进行了改进,提出激光与硬化剂或肾上腺素联合运用以及水喷射介导的激光止血技术。     

Endothelial progenitor cells modulated by IL-1β in multiple organ dysfunction syndrome in porcine

Objective To investigate the modulation of EPCs by interleukin 1β (IL-1β) and p38 mitogen activated protein kinase (p38MAPK) and the pathogenesis resulting from their dysdifferenfiation after trauma.Method Thirty pigs were divided into a control group (n = 15) and a multiple organ dysfimction syndrome (MODS) group (n = 15), the latter of which were subjected to a "two-hit" injury including hemon'hagic shock and endotoxemia. Phosphorylation of p38MAPK in peripheral blood mononuclear cells was monitored by western blotting. The concentration of IL-1β in peripheral blood plasma was determined by ELISA and the numbers of EPCs with FCM in peripheral blood plasma were monitored. The morbidity rates in the two groups were compared by chi square test. The levels of phosphorylation of p38MAPK in peripheral blood mononuclear cells, the concentmtions of IL-1β in peripheral blood plasma and the numbers of EPCs in the peripheral blood were compared between groups using with Student's t lest. Results The level of p38MAPK phosphorylation was more augmented and the concen-tration of IL-1β higher in peripheral blood mononuelear cells and plasma from MODS pigs compared with those from control pigs; nevertheless the mauler of EPC conspicuously decreased in the peripheral blood (P <0.01). The morbidity rate in the MODS group was much higher than that in the control group (P < 0.01). There were fewer EPCs in the peripheral blood of animals in group M than in the peripheral blood of animals in group C (P <0.01). Conclusions p38MAPK phosphorylation is important for the pathogenesis of MODS. p38MAPK phospho-rylation might cause the concentration of IL-1β in the peripheral blood plasma to rise and could cause a drop in the numbers of EPCs, thereby aggravating the inflanmmatory reaction in MODS.     

对院前急救人员维护患者最大利益决策能力的调查

目的：了解各类院前急救人员对维护患者最大利益决策能力的差别.方法：对院前急救医生和护士采取问卷调查,用Epidata软件建立数据库,用SPSS13.0软件进行统计学分析.结果：328份问卷中,认为有（30.79±24.47）%的情况下难以明确判断如何做才符合患者最大利益,其中医生（23.09±18.25）%低于护士（33.27 ±25.71）（Z=1.618,P=0.011）,本科以上学历护士（26.28±19.71）%低于专科以下护士（34.31±26.36）%（Z=1.375,P=0.046）.结论：院前急救人员对维护患者最大利益决策能力与医疗专业教育有关,在护理人员中与所受教育程度有关.     

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目的 分析和总结残胃癌的外科诊断和治疗情况。方法 回顾分析了28例残胃癌发病率、临床表现及治疗情况。结果 首次胃切除以胃溃疡为主，占64.3%。首次手术B-Ⅱ式22例，占84.6%。确诊残胃癌距首次手术时间平均为28.3年。残胃癌发生在吻合口占50%，残胃小弯侧42.9%，贲门部7.1%。结论 胃良性病行手术治疗时以B-I式为首选；定期胃镜检查残胃癌高危人群，早期诊断、早期治疗是提高残胃癌预后的关键。     

普外科医生的知识,技能和医德

１普外科的发展和范畴我国的外科学是一门历史悠久而又发展缓慢的学科。在古代，中国医学中就已有外科和外科医生。西方医学传入中国，叫西医。新中国建立以后，继承并发展了传统的中国医学，又进一步引进和吸收西方医学而成为中西结合的外科学。我国普外科的发展史主要是...     

胃间质瘤中p16基因缺失和突变的研究

本研究应用聚合酶链反应-单链构象多态性分析(PCR- SSCP)的方法对胃间质瘤(gastric stromal tumors,GST)中p16 基因外显子2的缺失和突变进行检测,目的在于探讨GST中 p16基因外显子2缺失和突变的情况及其临床意义。     

全胃肠外营养对胃癌术后患者的免疫恢复作用

作者对10例非肿瘤患者及22例胃癌患者手术前后和术后行全胃肠外营养(TPN)后的免疫状态变化作了前瞻性的观察.结果胃癌患者血清免疫球蛋白水平显著下降,CD_(?)~ 细胞百分率升高.CD_4~ /CD_(?)~ 比值下降;手术应激引起的免疫抑制在术后第10天已基本恢复;根治性手术可以提高胃癌患者的免疫机能状态;TPN可以增进患者的营养状态,对根治性手术的免疫恢复起明显的辅助作用,表现在显著升高的IgG、IgA、IgM水平,CD_(?)~ 、CD_4~ 细胞百分率,显著下降的CD_4~ 细胞百分率,致CD_4~ /CD_4~ 比值显著升高.     

经腹腔镜阑尾切除术

报告腹腔镜阑尾切除术１２例，术后３天全部出院，无并发症。手术适合于诊断不明确或无法耐受剖腹的病例。