Examiner Differences in the Mini-Cex

Objective: The objective of this study was to analyze whether faculty ratings of residents, using the mini-CEX oral exam format, differed in stringency or were influenced by the clinical setting. It also sought to learn whether the examiners were satisfied with the format.Method: A mini-CEX encounter consisted of a single faculty member observing a resident conduct a focused history and physical examination in an inpatient, outpatient, or emergency room setting. After asking the resident for a diagnosis and treatment plan, the faculty member rated the resident and provided educational feedback. The encounters were intended to be short and occur as a routine part of the training, so each resident would be evaluated on many occasions by different faculty.Sample: Sixty-four attending physicians evaluated residents from five internal medicine training programs; data were analyzed for 355 mini-CEX encounters involving 88 residents.Results: There were not large differences among the examiners in their ratings. Moreover, there were not great differences among the ratings in terms of the training program with which the examiner was associated, the setting of the mini-CEX, or the nature of the patient. The examiners were generally satisfied with the format and their level of satisfaction was correlated with the residents' perceptions of the format.Conclusion: The mini-CEX adapts itself to a broad range of clinical situations, and these results show that it should produce roughly comparable scores over examiners and settings. This makes it a worthwhile device for evaluation at the local level.This revised version was published online in September 2005 with corrections to the Cover Date.     

细针吸取活检细胞学在乳腺癌诊断中的应用

目的：探讨细针吸取活检细胞学对乳腺癌的诊断价值。方法：以术后病理诊断为对照（１３４例）,光镜下观察５２１例乳腺肿瘤的针吸涂片。结果：在５４例乳腺癌中,细胞学诊断正确者４９例（９０．７％）,可疑者４例（７．４％）,假阴性者１例。同期细胞学诊断为乳腺癌者未见假阳性。结论：细针吸取活检对乳腺癌的定性和分级诊断均准确可靠。     

盆腔囊性肿块超声手术对比及与中医辨证分型关系

本文对８３例患者盆腔囊性肿块超声诊断结果与手术及病理检查进行对比,提高了超声诊断的准确性。同时结合中医辨证分型拟找寻出中医分型与超声诊断的内在联系,以提高中医诊疗水平     

192例腰椎间盘突出症患者的诊断及手术治疗分析

目的：总结分析１９２例腰椎间盘突出症及侧隐窝狭窄伴黄韧带肥厚患者的诊断和手术治疗。方法：经临床检查明确定位、定性诊断,影像学检查证实,采用小切口半椎板或全椎板切除减压、突出椎间盘髓核切除手术治疗。结果：手术证实腰椎间盘突出症１８９例,侧隐窝狭窄伴黄韧带肥厚３例,术后随访６月－５年,优良率７９％。结论：临床检查是腰椎间盘突出症诊断的基础,影像学检查对进一步明确定位诊断和鉴别诊断是必要的。手术指征的严格把握是手术成功的关键。     

Implementation of percutaneous dilation tracheotomy – value of preincisional ultrasonic examination?

BACKGROUND: In this observational study we have evaluated the implementation of percutaneous dilation tracheotomy (PDT), using the forceps dilation technique (Portex) in a multidisciplinary ICU. METHODS: We included a preincisional ultrasonic evaluation of the neck in order to visualise the isthmus glandula thyroidea and major vessels. The observational period comprised one year. PDT was performed in 28 patients. RESULTS: Implementation of PDT was uneventful. Duration of insertion was 10 min (4-40 min). Total time of tracheostomy was 8 days (1-65 days). In nine cases, the proximal end of the isthmus was overlying the space between the 1st and 2nd tracheal ring, which was considered the optimal insertion site. This resulted in seven cases of insertion between the cricoidea and the 1st tracheal ring and in two cases in a more distal insertion. Nineteen tracheotomies were performed in the interstice between the 1st and 2nd tracheal ring. In nine patients, major vessels were overlying the trachea. In none of the patients did this information result in an altered insertion site. Two cases of minor bleeding were observed; both stopped upon compression. In two patients the primary tube size (8.0) was too big and a smaller tube had to be inserted. In one patient the tube was maladapted to the stoma and had to be interchanged with an ordinary tracheostomial tube on the 5th day of tracheostomy. CONCLUSION: Based on the experience gathered in this study and information from the literature, we have abandoned the routine use of ultrasonic examination of the neck prior to PDT. In order to achieve and maintain routine, we suggest that the procedure is performed by a restricted number of doctors.     

