Double Outlet Right Ventricle with Intact Atrial Septum and Restrictive Ventricular Septal Defect: An Analysis of Two Cases

Two cases of double outlet right ventricle with restrictive ventricular septal defect are described. This is an uncommon presentation that causes left ventricular dysfunction because of left ventricular outflow tract obstruction. The presence of an intact atrial septum leads to severe pulmonary hypertension, which tends to aggravate the right ventricular output. In the presence of a normal left ventricle, the authors suggest the possibility of enlargement of the ventricular septal defect in order to perform a biventricular repair. The association of a supramitral valve ring in both cases, and the isolation of the left subclavian artery and an aortopulmonary fenestration in one of these cases, are also discussed. In addition we explore factors that cause restrictive ventricular septal defects as well as the mechanisms that may lead to spontaneous closure of ventricular septal defect in a double outlet right ventricle.     

Appendicitis after appendectomy: CT diagnosis

This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue. Received: 21 April 1999; Revised: 11 August 1999; Accepted: 13 August 1999     

Lateral asymmetries in the trigeminal ganglion of the male rat

We have applied stereological methods to estimate the number and perikaryal size of primary sensory neurons in celloidin-embedded trigeminal ganglia of male albino rats, specifically looking for inter-individual and side variability. The mean total number of neurons per ganglion was 35,300, with a moderate variability among ganglia. On average, 66% of the neurons were classified as A-type and 34% as B-type. Although for individual cases there could be notable side differences in the number of neurons of each type, on a population basis these differences were not significant. Mean neuronal volume was four times larger for A- than for B-cells, and both populations exhibited a moderate variability among individuals. High intra-animal side differences were found for A-cells, which were on average a significant 23.5% larger in the right ganglia. B-cells did not show significant side differences. The distribution of individual volumes around the mean value was consistently skewed to the right, particularly in the case of A-cells, which partially overlapped with the largest B-cells. In the right ganglion the distribution of A-cells, but not of B-cells, showed a rightward bias, revealing the increase in bigger neurons. The existence of larger A-type neurons in the right trigeminal ganglion may provide a structural substrate for some somesthetically based complex behaviors which are best performed by rats using their right vibrissae.     

新型4通道单电源低功耗程控接口脑电放大器的研制

本脑电放大器针对现有同类电路缺点进行改进，采用了最新一代高性能模拟与混合信号集成电路芯片，优化了电路结构并通过精细的电路工艺措施实现了噪声电压1．9μVp-p、共模抑制比100dB、输入阻抗80MΩ、基线漂移小、单电源5V供电和工作电流小于10mA等电路指标，并实现了增益控制和滤波控制的数字化接口。1年的应用表明该放大器安全省电、体积小、结构简单、性能稳定，非常适合作为便携式智能型脑电图仪器的前端。     

所有权与经营权分离是城市公立医院改革和发展的途径

传统卫生管理体制承袭了计划经济的所有特征,价格扭曲的宏观政策环境、资源的集中计划配置体制与公立医院在微观上的缺乏经营自主权三者并存.这种制度安排越来越不适应市场经济条件下卫生改革和发展的需要,而卫生经济体制改革始自微观经营机制,核心是两权分离和放权让利,这是自然的,同时也是正确的改革方向.     

略谈公立医院产权制度改革

介绍公立医院改制的几种基本模式，认为在我国对部分公立医院实行产权制度改革是历史发展的必然，并且迟改不如早改、股份制改不如全部退出、被动突围不如主动突围。与此同时，国家应建立较完善的医疗保障制度；加强对改制后医院的监管，而不是一卖了之。     

Patient Capacity in Mental Health Care: Legal Overview

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today.     

长期雾化吸入硝酸甘油对高肺血流大鼠肺动脉压力及肺血管结构重建的影响

目的探讨长期雾化吸入硝酸甘油对高肺血流大鼠肺动脉压力、肺血管结构的作用及其机制。方法24只健康雄性Wistar大鼠随机分为对照组、分流组和吸入组。对分流组和吸入组大鼠开腹行腹主动脉-下腔静脉分流术,12周后两组大鼠分别雾化吸入生理盐水和硝酸甘油3周。以右心导管法测定肺动脉压,颈动脉插管测定体循环压,检测右心室肥厚,观测肺血管显微及超微结构变化,用免疫组织化学法检测大鼠肺动脉人类尾加压素Ⅱ(hUⅡ)的表达。结果分流组大鼠肺动脉平均压(PAMP)和右心室/左心室 室间隔重量比值(RV/LV S)明显高于对照组(P<0.01),且分流组大鼠肺小血管肌化程度明显增强(P<0.01),中、小型肺肌型动脉相对厚度(RMT)增加,肺动脉内皮细胞和平滑肌细胞hUⅡ表达明显增强。吸入组大鼠mSBP未受影响,PAMP明显低于分流组(P<0.01),RV/(LV S)高于对照组(P<0.01),但与分流组比较差异无显著性(P>0.01),吸入组大鼠肺小血管肌化程度明显改善,小型肺肌型动脉RMT及小型肺动脉内皮细胞和平滑肌细胞hUⅡ减少。结论长期雾化吸入硝酸甘油可缓解高肺血流量所致肺动脉高压和肺血管结构的重建,其对肺动脉内皮细胞和平滑肌细胞hUⅡ表达的抑制作用,可能参与高肺血流量所致肺血管结构重建和肺动脉高压的调节。     

产权改革对广东省医院运行状况影响研究

收集与医院退出市场行为相关的数据，研究在营利性、非营利性及国有和私有产权共存的医疗产业中，医院退出医疗市场行为与其运营效率的关系。应用医院的相对无效率残差、产权形式和其他相关因素来分析1999年至2003年广东省医院的退出行为。在方法上，将医院因为承担非营利性工作所导致的无效率从决定医院退出行为的运营效率中分离出来考虑。结果发现，相对无效率对营利性医院退出医疗市场的行为影响很大．而相对无效率对国有非营利性医院在医疗市场中存在无明显影响。产权改革既不是提高医院运营效率的必要条件也不是充分条件：医院运营效率的影响是多方面的，政策性负担是重要的影响因素。     

IP板对CR影像质量影响探讨

IP板是CR影像系统的重要组成部分,本文通过我院近几年由于IP板原因产生影像质量问题的各种原因分析,探讨如何正确使用IP板,提高CR的影像质量.