146例女性不孕症的病因分析

目的 分析女性不孕的病因。方法 收集1990-2000年我院女性不孕症146例，不孕时间2年以上。结果 不孕症的主要原因是子宫因素，感染因素及内分泌失调，原发性不孕以子宫因素为主，继发性不孕则以感染因素为主。结论 女性不孕症的原因常是多因素的，必须采用综合治疗，才能提高妊娠率。     

非典型输卵管妊娠的临床与超声

输卵管妊娠是一种常见的妇科急腹症 ,对妇女造成极大的危害 ,诊断不及时甚至可危及生命。近 2 0年来全世界异位妊娠的发病率均有显著增加 ,发生率增长了 2～ 3倍。我国部分地区统计异位妊娠与正常妊娠之比为 1∶ 4 3～ 1∶ 5 0 [1～ 5] ,其原因如下 :(1)诊断方法先进 ,手段增多 ,检出率提高 ;(2 )盆腔炎症未彻底治疗 ;(3)性病的蔓延流行等高危因素。为了提高对异位妊娠的诊断水平 ,特别是非典型输卵管妊娠 ,有必要再复习一下异位妊娠的成因、病理、临床及超声声像图的各种表现。1　病　因病因是多方面的 ,如生殖细胞精子畸形、核型分类异常、染色体异常、卵发育停滞、受精卵发育不良、着床部位异常。盆腔炎造成输卵管周围粘连影响输卵管蠕动 ,伞端粘连影响捕捉孕卵功能 ,使输卵管半阻塞、狭窄乃至阻塞 ,纤毛粘连成瘢痕。性传播性疾病 ,特别是沙眼衣原体与异位妊娠的关系 ,Martin,Chow等人研究结果表明异位妊娠患者与沙眼衣原体感染有关 [6 ,7] 。输卵管本身的因素 ,如手术、炎症 ,造成肌层增生、狭窄等。宫内避孕器可降低输卵管妊娠 95 % ,研究表明带避孕器者好发于输卵管伞端。人工流产可增加宫...     

Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

不同病理类型胃息肉流式细胞DNA定量研究

应用流式细胞计对５７ 例正常胃粘膜、不同病理类型的胃息肉和胃癌组织作ＤＮＡ 定量分析。正常胃粘膜、炎性息肉、增生性息肉、腺瘤性息肉及胃癌中，ＤＮＡ 非整倍体检出率分别为０％ 、７．７％ 、９．１％ 、３６．４％ 、５８．３％ ；各型胃息肉和胃癌组织的增殖期细胞比率均显著地高于正常胃粘膜组（Ｐ＜ ０．０１）；增生性或炎症性息肉组增殖期细胞比率与胃癌组比较，差异有显著性（Ｐ＜ ０．０５）或非常显著性（Ｐ＜ ０．０１），而腺瘤性息肉组增殖期细胞比率与胃癌组近似（Ｐ＞ ０．０５）。结果表明胃息肉是一种细胞增殖活跃性病变，其中腺瘤性息肉的ＤＮＡ 生物学行为更接近于胃癌，可能容易癌变；应用流式细胞ＤＮＡ 定量分析技术，结合组织病理学诊断，能对胃息肉的预后作出更为确切的判断     

替勃龙改善绝经期功能性消化不良症状

目的 :探讨替勃龙能否改善绝经期功能性消化不良患者临床症状及其相关机制。方法 :14 3例绝经期功能性消化不良患者随机分成 3组 ,分别给予替勃龙、西沙必利及替勃龙 +西沙必利 ,治疗 4周 ,观察治疗前后各组患者上腹胀痛、餐后胀满、早饱、暖气等临床症状积分的变化。在随机分成的 3组中再随机各抽出 2 0例患者治疗前后测定胃 30min排空率及胃半排空时间 ,观察治疗前后胃动力的变化。结果 :3组药物治疗后 2周和 4周上腹胀痛、餐后胀满症状积分均明显下降。西沙必利治疗后 2周和 4周对早饱、暖气症状无明显缓解 ,替勃龙及替勃龙 +西沙必利则对所观察的所有症状均有明显缓解 ,替勃龙改善早饱和嗳气症状优于西沙必利 ,但与西沙必利合用无增强效应。 3种药物治疗后 ,胃 30min排空率均明显增加、胃半排空时间缩短 ,与治疗前比较有显著差异 (P <0 .0 5 ) ,但 3种治疗方案之间无显著性差异 (P >0 .0 5 )。结论 :替勃龙能通过增强胃动力 ,明显改善部分绝经期功能性消化不良患者的临床症状 ,疗效优于促动力药。     

