58例多原发癌临床分析

Objective to Present 56 cases of multiple primary cancers,to make improvement of diagnosis and treatment.methods A total of 58 patients with multiple primary cancers admitted from 2003 to 2007 were analysed retrospectively in Beijing Tongren Hospital.Results Thirty-five cases were males,with sex ratio of male and female 1.5:1.The median age at the onset of the first disease was 61.5 years (ranged from 27 to 86).The onset age of the two primary cancers was mainly centered around 50～75 years,while half of the second cancers occurred within five years.Conclusion the treatment and prognosis of the two primary cancers are different from that of the recurred and metastatic malignancies and shoule be handled with care.     

门脉高压症患者肝脏储备功能评估的临床研究

目的 :探讨肝硬化门脉高压症患者术前肝脏储备功能的评估方法。方法 :用L ogistic多元回归法分析了 80例门脉高压症断流患者术后出现肝功能不全的相关因素 ,从中筛选与肝功不全关系最密切的危险因子。结果 :排除手术操作本身的影响后 ,术后发生肝功不全影响最大的因素依次为 :肝性脑病 ( ENC)、血浆吲哚氰绿潴留试验 ( ICGR15)及门静脉充血指数 ( PCI)等 ,而术前的血清总胆红素 ( TBIL)、白蛋白 ( A)、A/G比值、总胆汁酸( TBA)、透明质酸 ( HA)、凝血酶原时间 ( PT)、门静脉内径 ( dp)、门静脉流速 ( Vp)及门静脉流量 ( Qp)等因素 ,在多元回归中所占比例不大。结论 :综合分析术前患者临床指标和肝功能实验室检查有助于评价肝硬化患者肝储备功能 ,预测手术风险及术后转归     

Effect of a Low-Cost Intervention on Recording Body Mass Index in Patients'' Records

PURPOSE: Evaluate the effectiveness of body mass index (BMI) tables placed in exam rooms as an intervention to encourage providers to calculate and record BMI scores in patients' medical records. DESIGN: In a prospective cohort design, medical record data for 276 adult patients at a federally funded community health center in New England were examined from August 2000 to August 2002 following the intervention. METHODS: Prominent, multicolored, laminated BMI tables were posted in the exam rooms of one of the study site's three primary health care teams. Medical record data collected included documentation of BMI calculation in medical records, documentation of an obesity diagnosis, and inclusion of heights and current weights. Frequency distributions were calculated; chi-square tests were used to identify associations. FINDINGS: In contrast to the comparison teams, patients on the intervention team were more likely to have BMI recorded in the medical record. A statistically significant increase in the diagnosis of obesity was observed throughout the health center after the intervention. CONCLUSIONS: Posting BMI tables in exam rooms contributed to increased BMI documentation in patients' medical records.     

深圳市学生1982年与2003年生长发育指标比较

目的 了解21年来深圳特区小学生身高、体重的变化情况。方法 将2003年与1982年深圳特区4769名小学生身高、体重的资料进行对比分析。结果 2003年与1982年相比。7～12岁男女小学生身高的年增加率分别为4．36％～9．50％和4．89％～7．84％。体重的年增加率分别为21．72％～38．80％和15．47％～33．96％。结论2003年与1982年相比，同龄小学生的身高及体重有了明显的增加。     

Fumonisins as a possible contributory risk factor for primary liver cancer: A 3-year study of corn harvested in Haimen, China, by HPLC and ELISA

