慢性HBV感染患者HBsAg亚型分析

对包括慢性肝炎、肝炎肝硬变和原发性肝癌在内的１００例慢性ＨＢＶ感染者作了ＨＢｓＡｇ亚型分析。结果显示，在这组病例中ａｄｒ亚型占６１％，ａｄｗ占３３％，ａｙｒ占２％，ａｄｗｒ占４％。ａｄｒ亚型有随年龄增长更占优势的趋向。ａｄｒ和ａｄｗｒ亚型感染者ＨＢｓＡｇ滴度较ａｄｗ组显著增高，且ｅ抗原阳性率亦较高。上述发现提示，具有ａｄｒ和ａｄｗｒ亚型的ＨＢＶ株可能具有较强的复制活性，不易被清除，从而导致受感染者     

一期切开挂线术治疗肛周脓肿305例

采用一期切开挂线术治疗肛周脓肿３０５例，全瓿期治愈，无发生肛瘘及并发症者。作者认为手术成功的关键是正确处理内口及原发灶，良好通畅的切口引流以及合理的术后处理，对提高疗效，防止复发有重要意义。     

Primary linitis plastica of the descending colon: A case report

A rare case of primary linitis plastica carcinoma of the colon seen in a 44 year old Japanese man is described herein. The patient had a complete obstruction of the descending colon and was treated with a loop colostomy followed shortly afterward by a left hemicolectomy. At the time of the second operation, the entire thickness of the colonic wall was found to be infiltrated by cancer cells, however, the other intraabdominal organs were free of cancerous involvement. The histopathological diagnosis made at this time was primary linitis plastica carcinoma of the descending colon. Nine months later, the patient developed an intestinal obstruction and relaparotomy revealed diffuse peritoneal dissemination. Two years after the first operation, upper GI films and a gastrofiberscopic examination revealed gastric involvement. The patient died 28 months after his initial operation, and autopsy revealed widespread metastases in the peritoneal surface, paraaortic lymph nodes, small intestine, remaining colon and stomach.     

Primary orthostatic tremor is an exaggeration of a physiological response to instability.

Primary orthostatic tremor (POT) is a rare disorder characterised by an intense sense of unsteadiness upon standing and a 16-Hz tremor in which the timing between tremor bursts in different muscles (unilateral and bilateral) remains constant. Hitherto, similar EMG activity has not been described in healthy subjects and it has been postulated that the oscillations seen in POT are primarily pathological. In this study, EMG was recorded from tibialis anterior in healthy subjects who were made unsteady through vestibular galvanic stimulation or leaning backwards. Under these conditions, a peak at approximately 16 Hz was seen in the coherence between the left and right tibialis anterior. This bilateral coherence was absent when the subjects activated the same muscles when not unsteady. These data indicate the existence of a physiological system involved in organising postural responses under circumstances of imbalance and characterised by a highly synchronised output at approximately 16 Hz. In addition, the results suggest that the core abnormality in POT may be an exaggerated sense of unsteadiness when standing still, which then elicits activity from a 16-Hz oscillator normally engaged in postural responses.     

原发性肝癌栓塞化疗后血清AFP浓度与疗效关系的探讨

目的 :分析 5 5例原发性肝癌经肝动脉插管栓塞化疗 (Transcatheterhepaticarterialchemo -embolization ,TAE)后血清AFP浓度与疗效的关系。方法 :通过动脉插管和血管造影 ,采用不同的化疗药物对肿瘤组织进行局部注入。用放射免疫法测定AFP浓度。结果 :TAE后血清AFP浓度降低与疗效有关 ,AFP≥ 4 0 0ng dl组有效率为 12 % ,AFP <10 0ng dl组有效率为 85 7%(P <0 0 1) ;TAE治疗后血清AFP浓度仍大于 4 0 0ng dl组癌肿转移率明显高于AFP <10 0ng dl组 ,而 2年生存率明显低于AFP <10 0ng dl组 (P <0 0 5和P <0 0 1)。结论 :TAE后血清AFP浓度的检测可反映肝癌介入治疗后疗效、预后及生存率     

