胃癌行全胃切除术后消化道重建术式对营养代谢影响的临床研究

目的　从胃癌行全胃切除术后 5种消化道重建术式对营养代谢的影响 ,来探讨最佳的消化道重建的最佳术式。方法　将 14 9例拟行全胃切除的胃癌患者 ,随机抽签法分为 5组 ,每组 30例 (最后一组 2 9例 ) ,消化道重建采用 5种术式。术后 3、6个月检测生活质量指数、预后营养指数PNI ,体重 ,血浆营养学指标 ,作为判断各种术式优劣的依据。结果　 5种消化道重建术式对患者的体重 ,生活质量评分、PNI指数及血液营养学指标均有不同程度的影响。Roux en Y组术后体重下降明显 ,且ALB、TP、TF明显低于其他组 ,P <0 0 5 ,差异有显著意义。术后 6个月 ,空肠原位间置代胃术组 ,Hunt Lawrence经十二指肠组 ,HB、SI、TS明显高于Roux en Y组 ,P袢 +Roux en Y组和Hunt Lawrence组 ,P <0 0 5 ,差异有显著意义。结论　全胃切除术后消化道重建术式对患者术后营养有较大影响。有代胃者术后体重恢复较快。空肠原位间置代胃术既有代胃又恢复了十二指肠通道是一种较理想的消化道重建术式。     

Total testing process: appropriateness in laboratory medicine

BACKGROUND: The need to reduce costs in Laboratory Medicine is often related to the possibility of reducing test requests without taking into account patients' outcomes. Therefore, the term "appropriateness" in Laboratory Medicine as referred to the specific steps (pre-analytical, analytical, post-analytical) and related to the clinical process could allow the improvement of clinical effectiveness and economic efficiency. METHODS: Our experience has shown an improvement in analytical appropriateness (reorganization and re-engineering by Laboratory automation) and pre-analytical appropriateness (critical revision of the panel for cardiac markers) by evaluating the workload and errors rate in the pre-analytical phase. RESULTS: We obtained an economic saving (119,580 euro/year) in cardiac markers request (analytical appropriateness: 60%, pre-analytical appropriateness: 40%) and also an improvement in clinical appropriateness (diagnosis and therapy). CONCLUSIONS: Our data confirm the need to improve communications between physicians and Laboratory Medicine as regards the pre-analytical step and to implement educational programs for defining criteria and procedures. Appropriateness in analytical and post-analytical steps contribute to achieve economic saving (Core lab, POCT) and improvement of the turn-around time (TAT).     

The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4–20 ng/mL

Objective: In this study our aim was to investigate the efficacy of free tototal PSA ratio in discrimination of benign prostate hyperplasia andprostate cancer.Materials and methods: A total of 194 patients, 52 to 82 years old (mean66.06 ± 0.47 years) with PSA levels between 4 to 20 ng/mL wereincluded into this study. Each patient underwent sextant prostate biopsyunder transrectal ultrasound guidance. The patients were divided into twogroups as PSA 4–10 and 10–20 ng/mL. Patients with benign and malignresults were compared with respect to age, total PSA level, free PSA leveland free/total (f/t) PSA ratio.Results: Biopsies revealed prostate cancer in 16 of 130 patients (12.3%)with serum PSA 4–10 ng/mL and in 10 of 64 patients (15.6%) with serumPSA 10–20 ng/ml. In both PSA groups free PSA and f/t PSA levels werestatistically significant, where total PSA levels were not. In patients with4–20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, thesensitivity, specificity and positive predictive value for prostate cancerwere 88.5%, 53.6% and 20.4% respectively.Conclusion: Higher levels of PSA suggest prostate cancer, but stilladditional parameters are needed for patients with PSA 4–20 ng/mL, suchas free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seemsto be the most accurate one to discriminate benign and malign diseasesfurther studies on larger groups of patients are needed.     

