不同性别首次发作抑郁症的临床特征对比

目的：探讨不同性别首次发作抑郁症临床特征的异同。方法：采用一般情况问卷、抑郁白评量表(SDS)和汉密顿抑郁量表(HAMD)对不同性别首发抑郁症患者进行测查。结果：女性首发抑郁症患者发病年龄显著低于男性，HAMD的躯体化／焦虑、睡眠因子显著高于男性，而认识障碍、迟缓和绝望因子评分显著较男性为低。另外，女性抑郁症患者的共病显著高于男性。结论：不同性别首次发作抑郁症的临床特征存在一定的差异。     

Scientific quality of clinical research an analysis of 40 research projects in pharmacology/pharmacotherapy

Objective: The scientific quality of research is an important ethical issue. To clarify the quality of research projects in pharmacotherapy/pharmacology, 40 randomly selected research projects in pharmacotherapy/pharmacology submitted to a research ethics committee were reviewed. Results: Eight of the projects would not have contributed new knowledge nor were they necessary as controls for the results of previous research. Fifteen of the research protocols were of good quality, 15 could be used after revisions, and 10 were unfit for use. Eleven of the research projects were not finished 5 years after they were started. A written report was produced from 26 of the projects. Nine were of good quality and could be accepted for publication in a medical journal, 10 of the reports were in need of revision before publication, and 7 should not be accepted for publication. Conclusion: Research in this field ought to be improved, and ways to improve the standard of clinical trials in pharmacotherapy are dicussed. Received: 1 April 1996 / Accepted in revised form: 28 June 1996     

32例青年食管癌临床病理分析

目的：探讨青年食管癌患者的临床病理特点。方法：以病例对照方式对32例青年食管癌临床病理特点进行分析，选用同期50岁以上食管癌病例40例为对照组。结果：青年食管癌患者与老年者相比，病理分化程度低，恶性度高，早期诊断率低，生存期短。结论：青年食管癌症状隐匿，诊断率低，预后差。     

因症就诊检出早期大肠癌的临床及病理学特征

目的探讨在就诊的肛肠病人中如何提高早期大肠癌的检出率。方法在１１家医院推广对肛肠病人的四项检查程序——直肠指检，乙结镜检查，大便隐血试验，和Ｘ线气钡灌肠造影。结果在４８２１例有肛肠症状的病人中，检出大肠癌１８８例，检出率为３．９％，其中１８０例有术后病理诊断。４７／１８０例（２６．１％）属早期癌（ＤｕｋｅｓｓｔａｇｅＡ）。４１／４７例由上述四项检查作出初步诊断。初发症状为：（１）便血（２６例，持续１５．２±９．４周后就诊，肿瘤平均直径２．５８ｃｍ）；（２）大便习惯改变（９例，３３．４±１９．７周，３．３９ｃｍ）；（３）腹痛腹块（１０例，１９．２±１１．２周，５．０ｃｍ）；（４）贫血（２例，１７．２±９．９周，４．７５ｃｍ）。８／１２例的Ａ０和Ａ１期病例属便血组，并多位于直肠。４１／４７例以高、中分化腺癌为主，其中１５例伴有腺瘤癌变。术前曾作活检的２７例中，１２例未检出癌变细胞。结论四项检查对检出早期大肠癌是有效的，便血是提示早期癌最有价值的症状，加强大肠癌防治宣教，采用瘤灶多点或全瘤活检技术，高度重视大肠腺瘤和不典型增生等癌前病变，将有助于提高早期大肠癌的检出率     

Radiofrequency Catheter Ablation of the Anterosuperior and Posteroinferior Atrial Approaches to the AV Node for Treatment of AV Nodal Reentrant Tachycardia

Catheter Ablation Techniques in AVNRT. Radiofrequency catheter ablation has been established as a first-line curative treatment modality in patients with symptomatic AV nodal reentrant tachycardia (AVNRT). The successful sites of stepwise catheter ablation approaches of the so-called fast and slow pathways strongly suggest that AVNRT involves the atrial approaches to the AV node. The typical fast pathway ablation sites are located anterosuperior toward the apex of the triangle of Koch, which also contains the compact AV node, whereas the usual slow pathway ablation sites are located posteroinferior toward the base of the triangle of Koch at a greater distance to the compact AV node and bundle of His. Accordingly, ablation studies with large patient cohorts have demonstrated that fast pathway ablation carries a higher risk of inadvertent complete AV block. Thus, the slow pathway is clearly the primary target site, and fast pathway ablation is rarely necessary. Different approaches for slow pathway ablation have been elaborated: anatomically oriented stepwise techniques, ablation guided by double potentials recorded within the area of the slow pathway insertion, and combined techniques. The modern concept of AVNRT suggests that this arrhythmia involves the highly complex three-dimensional nonuniform anisotropic AV junctional area. Accordingly, mapping and ablation studies demonstrated that the anterior approach is not identical with fast pathway ablation, and the posterior approach is not identical with slow pathway ablation. Therefore, it is essential for interventional electrophysiologists to familiarize themsdves with the anatomic and electrophysiologic details of this complex and variable specialized AV junctional region. In this review, the anatomic and pathophysiologic aspects of the AV junctional area as they relate to interventional therapy are summarized briefly, and the catheter techniques for ablation of the so-called fast and slow AV nodal pathways for the treatment of AVNRT are described.     

