新生儿先天性心脏病监测与随访

目的探讨新生儿先天性心脏病(先心病)的发病情况和预后。方法(1)以彩色多普勒超声心动图配合尸检为主要诊断依据,对1992至1998年我院出生的31493例新生儿进行先心病发病情况前瞻性调查。(2)对1992至1995年出生的先心病患儿,随访3年。结果(1)以彩色多普勒超声心动图配合尸检,结合随访的修正诊断,检得先心病318例,患病率10.10‰。其中非青紫型255例,占80.2%,青紫型63例,占19.8%。室间隔缺损患病率5.14‰居首位。(2)318例先心病中新生儿期死亡35例,病死率11.0%,1992—1995年出生的167例先心病随访3年,死亡38例(22.8%),1岁内占94.7%,0～28d占68.4%。结论新生儿先心病发病率高,新生儿期是先心病死亡高峰年龄。     

通督调神针法配合中医护理对脑卒中后睡眠障碍的影响

目的:观察通督调神针法配合护理干预对脑卒中后睡眠障碍患者的影响。方法:将脑卒中后睡眠障碍患者76例分为对照组和治疗组各38例。对照组服用艾司唑仑改善睡眠,治疗组采用通督调神针法并配合护理干预。采用匹兹堡睡眠质量指数量表(PSQI)评定睡眠质量,并观察临床疗效。结果:治疗后2组患者PSQI评分比较差异有统计学意义(P0.05)。治疗组患者PSQI中的7个评分项目数值较对照组有所下降(P0.05)。结论:通督调神针法配合中医护理干预可有效改善脑卒中后患者睡眠障碍。     

经静脉安置埋藏式心脏复律除颤器的临床应用

目的　评价埋藏式心脏复律除颤器 (ICD)的治疗作用。方法　反复发作室性心动过速 (VT)患者安装 ICD,并随访 18个月。结果　术中测得除颤阻抗为 5 9欧 ,除颤阈值 <10 J。术后复发室性心动过速 ,均经 ICD治疗成功转复室性心律 ,有效率 10 0 %。结论　 ICD能有效转复恶性心律失常     

Clinical Review of Wegener's Granulomatosis

The prognosis of Wegener's granulomatosis (WG) improved following the introduction of immunosuppressant agents. We, however, still experience some difficult cases that are resistant to treatment. Early diagnosis and treatment may improve the prognosis of WG. We reviewed patients with WG attending the Department of Otorhinolaryngology, Kitasato University Hospital. Of the 13 patients reviewed, 5 are still alive. A definite diagnosis was difficult to make without the presence of certain characteristic features. Recently, cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) has gained importance in the diagnosis of WG and five of our patients were positive for c-ANCA. Close long-term follow-up of WG is recommended: remission was observed in two of our patients and side-effects of the treatment were identified in four.     

司国民应用角药经验

角药是三味中药联合使用、系统配伍的方药组合模式,在方剂中,角药可为核心组成的部分存在,也可为辅助组成部分存在,亦可单独成方。司国民教授临床应用角药治疗各类疾病,注重用药的层次感,紧抓病机,内外呼应、上下交通,开阖并用、攻补兼施。笔者分析司国民教授常用角药及其临床应用经验,以期为今后运用中药诊疗疑难疾病提供新思路和新方法。     

HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia

Objective  To evaluate human papillomavirus (HPV) testing in combination with cytology in the follow up of treated women.
Design  A prospective study.
Setting  Three UK centres: Manchester, Aberdeen and London.
Population or sample  Women treated for cervical intraepithelial neoplasia (CIN).
Methods  Women were recruited at 6 months of follow up, and cytology and HPV testing was carried out at 6 and 12 months. If either or both results were positive, colposcopy and if appropriate, a biopsy and retreatment was performed. At 24 months, cytology alone was performed.
Main outcome measures  Cytology and histology at 6, 12 and 24 months.
Results  Nine hundred and seventeen women were recruited at 6 months of follow up, with 778 (85%) and 707 (77.1%) being recruited at 12 and 24 months, respectively. At recruitment, 700 women had had high-grade CIN (grades 2 or 3) and 217 had CIN1. At 6 months, 14.6% were HPV positive and 10.7% had non-negative cytology. Of those with negative cytology, 9% were HPV positive. Of the 744 women who were cytology negative/HPV negative at baseline, 3 women with CIN2, 1 with CIN3, 1 with cancer and 1 with vaginal intraepithelial neoplasia (VAIN)1 were identified at 24 months. Nine of 10 cases of CIN3/cervical glandular intraepithelial neoplasia (CGIN) occurred in HPV-positive women. At 23 months, cancer was identified in a woman treated for CGIN with clear resection margins, who had been cytology negative/HPV negative at both 6 and 12 months.
Conclusions  Women who are cytology negative and HPV negative at 6 months after treatment for CIN can safely be returned to 3-year recall.     

门静脉高压症并上消化道大出血行贲门周围血管离断术的效果

目的提高及总结门脉高压症上消化道大出血手术治疗体会。方法回顾性分析102例门脉高压症上消化道大出血患者所采取治疗措施及结果。结果本组治愈97例,死亡5例。主要死于失血性休克、肝功能衰竭、多脏器功能衰竭。结论门脉高压症上消化道大出血行急症贲门周围血管离断手术是即刻有效的、手术损伤小、并发症少的手术方式。     

影响人群健康的心理社会因素随访比较研究

目的：运用应激理论和综合健康概念,研究影响人群健康的心理社会因素及其一年间变化。方法：抽取简阳市某厂1160名职工为研究对象,进行基线调查和一年后随访。以问卷和临床检查相结合调查其社会人口学特征、应激性生活事件、心理健康状况、社会支持和社会功能及现患疾病,并进行单因素和多元线性回归分析。结果：1997年影响该人群疾病总分的主要因素有工种、年龄、阳性症状数、阳性症状均分、主观支持分,R^2＝0．32;1998年的主要因素有年龄、SCL－90总分、阳性症状均分、支持利用度,R^2＝0．345。结论：年龄、心理应激水平、社会支持等是影响人群健康的主要心理社会因素,且一年时间变化不大。