血清唾液酸测定在预防性体检及肿瘤监测中的应用：唾液酸系统研究

目的　探讨血清总唾液酸（ＴＳＡ） 在预防性体检中应用的可行性及评价其监测恶性肿瘤的临床意义。方法　用化学比色法测定健康年检工人血清ＴＳＡ,分析４８２ 名ＴＳＡ 可疑阳性或阳性工人健康状况,研究２ ３０３ 名交警血清ＴＳＡ 与职业健康监护评定标准的关系、随访１０ ３７３ 名２ ～４ 年前测定血清ＴＳＡ 工人的健康状况、临床观察９４ 例恶性肿瘤患者ＴＳＡ 水平治疗前后变化。结果　（１）ＴＳＡ 在预防性体检中表明：①在４８２ 名ＴＳＡ 可疑阳性或阳性受检者中,肿瘤患者（１０ 例,２－５０ ±０－２１ ｍｍｏｌ／Ｌ） 血清ＴＳＡ 水平高于慢性疾病患者（２４０ 例,２－３９ ±０－２５） ,而后者又明显高于未患病的追踪观察者（２３２ 例,２－１４ ±０－２４） ,Ｐ＜ ０－００１ ;②按照广州市职业健康监护标准发现２ ３０３ 名广州交警血清ＴＳＡ 水平健康组明显低于异常组、追踪观察组和尚健康组,Ｐ＜ ０－０５ 或Ｐ＜ ０－００１ ;③随访发现,原ＴＳＡ 可疑阳性或阳性者新患恶性肿瘤和非恶性肿瘤疾病者明显高于ＴＳＡ 阴性者（ Ｐ＜ ０－００１） 。（２） 在肿瘤监测中发现：９４ 例恶性肿瘤患者ＴＳＡ 水平明显高于健康对照组,病人治疗后病情稳定或好转者ＴＳＡ 明显下     

腹腔镜在诊治宫外孕中的应用

目的：通过对拟诊为宫外孕的100例病人行腹腔镜检查,探讨腹腔镜在异位妊娠中的早确诊、早治疗以及对一些不典型病例诊断中的意义。方法：于腹腔镜下对83例有停经史、17例无停经文病人进行观察,同时部分病人实施药物局部注射治疗。结果：输卵管妊娠95例,卵巢妊娠2例,非宫外孕3例;平均出血量51ml,宫外孕未破裂者9例。结论：腹腔镜在异位妊娠的早期确诊中有重要价值,根据腹腔镜下观察的病变作出正确诊断,同时为手术方式提供合理方案。     

长期饮酒对男性生殖系统功能影响

目的探讨饮酒对男性生殖系统的损害及其机理。方法选择45名男性饮酒者和9名慢性酒精中毒者为研究对象,以15名不吸烟不接触毒物的男性为对照组。结果长期大量饮酒和酒精中毒者血清中T和CS水平下降,而LH和FSH水平升高;精浆和精子中LDH,LDH-x和G-6PD活力下降,以LDH-x下降为敏感;精子数量和活动精子年均降低,精子畸形率及异常精液检出率均升高。上述各指标与对照组比较差异均有高度显著性（P＜0.01）。结论长期饮酒可损害男性生殖系统功能。     

灰色关联分析方法在评估试卷质量中的应用

目的：在教学系统中,试卷质量是一个重要的指标因素,本文旨在探讨评估试卷质量的客观方法。方法：利用灰色关联分析模型。结果：对教研室几年来的试卷质量进行了分析,得到各年度试卷从优到劣的排列顺序是1998（r（5）＝0．83）,1997（r（4）＝0.67）,1996（r（3）＝0．55）,1995（r（2）＝0．51）,1994（r（1）＝0．48）。结论：灰色关联分析是一处理多因素问题的好方法。     

The Protective effect ofd-sotalol against hypoxia-induced myocardial uncoupling

Summary The effects ofd-sotalol on intercellular electrical coupling and ultrastructure under hypoxic conditions were investigated in myocardial samples from eight young (1–2 months) and four older (10–12 months) guinea pigs. A right ventricular muscle strip was kept simultaneously in two divided chambers and superfused with normoxic and/or hypoxic (97% N₂+ 3% C_O2) Krebs solution. Hypoxia caused shortening of action potential duration (APD) and electrical cellto-cell uncoupling. If the uncoupling appeared after short-term hypoxia (less than 30 min), administration of 3.10^–7M ofd-sotalol to the hypoxic perfusate led to a recovery of electrical coupling. Transmission electron microscopy revealed moderate reversible ultrastructural alterations of the cardiomyocytes. No apparent changes in intercellular junctions were observed. The recoupling effect of sotalol decreased with the time of hypoxia as the ultrastructural damage progressed. After prolonged hypoxia (more than 30min), cardiomyocytes were markedly injured, intercellular junctions were severely affected, and gap junctions occurred less frequently. In these cases, administration ofd-sotalol caused only transient recoupling. After 1h of hypoxia, no recoupling was observed. Pretreatment withd-sotalol prevented hypoxia-induced electrical uncoupling and markedly attenuated ultrastructural damage, although shortening of APD still persisted. Our results indicate that the cardioprotective effect ofd-sotalol on electrical intercellular coupling is closely associated with sotalol-induced prevention of the ultrastructural damage. Considering previous results, we suggest that this protective effect ofd-sotalol may be related to its ability to increase intracellular cyclic adenosine monophosphate and, thereby, to decrease cytosolic free Ca. These effects can explain the antiarrhythmic and defibrillating properties ofd-sotalol.