应用避孕套保护喉镜

喉镜是气管插管的必备工具，为在不影响其使用功能的同时避免交叉感染，我科使用避孕套保护喉镜，取得了良好效果。现介绍如下。     

舒张功能障碍对冠心病的诊断价值

目的应用超声多普勒方法评价冠心病患者的左室整体舒张功能及舒张功能障碍的发生率，探讨舒张功能障碍在冠心病无创诊断中的价值。方法对入选病人行常规检查，同时进行二尖瓣血流频谱、肺静脉血流频谱及二尖瓣环组织多普勒检查，对比临床标准与舒张功能障碍标准对冠心病的诊断率。结果舒张功能障碍标准对冠心病的检出率显著高于临床标准。结论舒张功能检查可作为冠心病诊断的初筛检查。     

Evaluation of the clinical, hemodynamic and neurohormonal response to levosimendan administration in decompensated heart failure patients. One-month follow-up.

INTRODUCTION: Levosimendan is an inodilatory drug with hemodynamic effects in patients with decompensated chronic heart failure. AIM: Short-term (one month) evaluation of clinical, hemodynamic and neurohormonal changes in patients with decompensated chronic heart failure undergoing levosimendan therapy. METHODS: Twenty-six (21 male) consecutive patients were studied, corresponding to 32 levosimendan administrations (bolus + 24h infusion), aged 56.7+/-13.0 years, with decompensated chronic heart failure, in NYHA functional class III-IV (78.1% in class IV), and cardiac index (CI) <2.5 l/min/m2. Clinical (NYHA class), non-invasive hemodynamic (echocardiography) and neurohormonal (Elecsys ECLIA NT-ProBNP) evaluations were performed before levosimendan administration and on days 1, 4, 10 and 30. RESULTS: 1) Until day 10, there was a progressive decrease in NT-ProBNP values and weight (p<0.001), with an increase in CI (p<0.001); 2) NYHA functional class improved progressively, with 76% of the patients in NYHA class II at day 30; 3) NT-ProBNP values at day 1 correlated inversely (r=-0.414; p=0.024) with CI at day 4; and 4) the absolute decrease in NT-ProBNP values at day 4 (relative to baseline values) correlated with weight loss at day 4 (r=0.495, p=0.005), day 10 (r=0.424, p=0.031) and day 30 (r=0.486, p=0.030). CONCLUSION: Levosimendan therapy in patients with decompensated chronic heart failure contributes to progressive NYHA class improvement. The variations seen in NYHA class and hemodynamics was reflected in changes in NT-ProBNP.     

针灸加推拿刮法治疗胫骨结节骨骺炎16例

胫骨结节骨骺炎是由于股四头肌肌腱对胫骨结节的过度牵拉造成的骨骺疾病，在刚从事运动训练的青少年及刚人体育院校学习的新生中发病率较高，尤其多见于田径、篮球、排球等项目专选的学生。笔者自2000年～2003年中，共收治了16例该病患者，均获满意疗效，现介绍如下。     

Septic cavernous sinus thrombosis due to Streptococcus constellatus infection.

Adult septic cavernous sinus thrombosis (CST) due to Streptococcus constellatus infection has not been reported. We report a case of CST due to S. constellatus in a 39-year-old man who had typical presentations of septic CST including headache, fever, and ophthalmoplegia, with an evolving course for 10 days before he was sent to our emergency room. Cranial magnetic resonance imaging (MRI) study revealed CST, which was confirmed by cerebral angiography study. Multiple positive blood cultures grew viridans streptococci and further species identification with conventional methods, API-20 STREPT system analysis, and polymerase chain reaction sequencing of bacterial 16S rRNA revealed S. constellatus. The presence of sphenoid sinusitis in this patient was also demonstrated by cranial MRI study, and the presence of meningitis by meningeal irritation signs and inflammatory cerebrospinal fluid (CSF) findings. Chronic alcohol consumption for more than 10 years was the only predisposing condition to this infection. He had a full recovery after 6 weeks of intravenous penicillin G therapy (24 x 10(6) U/day). Almost complete regression of cavernous sinus lesion and resolution of sphenoid sinusitis were shown on follow-up cranial MRI study about 6 months later.     

β-防御素在慢性鼻-鼻窦炎和正常鼻黏膜中的表达

近年来研究表明，鼻黏膜及黏膜下腺体中存在大量的免疫活性细胞并分泌大量的生物活性分子，如各类白介素、溶菌酶、抑菌肽等。研究这些生物活性分子对如何提高鼻腔黏膜的防御功能及慢性鼻-鼻窦炎的防治有重要意义。人类β-防御素（human β-defensins，hBD），包括hBD-1和hBD-2是近几年发现的广泛分布于口腔、呼吸道、胃肠道、泌尿道黏膜上皮及黏膜下腺体组织的重要蛋白质分子，     

2001年与2004年抗菌药物应用情况比较

目的　了解抗菌药物应用的基本情况。方法　将 2 0 0 1年 3月 14 3 0例住院患者病历与 2 0 0 4年 3月的 2 0 66例住院患者病历进行回顾性调查和对比分析。结果　 2 0 0 1年的 14 3 0例中有 948(66 3 % )例 ,和 2 0 0 4年的 2 0 66例有 10 60例 (5 1.3 % ) ,应用了抗菌药物。结论　定期检查考评 ,严格掌握用药指征 ,是加强抗菌药物应用管理的关键。     

Recent advances in the management of primary breast cancers.

The current concept of breast cancer treatment arises from Fisher's theory that operable breast cancer has distant micrometastasis at its very early stages. Since it is the presence of systemic diseases or micrometastasis that determines the final outcome, variation in local treatment would not affect survival. Fisher's theory led to a change in local treatment, from Halsted's radical mastectomy to breast-conserving therapy (BCT), and the introduction of adjuvant systemic treatment. As part of the job of surgery is replaced by radiation therapy in local control, the efficacy and side effects of radiation should be carefully monitored. The recently published results of 20-year follow-up in 2 important studies confirm that BCT achieves equal survival compared to mastectomy in women with early breast cancers, even after all causes of mortality have been considered. The introduction of sentinel lymph node biopsy has further decreased the adverse impact of breast cancer treatment on women. As variation in local control does not affect survival, more efforts are being put into developing adjuvant systemic treatment with curative intent. Adjuvant chemotherapy has been demonstrated to substantially affect the survival of women with early breast cancers. It is now apparent from numerous studies that adjuvant therapy improves survival in all subgroups of women with early breast cancer, although the absolute benefit varies depending on axillary lymph node status, tumor size, and other prognostic factors. This article reviews recent advances in the management of primary breast cancer, including: long-term follow-up after BCT; side effects of radiation therapy in BCT; post-mastectomy radiotherapy; sentinel node biopsy; adjuvant hormone therapy; and chemotherapy, including new strategies such as the incorporation of taxanes, dose-dense chemotherapy schedules, and the use of aromatase inhibitors in place of, or in addition to, tamoxifen.     

见于湖南的一例血红蛋白G-台中家系

见于湖南江华县的一例慢泳血红蛋白α链变种,其先证者为汉族青年,属杂合子。家系调查发现其父、大姐和弟均携有同样的异常Hb。血液学常规检查一般正常。除先证者肝在肋缘下0.5cm扪及外,无任何临床症状。经一级结构分析,确证此例为HbG一台中[α74(EF3)Asp→His]。功能观测其氧平衡特征与HbA无差异。这是见于湖南的首例。