针刀松解术治疗臀上皮神经炎经验

臀上皮神经炎是因为损伤而引起的严重腰臀部疼痛,亦可以称为臀上皮神经损伤,系臀上皮神经离位所致,中医学属"筋出槽"范畴.该病临床比较多见,主要表现为腰臀部疼痛.     

Airway Reactivity to Bronchoconstrictor and Bronchodilator: Assessment Using Thin-Section and Volumetric Three-Dimensional CT

Objective

To determine the extent to which thin-section and volumetric three-dimensional CT can depict airway reactivity to bronchostimulator, and to assess the effect of different airway sizes on the degree of reactivity.

Materials and Methods

In eight dogs, thin-section CT scans were obtained before and after the administration of methacholine and ventolin. Cross-sectional areas of bronchi at multiple levels, as shown by axial CT, proximal airway volume as revealed by three-dimensional imaging, and peak airway pressure were measured. The significance of airway change induced by methacholine and ventolin, expressed by percentage changes in cross-sectional area, proximal airway volume, and peak airway pressure was statistically evaluated, as was correlation between the degree of airway reactivity and the area of airways.

Results

Cross-sectional areas of the bronchi decreased significantly after the administration of methacholine, and scans obtained after a delay of 5 minutes showed that normalization was insufficient. Ventolin induced a significant increase in cross-sectional areas and an increase in proximal airway volume, while the effect of methacholine on the latter was the opposite. Peak airway pressure increased after the administration of methacholine, and after a 5-minute delay its level was near that of the control state. Ventolin, however, induced no significant decrease. The degree of airway reactivity did not correlate with airway size.

Conclusion

Thin-section and volumetric spiral CT with three-dimensional reconstruction can demonstrate airway reactivity to bronchostimulator. The degree of reactivity did not correlate with airway size.     

论公立医院的竞争力和适当引入市场竞争机制的必要性

鉴于我国的公立医院管理体制相同,且体制改革尚未进入大范围实践,难以获得不同体制医院之间直接竞争的案例,所以,该文通过建立县、乡、村三级医疗卫生机构之间的竞争模型,定量比较各自拥有的综合竞争优势,结果发现,具有十倍以上人财物规模的乡镇卫生院,在与村卫生室竞争中处于乏力状况,竞争乏力的原因是乡镇卫生院受管理体制制约,在服务收费、服务态度、医患关系和方便程度方面处于明显的劣势.提示当相同规模的不同体制医院获得准入,大中型医院以目前的状态参与竞争前景堪忧.     

Mediastinal mature teratoma perforated into the pericardial sac: a case report

Mature teratomas occasionally rupture into adjacent organs such as lung, bronchus, mediastinum and pericardial sac. However, perforation into the pericardial sac is rare. We experienced a case of mediastinal mature teratoma perforated into the pericardial sac. A 16-year-old man was admitted to our hospital due to sudden severe anterior chest pain. Chest X-ray showed a mass shadow in the right middle lung field. Chest CT scan and MRI demonstrated a heterogeneous mass with fat component in the right anterior mediastium adjacent to the pericardium. Some squamous cells were obtained from the mass by CT guided percutaneous needle biopsy. Operation was performed with the diagnosis of mediastinal teratoma. The mass adhered to the pericardium and turbid pericardial effusion was noted. The mass was removed with the pericardium. The mass was 9 x 6.5 x 6 cm in size, which contained yellow sebaceous material and a tuft of white hair. The pathological diagnosis of the mass was mature cystic teratoma with perforation into the pericardial sac.     

高度近视眼LASEK治疗并发症53例

目的:探讨准分子激光上皮瓣下角膜磨镶术(laserepithelialkeratomileusis,LASEK)手术并发症的类型、产生原因及处理方法。方法:应用LASEK治疗等效球镜为-7.25～14.50D的高度近视眼53例(106眼),对术中和术后产生的并发症进行相关原因分析。结果:LASEK术中并发症主要有上皮瓣剥离困难、破碎、游离、皱褶、局限性缺损等,术后并发症主要有角膜上皮下雾状混浊(Haze)、最佳矫正视力下降、屈光度回退、眩光、上皮瓣溶解等。结论:严格掌握LASEK的手术适应证,熟练掌握手术技巧和正确处理角膜上皮瓣的各种并发症是保证LASEK成功的关键。     

