Surgical management for mentosternal contractures by flap procedures

Mentosternal contractures still represent a surgical challenge due to their prominent position. They require early operative treatment for both function and aesthetic reasons. Careful clinical examination of scar position and traction forces, both at rest and when functioning, in addition to proper evaluation of the surrounding soft tissue are mandatory for precise preoperative planning of the required reconstruction. In general, the technically most feasible operation is favored if the functional and aesthetic results are good and postoperative risk for recurrence is low. Between 1987 and 1994, 21 patients with cervical, mentosternal, and mentothoracic contractures were operated upon. Eight patients were reconstructed with local flaps and 13 with microvascular free flaps.     

慢性病信息系统的指标及其收集方法的研究

目的 探讨我国目前慢性病监测系统应监测的指标、指标的收集方法。方法 DELPHI专家咨询法。结果 目前社区慢性病综合防治信息系统包括的指标有六方面内容，按照平均重要程度等级和排位的结果是死亡监测、发病或患病监测、危险因素监测、社区环境监测、疾病管理与卫生经济监测；指标的收集渠道应统一协调卫生系统的各个部门，包括医院、社区和各级疾病预防控制机构(CDC)以及公安和民政等部门；指标的收集方式主要依靠常规报告，部分指标通过流行病学调查来获得；监测指标的用途主要用于探测慢性病流行趋势和引起的疾病负担、确定防治重点、评价慢性病干预效果，以便更有效的防治慢性病；如何确保监测资料的质量和政府提供必须的费用是监测中比较普遍存在的问题。结论 死亡监测、发病或患病监测、行为危险因素监测应是慢性病综合防治信息系统应首选的内容。     

Effect of different questionnaire formats on reporting of occupational exposures

During an exposure monitoring study, 78 saw maintenance tradesmen were randomly assigned to be interviewed about their exposures using one of two questionnaire formats: open-ended and partly prompted questions about five categories of materials; and detailed prompting about 75 agents. The more open-ended questionnaire elicited fewer exposure responses overall, but more responses about agents not included on the detailed questionnaire. Composite materials and trade name products were more frequently cited as exposures than individual metals or compounds. Validity of responses was ascertained using air measurements (individual metals) or observations of the employees (composite materials). Sums of sensitivities and specificities were very low (near 1.0) for most of the metals for both types of questionnaire. For composite materials, validity improved substantially. Sensitivities with the partly prompted format (0.44–0.85) were always lower than with detailed prompting (0.80–1.00). Specificities were usually, but not always, higher with partial prompting (0.66–0.92) than with detailed prompting (0.18–0.86). Selection of questionnaire format for an epidemiologic study would depend on the likely prevalence of exposure in controls and the effects of trade-offs in sensitivity and specificity.     

Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving, the challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.     

益气养阴清热法合化疗治疗急性髓细胞白血病

目的 :探讨益气养阴清热法为基本治法配合化疗治疗急性髓细胞白血病的临床疗效。方法 :用黄芪、太子参、白术、生地、黄精、天门冬、麦门冬、白花蛇舌草、半枝莲、小蓟、蒲公英、甘草组方。配合 DA、HA、IA等联合化疗方案。部分 M3 患者应用维甲酸、亚砷酸治疗。部分患者静脉滴注榄香稀乳、参脉、丹参等辅助治疗。结果 :1 5 6例完全缓解 1 1 3例 ,完全缓解率 72 .4% ;部分缓解 2 0例 ,部分缓解率 1 2 .8% ;总缓解率 85 .3% ;3年生存率 37.2 % ,5年生存率 2 2 .1 %。 32例老年患者完全缓解率 43.8% ,明显低于其他年龄段 ( P<0 .0 1 )。应用维甲酸治疗的 1 8例 M3 完全缓解 1 5例 ,完全缓解率 83.3%。亚砷酸治疗 3例完全缓解 2例。结论 :益气养阴清热法作为中医的基本治法治疗急性髓细胞白血病符合临床实际。中西医结合治疗急性髓细胞白血病缓解率高 ,患者易于接受 ,有比较高的实用价值。其中提示老年患者治疗比较困难。     

AngleⅡ类错矫治的临床研究

目的 :观察联合运用功能矫治器和方丝弓矫治器治疗安氏 类错牙合患者的临床效果。方法 :以近 5年来收治的 30例安氏 类错牙合临床患者 ,平均治疗时间 1 8个月 ,治疗前后均拍摄头影测量片 ,将测量结果进行分析比较 ,评价治疗效果。结果 :儿童的上颌磨牙远中移动 ,下颌磨牙近中移动明显 ,儿童颌骨前后垂直关系显著增加。结论 :联合功能矫治器及方丝弓矫治器治疗的安氏 类错牙合有满意的疗效 ,可以相互促进改善患者的软硬组织关系     

如何上好医学生药品质量选修课

医学生在以后的工作中会经常接触到药品，而药品质量的好坏直接关系到患者的生命安全，因此在医学生中开设药品质量选修课非常必要。本文从教学方法、教学手段、教学内容的衔接等方面提出了一些观点和具体方法。     

浅议病理生理学教学改革

本文从病理生理学理论和实验教学两个方面论述了病理生理学方法的改革与实践。教学模式变学生被动为自主学习，在传授知识同时注重培养学生自学创新能力。     

Is the grading of breast carcinomas affected by a delay in fixation?

Summary The effect of delay in fixation on the modified Bloom and Richardson grade of eight breast carcinomas was investigated. Topologically shuffled samples of each tumour were immersed in fixative at times of 0.5, 2, 4, 6, 18 and 24 h after surgical removal. The grade of each tumour was assessed at delays of 0.5 and 6 h. The tubule formation and nuclear pleomorphism components of the grade showed no change with a delay in fixation of 6 h. The number of mitotic figures declined by a mean of 53% over the same period and this resulted in a decrease in the histological grade of one of the tumours. The implications of these findings for the handling of breast specimens in a diagnostic histopathological laboratory are discussed.Some of these data were presented at the 162nd meeting of the Pathological Society of Great Britain and Ireland at Cambridge, 3 January 1991. Published as an abstract in J Pathol (1991) 163:154A