重庆市城市居民1991～2000年死亡损失生命年分析

目的：研究重庆市城市居民20世纪90年代疾病所致早死的生命损失。方法：用死亡损失生命年YLLs为测量单位，计算不同性别、不同社区的死因别标化YLLs率，及分析1991～2000年死因别标化YLLs率的变化趋势。结果：非传染性疾病标化YLLs率为42.58‰，占全死因的82.76%，其中，恶性肿瘤标化YLLs率为12.80‰，占30.06%，脑血管疾病标化YLLs率 6.62‰，占15.55%，呼吸系统疾病标化YLLs率5.77‰，占13.55%，心脏病标化YLLs率4.38‰，占10.29%；意外死亡标化YLLs率为7.59‰，占全死因的14.75%；传染病、妇科及围产期疾病标化YLLs率为1.28‰，仅占2.49%。在社区之间，死因别标化YLLs率存在明显差异。结核病和精神病标化YLLs率曾出现上升趋势。结论：非传染性疾病已成为该城市居民的主要疾病负担，结核病防治不能放松，精神卫生工作急待开展。     

脾修补治疗脾破裂84例报告

目的 :探讨外伤性脾破裂行脾修补术的适应证及具体术式的选择。方法 :对 84例外伤性脾破裂行脾修补术的临床资料进行分析总结。结果 :84例中 ,死亡 1例 (死于颅脑损伤 ,尸检显示修补之脾脏创口缝线牢实 ,大网膜黏附良好 ,腹腔无术后陈旧性积血 ) ,死亡率 1.19% ;治愈 83例 ,治愈率 98.81%。结论 :综合生命体征指标和脾脏受损程度等多种因素 ,对 ～ 级的外伤性脾破裂可以施行脾修补术。根据不同情况选择相应的术式 ,修补时应充分利用大网膜 ,不宜剥掉创口中已形成的牢固血凝块     

Acute leukaemia in a defined geographic area – Incidence,clinical history and prognosis

A consecutive series of patients (1978–1981) comprising all patients with acute leukaemia from a population of 475000 inhabitants was reviewed. Thus, 94 patients were diagnosed as having acute leukaemia. No patients were lost from follow-up. The incidence figures of ALL and AML differed significantly from those of Sweden as a whole. 9 patients were < 15 years old. The median age of adult patients was 64 years, 60.8% being ≥ 60 years old. Of adult patients with AML, 20% had a preleukaemic history (chronic myeloproliferative disorders, myelodysplastic syndromes and others). None of 6 patients with leukaemia as a metamorphosis of a chronic myeloproliferative disorder achieved a complete remission. The overall remission rate of the remaining adult patients was 25%. Treated patients, 15–39 years old, with AML without any preleukaemic history, had a complete remission rate of 80% compared to 12% for patients ≥ 60 years old with the same diagnosis. Of 60 patients with ‘primary’ AML, 14 were not treated, mainly because of advanced age and complicating diseases. Most of these patients died within a week of admission.     

Primary papillary serous cystadenocarcinoma of broad ligament

A rare case of an advanced primary broad ligament carcinoma is discussed, with a review of the literature regarding its incidence, presentation and management. This patient showed a complete response to adjuvant cisplatin-based chemotherapy following panhysterectomy and is presently without any evidence of disease, 15 months after completion of her treatment.     

The expression of 3-fucosylated-N-acetyl lactosamine carbohydrate determinants in renal tumours

The distribution in renal tumours of 3-fucosyl-N-acetyl lactosamine has been studied by using the monoclonal antibodies AGF 4.36 and AGF 4.48 and immunoperoxidase methods on tissue sections. Seven of 19 nephroblastomas and 12 of 30 renal cell carcinomas contained the epitope. In nephroblastomas the epitope was found on the terminals of type B tubules in six cases and in one case on the type A or neoplastic tubules. In renal carcinoma the antigen was found on the surface of tumour cells. The results suggest that in kidneys bearing nephroblastomas ureteric bud elements may grow into the tumour from the adjacent kidney.     

