10Kg以下法乐氏四联症的急诊手术治疗

目的 总结低体重法乐氏四联症急诊或亚急诊手术的治疗经验。方法 15例体重小于10kg的法乐四联症患儿因合并有严重缺氧发作、感染性心内膜炎、心衰等，经积极的心内科治疗后转行急诊或亚急诊根治手术。结果 死亡1例，病死率6．7％；存活14例，但术后有较多、较重的并发症，其中1例的术前脑缺氧损害后遗表现仍然明显。结论 急诊或亚急诊根治术是救治合并有危急并发症低体重法乐氏四联症患儿的有效方法。     

颞骨岩部胆脂瘤

目的：探讨岩部胆脂瘤的临床特征及手术方法。方法：经迷路前上径路手术治疗1例，经迷路-耳蜗径路手术治疗8例。结果：术后8例随访2-9年，局部无胆脂瘤复发，其中2例面神经全程减压，术后未能恢复；1例术后2个月出现面肌运动，7个月后恢复正常，1例术后仅2个月，有待随访。结论：根据病变部位及侵犯范围选择适当的手术途径；术腔内填塞脂肪，封闭外耳道可防止脑脊液外漏。     

内耳畸形患儿的人工耳蜗植入

目的：探讨几种内耳畸形患儿的人工耳蜗植入效果。方法：对10例内耳结构异常的感音性耳聋患儿进行了人工耳蜗植入。结果：术后随访0．5～4．0年，10例基本达到了较满意的听觉言语恢复效果。结论：内耳畸形息儿行人工耳蜗植入，应严格进行术前听力学与影像学的评估，严格掌握手术的适应证，可以达到较满意效果。     

原发性高血压肝阳上亢证证治规律探讨

肝阳上亢证是原发性高血压的常见证型 ,与胰岛素抵抗增强、酪氨酸羟化酶基因过度表达、血小板α-颗粒膜蛋白分泌异常、血管内皮细胞损伤、红细胞变形能力降低、微循环障碍和垂体 -性腺激素分泌异常密切相关 ,其病机演变有内在规律 ,证候表现有自身特点 ,治疗以平肝潜阳为法。从而为平肝潜阳法治疗原发性高血压提供了理论依据     

Loss of regulation of circulating 1,25-dihydroxyvitamin D with paradoxically decreased serum phosphate levels in individuals with recurrent kidney stones

A low serum phosphate concentration is characteristic in individuals in whom kidney stones form, this being related to serum 1,25-dihydroxyvitamin D, parathyroid hormone and urinary phosphate excretion. In order to determine whether these parameters are related to recurrence of stone formation, they were analyzed in single and recurrent stone formers as well as controls. An inverse correlation between serum levels of phosphate and 1,25-dihydroxyvitamin D was observed in control subjects, indicating that a drop in serum phosphate results in upregulated circulating 1,25-dihydroxyvitamin D level in controls. While the circulating low phosphate level upregulated the 1,25-dihydroxyvitamin D level in single stone formers, the elevation was less than expected from the drop in serum phosphate in recurrent stone formers. The results thus suggest that loss of upregulation of 1,25-dihydroxyvitamin D by serum levels of phosphate might be important for stone formation. The possibility of deregulation of 1,25-dihydroxyvitamin D to maintain physiological requirements in stone formers and prevent further nephrolithiasis therefore warrants attention. Received: 27 January 1999 / Accepted: 25 June 1999     

