某地13所医院1997-2001年门诊费用的基本分析与评价

采用回顾性调查分析方法,对某地13所医院1997-2001年门诊费用变动情况进行分析。统计学处理结果提示样本医院5年来门诊费用平均发展速度和平均增长速度加快明显。作者对此提出借鉴国外教训、避免浪费的建议,以应对医疗费飞涨给全局工作带来的各种冲击。     

定量组织速度成像对右室起搏患者左室收缩运动的研究

目的　应用定量组织速度成像 (QTVI)评价右室心尖起搏 (RVAP)VVI型对左心收缩功能的影响。方法　应用GEVivid 7彩色多普勒超声显像仪对 2 0例RVAP患者和 2 0例正常人的心尖四腔切面的室间隔和左室外侧壁速度和位移曲线进行观察 ,测量心电图Q波分别至室间隔和左室外侧壁收缩期峰速度的时间 ,并除以R R间期进行校正。结果　QTVI显示右室起搏器置入者的室间隔与左室外侧壁速度曲线的收缩期S波非同步出现。Q波至室间隔收缩期峰速度的时间短于Q波至左室外侧壁收缩期峰速度的时间 ,两者分别为 ( 0 .12± 0 .0 2 )s和 ( 0 .14± 0 .0 2 )s,P <0 .0 5。结论　右室起搏后早期的左室整体收缩功能虽未见明显下降 ,但QTVI可以发现室间隔与左室壁收缩明显的不协调 ,可作为早期分析左室收缩运动的定量方法。     

产超广谱β-内酰胺酶菌的检测方法及耐药性的比较

【目的】比较3种方法检测产超广谱β-内酰胺酶(ESBLs)菌株的检出率，了解近期广东省人民医院大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的感染率及其耐药情况。【方法】walkaway-40机鉴定菌种，MIC初筛，双纸片协同试验，确证试验、药敏纸片扩散法。【结果】大肠埃希菌72株和肺炎克雷伯菌78株，确证试验检出率分别为46％和33％。上述产ESBLs菌株对三代头孢菌素和氨曲南大多耐药，对氨苄西林，环丙沙星多呈耐药，亚胺培南100％敏感，对5种复方制剂耐药率为18．2％～100％。【结论】双纸片协同法和NCCLs确证试验均是检测ESBLs的好方法，各实验室应重视ESBLs菌株的检测和药敏试验。     

经导管封闭治疗小儿继发孔房间隔缺损

目的探讨应用经导管封闭治疗小儿房间隔缺损的临床效果.方法 16例ASD患儿.男6例,女10例;年龄2～14(8±4)岁,体重10～40(23±9)Kg.先行右心导管用球囊导管测量ASD大小,选择适合的封堵器,在X线及超声引导下释放封堵器堵闭ASD,术后随访疗效,追踪残余分流率和并发症.结果应用此法封闭16例ASD,全部成功.手术时间为(70±30)血n,透视时间(13±8)min,术中无明显并发症.术后随访右房、右室径较术前明显缩小,恢复正常(P＜0.05);无残余分流发生.结论经导管封闭治疗小儿房间隔缺损术具有创伤小,成功率高,安全性好的优点,但其长期疗效需进一步随访观察.     

喉癌术后迟发性感染32例报告

目的：探讨喉癌患者术后出现迟发性感染的原因和治疗方法。方法：患者均为男性，平均58岁；声门上区21例(T1N0M0 5例、T1N1M0 6例、T1N2M0 4例、T2N0M0 2例、T2N0M0 3例、T3N2M0 1例)，声门区10例(T2N0M0 3例、T3N0M04例、T3N1M0 3例)，外院全喉切除术后1例(TNM分期不详)；喉重建术31例，术后18例(56．25％)患者接受放疗。迟发性感染发生在术后1～10个月，平均术后5．6个月；1～3个月13例，4～6个月16例，7～10个月3例，合并颌下隙感染2例。静脉应用广谱抗生素同时切开排脓或行局部扩大清创术，32例中23例(72．5％)切口内发现缝合丝线头。结果：10例10d左右完全愈合，22例愈合时间为15d～0，5年，平均2个月。随访2月～8年，失访5例，20例患者存活，9例患者拔管保留喉功能，死亡7例。结论：迟发性感染的主要原因是颈部切口留有缝线、细菌感染、手术局部血运差、放射治疗等。     