The "Mini-Elephant Trunk" Technique of Distal Anastomosis in Total Arch Replacement Through a Median Sternotomy for a Distal Aortic Arch Aneurysm

A median sternotomy is considered to have several advantages over a left thoracotomy as a route for the surgical treatment of a distal aortic arch aneurysm, including less pain and less lung damage. In a median sternotomy, distal anastomosis is such an important problem that we herein present a useful technique to prevent surgical bleeding from it. An invaginated 40-mm-long graft is inserted into the distal aorta, sutured to the aortic wall, unfolded, and anastomosed with a four-limbed tube graft. We applied this "mini-elephant trunk" technique to total arch replacement for both a saccural distal aneurysm, where the distal aorta was transected, and a fusiform aneurysm, where the invaginated graft was sutured by the "inclusion" method. This technique enables a greater surface contact area between the graft and the aortic wall at the distal anastomosis, thus resulting in a reduced risk of bleeding. Received: August 31, 2000 / Accepted: January 9, 2001     

社区卫生服务在医保总额预付制改革中面临的管理挑战

上海自2006年以来在试点区县实施了"医疗保险费用总额预付制"的改革,作为社区卫生服务机构在医保结算方式、内部运行管理、社会满意度提升等方面面临诸多挑战,在执行新型的医疗保险制度管理方式时,作为管理者要及时转变思想,做好积极应对,重点抓好内部医保数据监测及调控、药品结构管理,建立良好的内部考核机制等,才能够不断地适应和推进新一轮的社区卫生服务改革。     

Chondrosarcoma of the arytenoids- a rare laryngeal malignancy

Even though laryngeal malignancies are the most frequent primary malignancies of the upper aero digestive tract except for oral cavity cancers, laryngeal chondrosarcomas are rare tumors, constituting less than 1% of all laryngeal tumors. We present a rare case of chondrosarcoma arising from the right arytenoid cartilage with sub glottic extension. The mode of presentation and management of the case is presented along with a review of the literature.     

铂催化-非散射红外吸收法测定过氧化氢中的总有机碳

目的：建立测定过氧化氢产品中总有机碳的方法。方法：采用铂催化法对过氧化氢进行自催化处理，非散射红外吸收法测定过氧化氢中的总有机碳含量。结果：样品前处理简单，测定结果准确度高，精密度好，检测限为：0．1mg／kg。结论：该方法适用于过氧化氢产品中总有机碳的检测。     

自动电位滴定法直接测定葡萄酒中游离SO2、总SO2

目的：建立自动电位滴定法直接测定葡萄酒中游离SO2、总SO2的方法。方法：采用直接取样滴定，电位的突跃取代了淀粉指示剂来判定滴定等当点，测定出葡萄酒中游离SO2、总SO2含量。结果：该方法的变异系数为0．53％～0．76％，游离SO2测定回收率为90．4％～99．4％，总SO2测定与国标法相对相差不超过1．0％。结论：自动电位滴定法无需蒸馏处理，滴定简单准确，自动化性能高，对有色溶液、浑浊以及没有适合指示剂的溶液均可直接滴定。     

应用临床路径对子宫全切手术患者进行健康教育

目的探讨临床路径在子宫全切手术患者健康教育中的应用。方法将120例子宫全切手术患者随机分为观察组与对照组各60例。观察组按照制订的临床路径表进行健康教育，对照组采用传统健康教育方法。结果观察组对健康教育内容的掌握情况以及对护理工作满意度明显高于对照组p〈0．01（x^2=8．107）。结论应用临床路径对子宫全切手术患者实施健康教育，可提高教育效果，提高护理满意度。     

气管插管与非气管插管全麻在小儿腹腔镜疝修补术的应用

目的探讨气管插管与非气管插管全麻用于小儿腹腔镜下疝修补术的可行性及安全性。方法拟行择期腹腔镜下疝修补术的小儿患者40例，随机分为气管插管全麻组（Ⅰ组，n=20），非气管插管静脉全麻组（Ⅱ组，n=20）。组给予异丙酚、氯胺酮和阿曲库铵维持麻醉，气管插管控制呼吸。Ⅱ组采用异丙酚和氯胺酮全凭静脉麻醉，术中面罩给氧，保持自主呼吸。结果术中两组生命体征平稳，术后躁动、恶心、呕吐发生率差异无统计学意义。Ⅱ组麻醉诱导快，术后清醒略快于Ⅰ组，Ⅰ组麻醉效果较Ⅱ组满意。结论气管插管与非气管插管全麻用于腹腔镜下小儿疝修补术是安全可行的，Ⅰ组麻醉效果好于Ⅱ组。