Tolerance and dependence to opiates

In the 19th century, investigators recognized that addiction to opiates involves tolerance and dependence. In the United States, the National Academy of Sciences and the Public Health Service initiated systematic investigations into opiate addiction in 1929. Tolerance and dependence to morphine, the prototype for opiate drugs, were the emphasis of human studies for the next fifty years. This presentation highlights salient features of tolerance and dependence learned in these studies and relates these findings to clinical use in treating pain.     

首次自杀未遂者和重复自杀未遂者的对照研究

目的探讨首次自杀未遂者和重复自杀未遂者的区别.方法检查126名因自杀未遂而入院的患者,分为首次自杀未遂组和重复自杀未遂组,获得有关的临床资料并进行自杀意图及自杀企图冲动性和致死性的测定,将有关项目作对比分析.结果有51(40.5%)名重复自杀未遂者,与首次自杀未遂者比较,重复自杀未遂者已婚居多、文化程度较低、缺乏固定的经济收入、有较多的既往精神科治疗史、常饮酒、企图自杀前与他人交流少,自杀意图较低,冲动性较高(P均＜0.05).结论对伴有某些危险因素的自杀未遂者应积极进行医学干预,以期减少自杀行为的再次发生.     

Clinical Evaluation of a New Type of Centrifugal Pump

Abstract: The major problems with existing centrifugal pumps are leakage, mechanical trauma, and thrombus formation. In consideration of these problems, a new compact centrifugal pump system was developed. The purpose of this study was to evaluate the new centrifugal pump system clinically. Ten patients underwent open heart surgery with a centrifugal pump or a roller pump. During surgery, hemodynamic and hematological data were obtained. A pulsatile assist device in the pump circuit was used in patients with severe heart disease. There was neither operative death nor hospital mortality, and there was no difference with regard to hemodynamic data between the two groups. The centrifugal pump group, however, had significantly lower hemolysis, especially during prolonged cardiopulmonary bypass. This centrifugal pump could also create sufficient pulsatile flow with a pulsatile assist device. Postoperative macroscopic and microscopic findings demonstrated the smooth surface of the pump without thrombus formation. This centrifugal pump system might be useful for prolonged cardiopulmonary bypass.     

Immunological and respiratory reactions in workers exposed to organic dusts

The relationship of skin reactivity and serum immunoglobulin E (IgE) levels to the prevalence of chronic respiratory symptoms and to ventilatory capacity is examined in workers exposed to different organic aerosols. The results from group of control workers similarly tested are also presented. Workers exposed to occupational allergens had positive skin tests more frequently than did controls, except for soy bean workers. Workers with positive skin tests to occupational allergens had a higher prevalence of almost all symptoms than those with negative skin tests although the differences did not always reach statistical significance. Workers with positive skin reactions in general had significantly higher serum IgE levels than did workers with negative skin reactions. There were across-shift reductions of ventilatory capacity in all groups of exposed workers, varying for forced vital capacity from 1.7% to 13.3%, for forced expiratory volume from 0.4%–21.9%, for maximum flow rates at 50% from 1.5% to 16.1% and for maximum flow rates at the last 25% of control vital capacity from 0% to 24.9%. There was, however, no correlation between acute and chronic lung function changes and skin reactivity or IgE values. Our data suggest that although exposure to organic aerosols may be associated with frequent immunologic reactions, these findings do not predict objective respiratory impairment.The research was supported in part by grant no. JBP 733 from the National Institutes of Health, Bethesda, Md., USA, and by grant no. RO1 OHO-2593-04 from the National Institutes of Occupational Safety and Health, Centers for Disease Control, Atlanta, Ga., USA     

通瘀注射液盆腔给药法治疗外在型子宫内膜异位症的临床研究

目的　运用通瘀注射液在非直视下经输卵管盆腔给药对子宫内膜异位症 (EEMs)的治疗作用 ,探讨活血化瘀法对EEMs的作用机理及此给药法的优势。方法　将临床治疗的EEMs患者 60例随机分为治疗组 (通瘀注射液组 )和对照组 (丹那唑组 ) ,疗程各为 3个月。用药前后测定下列指标 :临床症状与体征、内分泌激素、血液流变学、癌抗原 12 5 (CA12 5)和子宫内膜抗体 (EMAb)的阳性率变化。结果　治疗组的临床症状与体征、血液粘滞度和红细胞压积、CA12 5和EMAb的阳性率均降低 ,卵泡刺激素 (FSH)、黄体生成素 (LH)、雌二醇 (E2 )和孕激素 (P)的含量均受到调节 ,与对照组相比 ,差异有显著性。而治疗组对内分泌的调节能力弱于对照组 ,但作用柔和、均衡。结论　通瘀注射液对EEMs的作用是通过清除月经时异位内膜的瘀血、水肿、改善微循环及组织供氧、调节免疫功能和内分泌紊乱而实现的 ,与丹那唑相比其副作用小、并以治本为主。盆腔给药法则可使药物直达病灶 ,见效快     

91例甲状腺疾病临床病理诊断分析

在临床病理手术切除中甲状腺疾病很常见，其疾病的良恶性鉴别和具体类型诊断有一定难度。因甲状腺疾病的病因复杂，有多病变并存现象，且密切相关、相互影响，如何合理准确地进行病理诊断是指导临床治疗和随诊的重要依据。现将我科2002年1月至2004年12月91例甲状腺病理活检材料进行回顾性分析，以进一步提高甲状腺疾病诊断和鉴别诊断水平。     

右室梗死临床诊疗新进展

右室梗死过去只能在尸检时确诊。20世纪70年代以来,随着医师诊断水平和检测设备的不断进步,临床上已能在患者生病确诊右室梗死[1],现对国内有关资料综述如下,仅供同道参考。1右心室栓塞发病及研究进展右心室心肌梗死是指累及右心室壁的心肌梗死。临床上相对少见。尸检病例中,单独右心室梗死不到3%,左心室心肌梗死同时延伸至右心室者占43%[1]。按其梗死发生部位分为:右心室游离下壁;右心室游离前壁;右心室游离下壁、前壁及右心室乳头肌。受累部位取决于受损血管的来源,右心室前壁和前乳头肌由左前支和圆锥支供血,前者分支较多,一般不会全部阻…     

我省医学临床教学基地建设的现状与思考

对我省医学临床教学基地评审结果进行分析，就大部分基地教学意识不强、教学设施不完善、教学条件有待改善、师资队伍素质水平不高等问题进行了阐述，并针对存在的问题提出建议和思考，从建章立制规范管理、加强建设、提供保障、重视培训、提高素质、强化管理、创新机制等方面进行探索，希望能使我省医学临床教学基地质量得以提高、完善，为我省培养一流的医学专业人才奠定基础．     

喂饲泵应用的临床观察及护理

目的 探讨用喂饲泵行肠内营养摄入的临床应用价值。方法 实验组30例采用喂饲泵控制肠内营养液的滴入速度，对照组采用传统方法，用20ml或50ml注射器灌注营养液，观察两组并发症的发生情况，所得量化指标进行卡方检验。结果实验组其返流、呕吐、腹胀、吸入性肺炎的发生率明显低于对照组。结论应用喂饲泵行肠内营养的摄入，可有效预防并发症的发生。