40所军队医院病种病例分型质量评价结果分析

应用病例分型质量费用监控管理软件和ＳＡＳ６．１２统计软件包,对４０所军队医院５０万份病例样本资料进行深入分析,结果显示：病例分型组合数据稳定,分析结果合理。     

Practice protocol for the examination of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, and urethra

This article details a practice protocol for the examination and reporting of specimens removed from patients with carcinoma of the urinary bladder, ureter, renal pelvis, or urethra. It was created by a multidisciplinary task force of pathologists and oncologists established by the Cancer Committee of the College of American Pathologists. Documentation for the protocol was obtained from the previously published protocol, the medical literature, personal experience, and consultation with colleagues. After creation and review by the task force, the protocol was sent to 1000 randomly selected practicing pathologists as a survey. Their comments and suggestions were addressed in the final version. The protocol was approved by the Board of Governors of the College of American Pathologists.     

lschaemic heart disease: Non-invasive prediction of reperfusion and coronary artery patency by continuous ST segment monitoring in the GUSTO-I trial

In the GUSTO-I ECG ischaemia monitoring substudy, 1067 patientsunderwent continuous ST segment monitoring, using vector-derived12-lead (406 patients), 12-lead (373 patients) and 3-lead Holter(288 patients) ECG recording systems. Simultaneous angiogramsat 90 or 180 min following thrombolytic therapy were performedas a part of the prospective study in 302 patients. Infarct vessel patency was established as TIMI perfusion grades2 or 3 and occlusion as TIMI perfusion grades 0 or 1. Coronaryartery patency was predicted from ST trends up to the time ofangiography. Predictive values at 90 and 180 min after the startof thrombolysis were 70% and 82% for patency and 58% and 64%for occlusion, respectively. In retrospect, accuracy appearedgreatest (79–100%) in patients with extensive ST segmentelevation (400 µV), if both speed of ST recovery and extentof ST segment: elevation were taken into account. Although thethree recording systems differed considerably in signal processing,no significant difference in accuracy was demonstrated amongthese systems. We conclude that continuous ECG monitoring may help select highrisk patients without apparent reperfusion who may benefit fromadditional reperfusion therapy. As ST recovery may occur earlyafter the start of thrombolytics and accuracy of the test isrelated to peak ST levels, the use of on-line ECG monitoringdevices on emergency wards and cardiac care units is recommended.(Eur Heart J 1996; 17: 689–698)     

Incidence of analgesic nephropathy among patients undergoing renal replacement therapy in Czech republic and Slovak republic

BACKGROUND.: The occurrence of analgesic nephropathy (AN) among renal replacementtherapy patients in former Czechoslovakia is not known. Previoussurveys were not based on representative samples and lackeduniform criteria for diagnosing the disease. METHODS.: Incidence of AN in former Czechoslovakia was investigated inpatients commencing renal replacement therapy in 24 (1/3 ofall) dialysis centres from 1 January to 31 December 1992. Patientsshowing an unclear renal diagnosis (n=149) were investigatedwith an interview and renal imaging techniques. The diagnosisof AN was withheld or rejected on the base of recently publisheddiagnostic criteria demonstrating that a decreased renal massof both kidneys combined with bumpy contours and/or papillarycalcifications had a high performance for diagnosing AN (NephrolDial Transplant 1992; 7: 479–486). RESULTS.: Based on the renal imaging criteria, AN was diagnosed in 30of 328 registered patients, resulting in an AN incidence of9.1% while the EDTA data only mentioned an incidence of 4.8%(period 1986–1989). The products most commonly abusedwere analgesic mixtures containing two analgesic substancescombined with caffeine and/or codeine. CONCLUSIONS.: AN was found to be a common disease in the Czech and SlovakRepublics. The disease was diagnosed using reliable renal imagingcriteria.     

