大树倒了?

2004年8月26日,哈医大二院建院50周年庆典,位于哈市近郊的这所庞大的医院一扫往日的紧张忙碌,被欢快的乐、缤纷的鲜花、五色的气球和飞扬的条幅紧紧包裹。在庆典活动的中心——该院科技会馆,前去采访的本刊记者穿过络绎不绝的祝贺来宾和整齐划一的迎宾方阵,流连在会场外整齐摆放的各类奖杯、奖牌和科研成果宣传展板之间。这些被物化了的荣誉,几乎挤满了偌大的会堂一层走廊的每一寸角落,静静地宣示着这家医院半个世纪的所有自尊和自豪。在随后进行的庆祝仪式上,在医院各科室职工代表声情并茂的发言之后,哈医大二院院长张岂凡走上讲台。面对眼前如云的嘉宾和着装整齐统一的医护人员方阵,看得出这位著名的技术型院长难掩激情。他在题为“弘扬二院精神,再创世纪辉煌“的演讲词中这样形容：“50年的砥砺前行,50年的春华秋实,令天的哈医大二院已经成为我国医院之林中的一棵生机盎然的大树,根深叶茂,硕果累累。”命运总是在不动声色间逆转,谁能料到,一年后爆出的“天价医药费”事件,使曾经激情飞扬的哈医大二院再一次名动天下,所不同的是,再度亮相的哈医大二院,这一次坐在了被告席上。这棵生长了50年的医疗常青树,难道就此在瞬间轰然倒地?     

Diagnostic Accuracy of Cervical Low-Grade Squamous Intraepithelial Lesions Is Improved With MIB-1 Immunostaining.

There is considerable interobserver variation in the diagnosis of low-grade squamous intraepithelial lesion that involves mature squamous epithelium. Our aim was to evaluate the utility of MIB-1 immunostaining as an adjunct test to increase diagnostic accuracy. Consecutive cervical biopsies originally diagnosed as normal (n = 26) or low-grade squamous intraepithelial lesion (n = 23) were reviewed by three pathologists to obtain a consensus diagnosis. MIB-1 immunostaining was performed, and positive staining was defined as a cluster of at least two stained nuclei in the upper two thirds of the epithelial thickness. Human papillomavirus (HPV) DNA detection was performed using a polymerase chain reaction assay. All cases were subsequently reclassified as low-grade squamous intraepithelial lesion (LSIL) or normal (NL) when two or three of three gold standard criteria were satisfied (LSIL gold standard criteria = consensus diagnosis of LSIL, HPV+, MIB-1+; NL gold standard criteria = consensus diagnosis of NL, HPV-, MIB-1-). Using the gold standard diagnoses, we have identified that 14 normal cases (36%) were originally overdiagnosed as LSIL, and one LSIL case (10%) was originally underdiagnosed as normal. All MIB-1-positive cases were HPV+ and identified as LSIL in the consensus review. All MIB-1-negative cases were NL by gold standard criteria. The sensitivity (1.0) and the specificity (1.0) of MIB-1 staining for identifying LSIL were superior to the sensitivity (0.9) and the specificity (0.8) of HPV testing. In conclusion, MIB-1 is a highly sensitive and specific marker for identifying low-grade squamous intraepithelial lesion and is helpful in verifying the diagnosis of equivocal cases.     

新生儿硬肿症脂质过氧化物变化的观察

为探讨脂质过氧化损伤及自由基在新生儿硬肿症发病机理中的作用，将观察对象分为疾病组和对照组，疾病组于入院时，对照组于出生后１周内取静脉血检测血浆脂质过氧化物及红细胞超氧化物歧化酶含量。     

肾综合征出血热患者T细胞亚群数量与白细胞介素2,4水平变化的关系

采用ABC免疫组化染色法及单克隆抗体夹心法ELISA，同步检测了34例肾综合征出血热（HFRS）患者外周血T细胞亚群数量和血清白细胞介素2和4（IL－2、IL－4）水平。发现HFRS病程中各T细胞亚群数量均有不同程度的升高，其中CDS阳性T细胞在各病期均有升高。IL－4水平升高仅见于发热期．而IL－2的升高主要在低血压期和少尿期。病程中有CD4／CD8比值的下降甚至倒置。这种比值的变化与IL－2和IL－4的动态变化有一定的相关性。结果揭示，在HFRS发病机理中存在Thl型和Th2型免疫反应等多种免疫病理机制。     