应把防治医患纠纷作为临床医德教育的重要内容

不断强化医务人员的服务意识是消除医患纠纷的首要条件,认真培养敬业精神是避免医患纠纷的根本途径;提高道德境界是避免医患纠纷的决定因素.     

Pneumatosis cystoides intestinii

Zusammenfassung Die Pneumatosis cystoides intestinii (PCI), das Auftreten submuköser oder subseröser, gasgefüllter Zysten in der Wand des Gastrointestinaltrakts, tritt als seltene Erkrankung ohne eindeutige Geschlechtspräferenz vorwiegend in der 3. bis 5. Lebensdekade auf. Atiopathogenetisch werden unterschiedliche Faktoren diskutiert, am wahrscheinlichsten ist eine bakterielle Ursache (Clostridium perfringens) in Verbindung mit einer minimalen Unterbrechung der Mukosaintegrität. Eine pathognomonische Symptomatik gibt es nicht, das klinische Bild reicht von asymptomatischen Zufallsbefunden bis zur Hämatochezie. Die Diagnose wird durch den Nachweis der Gaseinschlüsse mittels Abdomenübersichtsaufnahme und Kolonkontrasteinlauf gestellt. Als Behandlungsmethoden für symptomatische Patienten stehen Sauerstofftherapie, Antibiotikagabe (Metronidazol) und in schweren Fällen die Resektion des betroffenen Darmabschnitts zur Verfügung.

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Pneumatosis cystoides intestinalis (PCI), a condition involving submucosal or subserosal gas-containing cysts of the wall of the gastrointestinal tract, is a rare entity. It is mostly diagnosed between the third and fifth decades of life without a clear sexual predominance. Different aetiopathogenetic factors are under discussion, the most probable being a bacteriologic cause (Clostridium perfringens) in combination with minimal leaks in mucosal barrier. There are no pathognomonic symptoms; the clinical picture ranges from incidental findings to haematochezia. Diagnosis is based on plain abdominal film and X-ray following barium enema. Methods of treatment in symptomatic cases are oxygen and antibiotic (metronidazole) therapies and, in severe cases, resection of the diseased part of the intestine.

     

Quality of life assessment and HIV infection: A review

In the last few years, survival of patients infected with human immunodeficiency virus (HIV) has been improved because of a decreased incidence of some opportunistic complications attributable to prophylactic treatments and antiretroviral drugs. The impact of these agents should also be reflected in the quality of life (QoL) of patients. We have reviewed this topic with an emphasis on different types of measurements such as Q-TWIST, MOS and the Spitzer score which seem to be most appropriate for this patient population. We do not think that a special type of assessment should be designed for HIV-infected persons. It would be less time-consuming to improve already existing validated scores focusing on HIV infection. QoL in intravenous drug users with HIV should be evaluated more often.     

血清补体系统在流行性出血热患者中的变化及其意义

应用单向免疫扩散法测定了流行性出血热(EHF)患者的7种补体成份和血浆素原(Pg).结果表明,CT脂酶抑制剂在少尿期、多尿期和恢复期均高于正常(P<0.01);补体C_1q在多尿期高于正常(P<0.01);补体C_4在发热期和少尿期低于正常(P<0.01),以后逐渐恢复正常;补体C_3,C_5和C_9的变化与C_4相似;B因子在少尿期低于正常(P<0.01),在多尿期高于正常(P<0.05);Pg始终高于正常水平但在少尿期有回降.说明EHF患者不仅有补体经典途径的识别阶段、活化阶段和膜攻击阶段的变化,而且亦有旁路激活,其活化程度与病情有关.     

环丙沙星与氧氟沙星注射液治疗细菌性感染的疗效观察

以乳酸环丙沙星（ＣＰＬＸ）注射液和氧氟沙星（ＯＦＬＸ）注射液随机分组治疗各种细菌性感染４０例及４２例，并以注射用头孢噻肟钠（ＣＴＸ）治疗４９例作对照。三组平均年龄、体重、疗程及病情程度相比无显著性差异，具可比性。病种分布以消化道感染最多，共８１例，占总数的６１．８％。三组１３１例病人细菌阳性率为９４．７％。一疗程ＣＰＬＸ组、ＯＦＬＸ组、ＣＴＸ组治愈率分别为８７．２％、８３．３％、７１．４％，有效率