Cardiovascular effects of forces applied during laryngoscopy

The relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many difficulties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation causes more cardiovascular changes than laryngoscopy in routine uncomplicated procedures.     

数字影像会诊系统的创建及初步应用

目的：对数字影像会诊系统的创建、初步应用及其特点进行探讨。方法：双屏图文工作站1台，MatroxG450 AGP双头显卡1块，多媒体投影仪2台，投影大屏幕1个，线对灰阶测试卡1个。在Intranet和医学影像存储与传输系统（PACS）的基础上，使用GE Radworks软件对患者在放射学信息系统（RIS）上的信息和PACS图像调阅；并对图像的调取速度、分辨率及灰阶度进行测试。结果：成功使用MatroxG450双头显示卡将图像和文字单独或同时在2个屏幕上显示，并完成图文双屏和图像双屏的快速切换。图像调阅速度快、分辨率高（12 LP）和灰阶度良好，且图像无失真变形。结论：数字影像会诊系统具有调取速度快、分辨率高、功能完善、优良的效价比、操作简便、实用可靠等优势，值得推广。     

图像存储与传输系统的总体设计与分步实施

目的 探讨在组建图像存储与传输系统（picture archiving and communication system,PACS)过程中的总体设计及如何进行具体每一步的实施方案。方法 把具有医学数学成像及通讯（digital imaging and communication in medicine,DICOM)标准接口或非DICOM标准接口的影像设备进行联网，制定资源共享、系统存储的解决方案，建立典型的医院放射科PACS系统，连接目前医院现有的设备，服务器采用Windows NT SQL Server 7.0组成，解决管理及存储问题，工作站基于浏览（WEB）方式访问，扩大客户端的使用权限（license)，数量为100个，磁盘阵列（RAID 5）在线存储3个月，线性磁带库（DLT)离线海量存储；扩展全院并解决放射学信息系统（radiology information systems,RIS)、PACS的数据共享连接；建立地区影像数据交换中心。结果 建立了典型的医院放射科PACS系统，连接了目前医院现有的设备，实现了放射科初步的无胶片化方式；将PACS扩展到了全院的临床科室、手术室、急诊室等，以及实现了和已有的医院信息系统（hospital information systems,HIS)、其他医院网络联网，建立起了影像数据中心；实现了和本地区其他医院及其他地区的影像数据中心的联网，使用起来较为得心应手，方便了医生，提高了工作效率。结论 实践证明，上述PACS的总体设计与分步实施方案是可行的、成功的。     

河南省大型医疗设备现状分析

目的:全面掌握河南省大型医疗设备的拥有量、分布、使用率等资料,为编制河南省乙类大型医用设备配置规划提供科学依据.方法:采用普查法和抽样调查法相结合,对河南省乙类大型医用设备的相关资料进行调查.结果:CT、MRI在各级医院和各类医院的数量分布和比例分布较为合理.乙类大型医疗设备数量增长速度较快,不同级别医院工作量和设备检测的阳性率差别较大.结论:乙类大型医疗设备的数量分布和比例分布已经满足需求;适当控制过高的增长速度;注意提高乙类大型医疗设备的利用率和设备检测的阳性率.     

从中外临床实验室的现状探讨我国实验医学的发展

高质量的临床实验室服务是疾病正确诊断、治疗的重要条件。将中外医院实验室从实验设备、信息管理、人员素质、在职培训等方面进行比较，找出差距，以明确自己的努力方向，探索适合我国国情的实验医学发展模式。     

危急值在消毒供应中心设备安全管理中的应用

目的 借鉴危急值应用于消毒供应中心设备安全管理,以保证设备安全运转避免医院感染发生.方法 以确保患者与操作人员安全为原则,设立相关仪器设备危急值项目和界限值,制定危急值报告制度、应答标准,进行根本原因分析,实施质量追踪.结果 各类设备故障能及时发现并解决,各级人员的规范操作、危急管理及应对意识明显提高;运用危急值管理消毒供应中心清洗灭菌设备,有助于建立快速联动反应机制,可有效提升设备的安全运行效能.结论 管理者注重基础操作的同时应密切关注设备的运行质态,运用有效地管理手段才能保证患者、使用者的身体健康和生命安全.     

