Bioavailability and biological efficacy of a new oral formulation of salmon calcitonin in healthy volunteers.

Salmon calcitonin (SCT) is a well-tolerated peptide drug with a wide therapeutic margin and is administered parenterally for long-term treatments of bone diseases. Its clinical usefulness would be enhanced by the development of an orally active formulation. In this randomized crossover double-blinded phase I trial, controlled by both a placebo and a parenteral verum, we have tested a new oral formulation of SCT associated with a caprylic acid derivative as carrier. Eight healthy volunteers received single doses of 400, 800, and 1200 microg of SCT orally, a placebo, and a 10-microg (50 IU) SCT intravenous infusion. SCT was reliably absorbed from the oral formulation, with an absolute bioavailability of 0.5-1.4%, depending on the dose. It induced a marked, dose-dependent drop in blood and urine C-terminal telopeptide of type I collagen (CTX), a sensitive and specific bone resorption marker, with the effects of 1200 microg exceeding those of 10 microg intravenously. It also decreased blood calcium and phosphate, and increased the circulating levels of parathyroid hormone (PTH) and, transiently, the urinary excretion of calcium. It was well-tolerated, with some subjects presenting mild and transient nausea, abdominal cramps, diarrheic stools, and headaches. This study shows that oral delivery of SCT is feasible with reproducible absorption and systemic biological efficacy. Such an oral formulation could facilitate the use of SCT in the treatment of osteoporosis and other bone diseases.     

Preoperative endoscopic sphincterotomy in the treatment of patients with cholecystocholedocholithiasis

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) prior to laparoscopic cholecystectomy (LC) are the most common methods for the diagnosis and treatment of patients with cholecystocholedocholithiasis. We evaluated the selection criteria for preoperative ERCP examination and the results of endoscopic-laparoscopic treatment of patients with choledocholithiasis. Between January 1993 and December 1998, 1630 patients with symptomatic cholelithiasis were admitted for surgical intervention. Preoperative ERCP was performed in 247 patients according to the selection criteria. The criteria to perform ERCP were dilated common bile duct (CBD; more than 8 mm), abnormal serum liver test results, and a recent history of pancreatitis. Endoscopic sphincterotomy (ES) was performed if CBD stones were found during the procedure. LC was then carried out within 3 days after ES. Of the 247 patients selected for preoperative ERCP, CBD stones were confirmed in 146 patients (59.1%). ES was successful in 141 patients, and stone clearance was achieved in 133 patients, resulting in a 94.3% success rate. Eight patients (5.5%) had complications after endoscopic intervention, all of which resolved uneventfully. Open operative procedures were carried out in a total of 31 patients. Overall, 115 patients were successfully treated by this endoscopic laparoscopic sequence. The length of hospital stay in these groups was significantly lower than that for patients in whom an open method was employed. Preoperative ES combined with LC is a safe and effective therapy for cholecystocholedocholithiasis, and the criteria that we used for the selection of patients seem to be appropriate. Received: July 4, 2000 / Accepted: October 12, 2000     

电视腹腔镜泌尿外科手术36例报告

目的 :探讨腹腔镜治疗泌尿外科疾病的效果。方法 :应用电视腹腔镜治疗泌尿外科疾病 36例 ,其中肾囊肿去顶术 2 2例 ,肾上腺肿瘤切除 10例 ,肾切除 2例 ,隐睾切除 1例 ,肾错构瘤剜除 1例。结果 :一次手术成功 34例 ,1例肾错构瘤 ,1例肾囊肿术中中转开放术。术后平均住院 6± 4d。结论 :腹腔镜手术治疗泌尿外科疾病安全 ,有效 ,损伤小 ,患者术后康复快 ,疤痕少 ,值得推广 ,但须掌握适应证     

门诊输液室开展数字化药学服务初探

目的探讨用医院数字技术在门诊输液室开展药学服务的可行性,满足门诊输液患者对注射用药相关知识的需求。方法培训护士熟练掌握药学知识及计算机药学服务模块的应用,患者来注射室治疗期间,向其讲解所用药物的使用方法、注意事项等,根据其需要打印药品说明书等。结果应用药学服务模块进行药学服务后,患者对药物、输液知识健康教育满意度显著高于实施前(P0.05,P0.01)。结论门诊输液室利用数字技术开展药学服务能提高患者对健康教育的满意度。     

阴囊皮瓣修复阴茎缺损的临床应用

目的探讨阴囊皮瓣修复阴茎大部分缺损的临床效果。方法对由不同原因引起阴茎缺损的17例患者，采用阴囊皮瓣进行修复。在阴囊根部两侧阴囊前动脉之间的无血管区剥离一腔隙，将延长后的阴茎海绵体经腔隙转移至阴囊皮瓣的下方，以包绕海绵体创面，皮瓣缝合后瘢痕在阴茎腹侧。结果切口均Ⅰ期愈合。术后随访患者1～9年，未出现皮瓣坏死现象，阴茎的外观及功能恢复较好。结论阴囊皮瓣的血运丰富、组织柔软、弹性好、伸缩性强，而且此手术切口隐蔽，是修复阴茎缺损较理想的皮瓣。     

Violence at the workplace--a questionnaire survey of nurses.

