Adenoid cystic carcinoma: factors influencing survival.

We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.     

DermRx. An experiment in computerizing information on dermatologic therapy

The Task Force for Creating a Biomedical Communications System for Dermatology was commissioned by the American Academy of Dermatology to develop an experimental segment of a computerized data bank on dermatologic therapy. The Task Force has completed such a "first generation" system and has named it DermRx. Its data bank carries the following information on each entry: the name of the disease; topical, systemic, physical, and other kinds of treatment; caveats; references to the literature; and the date and reviewer(s). The DermLit and DermRx programs are two components of a projected broader concept of an eventual comprehensive Biomedical Communications System for Dermatology. Such a system is envisaged as a means of making available to dermatologists diverse data relevant to practice, teaching, research, and business aspects of the specialty. At the moment, access to the stored information on dermatologic literature and therapy is by telephone call to, or by correspondence with, the central computer facility at Northwestern University. Eventually it is projected to be accessible by dedicated microcomputers housed in the physician's office. This preliminary report on DermRx is presented to review the progress of the project to date and to elicit comment upon its structure and value.     

Prosthetic arteriovenous fistula for vascular access in hemodialysis.

Vascular access through subcutaneous prosthetic arteriovenous fistulas was studied in eighteen dogs. Dacron velour and woven Dacron grafts (6 mm diameter) were constructed across the lower abdomen between the common femoral artery and the opposite common femoral vein. In heparinized animals 197 percutaneous punctures were made with a "14 guage hemodialysis cannula at weekly intervals. Over a period of one and a half years there was no instance of infection. One of the fourteen Dacron velous and all four woven Dacron fistulas thrombosed. These data suggested the feasibility of achieving repetitive blood access through Dacron velour vascular prostheses. Nineteen Dacron velour fistula bypasses between the brachial artery and median basilic vein were performed in fifteen selected patients for a total dialysis period of ninety-six months. Failed standard subcutaneous fistulas or absence of suitable vessels in the upper extremity were indications for the primary procedure. Of three looped forearm fistulas, two thrombosed at twenty-two and two months. Complications among sixteen straight bypasses in the arm included two graft infections and one cannula tract infection. There were no instances of thrombosis in this group. The advantages of single needle dialysis in these high risk patients have been emphasized. Eleven grafts are presently functioning two to nine months postoperatively. Our preliminary results suggest that a Dacron velour fistula merits consideration as an alternative for vascular access in maintenance hemodialysis.     

Lipoplastics of Legs: Our Experience with a New Cannula Compared with Classical Technique

The Authors compare the results obtained between two groups of patients suffering from leg lipodystrophy, who were subjected to a reducing lipoplasty. In the first group, surgeons made use of a new sort of cannula, deprived of the classical grip, whereas in the second group, they employed the traditional probe. The best results, achieved with the first group, prove this new operating system is really effective, particularly on legs, for the following reasons: (1) Higher precision and better control of the instrument (2) Swan-neck cannula abolition (3) Opportunity to operate with both hands (4) Halved operating time (5) No tiredness after the operation.     

Conduct of trials in private clinical practice

PURPOSE: Trials of antiepileptic medications are usually based in tertiary referral centers with teaching hospital resources. Epilepsy Research & Services (ERS) is part of a private outpatient neurological clinic that is involved in research as part of multicenter clinical trials, adhering to Good Clinical Research Practice. ERS is subject to external monitoring and auditing, but does so outside of the teaching hospital environment. METHODS: The clinic is operated by a neurologist supported by a research assistant, administrative and nursing staff and has no formal university attachment. Patients are recruited for trials from routine referrals for clinical care. The center has formal ties with the ethics committee of the local teaching hospital, but none of the team is formally attached to that hospital. RESULTS: The center conducted trials of zonisamide, oxcarbazepine, gabapentin, remacemide, tiagabine, vigabatrin, felbamate, and lamotrigine both as add-on trials in refractory seizure disorders and as monotherapy trials in de novo epilepsy. More than 200 patients have been recruited for trials at ERS (with some patients being involved in more than one trial). External review endorsed ERS as a superior environment for such research and as a model for other centers. CONCLUSIONS: Private practice is a viable alternative for the conduct of clincial trials and should be considered when establishing such protocols. Simplicity of administration and clinical practice, which more closely mirrors standard patient care, may enhance recruitment and management.     

