重症急性胰腺炎的综合治疗

目的 探讨重症急性胰腺炎（ＳＡＰ）的合适治疗方法。方法 回顾性总结８８例ＳＡＰ患者的治疗经验。结果 治愈７３例（８２．９５％），死亡１５例（１７％）。非手术组５６４例，死亡７例（１０．９％）；手术组２４例，死亡８例（３３．３３％）（Ｐ〈０．０５）。结论 作者认为非手术治疗可以治愈大部分患者，重点在于维持血液动力学稳定和水电解质及酸碱平衡，营养支持，维持胰外受损器官功能，掏胰液分泌，促进胃肠道功能，     

Bildgebende Diagnostik der tiefen Bein- und Beckenvenenthrombose

Zum Thema Die sichere rein klinische Diagnose der Venenthrombose ist nur bei eindeutiger Symptomatik m?glich. Bei gering ausgepr?gten Beschwerden, unklarem Befund oder auch schon bei hohem Risiko für Venenthrombosen muss die klinische Untersuchung durch apparative Verfahren erg?nzt werden, da sich Thrombosen über lange Zeit ohne nennenswerte Symptomatik entwickeln k?nnen. Neben funktionsdiagnostischen Methoden standen als Goldstandard der Diagnostik lange Jahre allein die Phlebographie und Phleboskopie zur Verfügung. Durch die Entwicklung der Ultraschalldiagnostik bietet sich heute eine nichtinvasive Alternative in der Thrombosediagnostik. Im vorliegenden Beitrag werden die Indikationen, M?glichkeiten und Grenzen der einzelnen Verfahren der bildgebenden Diagnostik der Venenthrombose dargestellt.     

Antiinflammatorische Therapie in der Sepsis

A systemic inflammation with the release of multiple cytokines plays an important role in the pathophysiology of sepsis. During the last years, several anti-inflammatory substances have been investigated with respect to their effects on mortality in patients with sepsis. However, only the antibody fragment of the TNFα binding antibody afelimomab and the recombinant human activated protein C (drotrecogin α [acivated]) were capable of improving the outcome in controlled studies with large sample sizes. The possible administration of these substances should be restricted to patients who meet the inclusion criteria of these studies. In particular, the tight time window, which usually ends 24 h after the onset of sepsis, should be taken into consideration before starting an anti-inflammatory medication. In addition to the anti-inflammatory treatment, the control of the infectious focus and an aggressive hemodynamic stabilization must not be neglected. Ibuprofen, interleukin-1 receptor antagonists and soluble TNFα-receptors as well as high dosages of corticosteroids and antithrombin III do not have a place in the anti-inflammatory treatment of sepsis.     

吡哌酸和甲氧苄啶1或2天短程治疗菌痢

试用吡哌酸(PPA)和甲氧苄氨(TMP)短程治疗急性菌痢,PPA1.0g、TMP0.2gbid,治程2d,治疗55人;PPA2.0g,TMP0.4gq12h治程1d,治疗33人。均能获得很好效果:1个疗程治愈率为97％,两个疗程全部治愈。体温平均12±2.4h恢复正常,主要症状可于2.3±1.2d内消失,粪检和培养平均2.3±1.2d内转阴。1个疗程治后痢疾菌全部阴转,其中3d内阴转者88-97％,2d内阴转62-73％,1d内阴转亦达28-36％,远期症状复发率4％,未见带菌者。同时,亦未见明显毒副作用。     

茯苓合剂对冻融蟾蜍肝脏组织的生物化学研究

本实验采用显微镜和722分光光度计分别观察测定了冻融蟾蜍肝脏组织碱性磷酸酶（AKPase)活性，及茯苓合剂的保护效应。实验结果表明，药物复温组血浆脂质过氧化物（LPO）和红细胞的malondialdehyde(mda)含量显著低于对照组（P＜0．01）；全血谷胱甘肽过氧化物酶（GSH－Px)活性显著高于对照组（P＜0．01）；肝组织AKPase活性显著高于对照组呈强阳性。结果提示，茯苓合剂具有抗脂质过氧化，保护GSH－Px酶活性，对冻融肝脏组织能间接提高机体清除超氧自由基和羟自由基的能力。这为组织器官的保存和移植提供了理论依据。     