豚鼠柯替氏器支持细胞的分离和鉴定

目的：建立豚鼠柯替氏器支持细胞的分离方法，并观察活性支持细胞的形态特征。方法：对豚鼠基底膜用Ⅳ型胶原酶(1mg/ml)消化和微机械分离法获得柯替氏器单离支持细胞，在倒置显微镜下观察细胞的活性和形态特征并记数。结果：不同支持细胞在倒置显微镜下各有其形态特征，第一、二排Deiters细胞为逗点状，第三排为弓状：Hensen细胞为长圆形，半透明的胞质内含有数个脂质样颗粒；外柱细胞呈哑铃状，两端对称性圆球形，中间可见清晰的微管；内柱细胞呈“长勺形”，底部为圆球状，顶部逐渐向外侧弯曲成杯口样结构。每个豚鼠耳蜗可分离出单离Dieters细胞1～4个，Hensen细胞10～20个，内柱细胞和外柱细胞分别约80～100个。结论：Ⅳ型胶原酶消化和微机械分离法可分离出豚鼠柯替氏器的Deiters细胞、Hensen细胞和内、外柱细胞，可为在细胞和分子水平对单离活性支持细胞进行形态和功能变化的研究提供一种简便实用的方法。     

超声治疗外阴白色病变30例临床分析

目的 :探讨超声治疗外阴白色病变的临床疗效。方法 :收治外阴白色病变 6 0例 ,随机分为 :超声治疗组 30例 ,微波治疗对照组 30例。观察其临床症状、体征和组织学变化。结果 :超声治疗组 30例患者的外阴瘙痒症状基本消失 ,患处上皮不同程度地恢复正常 ,显效率达 90 %。不同的病理类型间疗效的比较 ,差异无显著性 (P >0 .0 5 )。结论 :用超声治疗外阴白色病变效果明显     

桐乡市剖宫产率变化趋势及对策

目的:剖析近年来剖宫产率逐年上升的原因,为遏制和降低剖宫产率的具体措施提供资料。方法:对本市七所医疗单位近二十年来的产妇病历资料进行回顾性分析。结果:①近十年剖宫产率平均以每年5个百分点速度攀升。②妇产科床位在30～50张之间的县(市)、区级医院剖宫产率上升速度较快。③剖宫产已逐步取代产钳、胎头负压吸引、臀位牵引等分娩方式,是处理重度妊高症、妊娠特发性疾病、妊娠合并症与并发症的重要手段。④社会因素影响剖宫产率。结论:剖宫产率上升已不是一个单纯的医疗问题,而是社会综合因素的结果,须采取综合性的对策和措施加以遏止或降低。     

Challenges of ethical research in resource-poor settings.

The disparity in resources between economically developed and developing countries presents ethical concerns when commercial sponsors of studies and investigators propose to conduct them with subjects in developing countries. Vulnerable people may be recruited into studies of little health benefit to themselves or their communities and, under undue inducements, may accept disproportionate risks. Reproductive health studies may present women with undue risks. Guidelines have been developed to protect exploitable populations in resource-poor settings, although guarding their right to make informed and voluntary choices poses special challenges. Guidelines pay special attention to pregnant women as research subjects, and may approve and even require their enrollment in studies of products not known to be harmful. Placebo-controlled studies are addressed in contexts where no recognized treatments are routinely accessible. The structure and functions of research ethics review committees present difficult challenges, but they may be mitigated by enlightened international collaboration.     

药品行政保护品种介绍:神经和精神系统药物(一)(待续)

文拉法辛缓释胶囊　通用名 :文拉法辛 (venla faxine)缓释胶囊。商品名 :怡诺思 (Efexor)缓释胶囊。化学名 :(R/S) 1 [2 (二甲胺 ) 1 (4 甲氧苯基 )乙基 ]环己醇盐酸盐。结构式见图 1。图 1　文拉法辛结构式　　　Fig 1　Structureofvenlafaxine　　申请日 :1999年 4月 16日。申请人 :荷兰AHP制药有限公司。申请号 :A NL 990 4 16 10。授权号 :B NL 9912 2 32 1。授权日 :1999年 12月 2 3日。法定行政保护期 :从授权之日起 7.5a ,到 2 0 0 7年 6月2 3日止。专利介绍 :欧洲专利第 0 12 2 6 6 9号。商标注册 :在我国注册的商标为怡诺…