名为用药,实为用方--施今墨对药初探

本文记述了施今墨对药的由来和祝谌予对施今墨对药的认识,笔者经过学习祝老经验,结合自己的心得体会,提出施今墨先生的对药是"名为用药,实为用方"的观点,并以具体对药和病案为例加以阐述,为学习施今墨先生的学术思想提供了一条新思路.     

加味玉屏风散对慢性阻塞性肺疾病稳定期患者通气功能影响

目的观察加味玉屏风散治疗慢性阻塞性肺疾病稳定期(肺气虚证)的临床疗效及对患者通气功能的影响。方法将患者49例随机分为治疗组与对照组,均口服茶碱缓释片、盐酸氨溴素片并吸入异丙托溴铵,治疗组加用加味玉屏风散;比较两组症状改善情况,治疗前后检测通气功能。结果治疗组临床疗效优于对照组。其通气功能较对照组改善更明显。结论加味玉屏风散能明显改善慢性阻塞性肺疾病稳定期症状,改善通气功能。     

海南艾滋病传播主途径:静脉吸毒感染病毒

相对于全国其它省市来说,我省艾滋病形势并不十分严峻。但静脉吸毒感染病毒成为我省艾滋病传播的主要途径。据了解,我省18个市县中有10个市县已报告艾滋病病毒感染者,感染者多集中在农村地区。总体处于低流行态势,局部地区高危人群爆发流行,各种年龄组均有发病,15至29岁年龄组占80%,农村人占60%。艾滋病病毒在静脉吸毒人群中以几何级数的速度传播。2000年,我省发现首例感染艾滋病毒的吸毒者,2001年4例,2002年62例,2003年82例。自2002年以来,经吸毒引起的新感染市县明显增多。同时,静脉注射毒品的比例也正逐年增加。据调查资料显示,1995年我…     

论糖尿病的中医核心病机与基本治法

病机是决定病情变化的关键,针对糖尿病的中医核心病机,专家或强调虚,或强调瘀,或认为糖尿病可划分为郁热虚损不同阶段,更有提出糖尿病贯穿"壮火食气"热伤气阴病机者。针对糖尿病基本治法,专家或强调健脾补肾、益气养阴;或强调活血化瘀;或强调分"脾瘅"和"消瘅",分别给予消中满、清内热与清胃健脾治法。更有认为应以清热为基本治法,并针对胃肠结热、肝经郁热、脾胃湿热以及痰火、瘀热等,具体选用清泄、清解、清化以及清补治法者。其实,糖尿病不同阶段,证候表现与病机特点有所不同,临床上应该紧抓糖尿病不同阶段的病机,选用针对性的治法,如此才能反映出中医药防治糖尿病及其并发症的丰富多彩。     

从瘀论消渴:祝谌予医话医案精读

祝谌予教授素来推崇中西医结合,运用活血化瘀法治疗糖尿病则是其中西医结合思想实际运用的例证之一。他传承老师施今墨的学术思想,结合自己临床观察及现代医学研究进展——糖尿病血管并发症多见的情况,创造性的提出用活血化瘀法治疗糖尿病,并结合现代医学关于微循环理论及自身免疫相关的学说进一步完善了具体的治疗方药,为推动中医药治疗糖尿病做出了新的贡献。     

体内外抗菌试验7种抗菌药物对临床常见致病菌抗菌活性的比较

本实验采取琼脂平板稀释法测定了泰宁等7种抗菌药物对215株临床常见致病菌的最低抑菌浓度(MIC),并统计了敏感率。结果表明7种抗菌药物对大多数受试菌均显示了较高的抗菌活性,其中泰宁的抗菌活性最强,金黄色葡萄球菌、变形杆菌属、大肠埃希氏菌、肺炎克雷白氏菌对泰宁的敏感率达97.6％—100％;而17.02％的绿浓假单胞菌对泰宁耐药;有2—6株绿脓假单胞菌和1株肺炎克雷白氏菌对泰宁和其他抗菌药物呈现部分     

阿尔茨海默病的发病机制与药物治疗

阿尔茨海默病(Alzheimer's disease,又称老年性痴呆)是一种慢性进行性精神衰退性疾病,发病原因和机制尚未阐明。就阿尔茨海默病发病机制的各学说以及各治疗药物进行综述。     

应用股前外侧皮瓣修复Gustilo Ⅲ B型小腿开放性骨折并软组织缺损

目的 探讨股前外侧皮瓣在Gustilo ⅢB型小腿开放性骨折软组织缺损修复中的应用价值.方法 对GustiloⅢB胫骨骨折合并软组织缺损42例,分别行股前外侧皮瓣急诊修复创面10例,早期修复创面16例和晚期修复创面16例,术后随访,对各组疗效进行分析.结果 移植皮瓣全部成活,无截肢病例,术后随访11～47个月,骨愈合时间6～13个月.和急诊、早期修复组相比,晚期修复组骨折愈合时间延长,骨感染、骨不连发生率明显升高,76%的病例需要行二期骨移植修复骨缺损和骨不连,下肢功能评分低于前两组.结论 对Gustilo Ⅲ B型骨折尽早行创面修复手术,可以缩短治疗周期,改善治疗效果,对严重开放性骨折创伤的治疗有较大临床指导意义.

