非体外循环冠状动脉搭桥术早期疗效的探讨

目的：探讨非体外循环心脏不停跳冠状动脉搭桥术的安全性和早期临床效果。方法：自2000年7月至2002年3月51例冠心病患接受冠状动脉搭桥手术，按手术方式分为非体外循环组（n=21）和传统体外循环组（n=30)。将两组病人的术前临床资料，手术方式，术后并发症和疗效等进行对比分析。结果：两组术前临床资料无明显差异。非体外循环组手术时间，术后出血输血量，呼吸机辅助时间显少于体外循环组，并且术后心律失常的发生率明显降低（P均＜0．05），其他重要器官的并发症发生率亦低于体外循环组。两组平均随访9．6个月，心绞痛均消失，心功能改善，活动量明显增加。结论：非体外循环冠状动脉搭桥术是安全可行的，并发症少，近期疗效满意。     

山东省中小学生麻疹爆发原因的病例对照研究

为探讨山东省中小学生麻疹爆发的原因 ,采用 1∶2配比的病例对照方法对中小学生麻疹疫苗 (MV)效力进行了研究 ,同时对近年来中小学生MV接种率进行了估算。结果显示 :中小学生MV效力为 74 % ,95 %可信区间为4 7%～ 88% ;小学生MV效力明显高于中学生 ,分别为 82 %和 6 8% ;1999～ 2 0 0 1年学龄儿童的估算接种率分别为75 4 %、75 6 %和 5 5 7%。较低的MV效力和接种率是计划免疫工作薄弱地区中小学生麻疹爆发的主要原因。     

Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

Expression of CD44V2 in transitional cell carcinoma of the urinary bladder and in urine

CD44 is the principal cell surface receptor for hyaluronate. Variant forms of the receptor, produced by alternative splicing, have been found to be associated with tumor progression in a variety of cancers. Based on investigations at the RNA level, it has recently been proposed that expression of CD44 variant V2 was present in urothelial cancer but not in normal urothelium. Since a distinctive marker for urothelial cancer would be extremely useful, frozen sections of normal urothelium and urothelial cancer were examined for expression of standard CD44 and CD44V2. Frozen sections of specimens of 35 patients with transitional cell carcinoma of the bladder, 16 specimens of normal bladder and 5 ureters were examined. Immunohistochemical staining was performed using a polyclonal antibody to CD44V2 (PAB CD44V2), a monoclonal antibody to CD44V2 (MAB CD44V2) and a monoclonal antibody to CD44S (MAB CD44S). CD44V2 and CD44S were also measured in lysates of urine sediments from 21 patients by enzyme-linked immunoabsorbent assay (ELISA). All investigated transitional cell carcinomas expressed CD44V2. There was no differentiation between invasive and noninvasive carcinoma. CD44V2 was also expressed in normal urothelium. Standard CD44 was expressed by the transitional cell carcinoma, normal urothelium, musculature and interstitial tissue. The amount of CD44V2 and CD44S in lysates of urine sediments is not correlated to diagnosis. In contrast to investigations at the RNA level, CD44V2 on the protein level seems not to be a distinctive marker for urothelial cancer. Therefore, CD44V2 will not be a useful diagnostic marker for detection of transitional cell carcinoma.     

低血糖症误诊探讨

目的 通过病例分析，探讨低血糖症的误诊原因，为提高糖尿病的早期诊断提供参考资料。方法 对误诊17例低血糖患者的临床体征、确诊方法、误诊疾病进行分析研究。结果 低血糖症因与某些常见病或共存病症状相似、表现不典型而误诊。医生询问病史、查体不全面、习惯性思维、未充分利用辅助检查，等确诊时，病情已十分严重。结论 低血糖症误诊率高。提高对低血糖症的认识和警惕性，综合分析病史，详细地检查，是减少误诊的关键。     

七种常见舌苔的细胞化学计量诊断研究

以１１７例常见舌苔上皮细胞内ＬＤＨ、ＭＤＨ、Ｇ－６－ＰＤＨ、ＡＣＰ、ＡＮＡＥ、－ＳＨ、ＲＮＡ七种生物大分子物质的定量检测为基础，运用多元逐步回归方法建立正常薄白、虚寒薄白及白厚、薄黄、黄厚、花剥、光剥种舌苔的计量诊断模型，经临床回代检验，其敏感性、特异性、准确度、可用度分别为９３．２％、８１．４％、８７．２％和７５．７％。     

