细支气管肺泡癌的X线CT诊断

目的提高细支气管肺泡癌(BAC)的X线、CT诊断水平.材料与方法回顾性分析24例BAC的X线、CT表现,将其分为结节型、炎症型和弥漫型.结果结节型7例,均为单发结节.炎症型6例,两肺多发斑片状影4例,大叶实变2例.弥漫型11例,两肺呈细小结节影10例,网状结节影1例.单侧或双侧胸腔少量积液8例,心包大量积液5例,双侧肺门淋巴结增大3例.胸部及远处骨质破坏6例.结论BAC影像表现多种多样,炎症型需与肺结核、肺炎等鉴别.仔细观察、分析X线、CT征象并结合临床表现与治疗情况,可提高BAC的诊断正确率.     

A 12-year experience with prehospital cricothyrotomies

Introduction: Maintaining cricothyrotomy skills is difficult for air medical crewmembers because the procedure is performed infrequently. The purposes of this study were to review our program's experience with cricothyrotomies and use this pilot study to guide an industry-wide study. Methods: We conducted a retrospective review of all cricothyrotomies performed by our flight crew during the past 12 years. The flight logs were reviewed for patient demographics, scene information, clinical data, and procedure data. Results: During this period, 8833 patients were transported: 1589 required intubation (18%), and eight of the 1589 required a cricothyrotomy (0.5%). Five nurses (14% of the total employed during the study) and one physician attempted this procedure. All patients had at least one intubation attempt before the cricothyrotomy (average 3.6, range 1-6 attempts). Six (75%) patients had airway edema, four (50%) had an unstable trachea, and one patient (12.5%) had an airway obstruction. Five (62.5%) of the cricothyrotomy attempts were successful. The remaining three patients were managed with bag-valve mask ventilation. Three patients arrived at the receiving hospital with a perfusing rhythm. Conclusion: Cricothyrotomy, rarely performed by our flight crews, is successful in 62.5% of cases. These preliminary data suggest current training practices should be re-evaluated. An industrywide survey is planned to determine the optimal training program.     

Comparison of air and ground transport of cardiac patients

Purpose: To investigate the outcome of cardiac patients transported by helicopter versus ground ambulance Setting: A hospital-based helicopter program in southeastern Minnesota Methods: Retrospective chart review assessing an 18-month period (January 1998 to June 1999). Charts were reviewed for type of cardiac diagnosis, level of pain, treatments en route, time to intervention, and length of stay (LOS). Two-hundred-sixty-six cardiac patients came by helicopter. Of the 86 turndowns, 50 came by ground ambulance; 28 records were recovered in this group. These patients composed the comparison ground group. Results: Prehospital time was less for patients transported by air than ground transports (P < .001). The amount of time from the call for transport until arrival at our hospital was less for helicopter transports (P = .002). Air transports had more patients with reduced chest pain on arrival. Difference in CCU LOS was not significant (P = .94). Air patients spent an average of 2 fewer days in the hospital than did ground patients (P = .036). Discussion: Helicopter transport benefits the cardiac patient with decreased chest pain as a result of more treatments en route; decreased time from the call until arrival, resulting in decreased time to intervention; and shorter prehospital time and hospital stays. Conclusion: All of these improved variables relate to salvaged cardiac muscle.     

Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study.

AIMS: Episodes of increased air pollution are associated with increases in hospital admissions for cardiovascular disease. Even modest acute phase responses are associated with increased risk of coronary heart disease. The study investigates whether induction of an acute phase response by exposure to air pollution may contribute to cardiovascular pathology. METHODS AND RESULTS: A prospective cohort study based on a survey in 1984/85 with a 3-year follow-up was conducted in 631 randomly selected men aged 45 to 64 years free of cardiovascular disease at entry 1984/85. Serum C-reactive protein concentrations were determined by a high sensitivity immunoradiometric assay. C-reactive protein concentration was increased in association with the 1985 air pollution episode. In multivariate analyses, elevated concentrations were independently associated with concentrations of total suspended particles and the sulphur dioxide episode. At ambient concentrations of pollution, as noted during the 1985 air pollution episode, the odds of observing C-reactive protein concentrations above 5.7 mg. l(-1)(>90th percentile) tripled, and increases of 26 microg. m(-3)total suspended particles (mean of 5 days) raised the odds of C-reactive protein levels 50% above the 90th percentile. CONCLUSIONS: Exposure to current levels of particulate matter in the atmosphere elicits an acute phase response in randomly selected healthy middle-aged men, which may contribute to the increased cardiovascular risk caused by air pollution.     

Strict Closed-System Drainage for Treating Chronic Subdural Haematoma

Summary. A comparative study chiefly of the recurrence rate of chronic subdural haematoma after two treatment modalities was conducted. Patients were divided into a burr hole strict closed-system drainage group (SCD group; n=56) and a burr hole closed-system drainage with irrigation group (CDI group; n=45). The burr hole strict closed-system drainage involved simply inserting a drainage tube into the haematoma cavity as quickly as possible after minimally incising the haematoma capsule. The introduction of air into the haematoma cavity was prevented, and irrigation was not performed. Symptoms in both groups disappeared soon after surgery, with no postoperative complications. Haematoma recurred in one patient (1.8%) of the SCD group compared with 5 (11.1%) of the CDI group. The rate of recurrence was significantly lower for the SCD than for the CDI group (p<0.05). In 4 of 5 recurrences in the CDI group, the volume of residual intracapsular air was sufficient after initial surgery. These results suggested that postoperative residual intracapsular air is a factor contributing to recurrence. Burr hole strict closed-system drainage is a simple, less invasive procedure with which to treat chronic subdural haematoma and the outcome is excellent. Furthermore, prevention of intracapsular air intrusion during surgery might help prevent recurrence.     

