腹膜转移瘤的影像学诊断

目的探讨腹膜转移瘤的影像学表现特点。方法回顾性分析经手术及穿刺活检证实的35例腹膜转移瘤的影像学表现,并与手术结果对照,35例做CT平扫及增强扫描,5例行MR I检查。结果(1)腹膜转移瘤常表现为大量腹水(22/35);(2)腹膜结节状增厚(23/35);(3)大网膜饼形增厚(16/35)和大网膜污垢样改变(12/35);(4)肠系膜污垢样改变(12/35)及结节状改变(9/35);(5)腹腔单发或多发囊性改变,有占位效应(4/35)。结论CT/MR I是发现腹膜转移灶的重要影像学方法。     

Goldenhar 综合征家系的临床表型和遗传学分析

目的分析1组Goldenhar综合征家系的临床表现及遗传学特征。方法我们随访到1组4代33人的Goldenhar综合征家系，对目前存活的29人进行了临床表型和遗传学的初步分析。结果家系内有Goldenhaar综合征患者5人．临床表现具高度多样性，累及眼、耳、脊柱、颜面、口腔等多个器官和系统的发育不良，在遗传方式上属于常染色体显性遗传。从细胞遗传学水平对家系中成员进行染色体检查，未发现核型异常。结论该Goldenhar综合征家系属常染色体显性遗传，染色体检查未发现核型异常。     

Evaluating clinical skills of RN students

A clinical performance examination was developed for basic baccalaureate nursing students and used to validate the clinical skills of registered nurses entering a baccalaureate degree program. With few exceptions, RNs returning to school demonstrated clinical competence in the secondary care area as measured by this examination. Therefore, another means of validating RN clinical skills was developed based on the evaluation criteria used for the clinical performance examination. Using employer and colleague validation, students individually documented competence in the area of practice. There was a decrease in student stress, an increase in self-esteem, conservation of the time and energy of students and faculty, and more effective use of program resources.     

伴ADHD的对立违抗性障碍儿童行为特征分析

目的：了解伴注意缺陷／多动障碍(ADHD)的对立违抗性障碍(0DD)患儿的行为特征。方法：以ICD-10作为诊断标准对门诊就诊儿童进行诊断，得到ODD伴ADHD者40例(64.52％)．ODD不伴ADHD者22例(35．48％)。自编家庭情况调查表调查患儿的基本情况。用家长填Achenbach儿章行为量表评定儿童行为。结果：与ODD组相比。合并ADHD组的家长更多对患儿经常打骂和严厉管教：对儿童的不良行为更多地采取打骂的方式。合并组父亲急燥易怒者比ODD组多；合并组起病年龄及就诊年龄比ODD组早：合并组在CBCI。思维、注意问题，违纪、攻击行为，外化性问题，行为总分均高于ODD组。结论：ODD合并ADHD的患儿在思维、注意问题，违纪、攻击行为，外化性问题方面表现更突出，家长对儿童管教方式及不良行为处理方式影响ODD的发生。提示要注重ODD、ADHD的早期干预。     

特异性荧光偏振免疫法监测521例肾移植后环孢素A全血浓度3275次

目的通过监测肾移植后病人环孢素A(CsA)全血浓度 ,提出CsA在三联免疫抑制用药方案中的理想治疗窗。方法用特异性荧光偏振免疫法测定CsA全血浓度 ,对521例病人监测3275次 ,按术后时间及临床表现分组比较。结果肾移植后<1 ,、1～3、3～6、6～12个月、1～2和>2年的CsA全血谷浓度的理想治疗窗应分别为250～450、200～400、150～300、100～250、100～200和100～180μg/L。结论CsA全血浓度在上述范围内 ,中毒反应和排异反应明显减少     

血脂调节剂的研究——Ⅰ.HMG-CoA还原酶抑制剂M-8614A及MH-2688B产生菌的筛选

利用酶联免疫吸附测定法,酶标β-羟基β-甲基-戊二酸单酰铺酶A(HMG-CoA)还原酶抑制剂Compactin抗体,定向筛选血脂调节剂。从青霉M-8614菌株发酵液中分离到M-8614A。该物质理化性质及波谱解释表明与Mevastatin为同一物质。 M-8614菌株用亚硝酸盐等诱变剂处理,从诱变株MH-2688发酵液中分离到MH-2688B。该物质理化性质及波谱解释表明与Lovastatin为同一物质。     

丙氧氨酚与酮咯酸治疗癌痛的比较

晚期肿瘤疼痛病人３１例（男性１７例，女性１４例，年龄５０±５１４ａ），用丙氧氨酚２片，ｐｏ，ｔｉｄ，共７ｄ。相似病人３０例（男性１６例，女性１４例，年龄５１±１３ａ），用酮咯酸１０ｍｇ，ｐｏ，ｑｉｄ，共７ｄ。结果：疼痛强度（标尺法）２组均有降低；显效时间前组（丙氧氨酚）快于后组（酮咯酸）；药效维持时间后组长于前组；不良反应前组嗜睡多于后组，而胃肠道不适少于后组。     

An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.     

Prospective survey of investigations in outpatients referred with iron deficiency anaemia.

Recent evidence has suggested that colonic neoplasm may be missed in patients presenting with iron deficiency anaemia unless colonic investigations are performed on all patients even when an alternative cause has been found. This study prospectively surveyed 114 consecutive patients referred from family practitioners to an outpatient clinic for the investigation of iron deficiency anaemia to determine the diagnoses contributing to the anaemia, the usefulness of certain clinical features, and the role of colonic and other investigations in obtaining the diagnosis. Upper gastrointestinal lesions contributing to anaemia were identified in 45 patients while colonic lesions were found in 18. Twenty three patients had a non-gastrointestinal cause for anaemia and in 12 patients no cause was found. Only two patients were identified as having colonic neoplasia (a small adenomatous polyp in each case) coexisting with upper gastrointestinal lesions. Symptoms and signs had a sensitivity and specificity of upper gastrointestinal disease of 50% and 83% respectively, and 44% and 80% for colonic disease. Endoscopy had a high yield (42%) and duodenal biopsy identified coeliac disease in three patients (two were aged > 70 years) each of whom had normal folate values. Barium enema had a yield of 13%. All colonic carcinomas occurred in patients > 65 years. The coexistence of colonic cancer or large polyps with an upper gastrointestinal lesion identified at endoscopy was rare in outpatients referred from family practitioners. Clinical symptoms and signs were poor indicators of the investigations that will detect a cause for the anaemia.(ABSTRACT TRUNCATED AT 250 WORDS)