Design and Performance of Blanket Heat Shields for Neonates

ABSTRACT. Background: Several designs of plastic blanket heat shields are in use. This study was done to compare different designs for their efficiency in reducing heat loss. Methods: Four heat shield designs were tested by sequentially covering each of 14 infants (wt. 640–2030 g) cared for under radiant warmers. The power consumption of the radiant warmers was measured as a surrogate for. heat loss. All designs were tested for a total of 20 min on all infants. Results were calculated as percent change in power consumption from shield to shield. The most efficient design was further modified and evaluated in another group of 14 infants (wt. 700–1180 g). Results: The relative reductions in power consumption were: no shield (control) –0%, a plastic foil over the side rails: –17%, a single layer close to the infant but excluding the head: –34%, the same as double layer –37% and the most efficient one, a single layer covering the whole infant –42%. A modification of this design, tested in the second group of infants, reduced power consumption by 13% (95% CI –5.9/–19.7), ( p < 0.004) when compared to the single layer covering the whole infant. It was tucked under the connecting tubes to the ventilator. It also reduced the risk for displacement and allowed for the endotracheal tube to be suctioned without removing the blanket. Conclusion: Modifications of the design of heat shield blankets for infants resulted in significant increases in efficiency.     

Accidental bronchial intubation An analysis of AIMS incident reports from 1988 to 1994 inclusive

Accidental bronchial intubation was examined in the first 3947 cases reported to the Australian Incident Monitoring Study and was found to have accounted for 154 (3.7%) of the total incidents reported. Most incidents were detected in the operating theatre (93.5%) and during maintenance of anaesthesia (77.9%), by unexplained oxygen desaturation alone (63.6%). Capnography remained normal or unremarkable during 88.5% of the episodes. One-third of cases were associated with head or neck surgery and possible flexion of the patient's head. A RAE tube was used in 20% of incidents, a greater frequency than occurred in the study overall. A third party was implicated in 36 (23.4%) of cases. Ninety per cent of cases were considered preventable. Major morbidity occurred in three cases and unplanned intensive care admission was required in a further five. Almost two-thirds (61.1%) of the incidents might have been avoided by the proposed markings on the tracheal tube. We conclude that when arterial desaturation occurs at any stage during anaesthesia the possibility of bronchial intubation must be considered. Asymmetrical ventilation may be difficult to detect clinically and in most cases there is no change in capnography.     

Comparison of p53 expression in proximal and distal gastric cancer: Histopathologic correlation and prognostic significance

Background: The overexpression of p53 has been found to be correlated with prognosis of some carcinomas, including gastric cancer, but no studies have reported on its relationship to the location of gastric cancer. In the present study, we compared the p53 expression of proximal and distal gastric cancer concerning histopathology and prognosis. Methods: A total of 170 tumors in the patients with proximal (80 cases) and distal (90 cases) gastric cancer were studied by immunohistochemical methods. Results: p53 immunopositivity was detected in 28.8% of all tumors. The p53-positive expression in proximal gastric cancer was higher than in distal gastric cancer (38.8% vs. 20.0%, p<0.05). A 5-year survival analysis showed that there is no significant difference between tumors that are p53 positive and p53 negative. No correlation was found between p53 expression and histopathology of gastric cancer. Conclusion: p53 nuclear staining is not useful as a prognostic indicator or as a parameter in gastric cancer.     

PTCD在诊治阻塞性黄疸中的应用及体会

对阻塞性黄疸病人,术前进行经皮肝穿刺胆道引流术(PTCD)能达到胆道减压,减轻全身黄疸的目的,为该类病人术前准备提供一项行之有效的方法。本文报告12例,其定位诊断符合率为100％,定性诊断符合率为75％,结合实践提出了进行PTCD的适应证选择和预防并发症的切实措施。     

猴头菇发酵茶安全性检测及对大鼠胃酸分泌的影响

目的：检测猴头菇发酵茶的安全性并观察猴头菇发酵茶对大鼠胃酸分泌的影响。方法：猴头菇发酵茶安全性测定按GBl5193．1-94《食品安全性毒理学评价程序》要求进行；用酸度计测定大鼠胃液pH值。结果：猴头菇发酵茶对小鼠的半数致死量为15．11g／kg，且无诱发小鼠骨髓细胞微核形成，不同剂量的猴头菇发酵茶对大鼠胃酸分泌有促进和抑制的作用。结论：猴头菇发酵茶安全无毒，高剂量时对大鼠胃酸分泌有抑制作用。