早期胃癌的双对比造影诊断

目的 :研究早期胃癌双对比造影 ( DC) X线特征 ,以提高准确检出率。　方法 :分析 42例早期胃癌 (包括始发阶段小胃癌及微小胃癌 )患者 DC像与手术切除后标本病理进行对照比较。　结果 :龛影口部和表面结节状改变 ,周围无一定规律的粘膜纠集 ,胃壁毛糙、僵直、凹陷、双边、边缘毛刺征 ,微皱襞的破坏和粗糙、充盈缺损是早期胃癌的重要特征。　结论 :早期胃癌 DC特征典型 ,结合粘膜法、充盈法和压迫法与胃镜密切配合可有效地提高准确的检出率     

尼卡地平预防双腔支气管导管插管反应的观察

目的　观察应用尼卡地平预防双腔支气管导管插管心血管反应的效果。　方法　肺、食道择期手术病人 40例 ,随机分为 2组 ,每组 2 0例。咪唑安定 0 .0 4mg/kg、异丙酚 1.5mg/kg、芬太尼 4μg/kg、维库溴铵 0 .12mg/kg静脉诱导后 ,甲组给予尼卡地平 4μg/kg ,乙组给予生理盐水 3ml作为对照。分别于诱导前、后 ,插管后即刻及 1、3、5min监测收缩压 (SBP)、舒张压 (DBP)、心率 (HR) ,并计算心率收缩压乘积 (RPP)。　结果　A组插管后血压无明显升高 ,心率较诱导前无明显增快 ,B组插管后血压明显升高。　结论　尼卡地平可抑制双腔支气管导管插管时的心血管副反应。     

58例双瓣替换术体外循环管理体会

目的：回顾５８例双瓣替换术体外循环管理状况,总结双瓣替换术中灌注技术。方法：对５８例风湿性心脏瓣膜病人施行二尖瓣、主动脉瓣替换术中体外循环手术的临床资料、心肺转汉方法和心肌保护中的难点及处理进行回顾总结分析。结果：５８例中早期死亡２例,死亡率３．４５％Ｒ。结论：只有良好的体外循环灌注技术和心肌保护,才能保证双瓣替换术病人顺利渡过围术期,降低手术死亡率。     

护理质量评价体系的改进及其软件开发

通过对《军队医院护理质量主要评价指标》在运用过程中存在不足之处的分析,结合实际对原评价体系的评价方法,评价内容进行了补充和完善,形成了一套既能从宏观上全面反映医院护理质量达标情况。又能从微观上具体反映各临床科室护理质量达标程度及名次排列的评价体系,使护理质量管理更具针对性。在此基础上又介绍了研制出的适合医院护理工作特点的《护理质量综合评价》软件。     

Double β-lactam regimen compared to an aminoglycoside/β-lactam regimen as empiric antibiotic therapy for febrile granulocytopenic cancer patients

In a prospective, randomized trial, 205 febrile episodes in granulocytopenic cancer patients were treated with ceftazidime with or without tobramycin (C±T), both agents being administered only if the initial granulocyte count was below 200/l, or ceftazidime plus piperacillin (C+P). The overall response rate was 71% (39 of 60 for C±T and 45 of 58 for C+P). Logistic regression analyses documented no evidence of a significant difference between the two regimens in overall treatment effect after accounting for the linear effects of potentially important variables, such as infection type and granulocyte count. Although the response rates for the subgroup of patients with bacteremias was better with the C+P regimen (P=0.06), there was no difference in response for patients with bacteremia and profound (<100/gml) sustained granulocytopenia. The double -lactam combination demonstrated in vitro synergism in 73%; antagonism was not seen. Both regimens produced execllent serum bactericidal levels (C±T geometric mean peak 1:170; C+P peak 1:137) against gram-negative but not gram-positive pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emergence of resistance and significant coagulopathy and/or bleeding did not occur during therapy. Antibiotic-related nephrotoxicity was noted in 7 of 95 trials in the C+P and in 6 of 89 trials in the C±T group (P=0.19). The incidence of secondary infections in patients with profound (<100/l) sustained granulocytopenia was lower in the C±T group (P=0.04). Alimentary canal anaerobic flora preservation with C±T, and suppression with C+P, was demonstrated. These results suggest that these regimens are of similar effectiveness and neigher is associated with major toxicity.     

