散发性戊型肝炎和散发性甲型肝炎临床比较

目的：了解散发性戊型肝炎（ＨＥ）和散发性甲型肝炎（ＨＡ）的差别。方法：对４２例ＨＥ和７０例ＨＡ的临床资料进行比较。结果：ＨＥ与ＨＡ相比,其发病年龄以青壮年为主（Ｐ〈０．０１）血清总胆红素（ＴＢｉｌ）、谷丙转氨酶（ＡＬＴ）、谷草转氨酶（ＡＳＴ）水平高（Ｐ〈０．０１）,黄疸持续时间及住院时间长（Ｐ〈０．０１）,重型肝炎发生率高（Ｐ〈０．０５）。结论：ＨＥ未成年患者发病少见,肝细胞损害较ＨＡ明显,预后差     

坚持妇幼卫生工作方针 促进妇幼卫生事业发展

妇幼卫生改革必须坚持“以保健为中心,保健与临床相结合,面向基层,面向群体”的妇幼卫生工作方针。以保健为中心是这一方针的核心,保护妇女儿童的健康,具有丰富的内涵;保健与临床相结合是这一方针的基础,保健与临床相结合的目的是为了提高妇幼保健工作质量;面向基层,面向群体体现了妇幼卫生工作的重点。     

Symptomatic compression of the optic nerve by the carotid artery: clinical profile of 18 patients with 24 affected eyes identified by magnetic resonance imaging.

OBJECTIVE: To characterize the clinical features and course of patients with magnetic resonance imaging (MRI)-defined optic nerve compression by the supraclinoid carotid artery. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eighteen patients with 24 affected eyes were identified by reviewing case records from the author's referral-based neuro-ophthalmology practice. Predetermined inclusion and exclusion criteria were applied to potential participants. MAIN OUTCOME MEASURES: The following variables were abstracted from the medical record: age, gender, presenting symptoms, past medical problems, visual acuity, color vision, visual field, pupillary reactions, optic disc appearance, other neurologic signs, and previously documented and follow-up examinations. RESULTS: There were eight women and ten men ranging in age from 28 to 86 years (median age, 72 years) at the time of diagnosis. Ten (56%) of 18 patients had hypertension. Twelve patients had unilateral optic neuropathy, whereas 6 patients had bilateral optic neuropathy. One patient presented with subacute superior orbital fissure syndrome due to mass effect of a dolichoectatic carotid artery. Another patient had oculomotor nerve palsy with signs of aberrant regeneration due to intracavernous mass effect of a dolichoectatic carotid artery. One patient had a bitemporal hemianopia associated with bilateral compression of the immediate prechiasmatic optic nerves by dolichoectatic carotid arteries. The predominant pattern of visual field loss in most patients reflected nerve fiber bundle injury. A central scotoma or absolute central visual field loss was noted in only 6 (25%) of 24 affected eyes. Most patients demonstrated saucerlike excavation of the optic disc. Progression of visual acuity loss occurred at a relatively slow rate. CONCLUSIONS: Although uncommon, intracranial compression of the optic nerve by the carotid artery should be considered in a patient with unexplained or progressive unilateral or bilateral optic neuropathy. This entity can be diagnosed using clinical skills to exclude more common causes of optic nerve injury and coronal-oriented MRI to confirm anatomic compression of the symptomatic optic nerve. Although many affected patients have excavation of the optic disc and nerve fiber bundle visual field defects, most have additional signs atypical for glaucoma, minimizing the potential for diagnostic confusion between the two disorders.     

Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.     

镁离子对脑保护作用的前瞻性临床实验研究

目的探讨分析镁制剂在重型颅脑损伤临床治疗中的实用价值.方法对76例重型颅脑损伤患者按随机方法分成实验组和对照组,对照组按常规方法治疗,实验组在常规治疗的基础上加用大剂量硫酸镁.治疗后从颅内压、NSE、CT、GCS评分和G0S评级等几个方面进行统计分析.结果实验组与对照组比较,颅内压和NSE水平明显下降,CT显示脑水肿程度减轻,而GCS和G0S则有明显提高,经统计学检验有显著性差异(P＜0.01和P＜0.05).结论镁制剂对重型颅脑损伤治疗确有实用价值,且经济、安全,值得推广.     

138例已绝经与未绝经子宫内膜癌患者临床病理分析

目的 回顾研究已绝经与未绝经子宫内膜癌的病理分型,组织分级和手术病理分期等.方法 分析1987年1月～1996年12月上海第一妇婴保健院收治的138例子宫内膜癌患者,其中已绝经者93例,未绝经者45例.所有的病人都进行了分段诊刮,134例经过手术治疗.标本均进行了病理诊断,并根据1988年FIGO标准进行分期,所得资料用X~2Fisher’s exact test分析.结果 已绝经组与未绝经组比较,早期患者(IaG_1)比例明显偏低,分别占6%与32%.(P<0.001).G_2、G_3和非内胰腺癌的发生率是高的,分别是71%和51%(P<0.05).Ⅰc、Ⅱ、Ⅲ、Ⅳ期所占的比例较大,分别是40%和30%(P<0.001).五年生存率:已绝经组为74.2%,未绝经组91.4%,两者比较有明显意义(P<0.05).结论 已绝经子宫内膜癌患者预后较未绝经者差与临床和病理特点有关.     

探索在综合性医院建立医疗量化考核体系

文章作者结合综合性医院临床工作的特性 ,探索如何建立医疗量化考核体系 ,并在大量的实践过程中 ,不断修改和完善 ,使医疗量化考核在综合性医院的业绩考核中更具科学性、合理性。文章简要论述了医疗量化考核工作的原则、方法以及实施医疗量化考核后取得的实效。     

加强高职高专医学生公共卫生和临床医学整合教育的思考

文章讨论了由突发公共卫生事件引发的对构建现代公共卫生和临床医学整合教育模式的反思及其对策措施.透过SARS危机，暴露出我国现行医学教育体制上存在的医防分离的严重性，提示我们应借鉴21世纪医学生培养目标与要求，改革医学教育模式，促进多学科、跨专业的合作，建立以社区为目标、以问题为中心的公共卫生与临床医学整合教育的全新综合化课程体系;积极推广计算机辅助教育（CAI），加强运用现代化教学手段;建设以社区实践为主要内容的公共卫生和临床医学整合教育基地，加强高职高专医学生实践技能的培养，以构建新型高职高专医学人才培养模式，培养防治结合的新型实用型医学人才.     

北京市某区肠道门诊现状和合理设置模式的研究

目的：了解并评价某一地区肠道门诊的现况。方法：定量描述2004年全区肠道门诊的地理分布、门诊量、硬件配备、消毒隔离、管理、病种分析等，对就诊的患者进行定性访谈。结果：全区共有31家肠道门诊，城区肠道门诊布局相对合理，农村地区肠道门诊的服务半径过大，平均38．6km^2；二级、三级医院的肠道门诊门诊量大、硬件配备较完善，而一级医院的肠道门诊门诊量较少、硬件配备不足，有11家医院全年门诊量不足60人；43％肠道门诊病人为普通肠炎，16％为痢疾。结论：政府对一级医院的肠道门诊资金投入不足；农村肠道门诊布局不合理；肠道门诊的常规检测项目不合理。