SPM5软件分析癫痫患者脑PET图像的应用研究

Objective To investigate the value of statistical parametric mapping 5 (SPM5) and its parameter settings in analysis of PET imaging for epilepsy patients. Methods Seventeen epilepsy patients and seventeen controls were scanned with PET. The datns were analyzed using PET and SPM5 with qualitative and semiquantitative analysis, statistical analysis of the percentage (numbers of agent distribution decreasing in focus to brain) for different parameters combinations, which were value adjustment to contral-p and voxels-k. Results There was decreasing of agent distribution at temporal lobe in epilepsy patients detecting with PET; the T/NT of focus to cerebellum was 1.07±0.24, the T/NT of normal tissue in opposite side to cerebellum was 1.27±0.18, there was a significant difference (t=1.87, P<0.05). Dealing with SPM5, there was more significant decreasing of agent in regions 19, 21, 39 of temporal lobe, regions 7, 19, 31, 40, 47 of parietal lobe and occipital lobe in epilepsy patients. With different value of k, the percentage was (27±22)%, (29±24)%, (32±23)%, (35±27)%, (39±31)%respectively, there was not significant difference (F=0.59, P>0.05) ; for different value of p, the percentage was (42±30) %, (29±25) %, (26±21) % respectively, with a significant difference (F=3.60, P<0.05); there was linear regression in value adjustment to contral-p and the percentage(b=-18.24, t=2.57, P<0.05). Conclusions Semiquantitative analysis by SPM5, the setting of value adjustment to contral-p would affect the results, the smaller of value adjustment to contral-p, the better of the result. SPM5 would be more objective and accurate to locate the focuses.     

Artificial bone of porous tricalcium phosphate ceramics and its preliminary clinical application

Summary The authors have prepared the artificial bone of porous tricalcium phosphate ceramics according to an appropriate formula and manufacturing technology. Physical and chemical testing shows that it possesses several distinguishing features: the communicating pores and macro/micropores; mean pore size, 380 μm (from 240 μm to 510 μm); porosity, 46.4 %; and compressive strength, 97.4 kg/cm². It consists of CaO (49.09 %) and P₂O₅ (48.84 %). The testing of its biocompatibility shows that it is devoid of systemic or local toxicity, and free of irritation or foreign body response in tissues, and it does not result in hemolysis or mutation. The new bone readily grows into its pores with direct contact to the implanted material. 11 cases of bone defects were treated with this artificial bone with satisfactory results.     

颈椎脱位的闭合复位

1985年5月～1996年3月,我们经治34例单纯颈椎脱位患者,30例行Crutchfield颅骨牵引闭合复位,20例成功,占66.6％。在成功组中,牵引重量最大为18kg,无一例出现神经损害加重。不全瘫均有不同程度恢复。尸体头颅标本测定,Crutchfield颅骨牵引承受的最大抗拨出力为60.3kg,在治疗颈椎脱位时,颅骨牵引是安全有效的闭合复位方法。     

The subdivisions of the intermediolateral nucleus in the sacral spinal cord of the cat

The subdivisions of the sacral intermediolateral nucleus (IML) of the cat have been studied by using a double-labeling technique of retrograde Fluoro-gold (FG) and wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) tracing. The parasympathetic preganglionic neurons (PGNs) that were labeled by the FG injected into the pelvic nerve formed a ‘V’-shaped column known as the sacral parasympathetic nucleus (SPN) in the sacral IML. The neurons that were labeled by the WGA-HRP applied to the lateral parabrachial nucleus (PBL) formed an elongated spindle-shaped column extending throughout the IML of the sacral segments. We designated it by the name of sacral visceral sensory nucleus (SVSN). These findings indicate that the sacral IML of the cat contain two distinct subdivisions, SPN and SVSN.     

DNA flow cytometry in stage IB and II cervical carcinoma

In a retrospective study the prognostic significance of nuclear DNA content was investigated, as measured by flow cytometry, of the tumor specimens from 212 women with nonpretreated FIGO stage IB and II cervical cancer. One-hundred and thirty cases (62%) were found to be diploid, whereas 82 (38%) were aneuploid. Univariate analysis of the follow-up data showed an increased relative risk (RR) for recurrence free survival (RFS) for stage II tumors (RR = 1.87, 95% CI: 1.13–3.10, P = 0.015) and for age (RR = 1.52, 95% CI: 0.66–3.52 and RR = 2.35, 95% CI: 1.19–4.65, P = 0.032). Ploidy showed a relative risk of 1.33 (95% CI: 0.83–2.13, NS). In addition, univariate analysis of overall survival (OS) revealed similar results. For the subgroup of patients with primary surgery ( n = 151), positive pelvic nodes (RR = 5.38, 95% CI: 2.70–10.71, P = 0.0001) and parametrial extension (RR = 2.53, 95% CI: 1.24–5.17, P = 0.011) were significant factors for OS after univariate analysis, the estimated effects on RFS were slightly smaller. Multivariate analysis of RFS for the whole study population showed age, histologic grade and stage with a slightly increased risk, but no effect was significant. Ploidy with an RR of 0.97 (95% CI: 0.58–1.62) seems to have no influence on prognosis. For the subgroup with primary surgery, ploidy again failed statistical significance with an RR of 1.20 (95% CI: 0.58–2.49). Our results suggest that abnormalities of the nuclear DNA content in this homogeneous group of patients are associated with clinical and morphological prognosticators, however, ploidy is not an independent prognostic factor for RFS, or for the whole study population or for the subgroup with primary surgery.