Empowering practice nurses in the follow-up of patients with established heart disease: lessons from patients' experiences

This paper reports on the views of patients with established heart disease of a structured programme of follow-up care provided by practice nurses (PNs) in general practice in England. It is based on in-depth interviews with 22 patients receiving an integrated primary and secondary care intervention being developed and piloted for patients following heart attack or diagnosis of angina. Patients identified the important features of follow-up care to be easy access to a health professional who possessed knowledge and social and emotional skills. A range of views about the ability of PNs to provide such care emerged from patients' accounts. patients' perceptions about the seriousness of their condition and the way PN follow-up care was provided in practices emerged as important issues affecting patients' views. In addition, perceptions about the practice nurse's role, status and knowledge, existing relationships with general practitioners, and issues of communication were also important factors. It is concluded that in order to develop high-quality PN-led services for patients with established heart disease, four issues need to be taken into account: practice nurse training; continuity of follow-up care; the integration of the primary and secondary care interface; and development of the practice nurse's status within the primary health care team.     

原发性青光眼的激光治疗

目前在青光眼的临床治疗中，激光治疗已成为介于药物和手术治疗之间的一种方法，本文仅就原发性闭角型青光眼的激光周边虹膜透切术和开角型青光眼的激光滤帘成形术做一介绍。     

第二原发胰腺癌临床特征分析

目的:探讨第二原发胰腺癌的临床特征.方法:以96例普通原发胰腺癌作为对照,回顾性分析了病理确诊的32例第二原发胰腺癌的临床特征.结果:32例第二原发胰腺癌15例(46.9％)发生于乳腺癌、胃癌之后.性别、年龄、部位、临床症状、常规实验室检查及肿瘤标志物检测与普通进展期胰腺癌具有可比性,仅年龄略为提前,消化不良稍多,腹痛、黄疸比例稍降.B型超声、CT、MRI、逆行胰胆管造影诊断敏感率较普通胰腺癌高.处于Ⅰ期者仅2例(6.3％).总体半年存活率为50.0％,较普通胰腺癌略低.病理显示84.4％为腺癌,分化差.结论:第二原发胰腺癌症状更不典型,诊断更为滞后,预后更差,故应加强联系与第一次癌肿的早期检测手段(如肿瘤标志物)研究.     

Executive cognitive deficits in primary dystonia.

Primary dystonia is a disorder of movement for which no consistent pathophysiology has been identified; in the absence of evidence to the contrary, it is assumed to be cognitively benign. We have studied a clinically heterogeneous group of 14 patients with primary dystonia on a battery of neuropsychological tests. Despite well-preserved speed of information processing, language, spatial, memory and general intellectual skills relative to normal controls, we have identified a constellation of attentional-executive cognitive deficits on the Cambridge Neuropsychological Test Automated Battery (CANTAB). Specifically, patients demonstrated significant difficulties negotiating the extra-dimensional set-shifting phase of the IED task. The implications of these findings for the pathophysiology of primary dystonia are discussed. This is, to the best of our knowledge, the first report of a significant cognitive deficit in patients with primary dystonia.     

中国食管癌高发区食管原发性腺癌组织病理学研究Ⅰ．食管原发性腺癌的临床病理学分析

中国食管癌高发区河南省近１５年（１９８０～１９９４）病理确诊的７３６４例食管癌中，其中食管原发性腺癌（ＰＥＡ）２３９例，占３．２５％。通过对２３９例ＰＥＡ手术标本（包括早期癌２０例，其余为中、晚期癌）切片系统观察，指出中国食管癌高发区ＰＥＡ主要起源于食管固有腺体的各级导管部分。ＰＥＡ的病理组织学可分６型：腺导管癌（１０９例）、腺鳞癌（５４例）、腺样囊性癌（２９例）、粘液表皮样癌（２０例）、基底细胞样癌（１５例）、胃型腺癌（１２例）。每型的组织图象及预后均各有特点，提示ＰＥＡ组织学再分型有意义。