煤烟型大气污染对成人呼吸系统疾病及其症状影响的研究

采用环境流行病学方法调查了太原市 3个不同程度大气污染研究区成人的呼吸系统疾病和症状以及相关影响因素。结果表明 ,成人呼吸系统症状的标化发生率和疫区的标化患病率均为重度污染区 >中度污染区 >相对清洁区 (P <0 0 5 ) ,出现呼吸系统症状和疾病的危险性 ,重、中污染区分别是相对清洁区的1 8倍和 2 1倍、1 3倍和 1 8倍 ,经多因素Logistic回归分析 ,在调整了年龄、性别、职业、吸烟、家庭燃料、家族史等因素后 ,燃煤产生的LNSO2 、LNTSP、LNPM1 0 、LNPM2 5 每增加一个单位 ,成人呼吸系统症状发生的危险性分别增加 1 39倍、1 71倍、1 6 7倍和 1 79倍 ,慢性阻塞性肺部疾病患病的危险性分别增加 1 31倍、1 5 3倍、1 5 1倍和 1 6 8倍。提示煤烟型大气污染对成人呼吸系统症状和疾病的发生已产生一定程度的影响。     

TY型燃油添加剂在降低隧道空气污染中的应用

目的 为降低采用无轨运输方式进行施工的隧道中空气污染。方法 应用TY型燃油添加剂促进柴油燃烧更充分。结果 使隧道内CO、NOx浓度及尾气烟度均值降低46％、55％、42％,测定值经统计学方差检验,有极显性差异（P＜0．001）。结论 在安装隧道内通风系统的同时,使用燃油添加剂改善施工环境,在我国目前的施工条件下有十分重要的现实意义。     

北京市大饭店中央空调系统作为军团菌感染因素的队列研究

目的探讨北京市大饭店中央空调系统与军团菌感染相关关系.方法随机抽取北京市4家大饭店414位工作人员作为暴露人群和414位对照者作为对照人群,用历史性队列研究方法,针对中央空调系统这一暴露因素进行血清流行病学研究.结果暴露人群与对照人群军团菌抗体总阳性(人年)率分别为11.5‰和2.1‰(X2=38.2,P＜0.01,RR=5.48,AR%=81.8%).通过年龄分层分析,暴露人群各年龄组抗体阳性(人年)率明显高于对照人群,其中差异最大的是＜35岁年龄组.比较暴露人群与对照人群Lp1～Lp14抗体滴度水平,暴露人群Lp1、Lp6、Lp12、Lp144个菌型高于对照人群.对暴露人群感染水平与暴露时间进行趋势性卡方检验(X2=0.59,P=0.75),没有显示出暴露人群感染水平随着暴露时间的延长而且上升趋势.结论中央空调系统是导致军团菌感染的一个潜在性危险因素.     

空气净化器吸附室内甲醛性能测试分析

目的：验证X牌空气净化器对室内甲醛的吸附性能。方法：在容积为30m^3,空气泄漏量小于0．05m^3/h,并装有中效和高效过滤器、空气循环通风系统、样品发生系统等的洁净试验室内,对其吸附甲醛的能力进行了衰减试验。结果：在一定时间内测定甲醛浓度的对数（lnCt)和时间变量之间求得的r值在－0．9950～-0.997之间,二个变量之间相关性显著,为负相关。同时对6组总衰减试验开启空气净化器后,甲醛浓度与初始浓度比较均有显著性差别（P＜0．01）,说明在开启空气净化器后,甲醛浓度随时间的延长而降低,而自然衰减试验20min时的甲醛浓度与初始浓度比较无显著性差异（P＞0．05）,净化效率分别为29．94％、31．85％、33．24％、44．31％、45．15％和44．68％。结论：该空气净化器能吸附室内空气中的甲醛。     

前房注气治疗闭角青光眼小梁切除术后浅前房

目的探讨应用前房注气术治疗原发性闭角型青光眼小梁切除术后浅前房的效果。方法原发性闭角型青光眼小梁切除术后Ⅱa级及Ⅱb级浅前房101例（118眼）分为2组：保守治疗组50例（60眼）,前房注气组51例（58眼）,进行回顾性研究,比较两组治疗后视力、眼压、远期滤过泡形态、治疗持续时间、治疗有效率及一次治疗成功率。结果原发性闭角型青光眼小梁切除术后浅前房经保守治疗和前房注气治疗两组治疗后视力、眼压、治疗有效率、远期滤过泡形态比较差异无统计学意义（P〉0．05）,一次治疗成功率和治疗持续时间差异有统计学意义（P〈0．05）。前房注气术一次治疗成功率93．1％,治疗时间短。结论前房注气术是治疗原发性闭角型青光眼小梁切除术后浅前房的简单有效的方法。