Dialysis — A family matter. A personal tribute to the relatives of kidney patients

The patient and his or her treatment is the main focus of the multidisciplinary team in the Renal Unit, yet the most important part of the patient's life is that spent at home, outside the hospital. It is important to recognise the contribution to care of the patient's family, especially the spouse. It is also important to understand the carer's needs. Carers experience many of the stresses associated with End Stage Renal Failure, while being relatively unsupported and unappreciated by hospital staff. This paper focuses on the need for imagination and understanding of the carer's predicament, and suggests ways in which carer's needs can be met.     

硝喹的临床与现场应用

本文综合报道了我们十几年来在硝喹与复方哨喹临床及现场与扩大使用方面的结果。治疗恶性疟198例,用50～75mg×3天(复方硝喹,下同),对恶性疟或抗氯喹恶性疟患者有良好的效果。治疗间日疟510例,当剂量为50mg×3天时,效果略逊于氯喹。在抗氯喹恶性疟地区的4540人群中进行防治验证,通过重点村寨详细观察认为:用50mg/天/半月或75mg×2天/月,均可达到防治效果。实验室研究表明本药对疟原虫的组织期、红内期、孢子增殖期均有作用,据此提出了复方硝喹的合理使用建议。     

271例婴幼儿完全性唇腭裂一期修复及初步观察

目的 探索婴幼儿完全性唇腭裂一期修复的可行性，并对其效果进行初步观察。方法 对3－12个月婴儿安全性唇腭裂进行了一期修复，同时对24例裂隙宽大的患儿进行术前腭部矫治，对术后1－4年的116例患儿唇的外形及事音进行了初步评价。结果 271例婴幼儿完全性唇腭裂修复手术，术后除2例发生呼吸困难，6例腭部瘘孔形成及5例作品渗血外，全部愈合良好。研究发现19例单侧完全性唇腭裂术前腭部矫治后，齿槽部裂隙左右距离轿治前平均缩小6．1mm；前后距离轿较矫治前平均缩小6．6mm；唇外菜评价优良率达93．1％，语音评价优良率达94．8％。结论 婴幼儿完全性唇腭裂一期是完全的、可行的。术前腭部桥治可明显缩小齿槽部的裂隙，有利于宽大裂隙的修复。婴幼儿完全性唇腭裂一期修复可获良好唇外形及语音功能恢复。     

东洞庭湖及长江涨水期水体血吸虫感染性实验报告

目的　探讨东洞庭湖及邻近长江水域在涨水期不同月份的水位下 ,血吸虫病易感地带水体感染性的变化。　方法　在东洞庭湖及长江水域各设 1个观察现场 ,采用小白鼠作为水体感染实验动物。 1999年 5月至 8月分别采用一批小白鼠连续感染 3 d,每天 2 h。　结果　东洞庭湖水域在 5、6、7、8月涨水期小白鼠感染率分别为 80 .49% ,10 0 % ,79.49% ,14.63 % ;长江水域感染率分别为 15 .0 0 % ,15 .3 8% ,2 8.2 1% ,7.5 0 %。　结论　在涨水期东洞庭湖水域哨鼠感染率明显高于长江水域 ( P<0 .0 1) ;长江水域在高水位期感染率较高     

脑震荡患者恢复期智力测试成绩的特征分析

目的分析脑震荡患者恢复期智力测试（智测）成绩，总结认知功能损害规律，寻求进行干预的可能性。方法77例脑震荡患者在发病后30d左右（恢复期）接受了中国成人韦氏智力测试量表（WAIS-RC）评估，并与48例正常人（对照组）测试结果比较。结果脑震荡组WAIS-RC智测成绩中，知识、算术、相似性、数字广度、数字符号、填图、木块图、图形排列、图形拼凑等分量表评分均明显低于对照组（t=2．063～3．277，均P〈0．01或0．05）。在按性别分组后，男性脑震荡患者（41例）的算术、数字广度、填图和图形排列等分量表评分均明显低于女性患者（36例）（t=2．153～3．132，均P〈0．01或0．05）。在按脑外伤部位分组后，前部损伤组的知识、领悟、算术、数字广度、数字符号、填图、木块图、图形排列和图形拼凑等分量表评分均明显低于后部损伤组（t=2．027～3．148，均P〈0．01或0．05）。结论脑震荡患者恢复期常伴有明确的认知功能损害特征，后者又常与患者性别和损伤部位密切相关。     

Longitudinal study on factors related to the course of vibration-induced white finger