妊娠黄体瘤1例报告并文献复习

目的：探讨妊娠黄体瘤（LP）的误诊原因。方法：对1例典型LP病例进行全面病理学检查和组化及免疫组化染色，与正常卵巢黄体进行对比分析，并复习文献。结果：LP均发生于妊娠后期，临床无明显自觉症状，其病理形态学、组织学、免疫组化反应与正常卵巢黄体相似。多在剖腹产时偶然发现而误为卵巢肿瘤。结论；LP为妊娠后期卵巢黄素化细胞的结节状增生，并非真性肿瘤。妊娠期出现卵巢明显增大，应首先考虑到本病的可能性。必要时术中可作活检，以避免误切卵巢。     

Use of self-efficacy and dyspnea perceptions to predict functional performance in people with COPD.

This correlational and comparative study explored whether self-reports of self-efficacy and dyspnea perceptions predict the perceived level of functional performance in adults who have chronic obstructive pulmonary disease (COPD). The convenience sample included 97 Caucasian men (52) and women (45). Participants had to have a forced expiratory volume in 1 second (FEV1) of less than 70% predicted, and a FEV1/forced vital capacity (FVC) of less than 70%. Participants were recruited from pulmonary function laboratories and from better breather support groups in a Midwestern state. Three standardized, self-report instruments, COPD Self-Efficacy Scale (CSES), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and Functional Performance Inventory (FPI) were used to measure the participants' self-report of their perceptions of self-efficacy, dyspnea, and functional performance. Dyspnea predicted 38.1% of the variance in functional performance, with self-efficacy contributing an additional 6.5% to the variance in the total sample. Self-efficacy predicted 36.5% of the variance in functional performance in men, with dyspnea contributing an additional 7.2% to the variance. However, in women, only dyspnea was a significant predictor of functional performance, at 48.5% when both dyspnea and self-efficacy were entered as independent variables. To improve patients' perceptions of functional performance, nurses can use methods such as breathing techniques and upper- and lower-body exercises that increase optimal management of dyspnea. Nurses may increase the self-efficacy of managing dyspnea by helping patients master breathing techniques and exercise through coaching and providing vicarious experiences through patient support groups or pulmonary rehabilitation programs.     

Excellent uricosuric efficacy of benzbromarone in cyclosporin-A-treated renal transplant patients: a prospective study

Patients on cyclosporin A (CsA) often develop hyperuricaemiaand gout. In transplant patients the use of uricosuric drugsfor treating hyperuricaemia may be preferable to allopurinolbecause of the known interaction of the latter with azathioprine.We therefore prospectively studied the uricosuric efficacy of100 mg benzbromarone (Bbr;Desuric®) daily in 25 CsA-treatedrenal transplant patients with stable graft function and hyperuricaemia(>359 µmol/l for females, >491 µmol/l formales). Benzbromarone decreased plasma uric acid from 579±18µmol/l to 313±24 µmol/l (mean±SEM;P<0.001) and thereby normalized plasma uric acid in 21 of25 patients. The remaining four patients had creatininc clearancesbetween 21 and 25 ml/min, the lowest of the entire study group.Mean fractional clearance of uric acid increased from 5.4±0.4%to 17.2±1.0% (P<0.001). The relative decrease of plasmauric acid closely correlated with baseline creatinine clearance(r=0.67; P<0.001). CsA trough values were not influenced.None of the patients experienced any significant side-effects.As an unexpected find-ing, urinary uric acid excretion increasedfrom 2082 ± 175 µmol7sol;24 h to 3233 ±232µmol/24 h after 4 weeks' treatment with benzbromarone. In conclusion, benzbromarone normalized plasma uric acid inall CsA-treated renal transplant recipients with a creatinineclearance >25 ml/min. Due to its excellent efficacy and lackof significant side-effects, benzbromarone appears to be preferableto allopurinol in CsA-treated renal transplant recipients witha creati nine clearance over 25 ml/min.