Impact of the environment on reproductive health

The WHO workshop on the impact of the environment on reproductive health is summarized. Topics include the nature of environmental factors affecting reproductive health, environmental factors blamed for declining sperm quantity and quality, the effects of natural and man-made disasters on reproductive health, chemical pollutants, how the environment damages reproductive health, and research needs for better research methodologies and surveillance data. Recommendations are made to: 1) promote international research collaboration with an emphasis on consistency of methodological approaches for assessing developmental and reproductive toxicity, on development of improved surveillance systems and data bases, an strengthening international disaster alert and evaluation systems; 2) promote research capabilities for multidisciplinary studies, for interactive studies of the environment and cellular processes, and for expansion of training and education; and 3) take action on priority problems of exposure to chemical, physical, and biological agents, of exposure to pesticides among specific populations, and of inadequate screening methods for identification of environmental chemicals. The costs of environmental injury to reproduction include subfertility, intrauterine growth retardation, spontaneous abortion, and various birth defects. Developed country's primary threats are from chemical pollution, radiation, and stress. There is a large gap in knowledge. Caution is urged in understanding the direct relationship between environmental causes and infertility. Sexual health is difficult to assess and research is suggested. Exposure to excessive vitamin A and toxic chemicals are cited as agents probably having serious effects on malformations. Sperm quality has declined over the decades; there is speculation about the potential causes. The effects of radiation such as at Chernobyl are described. Toxic chemical exposure such as in Bhopal, India killed thousands. Neurological damage is reported for fetuses and infants exposed to methyl mercury. There is the beginning of evidence that complications of pregnancy may be related to pollution levels surrounding industrial plants. Reproductive health is affected through chromosome damage and cell destruction, prenatal death, altered growth, fetal abnormalities, postnatal death, functional learning deficits, and premature aging.     

喉鳞癌瘤内微血管及微淋巴管形态计量研究及临床意义

目的:研究喉鳞癌瘤内微血管和微淋巴管形态、分布、密度,以及相关临床意义。方法:采用5’-Nase-AlPase双重酶组织化学法和HE染色对40侧喉鳞癌标本冰冻切片进行研究。结果:光镜下微血管呈蓝色,微淋巴管呈棕色。除转移组微血管密度显著高于未转移组外,与其余临床指标均未见相关性。结论:瘤内微血管密度与淋巴转移有明显相关,而微淋巴管密度未发现明显临床意义,其机制待深入研究。     

枕下-颞下联合入路颞骨良性肿瘤切除术-附3例报告

目的:介绍枕下-颞下联合入路切除颞骨良性肿瘤的方法及体会。方法:对3例颞枕骨化纤维瘤、颞骨纤维异常增殖症、颞骨血管瘤的巨大颞骨良性肿瘤,均采用枕下-颞下联合入路(倒钩形切口)。辅以显微外科技术进行手术摘除肿瘤。结果:3例均基本完整切除肿瘤,无颅内外感染、脑脊液漏、迷路及颅神经损伤等并发症,经术后随访1.5年～2年未发现肿瘤复发。结论:采用枕下-颞下联合入路切除颞枕骨良性肿瘤可获理想的暴露,最大范围切除肿瘤,可避免损伤毗邻的颅神经、血管以及内耳结构,值得推广。     

喉癌患者血清可溶性白细胞介素-2受体和肿瘤坏死因子水平的研究

应用单克隆、多克隆双抗体夹心ELISA检测了35例喉鳞癌患者的血清可溶性白细胞介素2受体(sIL-2R)和肿瘤坏死因子(7NF-α)水平。结果显示:喉癌患者sIL-2R水平较良性组或正常人显著升高(P<0.001),与喉癌临床分期、临床分型及淋巴结转移密切相关;喉癌患者7NF-α水平只有Ⅳ期显著高于良性组或正常人(P<0.05).提示:血清sIL-2R水平检测可作为喉癌诊断的一项辅助指标,并有助于了解喉癌的临床进程及生物学行为(如淋巴结转移等);TNF-α在介导喉癌的恶病质方面起重要作用。本文还探讨了血清sIL-2R水平在喉癌中升高的机理。