咽部射频热凝术配合针刺治疗原发性舌咽神经痛的临床观察

目的观察口咽部射频热凝术配合针刺治疗原发性舌咽神经痛的临床效果。方法选择12例原发性舌咽神经痛患者，首先采用射频疼痛治疗系统进行咽部舌咽神经咽支和舌支的热凝，然后在合谷等穴位配合针刺治疗5次。结果10例患者症状完全消失，2例症状明显改善。其中10例患者得到3个月至1年复诊和随访，9例症状均未再发作，1例疼痛发作但较原来明显减轻。结论咽部射频热凝术配合针刺治疗原发性舌咽神经痛具有简单、安全、效果确切、严重并发症极少发生等优点。     

妇产科临床见习中传统教学结合案例教学法的应用

目的探讨教学改革中传统教学结合案例教学法在妇产科妊娠高血压疾病教学中的效果。方法以首都医科大学2003级7年制临床医学专业6个见习小组共40名学生为教改组，教改前2002级7年制临床医学专业6个见习小组共37名学生为对照组，实验组每次授课时先由带课教师进行理论授课，继之安排1个案例讨论，然后由教师进行重点总结，对照组仅由带课教师进行理论授课。结果实验组与对照组在考试成绩上比较有显著性差异。结论传统教学结合案例教学法有利于提高学生的学习主动性和积极性，可以加深对所学内容的理解和记忆，提高学生的成绩，促进医学生临床技能的提高。     

Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization

Objective

To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.

Monoclonal gammopathy of undetermined significance. Natural history in 241 cases

Two hundred forty-one patients with a monoclonal protein in the serum but initially no evidence of multiple myeloma, macroglobulinemia, amyloidosis or lymphoma were followed up for more than five years. At the conclusion of the studies the patients were classified as follows: Group 1, patients without significant increase in monoclonal protein, 57 per cent; group 2, patients with more than 50 per cent increase in monoclonal serum protein or development of monoclonal urine protein, 9 per cent; group 3, patients who died without five-year serum studies, 23 per cent; and group 4, patients in whom myeloma, macroglobulinemia or amyloidosis developed, 11 per cent. Initially, the hemoglobin level, size of serum monoclonal protein peak, number of plasma cells in the bone marrow and levels of normal immunoglobulins were not significantly different among the four groups. The median interval from recognition of the monoclonal protein to diagnosis of multiple myeloma was 64 months, of macroglobulinemia 103 months and of amyloidosis 92 months. A significant increase of the monoclonal protein or development of myeloma, macroglobulinemia or amyloidosis occurred in 18 per cent of the patients with monoclonal immunoglobulin G(IgG), in 28 per cent with immunoglobulin A (IgA) and in 25 per cent with immunoglobulin M (IgM). Retrospective analysis of age, sex, presence of organomegaly, hemoglobin level, size and type of serum monoclonal protein peak, presence of small amounts monoclonal light chain in the urine, serum albumin level, levels of uninvolved immunoglobulins, IgG subclass and level of plasma cells in the bone marrow did not show how to distinguish initially between stable benign disease and progressive disease. Therefore, periodic reexamination of patients with monoclonal gammopathy is essential.     

Perioperative myocardial infarction related to coronary bypass surgery.

Frank lead electrocardiograms were recorded from 149 normal and abnormal adult males using four different electrode placements. All chest electrodes were placed at: (1) the fourth intercostal space level, (2) the fifth intercostal space level, (3) the fourth intercostal space level with V₄ substituted for C, and (4) the fifth intercostal space level with V₄ substituted for C.Differences in mean values of many commonly used amplitudes and orientations were not statistically significant among the four recording methods, but amplitude differences for individual subjects were often large and difficult to predict. When V₄ is substituted for C, as commonly done in some laboratories, R_x decreased and R_z increased by more than 10 per cent in about 40 per cent of the cases. In about 70 per cent of the cases, R_x and R_z changed significantly when electrode level was shifted from the fifth to the fourth intercostal space. For these 70 per cent, it does not appear possible to accurately predict increase or decrease of R_x, R_z, or QRS_m.Analysis programs which depend on individual amplitude measurements are likely to be significantly affected by electrode placement. It is suggested that criteria for analysis programs developed using a specified version of the Frank system should ideally be applied only to electrocardiograms recorded in the same manner.     

胆红素代谢紊乱

胆红素代谢紊乱的临床主要表现为黄疸，也是高胆红素血症的表征，同时为肝病最常见的症状之一，黄疸鉴别诊断在临床日常诊疗工作中占极其重要的地位。