Are Continuity Clinic Patients Less Satisfied When the Resident Is Postcall?

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.     

1 108例终末期肾脏疾病血液透析病人原发疾病构成及相关因素分析

目的 回顾性研究终末期肾脏疾病（end stage renal disease，ESRD）血液透析病人原发疾病构成及其相关因素。方法 收集ESRD血液透析病人1108例，分析其原发疾病构成、年龄、性别、透析治疗持续时间、转归、生存率和死亡原因。结果 301例病人透析时间超过3个月，其中43．9％仍在进行血液透析治疗，最长者已存活13年；13．0％病人已行肾脏移植；19．9％转至外院治疗；7．3％改为腹膜透析；1．3％因经济困难放弃治疗；14．6％病人死亡。ESRD维持性血液透析病人1年生存率为93．53％，3年生存率为68．92％。5年生存率62．51％。死亡原因为心血管事件占54．5％，脑血管意外占20．5％。结论 本组病人以中、老年为主，男性多见。ESRD血液透析病人主要原发疾病为慢性肾小球肾炎，主要死亡原因为心血管事件和脑血管意外。     

New sonographic techniques for the diagnosis and treatment of hepatocellular carcinoma

Ultrasound (US) contrast agents such as Levovist and Sonazoid are now commercially available in Japan. Innovative contrast agents and ultrasound technologies have dramatically changed both diagnostic and treatment strategies for hepatocellular carcinoma (HCC). Contrast-enhanced US is extremely useful in the differential diagnosis of hepatic tumors as well as in evaluation of post-treatment response of HCC after lipiodol transarterial chemoembolization and radio frequency ablation. Harmonic US sensitively detects residual cancer cells in HCC patients after treatment, to facilitate accurate guidance for needle insertion for US monitoring; no other imaging modalities, including computed tomography (CT) or magnetic resonance imaging (MRI), have such capability. In 2005, the breakthrough technology of pure arterial phase imaging, which depicts only intranodular arterial accumulated maximum intensity projection images, was developed from advanced raw data storing and accumulation technologies. This technique can clearly identify whether blood supplyin the tumor is of arterial or portal origin, to facilitate the non-invasive characterization of nodular lesions associated with liver cirrhosis. Again, CT or MRI do not have such capabilities. This innovative technique can help differentiate premalignant lesions from overt HCC. Concurrent real-time imaging of multi-detector CT and US, known as real-time virtual sonography, has recently become available. This technique greatly facilitates the treatment guidance for HCC. These newly introduced sonographic techniques are dramatically changing the diagnostic and therapeutic strategies for HCC, which are expected to improve the prognosis of HCC patients.     

肌萎缩侧索硬化合并颈椎病的临床特点分析

目的:探讨肌萎缩侧索硬化ALS合并颈椎病患者的临床特征。方法:对75例ALS患者的临床资料进行回顾性分析,并对合并颈椎病的ALS患者与未合并颈椎病的ALS患者的临床特点进行比较。结果:合并颈椎病的ALS患者与未合并颈椎病的ALS患者的发病年龄、性别比例与临床特点差异均无统计学意义。结论:ALS可以并合颈椎病,颈椎病对ALS的发病年龄、临床特点无明显影响。     

Liver regeneration in acute severe liver impairment: a clinicopathological correlation study.

BACKGROUND: Although normally quiescent, the adult mammalian liver possesses a great capacity to regenerate after different types of injury. Major players in the regeneration process are mature residual cells, including hepatocytes, cholangiocytes and stromal cells. However, if the regenerative capacity of mature cells is impaired, hepatic progenitor cells (HPCs) are activated and expand into the liver parenchyma. Upon transit amplification, the progenitor cells generate new hepatocytes and biliary cells to restore liver homeostasis. AIMS/METHODS: To study the relationship between different histopathological parameters as well as their correlations with clinical parameters and outcome, we examined liver specimens from 74 patients with acute or subacute severe liver impairment by immunohistochemistry for CK7/CK19 (evaluation of HPCs activation/differentiation), Mib1(Ki 67)/P21 (evaluation of proliferative activity/proliferation arrest of hepatocytes) and hematoxylin and eosin (evaluation of hepatocyte loss). RESULTS: Of the 74 patients, 32% survived without transplantation, 14% died without transplantation and 54% were transplanted. Our results show that a threshold of 50% loss of hepatocytes, associated with significant decrease in the proliferative activity of remaining mature hepatocytes, is needed for extensive hepatic progenitor cell activation. Such activation is a sign of disease severity and occurs early (within 1 week) in the disease course. However, development of intermediate hepatocytes, suggesting HPCs differentiation towards mature hepatocytes, takes at least 1 week's time. We found a positive correlation between histopathological parameters (percentage hepatocyte loss, number of proliferating hepatocytes and number of HPCs) and clinical parameters of liver impairment such as model for end stage liver diseases (MELD). Surviving patients compared with those who either died or were transplanted had significantly less hepatocyte loss, less HPCs activation and more mature hepatocyte proliferative activity. Hepatocyte proliferative activity and degree of hepatocyte loss were the most important independent histopathological parameters in predicting outcome. CONCLUSION: Liver biopsy can provide important additional information in a patient with severe acute liver impairment.     

