高血压家系802人的高血压患病率、知晓率、治疗和控制状况调查

目的了解高血压家系人群高血压患病率、治疗率和控制率特点。方法用整群随机抽样调查的方法调查高血压家系高血压的流行和控制情况，分析比较相关指标的差异。结果家系成员高血压患病率为55．86％，存在危险因素聚集现象。高血压的知晓率、治疗率、控制率分别为79．46％、62．72％、19．64％。结论该地区高血压家系高血压患病率较高，遗传因素是重要原因。虽高血压控制水平较高，但需加强高血压的一级预防。     

经内镜鼻胰管引流在重症急性胰腺炎治疗中的应用

目的 :初步总结经内镜鼻胰管引流在重症急性胰腺炎治疗中应用的疗效。　方法 :自 1998年 3月以来 ,在重症急性胰腺炎患者入院后常规非手术监测治疗的同时 ,随机床旁行经内镜置放鼻胰管引流 14例。其中明确合并胆结石 8例。观察每天胰管引流量和入院后第 5天在体温、心率、白细胞计数、血糖、血钙、动脉氧分压和血、尿淀粉酶的变化 ,并与第 1天比较 ,记录治疗结果和住院时间。　结果 :经鼻胰管引流时间为 (7.3± 4 .0 )天 ,前 5天的胰液引流量分别为每天 (2 36 .4± 176 .6 )、(2 87.1± 16 4 .7)、(2 84 .6± 2 16 .4 )、(435 .0± 35 7.8)ml和 (377.8± 2 2 3.8)ml。入院后第 1天和第 5天的体温为 (38.2± 0 .6 )和 (37.2± 0 .8)℃ (P <0 .0 1)、心率为 (10 2 .3± 17.0 )和 (82 .9± 14 .5 )次 /min(P <0 .0 1) ,白细胞计数为 (14 .6± 4 .2 )和 (10 .1± 5 .4 )× 10 9/L(P <0 .0 5 ) ,血糖为 (10 .0± 4 .9)和 (8.6± 3.3)mmol/L(P >0 .0 5 ) ,血钙为 (2 .1± 0 .2 )和 (2 .2± 0 .2 )mmol/L(P >0 .0 5 )　动脉氧分压为 (78.0± 16 .3)和 (113.0± 4 1.6 )mmHg(P <0 .0 1) ,血淀粉酶为 (6 95 .7± 4 4 5 .2 )和 (82 .6± 4 7.1)U/L(P <0 .0 1) ,尿淀粉酶为 (3174 .1± 2 5 4 2 .5 )和(2 86 .8± 2     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

Pilon骨折的治疗

作者自1988年1月至1993年12月收治Pilon骨折31例，根据Riled的分类祛：Ⅰ型5例，Ⅱ型10例，Ⅲ型16例．手术治疗22例，保守治疗9例．随访l－4年，疗效按Bourne的标准评定，Ⅰ型骨折手术或保守治疗优良率100％，Ⅱ、Ⅲ型骨折手术治疗优良率85％，保守治疗优良率33．3％．作者认为Pilon骨折Ⅱ、Ⅲ型应手术治疗．保守治疗仅用于Ⅰ型骨折．手术控AO的四步重建法进行．但严重的粉碎骨折或开放骨折伴软组织缺损，内固定确定难干实施者，则改用踝部超关节外固定支架固定．     

重组人红细胞生成素治疗肾性贫血的临床分析

目的　观察重组人红细胞生成素 (RhEPO)对肾性贫血的治疗作用。方法　根据使用EPO剂量的不同将 39例慢性肾衰竭并血液透析病人分成 4组 ,观察治疗后 2、4、12个月时与治疗前 (0月 )相比红细胞数 (RBC)、红细胞比积 (Hct)及血红蛋白含量 (Hb)的变化。结果　 2 4例使用EPO10 0 - 15 0IU/ (kg·w) (6 0 0 0IU/w - 90 0 0IU/w) ,治疗后RBC、Hct、Hb较治疗前有显著升高 (P≤ 0 .0 0 1) ;5例使用EPO5 0IU/ (kg·w) (30 0 0IU/w) +间断输血患者 ,其RBC、Hct、Hb升高不显著 ;10例不用EPO而单纯输血患者 ,其RBC、Hct、Hb无明显变化 (P >0 .0 5 )。结论　EPO能较好地纠正肾性贫血 ;单纯输血不能治疗肾性贫血     

急性胰腺炎病因和诊治十年变迁(附725例报道)