The contribution of GABA-ergic neurons to horizontal intrinsic connections in upper layers of the cat's striate cortex

Summary The contribution of neurons containing -aminobutyric acid (GABA) to horizontal intrinsic projections in layers I–III of cat's striate cortex was investigated by combining GABA-immunohistochemistry with axonal tracing. After intracortical injections of Rhodamine-labelled latex microspheres Rhodamine-labelled neurons form patch- or bandlike aggregations (clusters) separated from each other by regions containing fewer, evenly distributed or no labelled neurons. Of the Rhodamine-labelled neurons about 5% display GABA-immunoreactive material (double labelled = DL-neurons). Approximately 70% of the DL-neurons occur at distances of less than 1 mm, and the remaining 30% at distances between 1 mm and 2.5 mm from the injection. About 60% of the DL-neurons reside within clusters and 40% are located in regions between clusters; the respective percentages of the Rhodamine labelled GABA-negative neurons are about 85 and 15. Considering their small number and their spatial distribution inhibitory interneurons seem to make only minor contributions to the clustered pattern of intrinsic connections. Our results demonstrate that the topographical organization of neurons giving origin to lateral inhibitory interactions in upper layers of cat's striate cortex is different from that of neurons mediating excitatory functions.     

Plasmapheresis-related hypotension

Hypotension is an uncommon complication of procedures involving extracorporeal circulation, including plasmapheresis. From November 1993 to March 1999, we treated 139 patients who underwent a total of 1,137 sessions of double filtration plasmapheresis (DFP). Hypotension was defined as a systolic blood pressure (BP) < 80 mm Hg or any decrease of systolic BP with systemic reactions. A total of 17 (1.5%) episodes of hypotension were documented in 15 patients during the study period. Hypotensive episodes occurred in 2.3% of patients with inflammatory neuropathy, 1.2% of patients with myasthenia gravis, and 1.2% of patients with all other medical diseases. Involvement of the autonomic nerve system (ANS) and a low baseline BP were associated with the occurrence of hypotension. Eight (47%) of 17 episodes were symptomatic and 2 were complicated with seizure. Patients with symptomatic hypotension had a higher level of systolic BP prior to DFP and a larger drop of systolic BP and pulse rate during hypotensive attacks compared to asymptomatic patients. Most hypotensive episodes were resolved briefly after intravenous infusion of saline within 30 min. Eight (47%) of the hypotensive episodes occurred during the first session of DFP treatment. Twelve (71%) of 17 episodes occurred during the last half period of treatment; 6 of them were noted during the terminating stage of DFP. In conclusion, in this series plasmapheresis-related hypotension occurred in 1.5% of DFP sessions and had a higher prevalence in patients with ANS instability and low BP. Extra caution in monitoring BP during DFP therapy is warranted in these vulnerable patients, especially during the termination phase of the first DFP session.     

小肠双重造影对小肠肿瘤的诊断价值

 目的　探讨各种类型小肠肿瘤的小肠造影表现及双重造影的诊断价值。方法　回顾性分析 5 3例小肠肿瘤的双重造影表现。结果　病变 1.0× 1.2cm～ 17× 19cm ,<6cm的病变 2 6例。小肠平滑肌肿瘤主要表现为充盈缺损。小肠淋巴瘤病变范围广 ,主要表现为多发结节状充盈缺损 ,伴肠管狭窄及扩张。小肠腺癌主要表现为肠管不规则狭窄 ,肠壁僵硬破坏 ,显示“果核征”。小肠转移瘤主要表现为多发压迹 ,肠管粘连固定。结论　小肠双重造影是目前诊断小肠肿瘤最有价值的方法之一。     

Double Outlet Right Ventricle with Intact Atrial Septum and Restrictive Ventricular Septal Defect: An Analysis of Two Cases

Two cases of double outlet right ventricle with restrictive ventricular septal defect are described. This is an uncommon presentation that causes left ventricular dysfunction because of left ventricular outflow tract obstruction. The presence of an intact atrial septum leads to severe pulmonary hypertension, which tends to aggravate the right ventricular output. In the presence of a normal left ventricle, the authors suggest the possibility of enlargement of the ventricular septal defect in order to perform a biventricular repair. The association of a supramitral valve ring in both cases, and the isolation of the left subclavian artery and an aortopulmonary fenestration in one of these cases, are also discussed. In addition we explore factors that cause restrictive ventricular septal defects as well as the mechanisms that may lead to spontaneous closure of ventricular septal defect in a double outlet right ventricle.     

影响吻合器痔上黏膜环切术疗效的因素及改进方法

目的探讨影响吻合器痔上黏膜环切术(PPH)疗效的因素及改进方法。方法使用美国强生一次性PPH吻合器或国产PPH吻合器对68例痔病患者进行PPH手术，在手术改进前后分别对每例黏膜环切的标本以及症状的改善进行测量及观察。结果方法改进前，标本宽度为0．5～2．6cm，术后痔核回缩率75％；方法改进后，标本宽度为3．0～3．5cm，术后痔核回缩率100％。结论影响PPH手术疗效的因素主要是肛垫的提升复位与肛垫的固定。通过改进方法克服不利因素，使环切黏膜的宽度达到要求，进而使肛垫提升复位并得以固定，痔核回缩效果满意。