关于全科医生若干问题的答复

本对医学院校学生就全科医生有关问题给于相应的答复，其中还包括自１９９７年以来由美国全科医学会举办的学生代表大会上所提出的一些问题，例如：什么是全科医生？全科医生的行业范围是什么？全科医生的工作，生活及收入情况如何等等问题。（Ａｍ．Ｆａｍ．Ｐｈｙｓｉｃｉａｎ１９９０．６０：１６７－１７４）。     

Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.     

Euthanasia and assisted suicide in the Netherlands: Clarifying the practice and the nurse's role

Many people believe that euthanasia and assisted suicide are condoned carte blanche in the Netherlands. Not true. Both are formally forbidden by criminal law and can be administered only when certain procedures and criteria have been followed. Below, a look at the policies and practices regarding euthanasia and assisted suicide in The Netherlands and the role of nurses in this area.     

Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.     

低潮气量和呼气末正压在肝肺综合征患者肝移植期的临床应用

目的:终末期肝硬化患者肝病晚期常合并肝肺综合征,伴随低氧血症出现,在肝移植期间进行针对性的通气治疗和管理,对于降低肝移植期的肺部并发症,甚至降低死亡率具有重要的临床意义。文章综合分析低潮气量和低呼期末正压通气对肝移植期间呼吸治疗的作用及其愈后。资料来源:应用计算机检索1970-01/2007-07MEDLINE及万方数据库有关肝移植期间呼吸治疗方面的文献。中文检索词包括"肝移植,肝肺综合征,潮气量,正压呼吸";英文检索词有"liver transplantation,hepato-pulmonary zsyndrome,Tidal ventilation,end-expiratory positive pressure mechanical ventilation"。包括临床研究(不限观察对象的年龄、性别、种族)和基础研究,不限体内或体外研究。资料选择:共收集到1310篇文献,阅读全部文章的文题和大部分文章的摘要,选择肝肺综合征病理改变和通气治疗方面的文献。排除重复性研究和Meta分析类文章。资料提炼:共得到符合纳入条件的文献159篇,排除1141篇。选择其中27篇英文文献及4篇中文文献进行分析。资料综合:①肝肺综合征发病机制错综复杂,术中血流动力学变化及新肝期内毒素、炎性介质、内环境改变等均易发生顽固性低氧血症,甚至出现通透性肺水肿,导致呼吸和心功能衰竭。这些变化是多因素共同作用的结果,在众多发病机制中,肺不张、门肺分流、通气减少或灌流增加均可使通气/灌流比值降低,是导致低氧血症的重要原因。②目前关于肝肺综合征主要是药物处理文献较多,但呼吸治疗报道尚未见到。③根据临床表现术前动脉血氧分压<60mmHg(1mmHg=0.133kPa),动脉二氧化碳分压在正常范围,以及新肝期供肝炎性介质释放,类似于急性呼吸窘迫综合征,因此临床处理均采用呼吸治疗,小潮气量和呼气末正压治疗效果及预后较好。结论:肝肺综合征患者肝移值围手术期应用小潮气量和呼气末正压机械治疗,可降低术后肺部并发症和重症监护时间。     

骨纤维结构不良的诊断和治疗进展

目的:对长期以来关于骨纤维结构不良大量相关研究及文献进行回顾,综述骨纤维结构不良的诊断和治疗的最新进展。资料来源:通过计算机互联网检索OVID数据库1966-01/2006-10关于骨纤维结构不良的文献,检索词:Osteofibrous dysplasia,限定语言种类为English。同时检索1994-01/2006-10中国全文期刊数据库有关骨纤维结构不良的文献,检索词为:骨纤维结构不良,限定语言种类为中文。资料选择:选择与骨纤维结构不良相关的观察对比研究、经验总结、个案报道、最新研究进展等文献,力求资料全面,排除重复研究。资料提炼:共收集相关国内外文献41篇,排除重复性研究11篇,采用30篇,包括关于骨纤维结构不良定义、发病机制、病理、诊断及治疗等。资料综合:①骨纤维结构不良是一种起源于纤维组织的良性骨肿瘤。发病率低、误诊率高。目前具体发病机制不明,现认为与常染色体显性遗传有关。②骨纤维结构不良好发于胫骨,症状为局部肿块。特征性影像学表现为胫骨中段前侧皮质膨胀性密度减低。确诊方法为病理检查。重点与骨纤维异常增殖症、造釉细胞瘤相鉴别,现有大量研究证明该病与造釉细胞瘤有联系。③治疗上过去认为10岁以前应保守治疗,10岁后选择手术治疗,目前倾向于早期骨膜外切除手术治疗。结论:骨纤维结构不良发病率低,对该病认识较少,误诊率较高,重点需与骨纤维异常增殖症、造釉细胞瘤相鉴别,应提高对该病的认识与重视程度,对可疑者行病理检查,确诊者行骨膜外切除,切除范围较大的病例行重建手术。     

Donor sepsis is not a contraindication to cadaveric organ donation

Systemic donor infection is regarded as being an absolute contraindication to cadaveric organ donation for transplantation. This is largely due to fear of transmitting pathogenic organisms to the immunosuppressed recipient. However, due to the current shortage of organs available for transplantation, clinicians are faced with the option of using organs from 'non-ideal' donors, such as those patients with documented evidence of infection. We report the successful outcome of six orthotopic liver transplants, 11 renal transplants, one combined heart lung transplant and one simultaneous kidney and pancreas transplant with organs from eight donors in whom bacterial meningitis (n = 7) and acute bacterial epiglottitis (n = 1) were the antecedent causes of death.