胸大肌肌皮瓣在口腔颌面部缺损修复中的应用

报道２１９例口腔颌面部肿瘤，其中良性肿瘤１８例，恶性肿瘤２０１例，在肿瘤切除后，均采用胸大肌肌皮瓣修复缺损。采用单皮岛肌皮瓣２０１例，双皮岛肌皮瓣１６例，肌皮骨瓣２例。成功２０１例，失败１８例。讨论了胸大肌皮瓣的优点及适用范围。介绍了手术设计、操作方法。分析了成功与失败的影响因素，认为正确，精细的手术技巧是成功的关键因素。     

“亚地克病”诊断标准探讨及修正建议

在新疆石河子市远郊缺碘地甲病区7～17岁儿童中取样,检测智力、精神运动功能、身高、体重和骨龄,发现精神运动发育障碍和骨龄落后的程度及发生频度明显高于非病区;而智力落后和体格发育落后两区无显著差异。根据这一发现认为在“亚地克病”诊断中,“精神运动发育测验”较“比内测验”更具有特异性和敏感性;建议在“出生、居住于缺碘地甲病区”前提下,将精神运动发育障碍和智力落后并列为主要条件。另根据地克病的分型原则,提出“亚地克病”的分型标准。     

卵巢未成熟畸胎瘤43例综合治疗疗效分析

为探讨不同手术方式及化疗方法对卵巢未成熟畸胎瘤的疗效及相关影响因素，对43例卵巢未成熟畸胎瘤患者进行回顾性分析。手术方式分为：保守性手术（患侧附件、大网膜切除术＋盆、腹腔腹膜结节切除术＋盆腔淋巴结清扫术）及根治性手术（全子宫、双附件及大网膜切除术＿肿瘤细胞减灭术＋盆腔淋巴结清扫术）。术后采用VAC（长春新碱，阿霉素，环磷酰胺）方案、BEP（博莱霉素或平阳霉素，足叶乙叉甙，顺铂或卡铂）方案或VBP（长春新碱，博莱霉素或平阳霉素，顺铂或卡铂）方案进行联合化疗。患者5年生存率根治性手术为44．4％，保守性手术为64．0％，差异无显著性。VAC方案与BEP（或VBP）方案的5年生存率分别为33．3％和77．3％（P＜0．01）。疗程数≥4患者的5年生存率为73．9％，明显高于疗程数＜4患者的38．9％（P＜0．05）。认为对于有生育要求的卵巢未成熟畸胎瘤患者，可仅行保守性手术，术后辅以联合化疗。BEP（或VBP）方案对患者长期生存率的改善明显优于VAC方案。术后化疗的疗程数与疗效有关，对长期生存率的影响较明显。     

A case report and review of filamentary keratitis.

BACKGROUND: Filamentary keratitis is most often a chronic corneal condition, characterized by filaments attached at one or both ends to the cornea. Patients often experience foreign body sensation, grittiness, discomfort, photophobia, blepharospasm, and increased blinking. Filamentary keratitis is commonly the result of aqueous deficient dry eye syndrome. Management options include lubrication, punctal occlusion, removal of filaments, hypertonic saline, mucolytic agents, anti-inflammatory agents, and therapeutic contact lenses. CASE REPORT: A 58-year-old man came to us with acute symptoms of pain, photophobia, and redness x 2 days 0.S. The diagnosis of filamentary keratitis was made based on the clinical findings of positively staining mucus strands attached to the superior cornea. The patient was also found to have dry eye, blepharitis, and floppy eyelid syndrome. Numerous treatment regimens were implemented, including lubrication with non-preserved artificial tears, lubricating ointment, and topical steroids. The patient's condition was finally best managed with silicone plug punctal occlusion and therapeutic contact lenses. CONCLUSION: Filamentary keratitis can be a recurrent and incapacitating condition that may prove difficult to manage.     

复方阴阳莲治疗胆囊炎31例

一般资料31例中,男性21例,女性10例;年龄最小20岁,最大63岁,平均33岁;均符合《中药新药治疗胆囊炎的临床研究指导原则》的诊断标准。治疗方法复方阴阳莲方组:阴阳莲(即虎杖)15~30g,马蹄金15~20g,马齿苋15~20g,蒲公英15~20g,白花蛇舌草15g,金银花15g,白芍15~20g,青皮10~15g,延胡