肛门括约肌肌电图监测下双侧L2～S2选择性脊神经后根切断术治疗痉挛性脑瘫

目的为提高手术安全性,在L2～S2选择性脊神经后根切断(SPR)手术时,对肛门括约肌进行肌电图(EMG)监测,并评价其作用。方法在SPR手术监测中,当对S2后根小束进行电刺激时,采用针状电极记录双侧肛门括约肌的反应情况,有明显反应的后根小束予以保留。手术后随访患者踝痉挛改善情况和括约肌功能变化情况。结果所有患者手术后踝痉挛均有明显改善,无大小便功能障碍发生。结论SPR手术包括S2后根时,术中括约肌EMG监测对保证疗效,保护括约肌功能,提高手术安全,具有重要意义。     

华西医院专科经营助理详解

“跳起来摘桃子”，有人如此形容华西医院这些年的发展。5年前，华西医院拥有开放床位3466张，规模的扩大和管理相对滞后之间的矛盾随着医院发展逐渐凸现出来，医院管理者职业化建设的要求也越来越迫切。2004年春，本着“把时间还给医生，把医生还给病人”的宗旨，该院启动医院管理“运营创新”项目，探索了一条和时下流行的“MBA培训”不同的建设路径，并命名其为“专科经营助理培训项目”。一年后的2005年5月，随着27名“专科经营助理”上岗，该院专科经营助理培训和专科经营制度也被正式导入，并与信息化建设、财务成本制度改革、薪酬制度改革等共同构成了该院的“运营创新”体系。“他们是医院的眼睛，能发现问题，他们进入科室后，可使教授、博士生导师从不熟悉的行政业务中解脱出来，更多地考虑战略问题，把战术问题交给专科经营助理来完成。”事后，华西医院院长石应康这样评价该院专科经营助理的工作。这究竞是怎样一个群体？其日常工作和职能分工如何来界定？4年下来，这个群体工作情况又怎样？作为先行先试者，华西医院有关人士作出了若干解答。     

医院用血液制品HCV污染情况的调查

目的调查医院治疗用血液制品ＨＣＶ污染情况．方法临床治疗所用的血液制品，在输完后留容器之残液备检．采用酶标免疫法（ＥＬＩＳＡ）检测．对ＥＬＩＳＡ检测之阳性标本及在阴性标本中随机抽取９份，采用逆转录双ＰＣＲ方法检测ＨＣＶ＿ＲＮＡ．结果血浆白蛋白抗＿ＨＣＶ阳性率４５８％，新鲜血浆阳性率２６％．两种方法检测同一标本，ＥＬＩＳＡ检测阳性的血液制品中，用ＰＣＲ证实，并非都有病毒复制；而在ＥＬＩＳＡ检测的阴性标本中，仍旧有较高的ＰＣＲ阳性检出．结论血液制品存在着ＨＣＶ污染，抗＿ＨＣＶ对于ＨＣＶ感染的诊断价值很高．检测血液制品中的抗＿ＨＣＶ，合理使用血液成份，可防止ＨＣＶ在医院内传播．     

To market! To market! A new dawn for community care?

The public sector in Britain has been subjected to over a decade of major reform aimed at breaking up public service monopolies, at containing costs while at the same time opening services up to greater consumer choice. Health and social services have not been exempt from this revolution in the organization and management of public sector services. The long-standing policy of care in the community is being subjected to market principles and the introduction of a ‘contract culture’ very similar to the NHS reforms introduced in 1991. This paper reviews the origins of these developments in the doctrines of ‘new public management’, a movement which has proved attractive to policy-makers in many countries. Local authority social services departments have been identified as the lead agency for the development of a mixed economy of care following a review of community care policy by the government's health adviser, Sir Roy Griffiths, and a subsequent white paper. This paper examines the limited empirical evidence available on how managers and providers are meeting the challenge bestowed upon them, and concludes that most authorities are moving ahead cautiously if at all. Only a handful of authorities studied have embraced the reforms with any degree of enthusiasm. The paper concludes with an assessment of the reforms from two perspectives: a pessimistic one and an optimistic one. There are many worrying features of the reforms, not least among these being a lack of clarity over their intended purpose. Tensions and contradictions are plentiful, which places in jeopardy the certainty of the reforms in becoming user led rather than provider driven. A more optimistic scenario is that the changes are leading to a loosening up of services and practices which have often suffered from sclerotic tendencies, paternalism and sometimes complacency. If the reform process is skilfully handled and not rushed and if the ends are clearly established and communicated then users and carers could prove to be the principal beneficiaries.     