Therapie der juvenilen idiopathischen Arthritis (JIA) mit Zytokinantagonisten

Juvenile idiopathic arthritis is a chronic inflammatory disease with uncertain outcome. Patients may suffer from severe joint damage leading to mutilations as well as from extra-articular manifestations. Prognosis is variable and depends in part on the number of affected joints and the occurrence of extra-articular manifestations. Treatment regimes should take this into account. Pharmacomedical treatment strategies include the application of nonsteroidal antirheumatics, corticosteroids, sulfasalazine, and immunosuppressive substances. However, of the latter only methotrexate has been shown in controlled trials to be effective. Other immunosuppressive drugs such as azathioprine, cyclosporine A, and leflunomide have not yet been investigated sufficiently. In addition, there is no scientific basis for the application of gold salts or (hydroxy)chloroquine. New therapeutic biologic agents, notably the tumor necrosis factor inhibitors, have achieved dramatic improvements also in patients with severe, as yet intractable disease. However, until now randomized, placebo-controlled trials have been performed for etanercept only. Dramatic improvement was accompanied by low toxicity. Infections as well as the development of autoimmune diseases have been shown to be the major potential side effects. Long-term toxicity still has to be evaluated. Treatment with other biopharmaceuticals such as infliximab, IL-1Ra, anti-IL-6 receptor antibodies, and further cytokine antagonists remains experimental.     

Kolorektale Stapleranastomose bei Morbus Hirschsprung im Säuglingsalter

Zusammenfassung Es wird über eine Methode berichtet, bei der es nach vorausgegangener Rektumbougierung m?glich ist, im frühen S?uglingsalter eine intraluminare Stapleranastomose durchzuführen. 2 S?uglinge mit Morbus Hirschsprung wurden so behandeit.      

青年人胃癌59例分析

目的：探讨青年人胃癌的临床、内镜和病理特征。方法：对经胃镜病理证实的５９例青年人胃癌进行分析。结果：青年人胃部占同期胃癌检出率的８．９％，以３１～３５岁临床构成最多；发现早期癌３例，时展期癌５６例；好发于胃窦部；误诊率６９．５％。结论：上腹痛是青年人胃癌最常见的临床表现；进展期癌分型大多为ＢｏｒｒｍａｎｎⅢ型。     

Grenzen intensivmedizinischer Behandlungspflicht Teil 1: Erläuterungen zu den Leitlinien der DGAI

Every form of active euthanasia is a punishable offence under § 216 of the Penal Code; nor is there any ethical justification for it from a medical point of view. The many strands of the movement in favour of making ”death on demand” exempt from punishment in Germany as it is in The Netherlands cannot change this. In the area of passive euthanasia the limits of the intensive care team’s duty to treat depends on various factors: ·*The patient’s declared or assumed wishes. It is not permissible to carry out procedures refused by the patient, even when these alone would make an extension of life possible. ·*The indications for medical treatment. In the twilight zone between life and death, procedures with no prospect of success can no longer help the patient. In these circumstances they are pointless and are not medically indicated. According to Supreme Court rulings, the medical decision on whether to implement procedures designed to extend life or whether to withhold such procedures is based almost exclusively on the wishes or the assumed wishes of the patient, even though interpretation of the ”assumed wishes” can be difficult and is quite often liable to subjective influences. The question of using the presence or absence of medical indications for treatment as an objective criterion, in contrast, has so far been disregarded in rulings. If no life-extending procedures are implemented the physician’s duty to provide suitable basic care for the patient, in the sense of palliative care, remains. To make decisions easier, the authors discriminate between the essential ”ordinary” remedies that must be provided to all patients and the ”extraordinary” remedies of intensive care that are available for patients who can still benefit from them. There is some controversy over the correct assignment of artificial nutrition; according to German legislation it belongs in the category of extraordinary remedies. The palliative procedures that make up basic care include adequate pain relief, which can be a form of indirect euthanasia. The Supreme Court has ruled that it is the physician’s duty to prescribe adequate pain relief even when it might have the unavoidable side effect of unintentionally accelerating the patient’s death.