带血管甲状腺-甲状旁腺移植术5例报告

用带血管的胎儿甲状旁腺移植术治疗甲状旁腺机能低下症,共行手术6次(腹腔内移植5次,股三角区移植1次),6次中有3例术后发生4次排斥反应。经1年8月至3.5年随防,疗效显著者2例,有效2例,失败1例。本文讨论了有关甲状旁腺移植的手术方法、注意事项、免疫抑制剂应用等问题。     

SARS流行期间肺炎患者的临床表现和胸部影像变化的探讨

目的 探讨SARS流行期间肺炎患者的临床表现和胸部影像变化特点。方法 对76例SARS流行期间发热留观室收治的肺炎患者的临床表现及胸部影像进行分析。结果 (1)此组肺炎患者多为青壮年(占60．53％)，无固定职业或职业性质流动性较大者居多(69．74％)；(2)临床特征主要是发热，以中高热为多见(80．26％)，发病早期部分患者呼吸道症状并不明显(67．10％)，外周血WBC在正常或低于正常范围(85．53％)，淋巴细胞比例减少(75．00％)；(3)肺部CT表现为不同程度的炎性浸润；病灶形态以斑片状和球形多见(77．63％)；病灶常位于肺周边，常出现支气管气像；动态观察病变影像大多无明显进展(88．16％％)，经治疗均完全吸收。结论 SARS流行期间普通肺炎与非典型肺炎有相似的临床及胸部影像表现；肺部CT扫描能早期发现肺炎患者的异常阴影，明显优于胸片，但无特异性。因此，在SARS流行期间发热诊室医务人员应加强肺部炎性改变的早期诊断和鉴别诊断水平。     

咀嚼槟榔习惯与牙体磨损关系的临床研究

目的 :探讨长期咀嚼槟榔与牙体磨损的关系。方法 :对长期咀嚼槟榔的 6 4例患者的咀嚼槟榔时间、频率及其牙体牙合面磨损、曲面体层片进行分析。结果 :所有患者后牙牙合面出现不同程度的磨损 ,且咀嚼槟榔时间越长 ,牙合面磨损越严重 (P <0 .0 1) ;咀嚼频率越高 ,牙合面磨损加重 (P <0 .0 1) ,磨损严重者可伴根尖周炎症及牙槽骨不同程度吸收。结论 :长期咀嚼槟榔可导致牙体牙合面不同程度磨损。     

Carotid intima-media thickness in Parkinson's disease.

There have been a few studies and inconsistent results regarding the coincidence of Parkinson's disease (PD) and atherosclerotic diseases, such as cerebrovascular disease. Carotid intima-media thickness (IMT) is a known marker for subclinical atherosclerosis. The aim of this study was to investigate the carotid IMT between PD patients and controls. We studied 43 patients with PD and 86 matched controls. The carotid IMT in PD patients was significantly smaller than in controls (0.796 +/- 0.179 mm vs. 0.913 +/- 0.237 mm, P < 0.05). In multivariate analysis, the carotid IMT was inversely associated with the duration of levodopa medication and the severity of PD. These results suggest that PD patients have a lower risk of atherosclerosis.     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

Factors Affecting Cardiac Catheterization Rates in Elders with Acute Coronary Syndromes

Background: Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear.
Objectives: To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate–do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
Methods: This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
Results: Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
Conclusions: Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.     

特素联合卡铂治疗晚期非小细胞肺癌28例临床研究

目的 评价特素（紫杉醇注射液）联合卡铂（伯尔定）方案治疗晚期非小细胞肺癌（NSCLC）的疗效和不良反应.方法 收集我院2004年3月～2006年12月收治的Ⅲb～Ⅳ期的NSCLC患者28例,进行特素（紫杉醇注射液）联合卡铂（伯尔定）化疗.全部患者均有可测量的指标.给药方法：特素135～175mg/m2d1＋卡铂5mg·ml^-1·min^-1d2,静脉注射,28天为一周期.结果 全组总有效率50.0%,Ⅲb期有效率62.5%,Ⅳ期有效率45.0%.化疗副反应主要是骨髓抑制及消化道反应,其中Ⅲ～Ⅳ度分别为24.0%、10.7%.结论 特素联合卡铂治疗晚期非小细胞肺癌治疗有效,耐受性良好.     

武汉市3～5岁儿童牙齿酸蚀症的研究

目的：调查武汉市3～5岁儿童的酸蚀症流行状况；评价儿童饮用饮料和饮食习惯、口腔卫生习惯与酸蚀症的关系。方法：随机抽样武汉市4所幼儿园3～5岁儿童共500人。对所有儿童进行酸蚀症和龋齿发病情况的临床检查以及问卷调查，问卷内容包括：儿童每天消耗饮料或食物的频率，以及口腔健康行为。收集酸蚀症儿童和无酸蚀症儿童各20人，对其唾液pH值、流速和缓冲能力进行测定和比较。结果：武汉市3—5岁儿童酸蚀症的患病率为9．3％。儿童睡觉时含奶瓶、喝饮料的习惯与酸蚀症的发生呈正相关。酸蚀症儿童和对照组儿童唾液分析结果无显著性差异。结论：预防酸蚀症应该减少酸性食物及饮料的消费量及频率。     

青年维持性血液透析患者心血管疾病调查及危险因素分析

目的调查青年维持性血液透析（MHD）患者心血管疾病的发病情况和病变特点，并探讨其危险因素。方法采用横断面研究。MHD患者98例，以45岁为界分为青年组（47例）和中老年组（51例）。收集患者临床资料和生化指标。心脏超声检查测量心脏腔径及心功能参数。分析青年组患者心脏结构和功能异常的患病率、病变特点及其影响因素。结果（1）47例青年患者中有30例（63．8％）存在心脏结构异常，主要表现为左心室肥厚、左心房增大和瓣膜反流，患病率分别为61．7％、38．3％和34．0％。（2）青年组患者向心性肥厚的患病率为86．2％，离心性肥厚的患病率为13．8％，与中老年组相比，差异有统计学意义（P〈0．05）。（3）与无心脏病变青年MHD患者相比，伴心脏病变者的超滤量、收缩压、血磷和甲状旁腺激素明显增高，而Kt／V、血红蛋白和血清白蛋白明显降低，差异有统计学意义（P〈0．05）。Logistic回归分析结果显示，超滤量、收缩压、血红蛋白和血甲状旁腺激素是青年MHD患者并发心脏病变的独立危险因素。结论青年MHD患者心血管疾病的患病率较高，主要表现为左心室肥厚、左房增大和瓣膜反流。超滤量、收缩压、血红蛋白和血甲状旁腺激素水平可能是影响青年MHD患者并发心脏病变的独立危险因素。