急性冠状动脉综合征的急诊处理原则

急性冠状动脉综合征(acutecoronary syndrome,ACS)的病理机制是动脉粥样斑块纤维帽的靡溃或破裂后,血小板聚积在破溃斑块的表面,黏附的血小板填充在斑块破裂处并产生聚积。纤维蛋白原与血小板相互结合产生的纤维蛋白进一步激活凝血系统,临床上可表现出不同程度冠状动脉堵塞症状     

Phase I trial of doxorubicin-containing low temperature sensitive liposomes in spontaneous canine tumors.

PURPOSE: To determine the maximum tolerated dose, dose-limiting toxicities, and pharmacokinetic characteristics of doxorubicin encapsulated in a low temperature sensitive liposome (LTSL) when given concurrently with local hyperthermia to canine solid tumors. EXPERIMENTAL DESIGN: Privately owned dogs with solid tumors (carcinomas or sarcomas) were treated. The tumors did not involve bone and were located at sites amenable to local hyperthermia. LTSL-doxorubicin was given (0.7-1.0 mg/kg i.v.) over 30 minutes during local tumor hyperthermia in a standard phase I dose escalation study. Three treatments, given 3 weeks apart, were scheduled. Toxicity was monitored for an additional month. Pharmacokinetics were evaluated during the first treatment cycle. RESULTS: Twenty-one patients were enrolled: 18 with sarcomas and 3 with carcinomas. Grade 4 neutropenia and acute death secondary to liver failure, possibly drug related, were the dose-limiting toxicities. The maximum tolerated dose was 0.93 mg/kg. Other toxicities, with the possible exception of renal damage, were consistent with those observed following free doxorubicin administration. Of the 20 dogs that received > or = 2 doses of LTSL-doxorubicin, 12 had stable disease, and 6 had a partial response to treatment. Pharmacokinetic variables were more similar to those of free doxorubicin than the marketed liposomal product. Tumor drug concentrations at a dose of 1.0 mg/kg averaged 9.12 +/- 6.17 ng/mg tissue. CONCLUSION: LTSL-doxorubicin offers a novel approach to improving drug delivery to solid tumors. It was well tolerated and resulted in favorable response profiles in these patients. Additional evaluation in human patients is warranted.     

免疫磁珠分离技术纯化和检测泰泽氏病原体的研究

目的建立泰泽氏病原体(Ty)纯化方法,获得纯的菌体供抗原研究,为ELISA诊断抗原的制备提供依据;并尝试建立Ty隐性感染血清学抗原检查方法。方法选择特异性抗体包被磁珠,从感染大鼠肝脏中富集和纯化Ty;用SDS-PAGE和Western blot技术考察纯化Ty的蛋白和抗原图谱;同时用免疫磁珠分离技术(IMS)直接检查隐性感染大鼠肠道上皮细胞内的Ty。结果用辛酸-硫酸铵纯化的Ty单克隆抗体M5以0·5μg/107beads以上浓度包被抗IgG抗体预结合的磁珠4h,可最大效率地富集Ty;分离反应进行1h,敏感性达到103菌体/mL;吖啶黄染色镜检法可以直接、快速地观察到结合于磁珠上的细菌;抗原分析表明,IMS较好地去除了肝组织和真核细胞成分,纯化的Ty RJ株具有3个免疫优势的抗原成分,相对分子质量(Mr)分别为160×103、116×103、55×103;此外,IMS法可直接从隐性感染大鼠盲肠上皮细胞中检测到少量寄生的Ty。结论用IMS技术可有效地富集和纯化Ty,并可以作为Ty隐性感染血清学抗原检查的候选方法。     

胰腺假性囊肿的诊治体会

目的 总结胰腺假性囊肿的诊治体会。方法 回顾性分析46例胰腺假性囊肿患者的临床资料，7例保守治疗，行内引流术12例，外引流术9例，序贯式内外引流术5例，胰腺部分切除术13例。结果 保守治疗者均痊愈，无复发；行内引流术者中有1例发生肠瘘，其余11例恢复良好无复发；行外引流术1例出现胰瘘，2例复发；行胰腺部分切除术者有1例出现胰瘘，其余恢复良好。结论 根据病情和病程选择合适的术式是治疗胰腺假性囊肿的关键。     

