Management of ascites in cirrhosis

Ascites is one of the earliest and most common complications of patients with cirrhosis. A typical circulatory dysfunction characterized by arterial vasodilation, high cardiac output and stimulation of vasoactive systems is commonly present in these patients and is associated with a poor prognosis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past two decades, although controlled trials in large series of patients are needed to delineate whether TIPS is a safe and useful treatment for these patients.     

A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective Caesarean section

This study compares the efficacy of omeprazole and ranitidine at reducing gastric secretion in obstetric patients. Sixty-five women scheduled to undergo elective Caesarean section under general anaesthesia were randomly allocated to receive either omeprazole 40 mg or ranitidine 150 mg orally at 2200 hours the night before and at 0600 hours on the morning of surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. All patients had gastric aspirates less than 25 ml. None of the omeprazole group had an aspirate of pH less than 3.5. Six patients (19%) in the ranitidine group had aspirates of pH less than 3.5, a significant difference from the omeprazole group (p less than 0.05). Of these six, two (6%) had aspirates of pH less than 2.5. Hence this study showed that omeprazole was more effective and consistent than ranitidine at maintaining gastric pH greater than 3.5.     

不同年龄阶段颈椎病临床研究进展

目的:旨在研究不同年龄段颈椎病的临床患病特点。方法:把不同年龄阶段的颈椎病患者划分为儿童、青少年和中老年型颈椎病,分别从诊断依据、发病机制、预防与治疗方面进行分析。结果:儿童、青年、中老年型颈椎病在临床表现、病机、防治方面既有相同之处,亦有不同之处。结论:不同年龄段的颈椎病明显存在差异性,而相应研究缺乏统一的各型诊断标准、病情分级标准、治疗标准、康复标准及颈椎病的自我预防康复;对颈椎病的实验研究也甚少;在中医"治未病,既病防变"理论方面报道甚少。     

PLASMA CATECHOLAMINES AND NEONATAL CONDITION AFTER INDUCTION OF ANAESTHESIA WITH PROPOFOL OR THIOPENTONE AT CAESAREAN SECTION

Increased maternal sympathetic nervous system activity may decreaseplacenta! perfusion and cause adverse neonatal effects. We havestudied the catecholamine response and neonatal outcome in Chinesepatients with uncomplicated, singleton pregnancies undergoingCaesarean section. Anaesthesia was induced with thiopentone4 mg kg^-1 (n = 32) or propofol 2 mg kg^-1 (n = 30) followed bysuxamethonium. Laryngoscopy was performed after 7 min and trachea/intubation completed by 2 min. Anaesthesia was continued withatracurium, nitrous oxide and isoflurane. Maternal venous bloodsamples were taken at 0, 1, 2, 3, 4 min and at delivery forassay of catecholamines. The increase from baseline values inmean arterial pressure after trachea/ intubation was greaterin the thiopentone group (29 (SD 15) mm Hg) compared with thepropofol group (18 (14) mm Hg) (P < 0.01). The concentrationsof noradrenaline and adrenaline increased in both groups aftertrachea/ intubation. Maximum noradrenaline concentrations weregreater in the thiopentone group (413 (177) pg ml^-1) comparedwith the propofol group (333 (108) pg mh1) (P < 0.05), butthere were no differences between groups in adrenaline concentrations.Neonatal Apgar scores, neurobehavioural testing and umbilicalcatecholamine, blood-gas tension and oxygen content analysiswere similar between groups. Propofol attenuated the hypertensiveand catecholamine response associated with laryngoscopy andtrachea/ intubation but there was no improvement in neonataloutcome. (Br. J. Anaesth. 1993; 70: 311–316)     

Local Repolarization Abnormalities Induced by Transcatheter Radiofrequency Ablation in Pigs

Radiofrequency (RF) ablation alters action potential repolarization of myocardial cells and, theoretically, tbis should induce ST-T segment changes in the ECG. Since these ECG abnormalities have been rarely reported in patients submitted to RF ablation we assess the ability of the procedure to caase ST-T segment changes in local electrograms. Epicardial ECG mapping was performed in 17 anesthetized open chest pigs submitted to endocardial (n = 9) or to epicardial (n = 8) unipolar radiofrequency ablation (500 kHz, 20 W for 5-10 s). To characterize the cellular electrophysiological alterations induced by RE ablation transmembrane action potentials were recorded at various distances from the ablation lesion; these were compared with seven control pigs. Endocardial RE ablation induced a transient (< 5 min) change of 6.1 ± 2.4 m V in T wave amplitude (baseline: 12.8 ± 5.6 mV, P < O.OOl) in 141 out of 269 epicardial electrodes. T wave changes were associated with shortening in local activation time (20.1 ± 2.3 ms at baseline vs 18.5 ± 2.5 ms at 60 s after ablation, P = 0.03). RE current caused persistent ST segment elevation at the center of the ablation lesion with no transmural expansion. Intracellular potentials along a 2-6-mm wide myocardial band bordering the RE lesion showed lower amplitude (101 ± 7.0 mV vs 71 ± 23 mV, P < 0.01) and shorter duration (254 ± 44 ms vs 156 ± 29 ms, P < 0.01) than control hearts. The center of the ablation lesion was electrically anexcitable. We concluded that RF ablation alters cellular electrophysiology in small areas surrounding the ablation lesion and this causes short-lasting transmural changes in T wave amplitude and nontransmural ST segment elevation.     

结合模拟软件的PBL教学法在教学中的应用

将信息化教学与PBL教学结合,建立基于模拟软件的PBL教学模式。针对卫勤指挥班教学实际设计问题,以野战医疗所手术组为对象,构建基于MedModel平台的模拟模型,探讨教员、学员、软件在组织实施过程中的作用,分析了该教学模式的优势及改进之处。     

欧美等典型国家医疗保险制度改革借鉴

近年来,几个典型国家针对本国医疗保险制度存在的的问题和弊端,采取了一系列措施,进行了比较深入的改革,使本国居民在医疗保障方面得到了切实的利益。本文归纳总结了其成功的做法,期望能够对我国的医疗保险改革有所借鉴和启示。