Employing HPLC fluorometry, gas-liquid chromatography (GLC) and a novel enzymelinked immunosorbent assay (ELISA) based on a monoclonal antibody, 40 corn samples, each collected in 1993 from agricultural stocks for human consumption in Haimen (Jiangsu County) and Penlai (Shandong Province), high- and low-risk areas for primary liver cancer (PLC) in China, respectively, were analysed for fumonisins (FBs), aflatoxins (AFs) and trichothecenes. Levels and positive rates of FBs and deoxynivalenol (DON) were significantly higher in Haimen than in Penlai. ELISA of the 40 corn samples harvested in the two areas in 1994 revealed that FB contamination levels and rates in these areas were comparable to those observed in 1993 in Haimen. ELISA analysis of 1993 and 1994 products revealed a wide occurrence of AFB₁ but the positive rates as well as levels were not significantly different between these areas. ELISA of the same sample number of corn harvested in 1995 revealed that FB contamination in Haimen was significantly higher than in Penlai. These 3-yearly surveys of corn samples (240 in total) demonstrated that corn harvested in Haimen was highly contaminated with FBs and that the contamination level, as well as positive rate in 1993 and 1995, were 10–50-fold higher than those in Penlai, suggesting FBs as a risk factor for promotion of PLC in endemic areas, along with the trichothecene DON. Co-contamination with AFs, potent hepatocarcinogens, was assumed to play an important role in the initiation of hepatocarcinogenesis.     

Management of ascites in cirrhosis

Ascites is one of the earliest and most common complications of patients with cirrhosis. A typical circulatory dysfunction characterized by arterial vasodilation, high cardiac output and stimulation of vasoactive systems is commonly present in these patients and is associated with a poor prognosis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past two decades, although controlled trials in large series of patients are needed to delineate whether TIPS is a safe and useful treatment for these patients.     

慢性HBV感染患者HBsAg亚型分析

对包括慢性肝炎、肝炎肝硬变和原发性肝癌在内的１００例慢性ＨＢＶ感染者作了ＨＢｓＡｇ亚型分析。结果显示，在这组病例中ａｄｒ亚型占６１％，ａｄｗ占３３％，ａｙｒ占２％，ａｄｗｒ占４％。ａｄｒ亚型有随年龄增长更占优势的趋向。ａｄｒ和ａｄｗｒ亚型感染者ＨＢｓＡｇ滴度较ａｄｗ组显著增高，且ｅ抗原阳性率亦较高。上述发现提示，具有ａｄｒ和ａｄｗｒ亚型的ＨＢＶ株可能具有较强的复制活性，不易被清除，从而导致受感染者     

一期切开挂线术治疗肛周脓肿305例

采用一期切开挂线术治疗肛周脓肿３０５例，全瓿期治愈，无发生肛瘘及并发症者。作者认为手术成功的关键是正确处理内口及原发灶，良好通畅的切口引流以及合理的术后处理，对提高疗效，防止复发有重要意义。     

Primary linitis plastica of the descending colon: A case report

A rare case of primary linitis plastica carcinoma of the colon seen in a 44 year old Japanese man is described herein. The patient had a complete obstruction of the descending colon and was treated with a loop colostomy followed shortly afterward by a left hemicolectomy. At the time of the second operation, the entire thickness of the colonic wall was found to be infiltrated by cancer cells, however, the other intraabdominal organs were free of cancerous involvement. The histopathological diagnosis made at this time was primary linitis plastica carcinoma of the descending colon. Nine months later, the patient developed an intestinal obstruction and relaparotomy revealed diffuse peritoneal dissemination. Two years after the first operation, upper GI films and a gastrofiberscopic examination revealed gastric involvement. The patient died 28 months after his initial operation, and autopsy revealed widespread metastases in the peritoneal surface, paraaortic lymph nodes, small intestine, remaining colon and stomach.     

桂美辛和山莨菪碱治疗胆绞痛的比较

桂美辛组(男性21例,女性35例;年龄44±12a)治疗胆绞痛56例,剂量300mg, po, tid,显效32例,有效21例,总有效率95％。山茛菪碱组52例(男性18例,女性34例;年龄46±13a),剂量10mg, im, tid,显效、有效分别为9与20例,总有效率56％。2组比较,P<0.01。桂美辛治疗胆绞痛有疗效高、不良反应少的优点。