基层医院腹腔镜胃肠肿瘤手术应用分析

目的：通过腹腔镜技术在我院胃肠肿瘤手术中的大量应用,评价其安全性、疗效性、优越性及经济性,以探究其推广应用价值。方法回顾性分析我院2009年12月－2013年12月263例使用腹腔镜技术诊治胃肠肿瘤患者的临床资料。结果263例手术中成功242例。术中平均失血量100．5 ml,平均手术时间160．8 min,术后平均离床活动时间26．4 h,术后平均52．4 h 胃肠功能恢复,术中、术后未出现严重并发症,疗效满意。结论腹腔镜胃肠肿瘤手术在基层医院安全可行、疗效确切,且具有创伤小、出血少、疼痛轻、恢复快等优势,经济学评价良好,值得在基层医院推广开展,以提升广大患者的生活质量。     

基层医院基础护理操作中存在的问题及对策

目的提高基层医院临床基础护理操作水平。方法通过探讨基层医院基础护理操作中存在的问题,提出管理和培训对策并加以实施。结果临床基础护理操作达到医院分级管理标准。结论健全教学管理组织,打破传统的质量控制方法;加强对掌握规范操作重要性的认识;改进培训方法;补充新知识、引进新思维等是提高基层医院临床基础护理操作水平的重要举措。     

CIK治疗恶性肿瘤的疗效及相关肿瘤标志物的变化

目的探讨CIK治疗恶性实体肿瘤的疗效及相关肿瘤标志物的改变。方法选择32例恶性实体肿瘤患者进行CIK治疗,观察治疗前后生活质量、客观疗效、肿瘤标志物及免疫指标的变化。结果 CIK治疗后患者卡氏评分(KPS)提高率59.4%,RR为46.9%,DCR为84.4%。治疗后,相关肿瘤标志物CEA、NSE、AFP、CA153、CA199、Fer检测值总体有所下降。CD_3~+较治疗前显著升高(P0.05)。CD_4~+、CD_8~+、CD_4~+/CD_8~+与治疗前相比无显著变化(P0.05)。结论 CIK细胞治疗可提高恶性实体肿瘤患者的生存质量,但相关肿瘤标志物无明显变化。     

Elevated serum transforming growth factor β1 level in primary lung cancer patients with finger clubbing

The mechanism causing finger clubbing in patients with lung cancer (LC) is still unclear. We compared age, cigarette consumption, data on blood gas analysis and pulmonary function tests among patients with LC with clubbing ( n  = 30) and without clubbing ( n  = 28) and among patients with pulmonary emphysema (PE) with ( n  = 11) and without clubbing ( n  = 17). We also examined serum concentrations of transforming growth factor β1 (TGFβ1) and insulin-like growth factor-I (IGF-I) in the patients and healthy volunteers ( n  = 21). There were no differences in age or cigarette consumption. LC groups showed normal levels of P a O ₂ and P a CO ₂, suggesting that neither hypoxaemia nor hypercapnia caused clubbing in these patients. The level of serum TGFβ1 in patients with LC with clubbing was significantly higher than in other groups ( P  < 0.005), whereas levels of IGF-I did not differ among the groups. Our data suggest that TGFβ1 may play a role in the mechanism of clubbing in patients with LC.     

The role of the district nurse in bereavement support

BACKGROUND: District nurses are frequently involved in the care of patients immediately prior to death and could therefore provide support to bereaved relatives. However, little is known about nurses' views on bereavement support or their actual involvement. AIMS OF THE STUDY: To survey a representative sample of district nurses to ascertain their current practice and perceived role in supporting bereaved people and to identify factors that influence their practice. DESIGN AND METHOD: A self-completed postal questionnaire was distributed anonymously to 522 district nurses in the central southern coastal area of Britain. It comprised five sections: interest in and education about bereavement; a Likert scale to measure nurses' views about bereavement care; information about the practice with which the nurse had links; bereavement care provided by the practice; and demographics. RESULTS: A 62% response rate was achieved following two reminders. Sixty-nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow-up bereavement visiting. Ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient. CONCLUSIONS: Older age, higher qualifications and district of employment among district nurses were associated with greater interest in bereavement and more proactive care of bereaved people. The findings of this survey have important implications for the training, continued education and the extended role of the nurse in bereavement support.     

