克林霉素国内外制剂的研究进展

1克林霉素研究历史概况1963年Mason等首先提出用林可霉素母核合成克林霉素的设想,直到1966年由Magerlein等才合成克林霉素。克林霉素最早由美国普强公司首先开发成功,并于1969年取得美国专利权。1968年率先在瑞士上市,商品名:Dalacin。我国于1975年开发研制成功,此后国内很多厂都投入生产。目前克林霉素常与庆大霉素、氨曲南或其它抗菌药品联用治疗需氧-厌氧菌感染。近年来有报道用克林霉素治疗寻常座疮(外用)、艾滋病患者的肺囊虫和弓形虫感染以及消化道、皮肤、软组织、骨髓炎、妇产科的感染控制,并取得了良好疗效。克林霉素(clindamyci…     

Kimura''''s病复发1例

患儿,男,11岁,因Kimura's病治疗后5个月,右腮腺区肿物增大0.5个月住院.5个月前曾因右腮腺区肿大7个月在外院以淋巴结炎抗感染治疗效果差住院,根据其病史,末梢血嗜酸性粒细胞0.303,IgE明显升高,自幼有湿疹史,腮腺区无痛性肿块活检病理报告符合Kimura's病,诊断为腮腺区Kimura's病.     

富含血管的听神经瘤

目的探讨富含血管的听神经瘤的手术治疗。方法复习20年（1975—1995）手术治疗单侧听神经瘤90例，其中4例为富含血管的听神经瘤（HAT），与86例非富含血管的听神经瘤（NHAT），做回顾性分析，据临床表现、放射学检查、手术所见做比较。结果HAT较NHAT年轻（28±10与54±17岁）（P〈0．01），MRI显示HAT为实质性，无肿瘤囊变，多数较NHAT为大（P〈0．05）；MRI示HAT有多个代表较大引流静脉的流空效应；经皮股动脉、椎动脉造影显示HAT有广泛的肿瘤着色及早期引流静脉的充盈，并证实由椎基动脉供血。过去文献报道认为以分期手术为宜。作者在控制性低血压麻醉下，成功地完成了4例HAT的切除术，未输血，术后无明显伤残。结论HAT是一种实质性大型肿瘤，出现于青年期，血管造影能够提供特征性发现。MRI能显示肿瘤表面的流空效应而确诊。采用控制性低血压麻醉有望能一期全切除肿瘤。     

二手医疗器械监督管理现状及其对策

随着我国医疗水平的逐渐提高,大型医疗设备的添置已成为医疗机构面临的重要问题,三级甲等医院作为我国先进的诊疗水平单位,依靠雄厚的资金实力,把添置大型医疗设备的目光瞄向进口产品,而一些县级二甲医院和一级乡镇医院由于资金实力不足,通常采取购买和租赁二手医疗设备的办法,作为添置医疗设备的一种途径.     

Chronic orchialgia: Consider gabapentin or nortriptyline before considering surgery

OBJECTIVE: To establish if there is a role for gabapentin or nortriptyline in the treatment of chronic orchialgia. METHODS: Twenty-six consecutive patients with chronic orchialgia were seen in the chronic pain clinic by a multidisciplinary team. A pain questionnaire was completed prior to commencing either gabapentin or nortriptyline. They were reviewed at 3 months and a repeat questionnaire completed. A 50% improvement in pain was considered successful. RESULTS: Complete data was available for 19 patients. Overall, 61.5% of patients commenced on gabapentin and 66.6% of patients commenced on nortriptyline had a greater than 50% improvement in pain. Patients with post-vasectomy testicular pain were considered as a subgroup. None of these patients had a greater than 50% improvement in pain. However, 80% of patients in the subgroup with idiopathic chronic orchialgia had a greater than 50% improvement in pain. CONCLUSION: Although this is a small study, it appears that gabapentin and nortriptyline are effective in the treatment of idiopathic chronic orchialgia but not post-vasectomy pain.     

Surgical strategy of one stage surgery of anterior release combined with posterior correction in treatment of severe scoliosis

Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon. Methods :Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thorac icplasty. Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80. 6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average. Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.     

小脑后下动脉动脉瘤的诊断和治疗

目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。     

立体着床模型--小鼠囊胚与子宫内膜的共培养

目的:建立小鼠囊胚体外着床的三维模型,为着床机制的研究提供重要工具.方法:将小鼠囊胚与其自身子宫内膜分别共培养在空气、含500,750和950 mL/L O2的混合气体与组织培养液的气液界面上,比较不同O2浓度下小鼠囊胚的贴附率,确定体外共培养的最佳O2浓度;同时将确认有囊胚贴附的子宫内膜取出作HE染色.结果:不同O2浓度下,囊胚的贴附率分别为64.75%,47.86%,42.37%和30.97%,x2检验提示其差异有显著性(x2=28.145,P=0.000);且随着混合气体中O2浓度的逐渐升高,囊胚贴附率呈逐渐降低趋势.因此50 mL/L CO2 950 mL/L空气对囊胚与子宫内膜的共培养是最有利的;同时,囊胚贴附子宫内膜后并无扩展行为而是直接侵入子宫内膜.结论:50 mL/L CO2 950 mL/L空气最有利于囊胚与子宫内膜的共培养;且囊胚贴附子宫内膜后不发生外延生长,而是直接侵入子宫内膜.本实验成功地建立了小鼠囊胚体外着床的三维模型.     

拉米夫定对慢性乙型肝炎的疗效及肝脏组织病理学改变

目的:从血清生化,病毒学,肝纤维化指标以及肝脏组织病理学改变的角度分析拉米夫定(LMD)治疗慢性乙型肝炎的疗效.方法:慢性乙型肝炎患者21例,给予口服LMD100 mg/d,连用1 a,动态观察服药0,24和48 wk肝功能、乙肝五项、HBV-DNA定量、血清肝纤维化指标透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PⅢP)和Ⅳ型胶原(ⅣC)的变化,通过肝组织穿刺活检,观察用药前后肝脏组织病理学的改变.结果:LMD治疗48 wk,可显著抑制HBV-DNA(copy/L)复制(6.13×109±4.03×105 vs 9.01×105±4.89×103,P＜0.01),使大多数患者肝功能(nkat/L,ALT:1697±907 vs550±503;AST:1787±717 vs 498±430)恢复正常(P＜0.01),显著降低血清肝纤维化指标水平(P＜0.01).减轻肝细胞坏死,汇管区炎细胞浸润及纤维化.结论:LMD是治疗慢性乙型肝炎的一种较为切实有效的措施.