异位子宫内膜和在位子宫内膜分泌泌乳素的研究

作者将29例子宫内膜异位症（简称异位症）患者的异位和在位内膜进行离体组织孵育，应用放射免疫方法检测孵育液中泌乳素（PRL）含量；同时应用ABC免疫酶标记法确定异位和在位内膜分泌PRL的部位，结果异位和在位内膜离体组织经0～24h孵育，孵育液中PRL含量均显著增加（P＜0．05）；继续孵育至48h，PRL含量不再增加。但异位内膜分泌PRL的活性低于自身在位内膜。免疫组化PRL检测，异位和在位内膜分别有4和6例呈PRL阳性反应。组织学对照现察，内膜成熟上皮细胞数及前蜕膜细胞数越多者，其相应孵育液中PRL含量越高，免疫组化PRL阳性反应也越强。提示异位内膜PRL分泌特点与其自身在位内膜不完全相同，可能与病理环境有关。     

Gestion des risques et choix de maintenance à l'hôpitalRisks management and maintenance choices at the hospital

Regulations evolve and risks management becomes one of the biomedical engineers' preoccupations. Thus, risks are various, and consequently it is difficult to identify, to manage and to bring them under control. Furthermore, regulations exist for sectors like healthcare technology monitoring, but it is not the same thing for instance for the risks linked to the maintenance. Thus regulation in the sector of maintenance evolves and the decree of the 1^st July law of health safety is going to modify the biomedical environment. The goal of this work is to study the tools and the methods of risks management that have been used for several years in the industrial field and to use them for some biomedical equipment like monitors or IV pumps. These methods adapted to these equipment will allow us to determine some appropriate rules of maintenance.     

Is pregnancy the best treatment for hyperprolactinaemia?

This paper reports the changes in prolactin levels after 12 spontaneous and 52 induced pregnancies in 54 women with unambiguous hyperprolactinaemia (median plasma prolactin levels 67.5 ng/ml, range 40-400). Twenty-three of the patients showed radiological evidence of prolactinoma. The pregnancies were induced in 37 patients by bromocriptine, in nine by metergoline, in two by lisuride and in four by other treatments. Of the 64 pregnancies, 16 ended in spontaneous abortion, while 48 went to term. Follow-up was continued for at least 6 months after delivery or until the end of lactation. In a control group of 32 hyperprolactinaemic women (median prolactin 70 ng/ml, range 40-400) not wishing to become pregnant, prolactin changes were similarly registered over a mean period of 15 months without any treatment (range 6-38 months). After pregnancy, a significant downward trend of plasma prolactin was observed in the puerperal women with a 'normalization' rate of 17%. No changes were observed in the 32 controls who did not become pregnant.     

异环磷酰胺为主的联合方案治疗晚期复发鼻咽癌

[目的]观察比较异环磷酰胺(IFO)、顺铂(DDP)、5-氟尿嘧啶(5-Fu)联合方案(IPF方案)与DDP,5-Fu(PF方案)治疗晚期复发鼻咽癌(Ⅲ-Ⅳ期)的近期疗效及毒副反应。[方法]136例均经病理证实为晚期复发鼻咽癌患者,随机分为IPF组69例,PF组67例(对照组)[结果]IPF组和PF组有效率分别为69.56％(48/69)和43.3％(29/67),两组间差异有显著性(X2=8.519,P<0.01)。中位生存期:IPF组16个月(8-34个月),PF组为6.5个月(4-21个月),两组间差异有显著性(X2=22.36,P<0.05)。毒副作用主要为骨髓抑制,Ⅲ-Ⅳ度白细胞下降率IPF组为49.4％,PF组为5.97％,两组差异有显著性(X2=29.54,P<0.01)。Ⅲ-Ⅳ度血小板下降率IPF组为29.18％,PF组为0％(X2=30.29,P<0.01);Ⅲ-Ⅳ度消化道反应两组的发生率分别为15.94％和11.94％(x2=0.234,P>0.01).且以Ⅲ度为主。[结论]以IFO为主的方案联合治疗晚期复发鼻咽癌疗效好,毒副反应能耐受,可作为一线方案。     

Papilliferous keratoameloblastoma

A case of papilliferous keratoameloblastoma is reported which is only the second ever documented. The patient was a 76-yr-old black woman with a large expansile multilocular radiolucency of the body, angle and ramus of the mandible. Histologically the lesion consisted of sheets of cystic follicles filled with necrotic debris and sometimes parakeratin. The vast majority of the follicles were lined by a papilliferous epithelium consisting of large rounded cells with centrally placed nuclei. True papillary projections with cores of connective tissue were also present. The remainder of the follicles were lined by a thin parakeratinising stratified squamous epithelium. Histological features characteristic of ameloblastoma were absent. Final classification of these lesions will have to await the reporting of further cases.     

