Dose to patients through nuclear medicine procedures in a department in northern Greece

Diagnostic nuclear medicine procedures in a large hospital in northern Greece during 1984–1988 have been surveyed in order to estimate the radiation burden to the patients. The mean effective dose equivalent (EDE) was found to be 1.96 mSv/examination and 2.46 mSv/patient, allowing for the fact that a number of patients underwent more than one examination. Apart from EDE, absorbed dose has been calculated for bone marrow, thyroid, gonads, kidneys and bladder. Patients undergoing multiple examinations have been used to calculate true patient dose distribution as well as patient time-weighted dose distribution. Because of the predominance of renal examinations, 8.5 fatal renal malignancies are expected per 100000 patients.     

穴位体表电刺激对术后PCEA的强化效应

目的　观察穴位体表电刺激对术后患者硬膜外自控镇痛（PCEA）效果、镇痛药用量、血清皮质醇浓度和不良反应的影响。方法　 选择经腹全宫切除术患者40例（ASAⅠ～Ⅱ级）,随机分成二组,每组20例。A组：于术后第4,8小时 Han's各刺激30 min,术后行PCEA。B组：单纯行术后PCEA（对照组）。术后随访镇痛效果、镇静评分、布氏舒适评分（BCS）,分段记录24 h镇痛药用量及总按压次数/实进次数（D1/D2）比值,血清皮质醇含量,肛门恢复排气时间和不良反应情况。结果　两组镇痛效果满意,A组BCS评分高于B组（P＜0.05）。A组镇痛药用量为（31.7±1.9）ml,与对照组（34.2±2.1）ml相比差异有显著性（P＜0.01）。血清皮质醇浓度两组均较术前下降,但A组术后8 h的下降幅度大于对照组。A组恢复肛门排气时间快于B组,而且恶心、呕吐与对照组相比有所减少。结论　术后患者硬膜外腔自控镇痛（PCEA）复合应用穴位体表电刺激,可增强镇痛效果,减少用药量,降低不良反应,是安全有效的复合镇痛方法。     

对当前医患关系的再认识

医患关系在是规范浪潮冲击下出现了一些新的特征,同时也为医患双方提出了新的要求,作为医务人员一方应主动建立以病人为中心,充分新生病人权力的医疗服务体系,用主尚的医德医风去缔结医患关系。     

The role of carbon dioxide and atmospheric air in double-contrast barium enema

Background Patient discomfort 0–24 h after double-contrast barium enema (DCBE) was investigated in two ways.Methods In part 1, 139 patients, not previously informed, were contacted by telephone to assess symptom rates without bias. In part 2, designed as a prospective randomized double-blind trial, the effect of carbon dioxide (CO₂) as an insufflating gas was compared with conventional atmospheric air (AA).Results Part 1: 10% experienced severe abdominal pain, and 18% severe abdominal distention. Part 2: Low discomfort rates were found for both severe pain (7% for AA vs. 2% for CO₂) and severe distention (13% for AA vs. 8% for CO₂); the differences were not significant. In both parts of the study, female patients with a history of abdominal discomfort of colon irritabile type were significantly overrepresented in the severely symptomatic groups. Equal numbers of patients experiencing severe abdominal distention for the first time were found in both the AA and CO₂ groups, ruling out AA as the sole cause of these symptoms.Conclusion Abdominal post-DCBE discomfort seems to be less frequent than previously reported and is not effectively eliminated by CO₂. We still find the use of AA in DCBEs justified.     

Sexual Knowledge,Experience and Feelings Among People with Disability

The current study was designed to evaluate the sexual knowledge, experience, feelings and needs of people with intellectual disability or physical disability, and compare them to people from the general population. Sixty people with mild intellectual disability (28 males, 32 females, mean age=27.62 years), 60 people with physical disability (33 males, 27 females, mean age=28.65 years) and 100 people from the general population (40 males, 60 females, mean age=30.10 years) participated in the study. Each respondent completed the Sexual Knowledge, Experience and Needs Scale (SexKen). This scale assesses levels of knowledge, experience, feelings and needs in 12 different areas of sexuality. The results demonstrated that people with intellectual disability experienced lower levels of sexual knowledge and experience, more negative attitudes to sex and stronger sexual needs than people with physical disability, in all areas of sexuality. People with physical disability demonstrated these same trends when they were compared to people from the general population. An interpretation of these results as they relate to the sexuality of people with intellectual or physical disability is provided.     

