良性小脑出血13例分析

笔者对13例良性小脑出血的患者,从起病、临床表现进行了具体分析.总结出中老年良性小脑出血的6个特点,供临床工作者参考.     

绝经前后T1期乳腺癌患者临床特征的分析

目的:分析T1期(肿瘤直径<2cm)原发性乳腺癌女性患者绝经前后在肿瘤大小、病理分类、淋巴结转移率和数目。方法:常规病理检验以及应用免疫组化、HE法分别测定绝经前乳腺癌患者和绝经后乳腺癌患者者的ER、PR。结果:两组患者在肿瘤大小上无明显差异,但绝经前乳腺癌患者浸润导管癌的百分比为 84. 7%,绝经后乳腺癌患者的浸润导管癌百分比为 62. 2%,经χ2 检验,P<0. 01。两组淋巴结转移率分别为 39. 3%和 25. 5%,经χ2 检验,P<0. 01。两组ER和PR阳性伴淋巴结转移的比例经χ2 检验,P<0. 05。结论:绝经前乳腺癌患者和绝经后乳腺癌患者在病理分类、淋巴结转移率及数目、ER、PR阳性伴淋巴结转移上有显著性差异。对于T1原发性乳腺癌患者不论有无淋巴结转移,均应行癌肿切除伴Ⅰ、Ⅱ级淋巴结清扫。     

The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context

In this study we consider the process of the clinical encounter, and present exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview. We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds—for patients, acknowledgment of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice ‘surprises’, and to elicit what really matters to patients in their care.     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。     

病理技术质量控制的探讨

病理技术是病理学诊断不可分割的一部分,正确的染色结果是病理诊断的重要依据之一.病理技术的规范与否,制片质量的好坏很大程度上影响病理医生作出正确的病理诊断.     

丹芎瘢痕涂膜的临床应用研究

目的:本文通过769例病人应用丹芎瘢痕涂膜防治瘢痕增生的治疗效果,为烧烫伤后瘢痕增生提供一种新的治疗手段.方法:我们根据中医、中药活血化淤原理,经多年临床实践研制而成的丹芎瘢痕涂膜,由丹参、川芎等复方组成.药物使用,将丹芎瘢痕涂膜直接均匀涂于瘢痕表面上,形成药膜,次日揭去药膜,重新涂药,每日1次,连续用药5个月.疤痕止痒软化膏对照,每日1次,连续用药5个月.结果:(1)创面愈合后瘢痕刚开始增生者,丹芎瘢痕涂膜治疗组共415例,显效77例,有效323例,总有效率96.39%;疤痕止痒软化膏同体对照组51例,显效0例,有效20例,总有效率39.22%,治疗组显著优于对照组.(2)创面愈合后瘢痕已增生者,丹芎瘢痕涂膜治疗组354例,显效88例,有效257例,总有效率97.46%;疤痕止痒软化膏对照组63例,显效4例,有效34例,总有效率60.32%,治疗组显著优于对照组.(3)丹芎瘢痕涂膜治疗组与疤痕止痒软化膏对照组综合疗效比较,丹芎瘢痕涂膜治疗组769例,显效165例,有效580例,总有效率96.88%;疤痕止痒软化膏对照组114例,显效4例,有效54例,总有效率50.88%,治疗组显著优于对照组.(4)60例丹芎瘢痕涂膜治疗组与同体空白对照组比较,治疗组显效25例,有效34例,总有效率98.33%;对照组显效0例,有效11例,总有效率18.33%;治疗组显著优于对照组.(5)未发现不良反应.结论:经769例病人临床应用丹芎瘢痕涂膜,并与已知疤痕止痒软化膏比较,丹芎瘢痕涂膜治疗效果显著优于疤痕止痒软化膏,丹芎瘢痕涂膜是一种安全、有效、新的创面瘢痕外用药.     

医学研究生临床技能培训与和谐医患关系构建的协调发展

临床技能培训与和谐医患关系构建是临床医学教育中两个不可分割的重要组成部分.促进临床技能培训与和谐医患关系的协调发展,达到完美和谐的统一,以提高医学研究生的培养质量.武汉大学人民医院采用具有特色的新型培养方式,加强研究生法律意识、医德教育,注重换位思考,提高专业技能,保持心理健康,改进医患沟通技巧,在研究生教育工作中取得了良好的效果.     

Clinical parameters that predict histology of postchemotherapy retroperitoneal lymph node mass in testicular cancer

BACKGROUND: Since the advent of cisplatin-based chemotherapy, the majority of metastatic testicular cancers can be cured by chemotherapy followed by retroperitoneal lymph node dissection (RPLND). However, postchemotherapy RPLND confers no therapeutic benefit if the residual mass contains no viable cells. Therefore, to determine which parameters predict a patient's likelihood of having only necrosis in the residual mass, we retrospectively analyzed clinical parameters of patients who underwent postchemotherapy RPLND. METHODS: Data from 27 patients with metastatic testicular cancer were analyzed. The histology of the primary tumor was seminoma in 11 cases and non-seminoma in 16 cases. All of the patients with non-seminoma showed a normalization of tumor markers after chemotherapy. Analysis of clinical parameters included data for the initial histology, pretreatment tumor marker levels, postchemotherapy retroperitoneal mass size, and the histology of the dissected RPLNs. RESULTS: Histological examination of dissected RPLNs showed residual tumor in 27% of seminoma patients and 38% of non-seminoma patients. In seminoma patients, no viable cells were found in all six patients with pretreatment lactate dehydrogenase (LDH) levels below 7.5 times the upper limit of normal, or in all five of the patients with postchemotherapy RPLNs less than 2.5 cm. In non-seminoma patients, no viable cells were found in nine of 10 patients with pretreatment alpha-fetoprotein (AFP) levels less than 2700 ng/mL, or in eight of nine patients with residual mass less than 2.5 cm. CONCLUSIONS: Both postchemotherapy RPLN mass size and pretreatment tumor marker levels are possible predictors for necrosis of the residual mass in testicular cancer patients.     

Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients

BACKGROUND: Graft-vs.-host disease (GVHD) is the major cause of morbidity and mortality in patients undergoing allogeneic Bone Marrow Transplantation (BMT). The aim of our study was to identify the most relevant histological features for diagnosis of chronic Graft-vs.-Host Disease (cGVHD) in oral mucosa and minor salivary glands of 25 patients, as well as to evaluate the immunophenotype of the inflammatory cells. METHODS: Sixteen patients that were submitted to allogeneic BMT but did not present cGVHD were selected as a control group. The sections were studied on H & E and CD68, CD45, CD4, CD8, CD20 staining. RESULTS: The most frequent histologic findings in oral mucosa at the day of diagnosis of cGVHD were: hydropic degeneration of the basal layer of the epithelium, apoptotic bodies, lymphocytic infiltration, and focal or total cleavage between the epithelial and connective tissue. In the labial salivary glands (LSG), lymphocytic infiltration, acinar loss and fibrosis were the main alterations. Cytotoxic CD8-T cells and macrophages were predominant both in the epithelium and connective tissue, as well as in minor salivary glands. CONCLUSIONS: Histological features were useful in the diagnosis of oral cGVHD. It is suggested that CD8-T cells and macrophages play important role in the pathogenesis of the disease.