高压氧综合治疗持续植物状态30例疗效分析

目的评估高压氧综合治疗持续植物状态的疗效和探讨最佳治疗方案。方法回顾性分析了1999年—2005年应用高压氧治疗的30例持续植物状态病例,主要分析了原发病因、高压氧治疗次数以及高压氧治疗时机与疗效的关系。结果脑外伤组显效率和好转率明显高于非脑外伤组(P<0.05),开始治疗时间≤30d组及31～60d组好转率明显高于≥61d组(P<0.05)。结论高压氧综合治疗对脑外伤所致持续植物状态患者60d以内开始行高压氧治疗的患者疗效较好。     

从天价医药费事件折射出当前我国医疗机构存在的问题

目前，我国许多医院的医疗卫生工作人员在为患者进行医疗卫生服务的过程中，为了医院和个人的经济利益，存在着过度医疗消费现象。最典型的是哈尔滨医科大学第二附属医院发生的天价医药费事件。导致这种现象出现的原因是由于法律的不健全、制度的不完善等而导致的监督力度不够，加之有些医务工作者在经济利益的驱使下使自己的职业道德滑坡，从而导致了老百姓看病贵现象的出现。     

关节镜辅助下钢板内固定治疗关节内跟骨骨折

[目的]探讨分析关节镜辅助下钢板内固定治疗关节内跟骨骨折的方法和疗效;[方法]对78位患者，86例累及关节面的跟骨骨折在关节镜辅助下行切开复位钢板内固定术，术后平均随访18个月（12～30个月），通过比较术前术后X线片和踝足功能的AOFAS评分对治疗效果作分析评价．[结果]86例关节内跟骨骨折术后X线示复位满意．与术前存在显著性差异（P〈0．01），AOFAS评分优良率91．86％．[结论]对于关节内跟骨骨折，采用关节镜辅助钢板内固定更加接近解剖复位，足部功能恢复满意且并发症少     

带浅静脉干逆行皮瓣早期微血管构筑变化的体视学研究

目的 探讨带浅静脉干的逆行皮瓣早期微血管构筑变化的特点以供临床实践参考。方法 应用生物体视学技术测量带浅静脉干皮瓣微血管体积密度，结合组织学观察，与不带静脉干皮瓣作对照比较。结果 带浅静脉干皮瓣组微血管密度整体水平高于不带静脉干皮瓣组（P〈0．05）。结论 浅静脉干的存在有利于皮瓣的血管化进程，保留浅静脉干对皮瓣成活有利。     

Effects of magnetic resonance imaging diffusion gradient recalled echo on a patient with an intracranial hemorrhage presenting to the emergency department.

Generally, a computed tomography scan is conducted for the diagnosis of stroke in the emergency department, because these scans are easier and faster in the detection of stroke. If there are no signs of hemorrhage on computed tomography scan, an ischemic stroke is diagnosed and treated accordingly. A magnetic resonance imaging scan may be taken in order to verify ischemic stroke. This process may lead to improper treatment and is time consuming. To address this situation, case studies are presented in which magnetic resonance imaging diffusion-weighted imaging and gradient recalled echo were performed to detect hemorrhagic and ischemic stroke and particularly, subarachnoid hemorrhage, which is undetectable with a computed tomography scan.     

Lugol液染色对食管早期癌和癌前病变的诊断价值

目的 探讨Lugol液染色对食管早期癌和癌前病变的诊断价值。方法 对45例食管黏膜可疑病变经内镜以2％Lugol液喷洒染色，观察黏膜染色情况，并取活检送病理组织学检查。结果 45例食管病变染色后，39例呈浅染色或不染色，其中食管癌8例（食管早期癌5例，进展期癌3例），Barrett食管5例，轻至中度不典型增生1l例。本组Lugol液染色对食管早期癌和癌前病变的检出率达46．7％。结论 内镜下应用Lugol液染色结合活检有助于食管早期癌和癌前病变的诊断，且操作简便，具有重要的临床价值。