湖南省"七五"、"八五"、"九五"期间职业病报告及监测分析

目的了解“七五”、“八五”、“九五”期间湖南省职业病发病状况,为湖南省“十五”期间控制职业危害提供科学依据。方法追溯15年来上报的各类资料,进行整理分析,计算出监测率、合格率、体检率、检出率、患病率。结果“七五”、“八五”、“九五”期间,湖南省共发生职业病新病例22 196例,其中尘肺占60.25%、慢性职业中毒占16.02%、急性职业中毒占8.0%、物理因素等其他职业病占13.89%;至2000年统计年止,尘肺累计病例45 956例,现患尘肺35 610例,尘肺患病率6.21%。劳动卫生监测率明显下降,合格率呈上升趋势,但职业性体检率呈下降趋势,检出率略微下降。结论湖南省职业危害状况不容忽视,防治的重点是煤炭、冶金、化工、有色金属、建材、乡镇企业等工业部门。     

安徽省岳西县新型合作医疗对健康及卫生服务公平性影响的研究

目的 探讨新型农村合作医疗试点地区农村居民卫生服务公平性的现状。方法 采用分层整群抽样的方法，于2005年7月1—15日对安徽省新型农村合作医疗试点县岳西县2112名农村居民的卫生服务公平性现状进行入户问卷调查。用率、比、Gini系数、集中指数（CI）和χ^2检验进行统计分析。结果 试点地区5组收入状况居民中，从最低收入组到最高收入组的2周门诊就诊率分别为48．14‰、82．90‰、65．88‰、48．72‰和50．66‰，CI值为-0．026，各组居民就诊率差异无统计学意义（χ^2=5．52，P〉0．05）；近一年内住院率分别为59．08‰、67．36‰、51．76‰、58．97‰和52．86‰，CI值为-0．017；半年内慢性病患病率分别为295．40‰、243．52‰、230．59‰、225．64‰和176．21‰，CI值为-0．055，不同收入组居民慢性病患病率存在差异（χ^2=18．42，P〈0．01），随收入降低慢性病患病率呈增高趋势。5组收入居民中，年人均医药费用占人均家庭支出比例分别为36．12％、26．18％、22．47％、23．26％和15．65％。在新型农村合作医疗补偿措施前后，住院患者的Gini系数分别为0．445和0．448。结论试点地区农村居民卫生服务利用趋于公平性，但农村居民在卫生筹资、新型农村合作医疗补偿方面存在不公平性，低收入居民有较高的卫生服务需要。     

新型农村合作医疗制度实践合意性的理论考察

新型农村合作医疗制度是我国政府在新时期解决农村居民医疗保障问题的重要举措。新型农村合作医疗制度试点地区的实践措施与理论期望有一定差距，自愿原则、家庭账户和免费体检等措施以及制度设计中存在的问题使得新型农村合作医疗制度成为一种国家福利性医疗补贴和个人储蓄医疗的结合模式。这种实践模式对财政具有非常强的依赖性。并且损害了政策的持续性、稳定性、公平性和效率；新型农村合作医疗制度的良性运行存在较大风险。     

浅析现代化医院设备管理的新趋势

从医院设备管理的发展历史出发，结合现代化医院设备管理科学的发展和信息化的时代要求，对设备管理、维护、修理趋势进行分析，在此基础上提出现代化医院设备管理科学化的发展方向。     

2004年新疆某中专学生HBsAg、抗-HBs的检测结果分析

目的为了解新疆中等专业学校新生乙型肝炎病毒感染状况和抗-HBs水平。方法采用整群抽样法，抽取558名入校新生用ELISA法检测乙肝表面抗原（HBsAg）与抗体（抗-HBs）。结果558名新生的HBsAg阳性率为8．42％，城市来源的学生HBaAg阳性率高于农村来源的学生，但是差异无统计学意义（P〉0．05）。抗-HBs阳性率为54．84％，城市来源的学生高于农村来源的学生，差异有统计学意义（P〈0．01）。乙肝病毒无免疫保护作用的占检测总人数36．74％，其中农村学生高于城市学生，差异有统计学意义（P〈0．01）。结论新生体检很有必要，对乙肝无免疫力的给予乙肝全程免疫，抗-HBs弱阳性的给予一次加强免疫。