乳腺癌术后双肺及骨转移

疾病的正确诊断和合理治疗是患者和医务工作者共同的心愿。在广东省人民医院肿瘤中心，吴一龙教授指导临床医生应用循证医学理论进行肿瘤的多学科综合治疗，开展临床病例讨论。讨论会上各学科共同围绕一个病例或一个病种进行会诊，临床、病理、B超、放射影像等资料齐全。除相关科室提前准备的中心性发言外，到会人员各抒己见，气氛热烈。参会人员受益匪浅，提高了对疑难病例的诊治水平。为了将他们的诊治经验传播出去，让更多的临床医生获益，我刊开辟“循证病例讨论”栏目，希望广大医务工作者关注此栏目。[编者按]     

Blood platelets in severely injured burned patients

Unbelievable decrease of blood-platelet in the severely burned patients during the treatment of skingrafting caused two patients to unexpected death. From the records of changes of platelet number, a certain ‘platelet curve’ was made. By observing the curve, our treatments of skingrafting were carried out during the stable period and from then on we had no death cases.     

Antibody-dependent neutrophil-mediated parasite killing in non-lethal rodent malaria

The effects of administrating recombinant human granulocyte colony-stimulating factor (rhG-CSF) and passively transferring immune serum on infection with an attenuated variant of Plasmodium berghei XAT (Pb XAT), in severe combined immunodeficiency (SCID) mice were examined. In immune competent (C.B-17) mice, the attenuated parasite infection was inevitably self-resolving and degenerating forms inside erythrocytes appeared, coinciding with the drop in parasitaemia, whereas SCID mice were unable to control parasite growth and all the mice died. Continuous administration with rhG-CSF caused neutrophilic granulocytosis in both SCID and C.B-17 mice. The effect of rhG-CSF on the infection in C.B-17 mice was to suppress the course of the parasitaemia at an early phase whereas it had no effect in SCID mice. When immune serum was transferred on the day of infection, the prepatent period was prolonged two days in both SCID and C.B-17 mice. When administration with rhG-CSF was combined with transfer of immune serum, SCID mice showed four days delay in patency and degenerating parasites were seen during the course of parasitaemia, although the infection was ultimately fatal. C.B-17 mice similarly treated showed a seven day delay in the onset of the patent parasitaemia which was of a lesser magnitude and shorter in duration compared with control mice. On the other hand, when C.B-17 mice were splenectomized three weeks before infection and then treated with rhG-CSF and immune serum, no degenerating parasites were seen during the infection and all mice died with high parasitaemias. These results show that antibody-dependent neutrophil-mediated parasite killing may occur in the spleen of mice infected with P. berghei XAT.     

老年急性重症胆管炎的外科治疗(附76例分析)

目的：探讨老年急性重症胆管炎(ACST)的外科治疗。方法：总结60岁以上老年ACST76例，根据病程分段统计手术后并发症率和死亡率。结果：病程在1天以内手术者，并发症率为10．0％，死亡率为0；1～3天手术者，并发症率为21．9％，死亡率为6．3％；3天以上手术者，并发症率为64.3％，死亡率为28．8％。三组之间比较有显著差异(P＜0．01)。结论：老年人ACST治疗上应早期手术，解除胆道梗阻，建立通畅的胆道引流；手术应简捷，尽量缩短手术时间。     

骨盆骨折合并阴道损伤（附5例报告）

报告5例女性骨盆骨折合并阴道损伤，占骨盆骨折41例中的12.2%,均为交通事故伤，都合并有失血性休克，开放伤3例，闭合伤2例，治疗作阴道修补术2例，用碘仿纱条填塞阴道2例。未作处理1例，均治愈，阴道损伤表现为四型；横行撕裂伤，纵行撕裂伤，斜行撕裂伤和刺伤，强调早期诊断，及时治疗以防止合并症。     

Prediction of severe postoperative complications in patients admitted to neuroanaesthesia

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.     

成人结核性脑膜炎误诊原因分析

报告了成人结核性脑膜炎11例误诊,并收集国内报告的221例误诊病例,对结核性脑膜炎的误诊原因进行了综合分析。     

335例退行性骨关节病直流感应电康复总结

报告335例退行性骨关节病变,均经 x 线摄影证实,用直流感应电治疗。痊愈62例,占18.51%;显效115例,占34.33%;好转139例,占41.49%;无效19例;占5.67%。总有效率94.33%。有复发者再经治疗仍可收到效果。并对作用机制进行了探讨。     

大肝癌手术切除探讨（附16例分析）

报告16例大肝癌手术切除治疗效果，癌块直径>7cm。其中巨块型12例，癌块>10cm9例；癌块>14cm3例，均经病理证实。Ⅱ期切除3例，均经肝固有动脉结扎加插管注药化疗，肿块缩小后再手术，术后生存1年4例，2年3例，3年4例，4年1例，全组中位生存期24.1个月，并对大肝癌的手术适应证及术式选择等进行了探讨。     

胆囊小隆起性病变的诊断及治疗

报告37例胆囊小隆起性病变，其中良性颈变34例，胆囊癌3例。结果：本组23例有临床症状，多表现为反复发作的右上腹疼痛或不适；病灶部位，大小，多少，有无合并胆石及病变性质与临床症状有关；B-us,OCG,CT的诊断符合率例如辚33／37，9／24和5／10（x^2=18.75,P<0.005)。认为对胆囊小隆起性病变的病灶≥10mm，有增大趋势，呈恶性图像，合并胆石或血清CEA升高的病例应及早手术治疗。