糖尿病专科护理门诊工作现况调查分析

目的了解糖尿病专科护理门诊现况,为优化流程提供依据。方法采用自制糖尿病专科护理门诊患者满意度问卷对在糖尿病专科护理门诊就诊的200例患者进行调查;对4名糖尿病专科护士进行现场观察与访谈了解工作现况。结果患者满意度总体均分为(4.21±0.49)分,6个维度评分(3.45±0.78)~(4.36±0.64)分;专科门诊护理内容包括健康教育、胰岛素笔使用、检测血糖等13项,每个工作日实施0~48.00次;患者等待就诊时间(14.69±8.00)min。专科护理访谈提炼出工作职责不明确、工作时间未建立预约制、门诊导诊护士配合欠佳及患者健康档案登记欠全面4个主题。结论患者对糖尿病专科护理门诊就诊流程和就诊时间等方面满意度较低,专科护士健康教育工作受到影响,应改进流程,以促进健康教育的效果,提高患者满意度。     

Orthotopic sigmoid vs. ileal neobladders in Japanese patients: A comparative assessment of complications,functional outcomes,and quality of life

ObjectivesTo compare the clinical outcomes of sigmoid and ileal neobladders (NBs) created following radical cystectomy.Materials and methodsThis study included 90 and 144 Japanese patients undergoing radical cystectomy and orthotopic NB reconstruction with a sigmoid and ileal segment, respectively. Postoperative clinical outcomes between the sigmoid and ileal NB groups (SNBG and INBG) were compared.ResultsIn this series, 110 early and 51 late complications occurred in 71 and 41 patients, respectively; however, there was no significant difference in the incidence of complications between SNBG and INBG. At 1 year postoperatively, there were no significant differences in the proportion of spontaneous voiders and the continence status between these 2 groups; however, despite the lack of significant differences in the maximal flow rate and voided volume, the post-void residual in SNBG was significantly smaller than that in INBG. Voiding functional outcomes at 5 years postoperatively were also obtained from 28 and 49 in SNBG and INBG, respectively. Although there were no significant changes in the functional outcomes in SNBG, the proportion of spontaneous voiders and post-void residual in INBG at 5 years postoperatively were significantly poorer than those at 1 year postoperatively. Furthermore, the postoperative health-related quality of life assessed by a Short-Form 36 survey did not show any significant differences in all 8 scores between these 2 groups.ConclusionsBoth types of NB reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function, particularly that on long-term follow-up, in SNBG appeared to be more favorable than that in INBG.     

Irregular Defects in Hepatocellular Carcinomas During the Kupffer Phase of Contrast-Enhanced Ultrasonography with Perfluorobutane Microbubbles: Pathological Features and Metastatic Recurrence After Surgical Resection

The present study aimed to elucidate the association between post-vascular–phase (Kupffer-phase) images from contrast-enhanced ultrasonography (CEUS) with perfluorobutane microbubbles and metastatic recurrences after the resection of hepatocellular carcinoma (HCC). The study examined 73 patients with solitary HCC ≤5 cm in diameter who underwent CEUS before resection. HCC was defined as irregular type (including an irregular defect on Kupffer-phase images) or non-irregular type. Intrahepatic metastatic recurrence was defined as >3 intrahepatic recurrences. Metastatic recurrence included both extrahepatic and intrahepatic recurrences. Frequencies of microscopic portal invasion and intrahepatic metastasis were significantly higher in the irregular group than in the non-irregular group. Cumulative 5-y metastatic recurrence rates in the irregular and non-irregular groups were 43% and 7% (p = 0.028), respectively. Multivariate analyses identified Kupffer-phase findings as a factor significantly related to metastatic recurrence. In conclusion, HCCs with an irregular defect during Kupffer-phase CEUS are characterized by more frequent microscopic vascular invasion and intrahepatic metastasis and are significantly associated with metastatic recurrence after resection.     

