The 5-year outcome of multidrug resistant tuberculosis patients in the Cape Province of South Africa

Little is known about the outcome of multidrug resistant (MDR) tuberculosis (TB) in developing countries. In this study, 443 patients with MDR-TB, defined as resistance to two or more antituberculosis drugs, were identified over the 2-year period 1987 and 1988 in the Cape Province of South Africa. The 5-year outcome of the 343 (77%) patients that could be traced by questionnaire was evaluated retrospectively during 1992 and 1993. Of these, 240 (70%) were resistant to both isoniazid (H) and rifampicin (R) with or without resistance to other first-line antituberculosis drugs and 103 (30%) were resistant to H or R and/or other antituberculosis drugs. Mortality was 116 (48%) and 28 (27%) in these groups respectively with a significantly greater risk of death in the first group. Only 114 (33%) of all the MDR-TB patients were cured after 5 years, 50 (15%) were respiratory disabled and 44 (13%) were still bacteriology positive. Twenty-four (7%) patients were lost during follow-up. Taking into account the high costs involved in treating MDR-TB patients and the scarce resources available in developing countries, more emphasis should be placed on direct observed therapy to cure newly diagnosed infectious drug sensitive tuberculosis patients, thus preventing MDR-TB rather than treating it.     

自发性食管破裂的诊疗及死亡原因分析

目的　探讨自发性食管破裂 (SpontaneousRuptureofEsophagus,SRE)的诊断、治疗方法以及死亡原因。方法　对两家医院 35例自发性食管破裂患者的诊疗经过进行回顾性分析。结果　经手术治疗的 2 8例患者中术后死亡 1例 ;保守治疗的 7例患者中死亡 6例 ,1例术后死亡 ,病死率为 2 0 %。结论　早期诊断和积极手术是成功治疗自发性食管破裂的关键。     

经腹治疗先天性膈疝临床体会

报告５例膈疝的诊治体会。认为本病常有误诊，术前须与膈肌膨出鉴别，因两者手术方式不同。确诊后应及早手术，以降低死亡率。采用经腹膈疝修补术可以同时矫治肠鼻祖旋转不良。术后常规流置胸腔闭式引流，对患侧肺的膨胀及胸腔内渗液的排出有积极的意义。     

Transformations of mitochondria in damaged cardiomyocytes

Time course of intermitochondrial contacts in rat cardiomyocytes is studied in myocardial hypertrophy followed by its regression, alcoholic cardiomyopathy, acute pancreatitis, and acute diffuse purulent peritonitis. Contacts between mitochondria do not depend on the type of disease. Subacute and chronic myocardial hyperfuntion is characterized by hyperplasia of contacts involving an increase in the number and extent of mitochondrial associations resulting from these contacts during exposure to a damaging factor and a decrease in the number of contacts and mitochondrial associations after liquidation of the cause of pathological process. In a severe disease (acute diffuse purulent peritonitis) the number of contacts between mitochondria drops and associations of damaged mitochondria disintegrate, causing exhaustion of cardiac muscle energy. The results confirm Sarkisov's recombination theory that rearrangements of elements in biological system involve alterations of the quantity and quality of its function. This helps the heart overcome the critical stage of disease and later ensure hyperplasia of mitochondria and other structures in cardiomyocytes. This phenomenon possesses the characteristics of a biological regularity and is one of the earliest compensatory adaptive reactions of injured heart. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 125, No. 3, pp. 244–250, March, 1998     

儿童掌指关节脱位

目的：探讨儿童掌指关节脱位的损伤机制及最佳治疗途径。方法：１９８３～１９９５年收治新鲜掌指关节脱位８例、陈旧掌指关节脱位３例。１１例患儿均为背侧脱位，食指８例、拇指２例、中环小指同时脱位１例。闭合整复成功１例，余者均予切开复位。术中见掌骨头自关节囊掌侧薄弱部穿出形成脱位；掌板嵌顿在掌骨头背侧，掌骨头掌面被掌浅横韧带卡住，阻碍复位。结果：新鲜掌指关节脱位８例，治疗效果好；陈旧掌指关节脱位３例，即便切开复位，仍遗留掌指关节活动明显受限，１例甚至僵直。结论：强调一旦闭合复位失败，应及早手术解剖复位     

重型颅脑损伤的动物实验模型制作及其临床意义

目的 探索可复制重度颅脑损伤实验大鼠动物模型的制作.方法 采用改良自由落体装置,撞击80例麻醉后实验鼠颅骨穹窿部,砝码质量50～200 g,高度20 ～ 50 cm,撞击后观察时间为4h～12d,麻醉后取脑,制作652张病理切片,观察脑病理切片与临床脑创伤的相关性.结果 确认最佳冲击力为10 000g/cm,病理改变与临床有显著相关性,对重型创伤性颅脑损伤的诊治有参考价值.运用模拟临床的闭合性减压术与开放性减压术对比,获得有益提示,后者更有利于脑创伤康复.结论 通过本实验找到创伤性重型颅脑损伤大鼠最佳致伤冲击力,实验动物与临床有显著相关性,开放减压比闭合减压更有利于脑康复.     

