喉类癌—病例报告及文献复习

喉内分泌细胞来源的恶性肿瘤,可分为类癌和低分化小细胞癌即燕麦细胞癌两类,是非常稀少的喉肿瘤,尤以类癌罕见。自1969年 Goldman 等首例报告后,迄今仅3例喉类癌见诸世界医学文献。本文报告产生粘液的原发性喉类癌一例,经组织化学和电镜技术确诊,兹文献复习,简要讨论。     

人表皮细胞培养中Langerhans细胞变化的研究

研究表明表皮Langerhans细胞(Lcs)是一种重要的抗原递呈细胞,其参与同种皮肤排斥反应。如消除移植物内Lcs,可延长异体皮肤存活。本研究系利用ATPase染色,抗人HLA-Dr抗原单克隆抗体间接免疫萤光及免疫酶标(ABC)染色,观察了人表皮细胞(Ecs)培养中Lcs的密度及形态变化。并通过混合表皮细胞淋巴细胞培养反应(MEcLR),检查了培养前后Ecs的免疫刺激能力。发现在Ecs培养过程中,存于Ecs内的Lcs培养3天即显著减少同时明显变形;7天后Lcs减少达90％以上;培养14天或更长时间Ecs内Lcs基本消失。在培养新生的Ecs内自始未发现Lcs。培养7天后的Ecs及新生Ecs在MEcLR 中失去刺激异体淋巴细胞转化的能力。这些结果表明通过Ec体外培养可以消除Ecs内携带Ⅰ级抗原的Lcs,提示本培养系统培养的同种人Ecs如用于异体移植,其存活的时间可能延长。     

A Study on Changes of Langerhans Cells in Human Epidermal Cell Culture

Human epidermal cells (ECs) were grown in vitro from normalhuman foreskin and the changes of Langerhans cells (LCs) within theoriginal explants and the epidermal outgrowth were observed in culturewith ATPase staining, HLA - Dr monoclonal antibody indirectimmuno-fluorescence and enzyme labelling avidin-biotin complex (ABC)staining. The capacity of ECs to stimulate the proliferation of allogeniclymhocytes was tested in the mixed skin-lymphocyte culture response(MSLR). The ATPase HLA-Dr positive LCs were gradually decreasedand significantly deformed within the original explants in culture. 70% ofLCs was decreased 3 days after culture. 90% of LCs was lost and the LCsremained in the original explants were only seen their outline 7 days afterculture. LCs approximatively disappeared within the original explants 14to 21 days after culture. The ATPase, HLA - Dr positive LCs have neverbeen found within the epidermal outgrowth. The ECs which were freshlyisolated from skin explants potently stimulated the proliferation ofallogenic lymphocytes in the MSLR. The ECs which were separated fromthe original explants after 3 days of culture were significantly declinedtheir ability to stimulate the proliferation of allogenic lymphocytes in theMSLR. The ECs separated from the original explants after 7 days ofculture were lost their ability to stimulate the proliferation of allogeniclymphocytes in the MSLR. The ECs separated from the epidermaloutgrowth failed to stimulate the proliferation of allogenic lymphocytes inthe MSLR. These results suggested that the ECs grown in our culturesystem were declined their immunogenety of skin allografts.     

医院抗菌药物使用情况及分级管理的调查

目的调查医院实施抗菌药物分级管理前后抗菌药物使用情况,并分析抗菌药物分级管理效果。方法选取实施抗菌药物分级管理前后医院住院部患者病历各628例,其中手术、非手术病历各314例;采用问卷调查了解这两个时间段住院部病历资料、抗菌药物使用情况、给药方法合理情况,分析医院抗菌药物使用存在的问题;统计常用抗菌药物并比较分级管理前后各药物使用量、耐药率变化来分析分级管理效果。结果实施抗菌药物分级管理前后住院部病历主要为手术和非手术两类,手术病历患者均有应用抗菌药物,使用率为100.00%;非手术患者实施抗菌药物分级管理前后抗菌药物应用率分别为59.87%、70.06%,分级管理前后抗菌药物使用率比较,差异无统计学意义(χ~2=0.570,P0.05),但有增加趋势。手术病例患者分级管理前后抗菌药物使用合理率比较差异无统计学意义(χ~2=1.010,P0.05);非手术病例抗菌药物使用合理率比较差异无统计学意义(χ~2=1.099,P0.05);分级管理前各常用抗菌药物用量虽有差异,但并非明显,分级管理后各常用抗菌药物用量得到了明显控制,管理效果明显;分级管理后大肠杆菌、铜绿假单胞相比分级管理前菌耐药率明显降低(P0.05);其他耐药菌变化不大(P0.05)。结论抗菌药物管理存在的问题主要有:预防用药时机不佳、起点高、选药不当;对患者过敏史、肾功能等指标检测结果、用药禁忌等存有忽略;用药方法、用量不当等,对抗菌药物进行分级管理能明显控制抗菌药物用量,在一定程度上降低耐药菌耐药率,值得推广应用。