医用电气设备的漏电流测试

国标GB9706．1——1995《医用电气设备第一部分：安全通用要求》是目前医用电气设备认证的安全基础标准。本文就该标准中有关漏电流和患者辅助电流的要求进行论述，从电介质的特性开始，用直观易懂的图表，结合实际工作情况．对医用电气设备的漏电流的产生原因、种类、测量要求及测量方法等进行分析和整理，并用高压电位治疗仪为例，说明如何正确理解标准的测试方法。希望本文对医用电气设备制造商和医院等医用电气设备使用单位的工作能提供一些帮助．同时也期待得到检测同行的指正。     

Comparative analysis between epidural (Gaeltec) and suboural (Camino) intracranial pressure probes

The new fiberoptic Camino system has recently been introduced for clinical intracranial pressure (ICP) monitoring. We compared the subdural Camino system with the well-established epidural Gaeltec system in both in vitro and clinical conditions. In the in vitro experiments the intracranial vault was simulated by a tightly closed, fluid-filled box (0.9% sodium chloride) with the two probes inside. We simulated pulsating waveforms with a jet ventilator. No difference between the simulated curve patterns and values could be detected. In the clinical studies, both probes were implanted in 10 patients who had either head injuries, subarachnoid hemorrhage, or intracerebral hemorrhage. The in vivo comparison revealed no significant difference between the two systems in the recorded pressures in group 1 (ICP<20 mm Hg). The subdurally placed Camino probe showed insignificantly lower ICP values than did the extradural Gaeltec probe. Although group 2 (ICP>20 mm Hg) waveforms were nearly identical, significant differences (p<0.01) in pressure measurements (systolic, diastolic, and mean) occurred (Camino, 18±3 mm Hg; Gaeltec, 27±3 mm Hg). Correlation coefficients for mean ICP values were 0.82 in group 1 and 0.49 in group 2. Problems with the Camino probe were usually mechanical and occurred in 2 patients. The problems were either easy to recognize or manifested as an ostensibly pathologic curve. No infection occurred with either system during or following implantation. The dissimilar characteristics of the two probes can be ascribed to their different extradural and subdural implantation sites. The Gaeltec probe was more durable over the period of implantation, which averaged 98 hours and ranged from 44 to 298 hours. Intracranial pressure values measured subdurally seemed to be more true to life in the high-pressure ranges. Both probes can be used for routine, continuous ICP monitoring. While subdural ICP probes can give correct values without delay and in vivo show more detail and change with ventilation, the epidural system was more durable.Presented in part at the 20th Congress of the Scandinavian Society of Anaesthesiologists, June 1989, Copenhagen, Denmark.     

Continuous noninvasive cardiac output as estimated from the pulse contour curve

We developed a noninvasive computer-based system for estimating continuous cardiac output by a modified pulse contour method using a finger pressure waveform. The method requires no individual patient calibration or baseline cardiac output. First, we calibrated the system in a learn group of 20 patients. The computer-based cardiac output was then compared with thermodilution cardiac output in 27 patients undergoing coronary artery bypass surgery. A total of 94 cardiac outputs were performed (three averaged per determination) at four predetermined time periods: preinduction, postinduction, prebypass, and postbypass. During determination of each thermodilution cardiac output, the pulse wave data were simultaneously recorded on cassette tape. The patients had cardiac outputs ranging from 2.9 to 6.4 L/min. The correlation coefficient was 0.75. The average thermodilution cardiac output was 4.50 (±0.83 SD) L/min, while the cardiac output derived from the finger pressure wave was 4.48 (±0.7 SD) L/min (95% confidence interval [CI] of difference, 0–3.2%). The mean difference between the two methods was 0.02 (±0.55 SD) L/min. The 95% CI for the bias was 0.0001 to 0.036 L/min. The 95% CI for the lower limit of agreement was – 1.12 to – 1.06 L/min; the upper limit for the 95% CI was 1.09 to 1.16 L/min. The program demonstrated that information about cardiac output can be obtained by using the Finapres device (Ohmeda, Boulder, CO). The cardiac output values obtained by this continuous noninvasive technique were within ±20% of the simultaneous thermodilution values 87% of the time. This was true over the narrow range of cardiac outputs (2.9 to 6.4 L/min) and wide range of heart rates (45 to 140 beats/min).     

A review of 560 Hickman catheter insertions

Indwelling, cuffed, tunnelled, central venous (Hickman) catheters are increasingly being used for venous access and the administration of chemotherapy for oncological patients. This paper reviews the technical problems associated with the percutaneous insertion of these catheters and the complications arising from their use. Five hundred and sixty catheters were inserted; 31.3% had complications at insertion, most commonly precipitation of an arrhythmia (13.9%). Arterial puncture occurred in 3.8% and pneumothorax in 1.6%. Catheters remained in place for a median period of 91 days. Forty percent of catheters were removed electively on completion of treatment; 30.2% required removal because of complications, which included sepsis, migration, thrombosis and blockage. Twenty percent of patients died with their catheter in place, 8.5% were still in situ and 1.6% were removed because of patient non compliance. Sepsis remains the commonest, long term complication, with staphylococcus epidermidis being the organism isolated most frequently. There were no catheter-related deaths.