 Follow-up surveys were conducted in 1982 and 1988 to investigate factors affecting the course of vibration-induced white finger (VWF). Subjects were 353 patients, aged 40 to 70 at the start of the 1982 survey, who were receiving treatment for hand-arm vibration syndrome. Between 1982 and 1988, the attacks of VWF decreased, while numbness and pain in the hand changed slightly. Finger skin temperature showed a tendency to increase, but recovery time in nail compression tests was unchanged. Vibration perception threshold and grasping power tended to become worse. Of the 177 patients with VWF in 1982, 55 (31%) had no VWF in 1988. The improvement in VWF depended on its severity assessed by the frequency of attacks, the extent of the affected finger phalanges and the Stockholm vascular (V) stage at the start of the 1982 survey. The improvement was observed in 46% of the 1V (mild) stage cases, against only 17% of the 3V (severe) stage cases. Patients in the 2V (moderate) and 3V stages had lower finger skin temperature than those without VWF (the 0V stage). Patients with milder VWF seemed more likely to improve. Continued use of vibratory tools was found to be an unfavourable factor for improvement of VWF. Age, smoking and drinking habits, and medical complications showed no significant effects on the course of VWF. Received: 26 February 1996/Accepted: 2 May 1996     

Clinicopathologic analysis of microscopically invasive breast carcinoma

Breast biopsy or mastectomy cases having diagnoses of carcinoma in situ with “microinvasion,” “minimal invasion,” “focal invasion,” or “suggestive of invasion” were reviewed and all histologically identified foci of invasive disease from each case were measured using an ocular micrometer. Cases in which any single focus of invasion was greater than 5 mm or the added size of separate invasive foci exceeded 10 mm were excluded, resulting in a study group of 75 patients. Invasive neoplasm was present in the initial biopsy in 69 of 75 cases (92%); however, residual invasive neoplasm was found in the subsequent lumpectomy/mastectomy from 14 of these (20%). In 59% of cases, two or more histologically separate foci of invasion were identified. Invasive foci consisted of isolated cells or cell clusters, each less than 1 mm (microfocal invasion), in 33% of cases. In 12 cases, the sum of individual invasive foci was 5 to 10 mm. Axillary lymph nodes (LN) from 5 of 69 patients (7%) contained metastatic carcinoma (four cases, one LN positive; one case, two LN positive). The cumulative sizes of all invasive foci in the LN-positive group were microfocal invasion (one case), 0.6 mm (one case), 1.1 mm, 2.5 mm, and 5.8 mm. The difference in frequency of axillary node metastasis between tumors with microfocal and measurable invasion (4.3% v 8.6%) was not statistically significant. Follow-up data were available on 55 cases (mean interval, 66.1 months). One (node-negative) patient had duct carcinoma in situ recurrence in the same breast 4 years after initial treatment. Another (with unknown node status) developed an axillary lymph node metastasis 13 months after initial treatment (96% disease-free survival). We conclude that microscopic stromal invasion in breast carcinoma, at least in the setting of significant in situ component, is often initiated from multiple foci. Patients with microscopically invasive breast carcinoma have a small but significant risk of axillary metastases, although a highly favorable survival.     

护理程序在大面积烧伤休克患者中的应用

目的：运用护理程序设计大面积烧伤病人接受湿性医疗技术(MEBT/MEBO)治疗的综合护理计划并实施整体护理。方法：由责任护士为新人院病人根据病人病情提出护理诊断、预期目标、实施护理措施。结果：烧伤面积为31％～80％的TBSA的80例患者均平稳渡过休克期。结论：将护理程序这一科学的工作方法，贯穿于大面积烧伤休克期病人的整体护理全过程中，是成功抢救大面积烧伤病人必不可少的重要因素。     

How to define intermediate stage in Hodgkin's lymphoma?

Abstract:  Background : Intermediate or unfavourable stage Hodgkin's lymphoma (HL) definition relies upon at least three different scoring systems defined by cooperative groups (EORTC, GHSG and Canadian-ECOG). We aimed to investigate their efficacy and their correlation with International Prognostic Score (IPS) for advanced HL. Patients and methods : We studied a population of 1156 patients with localized stage HL treated prospectively within GELA centres in H8 (518 patients) and H9 (638 patients) protocols. Median age: 30 yr, 18%, Female 50%; stage I: 25%; stage II: 75%. According to scoring systems 70% had 0–1 EORTC factors; 60% 0–1 GHSG factors and 82% 0–1 Canadian factors. The IPS for advanced stages was available only in H9 study with 64% 0–1 factor. Results : Survival curves according to each of the different scoring systems could significantly discriminate the subgroup populations. When a multivariate Cox analysis was performed for overall survival (OS) including all the scoring system variables: age >45 yr, sex male, Haemoglobin <10.5 g/dL, lymphocytes <600/ μ L, B symptoms with elevated ESR, extra nodal sites did retain an independent significant value. Probability of OS was 99%, 98%, 92%, 82% and 73% for patients with 1–5 factors, respectively P  < 0.0001. Conclusion : These factors are similar for most of them with those described in the IPS when stages III and IV are replaced by extra nodal localization. This new score should be validated in other prospective trials, as it will simplify the Hodgkin prognostic scoring systems for localized and advanced stages.