Quality in Clinical Practice

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.     

老年慢性病患者常见症状与生存质量的相关性研究

目的 探讨老年慢性病患者常见症状间的相互关系及其对生存质量的影响,以寻找提高其生存质量的护理对策.方法 采用焦虑自评量表、老年人抑郁量表、SF-36量表对230例老年慢性病患者进行常见症状及生存质量调查,并分析各种症状间的关系以及症状与生存质量的相关性.结果 老年慢性病患者生存质量八大项目得分偏低.常见躯体症状包括躯体疼痛、头晕、疲乏、睡眠障碍发生率依次为25.73%、33.80%、25.00%、22.05%.常见心理症状焦虑和抑郁得分为38.35±7.26、8.71±5.21.且各种常见症状之间呈正相关(r=0.80～0.612,P<0.05),各种常见症状与生存质量呈负相关(r=-0.175～-0.623,P<0.05).结论 在老年慢性病患者居家护理过程中,须及时采取积极有效护理措施控制或减轻病人症状,且躯体症状护理与心理护理应并重,措施实施与原因排查应同步,主要症状与次要症状要兼顾,以提高其生存质量.     

甲状腺切除术中喉返神经损伤的预防

目的：探讨降低喉返神经损伤的方法。方法：2005年9月-2007年1月共有375例甲状腺手术患者，对其喉返神经损伤进行分析。结果：375例病人中有5例喉返神经损伤，其中甲状腺腺瘤3例，桥本甲状腺炎1例，甲状腺癌1例，损伤后立即行喉镜检查示声带处于外展位。给予营养神经治疗，15 d-3个月后完全恢复，喉镜检查示声带正常。结论：喉返神经损伤可以预防，关键是术者应熟悉喉返神经的解剖结构和变异，熟悉其与周围组织及血管的关系，要有手术区域的组织结构特别是喉返神经走行的“立体影像”。     

胆道镜应用对肝胆胰术式选择的影响

目的 探讨分析胆道镜检查在肝胆胰疾患术式选择中的价值。方法 回顾分析1994～2004年收集术中或联合术后应用胆道镜治疗肝胆胰疾患2276例临床资料，进行分析及总结。结果 1966例肝胆管胆石患者胆道残留结石率从34．5％降至9．6％；82例术中胆道镜发现合并胆管狭窄，其中45例肝胆管膜状狭窄者在胆道镜指导下实施了有效扩张治疗；胆总管下段梗阻患者中224例肿瘤依据形态学检查，结合术中扪诊及活检组织学检查得到确诊，并采取了相应的手术方式。结论 胆道镜的应用有利于肝胆胰疾患术式的选择，可使一些较为复杂的胆道手术变得简单易行；对术前未能确诊的病变可以达到明确诊断并指导选择合理的术式。     

食管癌放疗中二次模拟定位临床探讨

目的：探讨食管癌放疗中间再次定位的必要性和重要性。方法：我院放疗科自1998年10月－2001年3月对356例食管癌患者行单纯放疗或放疗加化疗，356例患者照射全过程都进行二次模拟定位（第一次模拟定位后照射30－40GY／15－20次后进行第2次模拟定位）。比较分析前后二次模拟定位靶中心移位的情况。结果；靶中心移位＜0．5cm为157例，移位0．5－1．0cm为130例，移位＞1．0cm为69例。全部靶中心移位达55．90％。食管肿瘤长度＜5cm靶中心移位27例，5－8cm移位117例，病变长度＞8cm移位55例，P＜0．05；食管肿瘤发生于颈段，上胸段靶中心移位25例，而中、下段食管移位174例，P＜0．01。结论：食管肿瘤外照射达到一定剂量时，靶中心会出现不同程度的移位，肿瘤长度越长靶中心移位会更明显， 肿瘤位置越小，移位亦显著。因此，我们对食管癌患者放疗全过程必需进行2到3次定位，这样才能保证靶中心的精确度，以达到预期治疗目的。