50例手术患者的成人依恋类型分析

目的：探讨生病住院必须进行手术时患者的依恋方式的特点。方法：采用两种常用的成人依恋量表——关系问卷（RQ）和亲密关系经历量表（ECR），对住院接受非肠道手术的50名患者进行依恋类型的测量。结果：接受手术患者的依恋类型的分布为：安全型18人（占36％），轻视型20人（占40％），矛盾型6人（12％），害怕型6人（12％）；ECR中的依恋焦虑与用RQ测量的自我模型的得分有显著的负相关（P〈0．01），而依恋回避则与RQ测量的自我模型和他人模型的得分都存在显著的负相关（P〈0．05）；在依恋焦虑维度上，安全型与轻视型没有差异，但两者都与矛盾型和害怕型有显著差异。而在依恋回避维度上，害怕型得分显著高于其他类型，矛盾型次之，安全型和轻视型最低。结论：接受手术的患者的依恋类型与大学生的样本不同，通过两种量表测量的患者的依恋方式有较强的相关。     

涂阳肺结核密切接触者筛查与随访分析

目的：对涂阳肺结核密切接触者进行筛查与随访,并且分析相关因素以及检出概率。方法：选取2012年6月-2013年6月在肺结核门诊登记的421例涂阳肺结核患者,并对其密切接触者进行分析。结果：在涂阳肺结核密切接触者中,子女检出的概率为0.25%,父母检出的概率为2.34%,配偶检出的概率为5.45%。父母、配偶的检出概率与子女检出概率比较差异有统计学意义（P〈0.05）;不同年龄组、不同文化程度的密切接触者中,检出涂阳患者的概率比较差异具有统计学意义（P〈0.05）;是否与涂阳肺结核患者在一个房间居住,检出涂阳患者概率比较差异有统计学意义（P〈0.05）。结论：对涂阳肺结核患者的家庭密切接触者进行检查,是掌握肺结核感染与发病的最早时点,对密切接触者定期随访检查能发现相当多的患者,其检出率也高,从而达到发现患者控制结核病传播的目的。     

糖尿病患者顺式阿曲库铵肌松效应的探讨

目的：在闭环输注系统（CLMRIS-1）指导下比较糖尿病患者与非糖尿病患者顺式阿曲库铵的肌松效应,并探讨糖尿病患者血清中α1-酸性糖蛋白（AAG）水平的变化及其对顺式阿曲库铵药效的影响。方法选择60例拟在全麻下行腹部外科手术的患者,ASAⅠ~Ⅱ级,依据其是否合并2型糖尿病,分为糖尿病组（D组）和非糖尿病组（C组）。麻醉诱导前15 min及术毕即刻,分别抽取静脉血3 ml,离心后取上清1 ml,于-20℃冰箱中保存并及时送检,测定血清中AAG的水平。麻醉诱导采用舒芬太尼、依托咪酯、顺式阿曲库铵。记录两组患者肌松药起效时间T0（注药毕至T1抑制至0的时间）,恢复指数RI（T1从25%恢复至75%的时间）及TOF90（TOF从25%恢复至90%的时间）。结果2组患者顺式阿曲库铵的起效时间[（4.0±1.1）min vs.（4.1±1.2）min]、恢复指数[（16.8±5.0）min vs.（16.5±3.1）min]及TOF90[（75.0±9.1）min vs.（73.2±6.8）min]差异均无统计学意义（P>0.05）。同时2组患者术前及术毕即刻血清中AAG水平[（69.1±7.2）mmol/L vs.（68.4±6.7）mmol/L,（69.4±9.8） vs.（68.5±6.2）mmol/L]的差异也无统计学意义（P>0.05）。结论血糖控制良好的糖尿病患者与非糖尿病患者相比,顺式阿曲库铵的肌松效应并无明显改变,血清中AAG的水平也无明显升高。