Review article: Late post‐hysterectomy ectopic pregnancy

Ectopic pregnancy after hysterectomy is a rare but potentially life‐threatening condition requiring prompt diagnosis to prevent the increased mortality associated with rupture. Twenty‐seven cases of late post‐hysterectomy ectopic pregnancy reported in the English literature since 1918 were reviewed and analysed for presenting symptoms, missed diagnosis rate at initial presentation, location of ectopic and rupture rate at diagnosis. The presenting symptoms were found to be non‐specific. The diagnosis in this population is twice more likely to be missed than in women with intact uteri. The rupture rate is 63%, compared with 37% in women with intact uteri. The majority of late post‐hysterectomy ectopic pregnancies (62%) were located in the fallopian tubes. Because of the potential risk of mortality, emergency physicians should always consider the possibility of ectopic pregnancy in childbearing women whose surgical history includes hysterectomy without oophorectomy. Evaluation of abdominal pain in this population should include a pregnancy test to ensure prompt diagnosis when the possibility of pregnancy exists clinically.     

A case of phlegmesia cerulea dolens after dialysis catheter insertion

Phlegmesia cerulea dolens (PCD) is a rare complication of deep vein thrombosis characterized by massive venous thrombosis leading to arterial compromise and tissue ischaemia. PCD carries high morbidity and mortality and is an often times overlooked cause of acute limb ischaemia that must be recognized and treated promptly. Early referral for percutaneous catheter directed thrombectomy offers an alternative to thrombolysis in patients who present with venous gangrene or fail anticoagulation therapy. A case of PCD is presented in a 71‐year‐old woman with end‐stage renal disease 3 days after right femoral dialysis catheter placement.     

What Do Program Directors Look for in an Applicant?

Program directors (PDs) are faced with an increasing number of applicants to emergency medicine (EM) and a limited number of positions. This article will provide candidates with insight to what PDs look for in an applicant. We will elaborate on the performance in the emergency medicine clerkship, interview, clinical rotations (apart from EM), board scores, Alpha Omega Alpha membership, letters of recommendation, Medical Student Performance Evaluation or dean's letter, extracurricular activities, Gold Humanism Society membership, medical school attended, research and scholarly projects, personal statement, and commitment to EM. We stress the National Resident Matching Program process and how, ultimately, selection of a residency is equally dependent on an applicant's selection process.     

阿司匹林和塞莱昔布对幽门螺杆菌的体外影响

目的:探讨阿斯匹林和选择性COX-2抑制剂塞莱昔布对体外培养的幽门螺杆菌(H pylori)生长、毒力因子及外膜蛋白的影响．方法:不同浓度的阿司匹林及塞莱昔布与H pylori共同培养,以活菌计数、分光光度计法检测H pylori的生长状态,分光光度计检测A 560nm值判断尿素酶活性,Hela细胞空泡变性实验和中性红吸收试验检测空泡毒素的活性,以SDS-PAGE电泳检测H pylori外膜蛋白的变化．结果:阿司匹林及塞莱昔布可以抑制H pylori的生长,此过程为剂量依赖性效应．阿司匹林0．5 mmol／L及塞莱昔布0．01 mmol／L时与DMSO对照相比H pylori24 h和48 h的菌落计数开始降低,随着两药剂量的加大菌落计数降低得更加明显,阿司匹林2．0 mmol/L和塞莱昔布0．04 mmol／L时H pylori被完全杀灭．阿司匹林及塞莱昔布可剂量依赖性的抑制H pylori的尿素酶活性及空泡毒素的活性．在对H pylori外膜蛋白的研究中发现,NSAIDs可能对H pylori的某种外膜蛋白表达有影响．结论:阿司匹林和塞莱昔布可抑制H pylori的生长、毒力因子的活性,并可能改变H pylori外膜蛋白的表达．     

慢性乙型肝炎患者及其配偶心理状况

目的:认识慢性乙型肝炎患者及其配偶心理健康、生活质量及心理治疗的相关研究现状。资料来源:检索维普期刊全文数据库和中国医院知识仓库(CHKD期刊全文库)1985-01/2006-01有关乙型肝炎与心理方面的文献,检索词为"生活质量,乙型肝炎,心理健康,心理干预,配偶",并限定语言种类为中文;检索Pubmed数据库同期相关文献检索词为"CHB,quality of life,psychology health",并限定语言种类为英语。其他文章查找具体书籍或杂志获得原文。资料选择:对资料进行初审,选择与乙型肝炎患者及配偶心理健康、生活质量及心理治疗等相关的文章。纳入标准:阐述详细,文章内容较新,有助于说明问题的文章。排除标准:去除重复性研究和一般了解性的文章。资料提炼:共收集到204篇文章及2本相关书籍,符合纳入标准的文章48篇,排除158篇。资料综合:慢性乙型肝炎是一种身心疾病,其发病机制复杂,除与病原和免疫因素有关外,心理社会因素起重要作用。同时,与之共同生活的慢性乙型肝炎患者配偶承受了巨大的心理压力,存在许多心理障碍,即夫妇的心理症状可交互影响。心理治疗对于乙型肝炎患者是必要的。结论:慢性乙型肝炎患者及其配偶存在严重的心理问题,心理治疗能取得一定的疗效。     

体表高频超声技术评价家兔血管成形术后再狭窄模型与病理学结果的相关性

目的:分析体表高频超声检测家兔血管内球囊成形术后再狭窄程度与组织病理学分析的相关性。评估体表超声检测的可行性、可靠性及应用价值。方法:实验于2002-03/2003-12在北京中医药大学中医内科学重点学科实验室完成。①日本大耳白兔26只,随机分为正常组10只、假手术组6只、模型组10只。②模型组电刺激兔颈总动脉,电流1.2mA,刺激12～15min,术后第2天喂饲高脂饲料共8周,假手术组仅剥离颈总动脉,不做电刺激,喂高脂饲料,正常组不施加任何干预因素。③模型组和假手术组根据B超选择颈总动脉有斑块或血流明显改变者行球囊血管内成形术。分别于电刺激后8周、血管成形术后4周行超声检查动脉内径和动脉内膜厚度。④所有动物于血管成形术后4周处死取材,进行病理学半定量分析,并与超声测量结果进行相关分析。结果:进入结果分析数量24只,正常组中途死亡1只,原因为牙齿畸型影响进食。模型组1只因电刺激8周时超声评价颈动脉未形成斑块及血流无明显改变而剔出实验。①超声检测电刺激8周时正常组内膜厚为(0.028±0.004)cm,模型组管壁明显增厚(0.043±0.014)cm,差异有显著性(P<0.05),至血管成形术后膜厚增加更明显(0.064±0.002)cm,内径稍有扩大,但差异不显著。②超声检测模型组颈动脉内径与膜厚的测量结果与病理学测量结果呈正相关关系(OR=0.361,P<0.05;OR=0.526,P<0.01),病理狭窄率与超声是否检测到斑块呈正相关关系(OR=0.796,P<0.01)。结论:体表高频超声在评价家兔颈动脉狭窄诊断中有一定应用价值,与病理学半定量分析结果相关性良好。