冰黄肤乐软膏联合奥深软膏治疗寻常型银屑病临床疗效观察

目的:观察冰黄肤乐软膏联合奥深软膏治疗寻常型银屑病的疗效及安全性.方法:选择84例寻常型银屑病患者,随机分入治疗组和对照组,治疗组36例用冰黄肤乐软膏联合奥深软膏,每日2次,对照组48例仅外涂冰黄肤乐软膏,每日3次或奥深软膏,每日2次,疗程均为14天.结果:用药1个疗程,三组疗效无显著性差异.用药2个疗程后治疗组显效率为83.33%,冰黄肤乐对照组有效率为50.00%,奥深软膏对照组显效率为53.85%,三组比较差异有显著性(P＜0.05),均无严重不良反应发生.结论:冰黄肤乐软膏联合奥深软膏治疗寻常型银屑病疗效好,患者依从性强.     

Malignant parotid gland tumors and facial nerve paralysis

Summary During the last three decades, 586 cases of parotid gland tumor have been extirpated in our clinic. The tumors were malignant in 170 cases and, of these, facial nerve paralysis was observed at first examination in 59 patients. This paper deals with the retrospective study of these cases and is chiefly concerned with the histological types and facial nerve paralysis.     

Effect of gentamicin on pharmacokinetics of lysozyme in rats: interaction between megalin substrates in the kidney

To investigate the pharmacokinetic interaction between substrates of megalin, a 600-kDa endocytic receptor abundantly expressed in the renal proximal tubules, we examined the effect of gentamicin infusion on the pharmacokinetics of fluorescein isothiocyanate (FITC)-lysozyme in rats. Infusion of gentamicin did not affect the plasma concentration-time profile of FITC-lysozyme. On the other hand, gentamicin significantly decreased the accumulation of FITC-lysozyme in the renal cortex and medulla, whereas the accumulation in the renal papilla, liver, brain and lung was not changed. Urinary excretion of FITC-lysozyme was increased by gentamicin, whereas there was no change in the biliary excretion of FITC-lysozyme or its degradation products. Gentamicin infusion had little influence on the ATP content in the renal cortex and urinary excretion of glucose, indicating that nephrotoxicity is not induced by short-term infusion of gentamicin. These findings suggest that lysozyme and gentamicin interact with each other in their reabsorption processes in the renal proximal tubules, probably by competing for their binding to megalin expressed in the apical membrane of the renal proximal tubules.     

Antimetastatic Effect by Anti-adhesion Therapy with Cell-adhesive Peptide of Fibronectin in Combination with Anticancer Drugs

We have investigated the therapeutic effect of CH-271 fusion polypeptide containing both cell-binding domain (C-274) and heparin-binding domain (H-271) of fibronectin in combination with anticancer drugs such as doxorubicin (DOX) or mitomycin C (MMC) on tumor metastasis of different types of tumors. CH-271 fusion polypeptide alone significantly inhibited both liver and lung metastasis when it was co-injected with L5178Y-ML25 T-lymphoma, RAW117-H10 B-lymphoma or B16-BL6 melanoma cells, and spontaneous lung metastasis of B16-BL6 melanoma cells when administered i.v. seven times before or after surgical excision of the primary tumors. Combined treatments with CH-271 and either DOX or MMC significantly inhibited liver and lung metastasis of lymphoma or melanoma cells respectively, as compared with either treatment alone or the untreated control. Administrations of CH-271 and DOX in combination substantially prolonged the survival time of mice injected i.v. with L5178Y-ML25 cells. CH-271 or DOX was effective for inhibiting the invasion of LS178Y-ML25 cells into Matrigel in a concentration-dependent manner. Our previous study has shown that CH-271-mediated inhibition of tumor invasion may be due in part to the anti-cell adhesive property without affecting the cell growth, whereas the anti-invasive effect of DOX was established to have resulted from the growth inhibition of tumor cells. Moreover, the combination of CH-271 with DOX provided a more effective inhibition of tumor invasion into Matrigel than did either alone. Thus, we have demonstrated that the combination of anti-cell adhesive CH-271 and anticancer drugs such as DOX or MMC, i.e. anti-adhesion therapy and chemotherapy, is a new approach that offers enhanced (additive) inhibitory effects on tumor metastasis and invasion.     

Thoracotomy for a Patient with Stevens-Johnson Syndrome: Report of a Case

(Received for publication on Oct. 24, 1996; accepted on May 12, 1997)