老年及老年前期重症肌无力的手术治疗(附23例报告)

目的总结胸腺切除术治疗老年及老年前期重症肌无力的临床效果。方法对1981年～2001年在我院行胸腺切除治疗的23例老年及老年前期重症肌无力患者的手术疗效进行回顾分析。结果在所有重症肌无力患者中老年及老年前期患者所占比例小,男性为多见;全身型为主,合并胸腺瘤及危象者多;手术总有效率43.5％。结论老年及老年前期重症肌无力的手术疗效较青壮年为差,但仍是可选择的一种重要方法。     

Developing a model for clinical and basic science teaching skills

This report describes a model for identifying sets of teaching abilities considered to be effective for medical school teaching staff, based on roles teachers assume and functions they are expected to perform as instructors. The specification of these teaching abilities was the first step in the development of a comprehensive course on Medical Instruction at the Basic Institute of Medical and Agricultural Biology of the State University of Sao Paulo, Botucatu, Brazil, where the senior author is employed. The work was based on the assumption that medical school teachers are expected to assume a variety of teaching roles and that identification and specification of the abilities that define their roles can result in more effective and efficient teaching.     

Management of pediatric pontine gliomas

We present 36 consecutive patients with intrinsic glioma of the pons. Tumors with exophytic expansion were excluded. There were 16 females and 20 males, ranging in age from 2 to 13 years, median 6 years. The most common presenting symptoms were cranial nerve dysfunction. unsteadiness of gait, and hemiparesis. Computed tomography (CT) showed a hypodense (17/21) or isodense (4/21) expansion of the pons. Five tumors had areas of contrast enhancement. Following information about prognosis and possible types of management, parents decided for or against radiation therapy: twentyfour children underwent irradiation and 12 did not. Median survival among children receiving a full course of irradiation was 280 days, compared to 140 days in an equivalent group of non-irradiated children. Hemiparesis presenting without cranial nerve symptoms and contrast enhancement on CT scan were poor prognostic factors, whereas sex, age, and duration of symptoms at diagnosis were unrelated to prognosis.     

全去带乙状结肠原位可控膀胱术25例随访报告

目的：探讨全去带乙状结肠原位可控膀胱术的临床效果。方法：对25例施行该术式术后患者的可控性、尿动力、血清电解质、肾功能、生活质量等进行随访观察。结果：25例随访2－15个月，平均11．3个月。白天完全自控排尿25例（100％）；夜间完全自控排尿24例（96．0％），1例偶有遗尿；贮尿囊容量220－370ml，平均320ml；贮尿囊内压力1．86－3．92kPa，平均2.44kPa。IVU及贮尿囊造影示单侧贮尿囊输尿管反流2例（8．0％），无肾积水；膀胱镜检查2例（8．0％）贮尿囊内出现细沙样结石，1例（4．0％）贮尿囊后尿道吻合口狭窄，经尿道直视内切开术治愈。15例（60．0％）男性患者保留性功能，肾功能正常，1例（4．0％）出现一过性高氯血症。结论：全去带乙状结肠原位可控膀胱术手术成功率高，疗效可靠，患者生活质量高，是一种较理想的尿路分流术，值得推广。     

二肽基肽酶Ⅳ抑制剂P32/98

二肽基肽酶Ⅳ(DPPⅣ)涉及2型糖尿病病理过程中的信号传导过程,其抑制剂能够增强胰岛素样多肽(GIP)和胰高血糖素样肽片段(GLP)的活性,并能提高葡萄糖耐受水平.动物实验研究表明,糖尿病模型大鼠口服DPPⅣ抑制剂P32/98,能降低DPPⅣ的活性,改善糖耐受性以及增加胰岛素的敏感性.临床试验进一步揭示,P32/98的安全性和耐受性良好,能明显改善受试者糖耐受性和胰岛素应答水平.