急性胰腺炎的病因和早期诊治一直是临床医师关注的问题。目的：探讨近十年来急性胰腺炎病因、诊断和治疗的变迁及其对预后和住院费用的影响，总结急性胰腺炎的治疗经验。方法：采用回顾性临床研究方法，将725例人选患者分为两组．1993年4月～1998年12月就诊的患者为第一组，1999年1月～2002年8月就诊的患者为第二组：分析两组患者病因、诊断指标、治疗方案、并发症、预后、住院费用方面的变化。结果：比较两组病因，两组患胆囊炎胆结石者分别占72．3％和75．8％，高脂血症者分别占25．3％和25．8％，酗酒者分别占10．6％和9．7％。血清淀粉酶水平高于正常上限3倍的总检出率为66．9％．CT诊断总阳性率为92．0％。第一组46．9％的患者应用生长抑素，31．1％的重症患者发生胰腺假性囊肿，2．2％发生胰腺脓肿，死亡率为15．6％。第二组72-3％的患者应用生长抑素，13．2％的重症患者发生胰腺假性囊肿，2．2％发生胰腺脓肿，死亡率为6．5％。第二组的住院费用与第一组相比呈下降趋势，但无显著差异。结论：胆道疾病仍为急性胰腺炎的主要病因，血清淀粉酶和CT是急性胰腺炎较常用和可靠的检查手段。通过早期足量应用胰酶抑制剂(尤其是生长抑素)、肠道去污和改善胰腺微循环，可改善急性胰腺炎的预后，降低并发症发生率、死亡率和住院费用。     

Treatment of osteoporosis in men

Osteoporosis in men is recognised worldwide as an important and increasing public health problem. The causes are more heterogeneous than those in women. About 50% are diagnosed as secondary cases. In some secondary forms of osteoporosis the specific diagnosis results in additional therapeutic options (e.g. androgen therapy in proven hypogonadism). The basic therapy for osteoporosis in men is no different to that in postmenopausal women, namely recommendations for counteracting modifiable risk factors, especially with regard to diet, physical exercise, and calcium and vitamin D supplementation. Concerning specific drug medications, however, even today there is still a therapeutic dilemma in male osteoporosis. While older substances (e.g. calcitonin, fluoride, alfacalcidol) are approved for both sexes, all newer medications have primarily been approved for the treatment of postmenopausal osteoporosis. Health authorities request studies in purely male populations. For new drugs, fracture data are necessary while for new substances within a class (e.g. bisphosphonates), at the very least consistent effects on bone mineral density (BMD) and bone turnover markers are requested. Due to these regulatory rules, ibandronate, teriparatide and strontium ranelate are not approved in the European Union. Some years ago, alendronate was the first bisphosphonate that was approved for the treatment of men with osteoporosis, based on consistent results from two independent male studies using a daily 10 mg dosage. Very recently risedronate was approved by the FDA and EMEA. A randomised, placebo-controlled multicentre trial of 285 male patients showed, after 2 years, a 5.8% increase in lumbar spine BMD in the risedronate 35 mg once weekly group vs 1.2% in the placebo group. In a prospective controlled study on 316 men with primary or secondary osteoporosis we found, after 12 months, a lumbar spine BMD of +4.7% vs +1.0% in controls. The number of patients with one or more new vertebral fractures was 8 in the risedronate group and 20 in the placebo group (a fracture reduction of 60%). Furthermore, we found a significantly smaller decrease in height and a steeper decrease in back pain in the risedronate group. Risedronate is the first oral bisphosphonate available for men with the more comfortable once weekly dosage.     

Graves甲亢多种治疗方法对Graves眼病影响的系统评价

目的 通过榆索、分析文献系统评价131I、手术、抗甲状腺药物(ATD)治疗Graves病(GD)对Graves眼病(GO)的影响.方法 检索了MEDIJNE(1966年-2006年3月)、EMBASE(1984-2005年)、The Cochrane Library(2006年第1期)、中国生物医学文献光盘数据库(EBMdisc,1978年1月-2006年4月)和中国学术期刊全文数据库(CNKI,1994-2006年)所收录的有关不同GD治疗方法对GO影响的文献,同时从参考文献中追溯文献.对纳入研究的方法学质量进行评价,根据是否采取预防甲状腺功能低下(简称甲低)发生的措施对纳入研究进行亚组分析,结果采用RevMan4.2软件进行统计学分析.结果 最终纳入随机对照研究5项,非随机对照研究2项,病例对照研究1项,共1625例患者.Meta分析显示:如GD治疗后早期未采取措施预防甲低,131I与手术治疗、131I与ATD治疗GD在诱发或加重GO以及减轻GO症状方面莘异有统计学意义[检验值分别为2.31,5.97,3.70,5.55;P均＜0.05];如GD治疗后早期采取措施预防甲低,手术与ATD治疗GD在诱发或加重GO以及减轻GO症状方面差异无统计学意义(检验值分别为0.27,0.99;P均＞0.05),尚无研究涉及131I治疗GD后早期采取甲低预防措施时131I对GO的影响.结论 若未及时采取甲低预防措施,131I较ATD、手术治疗GD更容易诱发或加重GO,减轻GO的症状却不如后两者,对于治疗前已有活动性GO的患者,应慎用131I.