患者接受医院免费健康教育处方状况分析

目的　了解来北京大学第一医院就诊者及其家属对《健康教育处方》的认同状况。方法　对摆放健康教育处方前来院就诊者及其陪同家属 3 98人和摆放《健康教育处方》后主动索取《健康教育处方》的 5 49人进行问卷调查。结果　《健康教育处方》摆放前 ,97 74%的人认为候诊等待时烦躁 ,92 2 1 %的人抱怨缺乏阅读材料 ,97 99%的赞成摆放《健康教育处方》 ;摆放《健康教育处方》后 ,3 7 70 %的人候诊等待时感到烦躁 ,仅 9 47%的人抱怨缺乏阅读材料 ,98 1 8%的人赞成摆放《健康教育处方》。结论　在医院发放《健康教育处方》是可行的 ,由制药厂赞助《健康教育处方》印制的方式受到大多数就诊者的认可     

有机改进剂用于离子色谱法测定水中S2O3^-2、SCN^-、ClO4^-的研究

目的：探讨有机改进剂对S2O3^-2、SCN^-、ClO4^-的保留时间的影响，并建立同时测定水中7种标准阴离子和S2O3^-2、SCN^-、ClO4^-的离子色谱分析方法。方法：采用丙酮和乙腈作有机改进剂。采用Metrosep ASupp5—100阴离子交换柱，以3．2mmol／LNa2CO3＋1．0mmol／LNaHCO3为淋洗液，比较加入不同浓度有机改进剂后S2O3^-2、SCN^-、ClO4^-的保留时间、ClO4^-的峰形和柱压，化学抑制电导检测离子色谱法。结果：随着丙酮浓度的增加，ClO4^-的保留时间则由36min（0％丙酮）缩短为21min（25％丙酮），ClO4^-峰形有改善，但柱压也明显增加。采用20％乙腈代替丙酮，保留时间只有轻微改变，但柱压和ClO4^-峰形有明显的改善。各阴离子的线性好（r〉0．9990），相对标准偏差均小于3．7％（n=6），平均加标回收率均在89．4％-105．3％之间，检出限在2．92-32．1μg／L之间。结论：有机改进剂可缩短分离时间、改善峰形。在本文所作的试验中，加入20％乙腈作为有机改进剂所得分离效果最好。     

改进的亚硫酸氢钠测序法检测HepG2 RASSF1A基因CpG岛甲基化状态

目的 改进亚硫酸氢钠测序法，并检验改进后方法在甲基化检测中的可行性。方法 提取人肝癌细胞株HepG2基因组DNA，亚硫酸氢钠化学修饰，针对修饰后Ras相关家族1A基因（RASSF1A）启动子序列设计特异引物并结合沉降PCR扩增，T-A载体克隆、测序。结果 HepG2细胞RASSF1A基因启动子CpG岛的16个CpG位点均被甲基化。结论 改进后亚硫酸氢钠测序法能明显减少非特异性扩增，提高PCR效率，更适于基因甲基化状态的检测。     

儿童双表型白血病的临床特征及预后分析

目的分析儿童双免疫表型白血病的临床及生物学特征，评价儿童急性白血病双免疫表型与治疗相关因素及预后的临床重要性。方法自1998年1月1日至2003年5月31日进入XH 99治疗方案的所有新诊治的急性白血病(AL)患儿，诊断采用MICM分型诊断，治疗分别按AML XH 99、ALL XH 99危险度分类标准进行分层治疗。用流式细胞仪进行免疫表型分析，根据免疫表型结果将患儿分为4组，伴有/无髄系相关抗原表达的急性淋巴细胞白血病(My+ALL/My-ALL)以及伴有/无淋系相关抗原表达的急性髓系白血病(Ly+AML/Ly-AML)。生存分析采用Kaplan Meier方法；生存率之间的比较采用log rank检验；临床及生物学特征与治疗相关因素的分析采用χ2检验或Fisher精确概率法(双尾)。结果①174例提供免疫分型的ALL患儿中，My+ALL患儿34例，占19.54%，其与My-ALL组患儿除在B ALL组患儿达缓解时间有统计学差异外(P<0.05)，其它临床、生物学特征及治疗反应均无统计学差异(P>0.05)；两组患儿5年无事件生存(EFS)率分别为\[(61.76±8.33)%与(68.03±5.55)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.0526)。②74例提供免疫分型结果的AML患儿中，Ly+AML患儿18例，占24.32%，其与Ly-AML组患儿临床、生物学特征及治疗反应无统计学差异(P>0.05)；两组患儿5年EFS率分别为\[(39.82±13.59)%与(51.29±9.70)%\],log rank检验两组患儿5年EFS率无统计学差异(P=0.3164)。结论双免疫表型对儿童白血病预后无明显影响，可用同样现行的化疗方案治疗这部分患儿。