乙型肝炎患者特异性CMSC及IIPC实验与临床研究

了解乙型肝炎患者补体介导 ＨＢｓＡｇ特异性免疫复合物溶解能力（ＣＭＳＣ）及补体介导免疫沉淀 的抑制作用（ＩＩＰＣ）两种新功能低下在乙型肝炎发病中的作用。方法：采用ＰＥＧ沉淀法测定患者血清循环免疫复 合物（ＣＩＣ）,以ＨＢｓＡｇ和抗－ＨＢｓ制备特异性免疫复合物（ＩＣ）,加入补体（血清）抑制其沉淀,或使ＩＣ裂解并定量测 定上清中的ＨＢｓＡｇ,确定ＣＭＳＣ及ＩＩＰＣ功能,同时用单向琼脂扩散法测定Ｃ３、Ｃ４。结果：患者组ＣＩＣ检出阳性率为 ４５．０％～８２．６％,均显著高于正常组（Ｐ＜０．０５～０．００１）;正常组ＣＭＳＣ后上清液ＨＢｓＡｇ为０．５８±０．１３ｎｇ,各种乙肝 组均明显低于正常对照组（Ｐ＜０．０５～０．００１）;ＩＩＰＣ后上清中ＨＢｓＡｇ浓度为０．４５±０．１８ｎｇ,急性肝炎、慢活肝、重症 肝炎均显著降低（Ｐ＜０．００１）,肝硬化组亦明显降低（Ｐ＜０．０５）;Ｃ３、Ｃ４在患者组亦有不同程度的降低。结论：乙型 肝炎患者血清中存在特异性ＩＣ,患者ＣＭＳＣ及ＩＩＰＣ明显降低在乙型肝炎的发病中有一定作用,补体成分的减少与 ＣＭＳＣ和ＩＩＰＣ的降低有一定关系。     

眶上神经的走行层次及其临床意义

目的探讨眉区和额部不同手术层面眶上神经的保护方法。方法在１５例成人头部标本上,对眶上神经在眉区和额部的行程、走行层次和入肌点的位置进行解剖观测。结果眶上神经出眶上孔后,以５２．８±７．４°角向外上经额肌筋膜附着处入帽状腱膜下隙,达发际附近穿帽状腱膜和额肌至皮下。眶上神经起始部直径１．４±０．３ｍｍ,本干入肌点至眶上孔的直线距离为４０．２±９．１ｍｍ,水平距离和垂直距离分别为３０．５±８．８ｍｍ和３３．８±８．４ｍｍ。结论根据手术层面的不同,额眉区的深层面手术应注意保护眶上神经     

22例三尖瓣闭锁的临床分析

目的　探讨简便而适用的三尖瓣闭锁诊治要点。方法　分析临床资料 ,复习有关文献。结果　 2 2例三尖瓣闭锁 ,早发青紫 19例 ,心电图电轴左偏 19例。所有病人二维超声心动图显示三尖瓣区无瓣叶活动 ,CDFI显示右房室连接处无血流信号。右心导管检查导管不能自右房进入右室 ,而易通过房间隔缺损进入左房。心血管造影显示右房、左室及横膈间有三角形的充盈缺损。 3例进行Fontan手术 ,成功 1例。结论　早期青紫、电轴左偏应高度怀疑此病 ,超声心动图、右心导管可明确诊断。Fontan手术成功的关键在于严格选择手术适应症、娴熟的操作及术后良好的处理。     

玉津药酒治疗类风湿性关节炎的临床观察

笔者应用复方玉津药酒对120例类风湿性关节炎(RA)患者进行了临床治疗效果观察.结果表明,近期控制为54.2%,显效为29.2%,有效为13.3%,无效为3.3%;经免疫学检查,玉津药酒可促使CD_8细胞增高,改善CD_4/CD_8比值,抑制T淋巴细胞增殖,降低白细胞介素-2(IL-2)活性,从而抑制机体免疫活性细胞对关节、关节软骨的破坏作用.     

Aortopulmonary collateral artery embolization during postoperative extracorporeal membrane oxygenation after arterial switch procedure

Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.     