Needs assessment for persons with severe mental illness: What services are needed for successful community living?

The development and implementation of effective community support systems are goals of many public mental health authorities who are attempting to shift the focus and dollars for mental health services from inpatient to community care. This article presents the results of a survey which asked 90 community mental health agency case managers to assess the community support and residential needs of over 1400 of their clients. Medication monitoring and therapy were rated high priority needs. Psychosocial treatment, day and vocational activities also ranked high. Survey responses regarding residential services indicated a need for more supported and supervised options.The study reported was a collaborative effort by county and agency staff.     

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.     

Stereotactic brain biopsy in AIDS

Summary In the hope of finding a treatable condition, the need for rapid diagnosis in HIV-seropositive patients with brain lesions is apparent. In order to evaluate the efficacy of stereotactic brain biopsy in AIDS patients, we retrospectively studied 25 HIV-infected patients undergoing stereotactic biopsy. Brain lesions were identified with gadolinium-enhanced MRI and/or contrastCT. Brain biopsy was performed using the system of Riechert. From 8 up to 15 small tissue samples from one or two targets were obtained in every patient. The biopsy material was examined cytologically, histologically (including electron microscopy), immunohistochemically and, in part, by animal test and polymerase chain reaction (PCR). A definite diagnosis was achieved in 92%. Diagnosis included primary central nervous system lymphoma (PCNSL) (10), toxoplasmosis (10), progressive multifocal leukoencephalopathy (2) and one case of co-existing toxoplasmosis and cytomegalovirus infection. Two biopsies were non-diagnostic. All PCNSLs showed polymorphic B-cell populations of high malignancy; accurate classification according to the Kiel classification was not possible. In 3 lymphomas Epstein-Barr nuclear antigen (EBNA) 2-mRNA could be detected by PCR and confirmed immunohistochemically by EBNA 2 expression. In 6 cases autopsy confirmed the biopsy diagnosis. Conventional histology was not sufficiently decisive for toxoplasmosis and progressive multifocal leukoencephalopathy, so that immunohistochemistry and animal tests became very important for a final diagnosis. With the help of different morphological and molecular biological techniques stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions. In view of the marked radio- and chemosensitivity of PCNSLs it is mandatory to establish an early and accurate histological diagnosis for adequate treatment.     

Neuropathy with lysosomal changes in Marinesco-Sj?gren syndrome: fine structural findings in skeletal muscle and conjunctiva.

The light- and electron-microscopical findings in the skeletal muscle and conjunctiva of 6 patients with Marinesco-Sj?gren syndrome (MSS) were presented. All patients were related and showed the cardinal clinical symptoms of the syndrome: congenital cataracts, mental retardation, delayed statomotor development, and cerebellar ataxia. The most prominent alteration found in the skeletal muscle of four patients was extensive neurogenic atrophy with conspicuous groups of atrophic muscle fibers. Additional findings were vacuolar degeneration and secondary, unspecific changes like slight mitochondrial alterations and increased variability in muscle fiber calibers. The ultrastructural examination revealed double-membrane structures near to, but not in direct contact with the nucleus. The nuclear changes described earlier (7, 20) were not found in any of the cases. Conjunctival biopsies revealed a marked increase in the number of lysosomes in fibroblasts. In summary, to the well known myopathic damage of muscles in MSS a neurogenic component should be added. Disturbed lysosomal function is to be considered as the basic abnormality, though the enzyme defect has not yet been identified. In cases of clinically suspected MSS, examination of a conjunctival biopsy is highly recommended.     

骨质疏松症的治疗和预防概述

原发性骨质疏松症 (Op)是骨构建和骨重建中 ,骨形成和骨吸收恒常调节失衡引发的一种缓慢的、渐进的骨吸收亢进症 ,是一类综合征。多种病因可以引起 ,现今一般认为和机体遗传、个体生活习惯、生理状态与生存环境等多种因素综合影响有关。因Op病因的多源性和发病机理的复杂性 ,现今尚在不断阐明中 ,多主张综合治疗处理。凡是骨密度(BMD)有明显减低或骨吸收生化标志有明显上升者 ,无论伴有或不伴有非暴力性骨折 ,均应给予治疗处理。一、Op的治疗原则和许多慢性非传染性流行性疾病类似 :(1 )去除病因 ,阻止骨量减少和骨质量劣化进程。 (2 )增…