Effect of renal function on renal responsiveness to parathyroid hormone in primary hyperparathyroidism and chronic renal failure

The effect of renal function on the cyclic AMP (cAMP) response to exogenous parathyroid hormone (PTH) was examined in patients with chronic renal failure (n = 22) and primary hyperparathyroidism (n = 19). In the patients with chronic renal failure there was marked resistance to the effect of exogenous PTH. In primary hyperparathyroidism the cAMP responses were variable; most of the patients with an abnormally small response having impaired renal function. After parathyroidectomy, responsiveness improved to varying degrees. In three patients repeatedly tested up to several months after parathyroidectomy, the recovery of responsiveness was a gradual process which began within days but did not, however, return to normal. Thus, there was an irreversible component to the resistance to PTH in these patients. A strong negative correlation between plasma creatinine and the cAMP response to PTH (P less than 0.001) was found in a group of patients, some with treated primary hyperparathyroidism and some with chronic renal failure. Thus, renal impairment is an important, but probably not the sole, contributory factor involved in the irreversible resistance to the action of PTH in hyperparathyroidism.     

MRI of Long-Term Epilepsy-Associated Tumors

In 20 to 30% of patients with long-term drug-resistant epilepsy neuroepithelial tumors, usually glioneuronal tumors are found. Gangliogliomas and dysembryoplastic neuroepithelial tumors (DNTs) are well characterized, both clinically and on MRI. Both tumor types are located in the cortex or in the cortex and subcortical white matter, gangliogliomas most commonly in the mesial temporal lobe ("around the collateral sulcus"). Both tumor types have typical imaging features, and from both, location and imaging features, they can be usually distinguished from glial tumors. This distinction is important since more than 70% of patients with drug resistant temporal lobe epilepsy caused by gangliogliomas and DNTs get seizure free following extended lesionectomy.     

循证护理对原发性胆汁性肝硬化患者术后并发症及康复进程的影响

目的探讨循证护理对原发性胆汁性肝硬化患者术后并发症和康复进程的影响。方法抽取入院行手术治疗的原发性胆汁性肝硬化患者50例作为研究对象,采用抽签法分为2组,对照组行常规护理,观察组行循证护理,观察2组康复进程并记录并发症发生情况。结果观察组并发症发生率为24.0%,低于对照组的60.0%,差异有统计学意义(P0.05)。观察组瘙痒好转时间、水肿消失时间、腹水消失时间、出院时间均显著短于对照组(P0.05)。结论原发性胆汁性肝硬化患者术后接受循证护理,可降低并发症发生率,改善康复效果。     

Fatigue after treatment for malignant and benign bone and soft tissue tumors

Fatigue has been mentioned as an important complaint in several groups of disease-free patients after curative treatment for cancer. However, it has never been investigated in a sample of patients who have been treated for a bone or soft tissue tumor in the past. In the current study, these patients participated. Measurement included posted questionnaires at baseline and at follow-up (two years later). Baseline results indicated that fatigue is a severe problem for 28% of the investigated patients. Percentages were equal for patients who were treated for malignant or benign tumors. Fatigue complaints seem to be most severe for patients who finished treatment relatively recently, and for patients who had to undergo more than one operation. In addition, fatigue was associated with several psychological and physical variables. At follow-up, the majority of all patients who were severely fatigued at baseline continued to be severely fatigued. Severe fatigue at follow-up was predicted by oncological complications after initial treatment, less optimism, and more somatization. It can be concluded that fatigue is an important problem for more than a quarter of a sample of patients who have been treated for a malignant or benign bone or soft tissue tumor in the past.