BACKGROUND: In the health sector, anywhere in the world nurses are one of the most exposed groups to violence. However, it is not obvious that psychiatric nurses (PNs) are more exposed to aggression and burnout. OBJECTIVES: To determine the nature and effects of aggressive acts towards nursing staff in psychiatric and other medical services in Poland. METHODS: Various questionnaires (Stress at Work Scale, General Health Questionnaire, Maslach Burnout Inventory, Work Satisfaction Scale), were distributed among psychiatric (N=78) and non-psychiatric nurses (N-PNs) (N=335). A 92.6% response rate was achieved. RESULTS: Significant differences were found between PNs and non-psychiatric counterparts with respect to their experiences of violence. The most frequently reported incident was verbal abuse, followed by threats and physical assault. Patients were significantly more frequent perpetrators in psychiatric wards than in others. The level of intra-staff aggression did not significantly vary between groups, neither did the level of work satisfaction and absenteeism. CONCLUSION: The frequency of violent acts and stress related to them point out the strong need for the development of preventive programs to address the issue of violence at work.     

猪脱细胞真皮基质修复兔腹壁缺损的实验研究

目的研究猪脱细胞真皮基质修复兔腹壁缺损的效果,探讨异种脱细胞真皮基质应用的可行性。方法健康小白猪1头,取背部及两侧皮肤制备脱细胞真皮基质。26只日本大耳白兔,雌雄不限,体重2.2～2.3 kg,随机分为对照组(n=6)和实验组(n=20)。对照组制备5.0 cm×0.5 cm腹壁缺损,单纯缝合关闭缺损。实验组制备5.0 cm×2.5 cm腹壁缺损,用同样大小的猪脱细胞真皮基质补片(简称"补片")修复,补片基底膜面朝向肠管。术后观察是否有疝形成,比较两组腹腔内脏器粘连情况,以及对照组腹壁肌筋膜单纯缝合处和实验组补片-腹壁肌筋膜吻合处的最大张力,组织学观察补片是否有纤维血管组织长入及其在体内的生物学转归。结果实验动物均无疝形成。术后5周,实验组补片和腹壁融为一体,补片皮肤面和脏器面均有纤维血管组织长入,补片处于新生组织掺入重建过程。实验组1只动物补片和腹腔内脏器粘连较重(2级),5只发生了轻微粘连(1级),12只无粘连(0级);对照组1只轻微粘连(1级),5只无粘连(0级);两组粘连分级比较差异无统计学意义(Z=—0.798,P=0.425)。术后5周,实验组补片-腹壁肌筋膜吻合处的最大张力为(13.0±5.5)N,对照组腹壁肌筋膜单纯缝合处为(13.6±4.0)N,差异无统计学意义(t=—0.410,P=0.683)。组织学观察显示,术后5周,实验组补片中有大量小血管,并有中性粒细胞及淋巴细胞为主的炎性浸润,补片边缘偶见巨噬细胞,补片-腹壁肌筋膜吻合处由纤维结缔组织连接;术后6个月,补片及周围炎性反应消退,胶原纤维结构发生了改建,补片和肌筋膜层由有纤维结缔组织愈合。结论补片修复兔腹壁缺损取得了较好效果,补片-腹壁肌筋膜层愈合,其吻合处的力学强度达到了自体腹壁单纯缝合吻合的力学强度,补片胶原纤维结构发生了改建。     