静脉药物配置中心的建立在临床中的应用

静脉输液药物集中配置、管理是我国医院管理的一项新举措.长期以来,临床静脉输液中的加药工作一直是由护士在治疗室独立完成,这种方式存在着很多不足之处.在这种环境污染下,职业健康安全管理越来越受到各国政府的重视.为了提高服务质量,预防和控制可能存在的环境污染及职业健康安全风险,国家颁布 GB/T24001～ 1996<环境管理体系规范和使用指南>, GB/T28001-2001<职业健康安全管理体系规范>标准,引进国外的先进管理模式,此项工作由药师和护士共同完成,以期达到合理用药减少药物的流失和浪费,科学配置、降低输液反应.静脉药物配置中心把静脉药物配置从普通环境的治疗室转为在具有洁净条件的配置中心进行集中管理配置,保证配置出来的药品安全无菌、有效.需要输液的患者在舒适、整洁和安静的环境下进行输液,减少临床护理工作量的目的,把更多的时间还给病人.这为顺利实施静脉配置中心的项目提供了保障,确保了输液中心正常运行.     

眼外伤临床统计规范探讨

眼外伤是我国眼科住院三大主要疾病之一，占眼科住院病人总数的１６￣３２％。每年发表临床统计文章百余篇，但由于统计资料不全面，标准不统一，降低了这部分劳动的价值。本文就眼外伤临床统计规范及某些问题进行讨论，强调规范化的重要意义。     

The value of pretreatment clinical and biochemical parameters in patients with newly diagnosed untreated prostate carcinoma and no indications for bone metastases on the bone scintigram

Between 10% and 25% of patients with newly diagnosed prostate cancer without bone metastases at the time of diagnosis will develop metastases during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases. Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class 2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases were used as controls. For all parameters tested, no statistically significant differences were found between the three bone scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the risk of development of metastases only PSA was found to be a significant correlate (P=0.0075). However, when tumour stages were clustered in limited disease (T0–2) and extensive disease (T3–4), the incidence of metastases was significantly higher in patients with extensive disease than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise analysis PSA was selected as the most prognostic variable (P<0.0001). In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without bone metastases at the time of diagnosis, pretreatment PSA and tumour stage can be used for the assessment of risk of development of metastases during follow-up and survival. For this purpose, tumour stage should be clustered in limited and extensive disease. Received 14 April and in revised form 9 June 1997     

磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价

目的　探讨磁共振胰胆管成像 (MRCP)对胆道梗阻性疾病的临床诊断价值。方法　对 42例胆道梗阻患者进行MRCP检查 ,并经手术病理或 /和其它影像学和临床资料证实。结果　①本组MRCP定位诊断率为 10 0 % ,定性准确率为 83 % ;②扩张的胆道表现为枯枝状 2 3例、软藤状 15例、腊肠样 4例 ;③梗阻端呈倒杯口状 6例、截断状 5例、杵状 17例、鸟嘴状 9例、鼠尾状 5例。结论　MRCP对胆道梗阻性疾病定位诊断准确 ,结合MRI及源像对胆道梗阻性疾病的定性诊断也具有较高的特异性 ,是一种安全快捷、非创伤性的检查方法 ,能为胆道梗阻的诊治及术后评估提供可靠的依据。     

全肠外营养对老年晚期消化系统恶性肿瘤病人生存期的影响

目的:评估全肠外营养(TPN)对老年晚期消化系统恶性肿瘤病人生存期的影响。方法:回顾性分析121例老年晚期消化系统恶性肿瘤病人TPN治疗后的生存期。结果:TPN治疗后,患者生存期不同程度延长,为9～126天,平均68.1天,多数在两月左右。结论:TPN可延长老年晚期消化系统恶性肿瘤病人的生存期。