Single-handed practices – their contribution to an undergraduate teaching network in the first year of the new curriculum

OBJECTIVES: The new curriculum at King's College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5 years of their medical education. DESIGN: This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King's teaching network. SETTING: King's College School of Medicine and Dentistry. SUBJECTS: Medical undergraduates. RESULTS: The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. CONCLUSIONS: The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise.     

Does a student log provide a means to better structure clinical education?

CONTEXT: In order to optimize student learning during clinical rotations, the learning situation could be better structured. A student log was developed in order to improve the structure of clinical education. In this log, students systematically register essential learning activities. Students record daily the patient problems with which they had been confronted and in which fashion (passive, active, without or with feedback). OBJECTIVES/RESEARCH QUESTIONS: Two questions were addressed. Firstly, did the log provide insight into the content and nature of students' learning experiences and did these learning experiences differ between hospitals? Secondly, was the log used by students, supervisors and the faculty to improve the structure of student learning during clinical education? METHOD: Three student logs, used in an ear, nose and throat, an ophthalmology and a paediatrics clerkship at the Medical School of the University of Maastricht, were developed and implemented. In order to answer the first question, a number of completed student logs were analysed. In order to answer the second question, students were asked to rate the log on five evaluative statements. In addition, the clerkship coordinators were interviewed. RESULTS: The results showed that the logs provided the clerkship coordinators with a useful overview of the content and nature of students' learning experiences in the hospitals. The differences between hospitals were small. However, the logs were not used by students, supervisors and faculty to improve the structure of student learning. CONCLUSIONS: In order to be effective, i.e. to better structure clinical education, a student log should be integrated into the supervision activities.     

橡胶职业暴露与多种疾病关系研究的死因别危险度联合分析模型

应用Ｃｏｘ回归风险度模型,进行了死因别（肺癌,肠癌和胰腺癌,及心脑血管疾病）联合分析,以便估计和检验橡胶化合物暴露对特定死因别的效应,以及死因间竞争性危险度。结果表明：心脑血管疾病可能对肺癌、肠癌和胰腺癌产生了竞争性死亡的效应。亚硝胺暴露的３类死因别危险度之间有显著性差别,表现为肺癌危险度最高。其他４种橡胶化合物的死因别危险度之间差别不显著。这些结果有力地证实了亚硝胺与肺癌的联系。     

黄南州医院126例包虫病临床分析

本文分析了黄南州医院126例囊型包虫病,结呆发病多见于青壮年,其次为中老年;包虫病与从事牧业生产和在牧区生活的人密切相关;病人以藏族、蒙古族多见,而汉族、回族、撒拉族次之;包虫病常见为肝包虫病,其次为腹腔包虫,其他部位的包虫病少见。B赵、X线拍片、卡松尼氏皮内试验与手术证实的包虫囊肿相吻合,但无特异性。在手术过程中加大处理液（甲醛、乙醇、双氧水）的浓度,或在手术前后服用一定的杀包虫药物（如丙硫咪唑）可降低自虫病的复发率,提高治疗效果。     

国产环丙沙星注射液临床疗效的观察

目的 :评价国产环丙沙星注射液治疗下呼吸道、泌尿系及伤寒等细菌性感染的临床疗效、细菌学疗效和安全性。方法 :采用随机对照开放试验的方法 ,对国产环丙沙星注射液的临床疗效和细菌清除率进行了观察。结果 :国产环丙沙星注射液临床疗效有效率 84.0 % ,痊愈率 56.0 % ,与对照组头孢氨噻肟疗效一致 ,无显著性差异 ( P>0 .0 5)。国产环丙沙星注射液细菌清除率 76.9% ,与头孢氨噻肟比较疗效接近 ( P>0 .0 5) ,对肺炎克雷伯杆菌、大肠杆菌、变形杆菌、枸橼酸杆菌、伤寒杆菌及不动杆菌具有良好的清除作用 ,对铜绿假单胞菌亦有满意的抗菌活性。不良反应轻微 ,用药安全。结论 :国产环丙沙星注射液为广谱、高效、安全的抗菌药物 ,对不能耐受口服制剂者可避免胃肠道的直接刺激作用 ,对重症不能口服者提供了很好的给药途径