腹腔镜肾上腺肿瘤切除术75例报告

目的探讨腹腔镜下肾上腺肿瘤切除的方法和临床应用价值.方法1999年1月～2004年6月75例患者行腹腔镜肾上腺肿瘤切除术,其中采用经腹腔途径51例和经腹膜后途径24例.结果手术时间平均为(170.16±33.81)min,术中的出血量平均为(70.82±37.15)ml.术后平均住院时间为(5.87±1.01)d.中转开放手术2例(2.67%).发生并发症4例(5.33%),分别为膈肌损伤、胰腺损伤、肠道损伤、皮下血肿各1例.结论腹腔镜下行肾上腺肿瘤切除术具有创伤小,术中出血少,术后恢复快等优点,已经成为现代治疗肾上腺肿瘤的金标准.     

Universal applications of sentinel node technology

The sentinel node (SN) concept was originally proposed by several pioneers in the middle of the last century. After Donald Morton and his colleagues demonstrated the clinical significance of the SN concept in melanoma, it attracted vast attention in surgical oncology. At recent international conferences, a number of new approaches in this field for various solid tumors have been reported. Now, there are several possible applications with different technological aspects, such as individualized surgical management of solid tumors, multidisciplinary treatments, and novel therapeutic approaches. This article provides an overview of the future potential of SN technology.     

急性传染性非典型肺炎的影像表现

目的探讨急性传染性非典型肺炎(SARS)的X线表现及变化规律.方法回顾性分析临床诊断SARS的61例患者,对发病后的一系列胸片和CT影像进行统计分析.结果患者以发热为最早起病症状,88.5%患者在起病1周内肺部出现肺局灶性斑片状模糊影,并迅速扩大.2周内病变达高峰,有57.4%患者两肺大部分肺野受累,病情重.83.6%患者在5周内肺部阴影逐渐消散.在恢复期16例CT扫描中,有13例显示肺部遗留纤维化病灶.有6例患者合并感染,病期延长,4例死亡.结论SARS早期出现肺部炎性改变,发展迅速,大部分两肺受累,重症比例高,易致肺纤维化.     

力学刺激对3月龄骨质疏松大鼠成骨细胞增殖与合成功能的影响

探讨周期性双轴力学应变对成骨细胞增殖与分化合成功能的影响。将正常 3月龄雌性 SD大鼠和骨质疏松大鼠颅顶骨分离的成骨细胞分别在含 10 %胎牛血清的 F- 12培养液中培养 ,并接种在双轴力学应变装置中。当细胞生长至亚融合状态 (Subconfluence) ,给细胞施加力学刺激 ,频率为 1Hz,力学刺激分别为 4 0 0、10 0 0、4 0 0 0μ strain;作用时间分别为每天 30 m in,2、4、8h,共加载两天。以未受力学刺激的细胞为对照组 ,受力学刺激的细胞为实验组 ,并进行比较。采用流式细胞技术测定细胞增殖变化 ;采用同位素标记方法检测成骨细胞骨钙素、I型胶原 C端前肽 (PICP)和总蛋白的分泌量。结果表明 :1)在静态培养条件下 ,3ovx组与 3control组比较 ,其细胞功能活性无明显变化 ,但 3ovx组大鼠成骨细胞增殖活性明显增高 ,这与绝经后骨质疏松骨代谢的高转换率相一致。 2 )4 0 0、10 0 0 μstrain力学刺激可以促进 3control组成骨细胞 I型胶原、骨钙素和总蛋白的分泌量增加 ,促进成骨细胞的分化成熟 ;在 10 0 0μstrain力学刺激下 ,成骨细胞合成骨基质的能力增加最为明显。同时 ,在 4 0 0、10 0 0μstrain力学刺激的初期也可以促进成骨细胞的增殖 ,而促进成骨细胞的分化成熟的作用大于促进细胞增殖的作用。 3)在4 0 0 0 μ     

澳大利亚卫生资金的筹集与分配

澳大利亚的卫生服务市场是一个在政府高度调控状态下的政府部门、私人部门共存的混合体，在卫生服务的提供和卫生资金的筹集方面存在着复杂的关系。其卫生资金是指全国用于卫生服务的所有费用的总和，主要包括为患病人群所提供的卫生服务，以及以健康促进和疾病预防为目标所提供的服务费用，不包括非卫生部门用于与健康改善有关的费用(如生产、开发营养食品的费用)。根据来源可分为政府提供和非政府部门提供两大部分。     

借鸡生蛋:三九中原试水社区医院

去年8月20日,国家十一部委联合下发了《关于加快发展城市社区卫生服务的意见》,其中提出:打破部门垄断和所有制等界限,鼓励企业事业单位、社会团体、个人等社会力量多方举办社区卫生服务机构,健全社区卫生服务网络,并鼓励部分国有中、小型医疗机构转制为民办社区卫生服务机构,或实行国有民营。     

Extracorporeal shock wave lithotripsy for difficulty in withdrawal of double J ureteral stents due to ureteral lithiasis.

OBJECTIVE: To explore the efficacy of extracorporeal shock wave lithotripsy (ESWL) to coping with lithiasis-induced difficulty in withdrawing double J ureteral stents. METHODS: This study includes 6 patients with difficulty in withdrawing the stents due to lithiasis, who were in the anterior prone position or posterior oblique supine position to receive ESWL treatment. The stones were localized by double-band intersection X-ray system. The treatment voltage of shock wave was 11.2 kV initially, which was gradually increased to 18.1 kV, and the shock wave attack amounted to 1,000 to 3,000 times in total. RESULTS AND CONCLUSION: After ESWL treatment, the encrusted double J stents were successfully withdrawn in all the 6 cases, without causing any morbidity related to the use of ESWL. Among the various techniques available for removing encrusted double J stents, ESWL appears to be the most effective and the least invasive modality.     

Coordinated diagnostic approach for adult obstructive lung disease in primary care.

AIMS: To present an age-stratified approach to the diagnosis of obstructive lung disease based on asthma and COPD guidelines and epidemiology. METHODS: Asthma guidelines emphasize the role of the history and physical examination, with pulmonary function used primarily to confirm the diagnosis. COPD guidelines begin with symptoms and risk exposure, presenting spirometry as the primary diagnostic maneuver. Data from the National Health Interview Survey and the Third National Health and Nutrition Examination Survey illustrate relationships in prevalence of asthma and COPD in nationally representative samples. RESULTS: Asthma prevalence in adults declines with age from 5-10% at age 20-40 to 4-8% above age 60. COPD is uncommon in adults under age 40 but increases with age, surpassing asthma in older adults. CONCLUSIONS: These trends suggest that asthma screening is most useful in adults up to age 40, after which COPD screening and differential diagnosis are of comparable or greater utility.