Abstract：

Objective To investigate the clinical results of the anterolateral thigh free flaps for the soft tissue coverage of Gustilo grade-Ⅲ B open bone fractures in lower extremities.Methods The anterolateral thigh free flaps were applied to treat 42 Gustilo grade-11Ⅲ B open fractures.Ten flaps were performed through an emergency procedure.Sixteen were performed at early stage and the other 16 were performed at later stage .The results of the therapy were analyzed after long time follow up. Results All limbs were salvaged and all the flaps survived without protracted course to obtain soft tissue coverage.The follow up ranged 11 to 47 months.The healing time of the bones were significant prolonged in the later stage therapy group compared with the emergency therapy group and the early stage therapy group.In the later stage therapy group,the incidences of the bone infection and nonunion were also higher than the other two groups,and the second stage bone transplantation to repair bone defect and nonunion were needed in 76% patients in this group.The lower limb functions of the later stage treated group were worse than those of the other two groups.Compared to the early stage treated group,better lower limb functions could be obtained in the emergency treated group. Conclusion Delayed soft tissue coverage resulted in higher incidence of complications.The immediate soft tissue coverage of severely injured limbs complicated by Gustilo grade-Ⅲ B open fractures and massive soft tissue defects had the advantages over traditional methods.Hard work though it was,one-stage soft tissue coverage using anterolateral thigh free flaps could obtain better lower limb function.     

Use of the anterolateral thigh free flap for the soft tissue coverage of Gustilo grade-ⅢB open bone fractures in lower extremities

Objective To investigate the clinical results of the anterolateral thigh free flaps for the soft tissue coverage of Gustilo grade-Ⅲ B open bone fractures in lower extremities.Methods The anterolateral thigh free flaps were applied to treat 42 Gustilo grade-11Ⅲ B open fractures.Ten flaps were performed through an emergency procedure.Sixteen were performed at early stage and the other 16 were performed at later stage .The results of the therapy were analyzed after long time follow up. Results All limbs were salvaged and all the flaps survived without protracted course to obtain soft tissue coverage.The follow up ranged 11 to 47 months.The healing time of the bones were significant prolonged in the later stage therapy group compared with the emergency therapy group and the early stage therapy group.In the later stage therapy group,the incidences of the bone infection and nonunion were also higher than the other two groups,and the second stage bone transplantation to repair bone defect and nonunion were needed in 76% patients in this group.The lower limb functions of the later stage treated group were worse than those of the other two groups.Compared to the early stage treated group,better lower limb functions could be obtained in the emergency treated group. Conclusion Delayed soft tissue coverage resulted in higher incidence of complications.The immediate soft tissue coverage of severely injured limbs complicated by Gustilo grade-Ⅲ B open fractures and massive soft tissue defects had the advantages over traditional methods.Hard work though it was,one-stage soft tissue coverage using anterolateral thigh free flaps could obtain better lower limb function.     

骨肉瘤中survivin、Caspase-8的表达及其与凋亡的相关性研究

目的探讨survivin mRNA、Caspase-8蛋白在骨肉瘤中的表达及其与细胞凋亡的关系。方法分别采用RT-PCR和免疫组化技术检测40例骨肉瘤及正常组织中survivin mRNA和Caspase-8蛋白的表达,运用TUNEL方法检测细胞凋亡。结果77.5%的骨肉瘤组织survivin mRNA呈阳性表达,显著高于正常组织;Caspase-8蛋白在骨肉瘤和正常组织中的阳性表达率分别为27.5%和85%(P<0.05);在骨肉瘤组织中,survivin mRNA和Caspase-8蛋白表达呈负相关;survivin mRNA阳性的骨肉瘤中细胞凋亡指数明显低于survivin mRNA阴性组(P<0.05);Caspase-8蛋白阳性的骨肉瘤中细胞凋亡指数明显高于Caspase-8蛋白阴性组(P<0.05)。结论survivin、Caspase-8均参与骨肉瘤的发生、发展变化,survivin是通过抑制Caspase-8的活性而发挥其抑制细胞凋亡作用的。