Previous maternal experience potentiates the effect of parturition on oxytocin receptor mRNA expression in the paraventricular nucleus

In sheep, central oxytocin release at parturition induces maternal behaviour which is thought to be mediated by changes in the expression of central oxytocin receptors. The distribution, effects of parturition, previous maternal experience and hormonal status on the distribution of an oxytocin receptor was investigated using immunocytochemistry and in situ hybridization. In ewes with no previous maternal experience, parturition induced significant increases in oxytocin receptor mRNA expression in the anterior olfactory nucleus, medial preoptic area, ventromedial hypothalamus, lateral septum, medial amygdala, bed nucleus of the stria terminalis and diagonal band of Broca. In maternally experienced ewes, parturition induced additional increases in two areas, the paraventricular nucleus and the Islands of Calleja. The changes in progesterone and oestrogen that occur during late pregnancy and parturition appear to contribute to increases in expression in the anterior olfactory nucleus, Islands of Calleja, medial preoptic area, ventromedial hypothalamus, bed nucleus of the stria terminalis and diagonal band of Broca, but not in the paraventricular nucleus, lateral septum and medial amygdala. These results demonstrate that progesterone and oestrogen priming enhance oxytocin receptor mRNA expression in a number of regions in the olfactory system, hypothalamus and limbic brain. These effects appear to be independent of maternal experience. Parturition increases oxytocin receptor mRNA expression in all the areas influenced by hormonal priming and the lateral septum, medial amygdala and paraventricular nucleus. Maternal experience also enhances expression of oxytocin receptor mRNA in the paraventricular nucleus and the Islands of Calleja. Because the paraventricular nucleus is the main source of oxytocin release in the brain, this upgrading of autoreceptors as a result of maternal experience may serve to enhance release of this peptide in projection sites regulating maternal behaviour.     

病人图书馆是医院图书服务的新领域

建立病人图书馆,以“图书治疗”、“图书护理”为患者提供服务,是现代医学模式转变的需要。国外病人图书馆的发展对病人治疗康复已起到了积极的作用。我国应根据国情建立不同模式的病人图书馆,为患者提供多种多样的服务。     

The impact of nurses' encounters with cancer on their attitudes towards the disease

Summary

• ? A study to develop understanding of nurses' knowledge, confidence and educational needs in relation to cancer care was undertaken.
• ? Data from this study on nurses' attitudes and the effect of professional encounters with cancer on such attitudes are presented.
• ? A cancer attitude scale was completed by 127 nurses, and 68 of the sample were interviewed in depth.
• ? Data presented reveal a pervasive negative attitude towards cancer amongst these nurses, and the important negative impact that professional encounters with cancer have on nurses' feelings about the disease.
• ? Data presented are taken from a larger study, which is reported elsewhere (Corner, 1990; Corner & Wilson-Barnett, 1992).

     

舌状浆肌瓣覆盖—食管胃粘膜吻合术治疗食管癌100例临床体会

作者用“舌状浆肌瓣覆盖——食管胃粘膜吻合术”治疗食管癌100例,随访1—10个月,无吻合口狭窄及返流性食管炎。本组无吻合口瘘及手术死亡。本组经验:保持舌状浆肌瓣的完整和保证吻合口良好血供是本手术成功的关键。     

从中医对热病的认识看SARS患者治疗之得失

通过观察SARS恢复期的各种临床表现，结合中医对外感热病的认识，提出SARS患者疾病早期要宣散清透，喘脱期仍要注意疏利，恢复期不可一味补益，要注意调畅气机。