髋臼骨折ABC损伤变数定位系统的设计与1122例多中心研究分析

目的：设计髋臼骨折ABC损伤变数定位系统并通过1122例髋臼骨折多中心分析研究,探索该系统的可行性与临床实用价值。方法：根据髋臼三柱壁概念,参考髋臼骨折多米诺骨牌效应所致的骨盆环损伤方向和股骨近端关节损伤程度,设A类为髋臼任何一柱、壁骨折;B类为任何二柱、壁骨折;C类为髋臼前、中（臼顶）、后柱/壁混合骨折。小写英文字母a、m、p,分别代表前、中、后柱/壁骨折。采取损伤变数分型：髋臼损伤变数,1系简单移位骨折;2系粉碎骨折;3系压缩性缺损。盆环损伤变数：α系骶髂关节/骶髂处骨折呈水平位分离变位;β系前者垂直方向分离变位;γ系耻骨联合分离/耻骨上、下支骨折变位;δ系αβγ综合性的浮动损伤。股近端关节损伤变数：Ⅰ系股骨头骨折;Ⅱ系股骨颈骨折;Ⅲ系股骨转子部骨折;Ⅳ系Ⅰ～Ⅲ混合性骨折。应用上述构成的髋臼骨折ABC损伤变数定位系统,统计1997年3月至2010年2月,1122例髋臼骨折,其中18例双侧髋臼骨折,共1140例髋。分析研究骨盆前后位片,髂骨、闭孔斜位片及2/3DCT资料。结果：1140例组别各损伤变数构成比：A类骨折237例（20.8%）,B类骨折605例（53.1%）,C类骨折298例（26.1%）。涉及前柱壁骨折808例,发生率为70.9%,中柱壁骨折507例,发生率为44.5%,后柱壁骨折1026例,发生率为90%。涉及髋臼变数1,即简单移位骨折203例（17.8%）;变数2,即粉碎性骨折516例（45.3%）;变数3,即压缩性骨折缺损421例（36.9%）;涉及骨盆环损伤249例,占总数21.8%;涉及股骨近端骨折75例,占总数的6.6%;双侧髋臼骨折与相关盆环、股骨近端变数组18例（1.6%）。1140例髋臼骨折之关键部位与疗效要素：涉及髋臼中（臼顶）柱/壁骨折507例（44.5%）;压缩性缺损421例（36.9%）;盆环变数249例（21.8%）;股近端关节变数75例（6.6%）;而相对简单的Aa/p1/2、Bap1/2型髋臼骨折486例（42.6%）。结论：研究表明髋臼损伤变数中粉碎压缩,尤其是压缩缺损骨折占重要比重,同时彰显了髋臼骨折合并骨盆环或股骨近端损伤变数并非少见。该研究揭示了髋臼骨折损伤变数之间的相互关系,其百分比表明了临床治疗的重点和要素：负重之臼顶44.5%;压缩之缺损36.9%;盆环之浮动21.8%;＂头-臼＂之双折6.6%。该系统在伤情评估、解剖定位、难度指数、选择对策、手术入路、疗效预后等方面,起到临床指导作用,创建了同类型骨折损伤变数的比较,为＂同质语言＂的交流,探索了新的途径。     

甲状腺锥体叶^99mTc显像的临床价值

目的：探讨甲状腺锥体叶显像的临床价值。材料和方法：常规肘静脉注射９９ｍＴｃＯ－４后３０分钟甲状腺显像,对２６０例甲状腺机能亢进症患者和２４３例非甲亢对照组患者行甲状腺显像,观察甲状腺锥体叶的出现情况。结果：２６０例甲亢患者中７８例锥体叶阳性,２４３例对照组中８例锥体叶阳性,两者差异有显著性（Ｐ＜００１）,锥体叶阳性对甲亢诊断的敏感性为３００％,特异性为９６６％。锥体叶可位于峡部或一叶上方,多呈舌状,放射性分布略低于左右叶,大小不等。甲亢术后原有锥体叶可长大。结论：甲状腺锥体叶显像有助于甲亢的临床诊断。     

胆酸对肝硬化大鼠肝大部分切除术后肝脏功能的影响

目的探讨胆酸对肝硬化大鼠肝切除术后肝脏功能的影响。方法24只肝硬化大鼠肝切除术后随机分为胆酸组和对照组喂养1周,每组12只。对照组给以标准饲料喂养,胆酸组给以含0.2%胆酸的饲料喂养。1周后检测大鼠胆汁分泌速度及胆汁总胆汁酸（TBA）含量,检测肝功能、有丝分裂指数（MI）、增殖细胞核抗原（PCNA）标记指数、细胞核DNA含量。结果胆酸组胆汁分泌速度、胆汁TBA含量、血清ALB含量、MI、PCNA标记指数、细胞核DNA含量均高于对照组（P〈0.01）,血清谷草转氨酶（AST）、谷丙转氨酶（ALT）含量均低于对照组（P〈0.01）。结论胆酸可以增加肝硬化大鼠肝切除术后胆汁分泌速度及胆汁TBA含量,促进大鼠肝功能恢复和肝再生。