创伤性休克病人的早期急救护理体会

目的:讨论在院前和急诊科对创伤性休克病人施行早期急救护理,对挽救病人的生命及伤情预后有重要的意义.方法:对我科1997年2月至2001年4月27例创伤性休克病人进行早期,快速,积极的补液,输血增加有效循环量,监测生命体征等综合性抢救治疗与护理措施.结果:经早期积极急救护理,26例病人收缩压维持在60mmHg以上,意识清醒,脉搏有力,转入手术室或专科治疗,1例病人伤势严重抢救无效死亡.结论:创伤性休克病人,伤势复杂,死亡率高,伤后早期院前与急诊科的有效救护,是提高抢救成功率的关键.     

非霍奇金淋巴瘤采用CHOP方案治疗与护理

目的探讨NHL采用CHOP方案治疗中护理的重要性.方法对115例NHL采用CTX,750mg/m2 静滴第1日,VCR 1.4g/m2静滴第1.8日,PDN100mg/m2PO第1～5日,每21天为1周期,本组病例用药4～6个周期.结果顺利地完成了115例NHL的化疗,无1例出现化疗作用.结论肿瘤专科护理的措施是顺利完成化疗,减轻副作用,提高生活质量的保证.     

复治矽肺结核化疗效果观察

我们自１９８０～１９８８年对７９例复治矽肺结核进行化疗。其中绝大多数为慢性纤维化空洞性病例，均经细菌学证实，并由尘肺诊断组认定为矽肺合并结核。本组病例分别以ＫＭ、ＩＮＨ、ＲＦＰ、ＰＺＡ，或ＳＭ、ＩＮＨ、ＲＦＰ、ＥＢ联合，分两阶段治疗１８个月，获痰菌阴转７９．２％，其中ＫＨＲＺ与ＳＨＲＥ组分别为９３．９％与６８．２％（Ｐ＜０．０５）。自疗程结束追踪２～８年，其细菌复阳率分别为６．４５％和１０．０％（Ｐ＞０．１）。并对影响其过去治疗失败的原因及对策进行了讨论。     

乳腺癌的二级预防

在我国乳腺癌的发病率有逐渐增加的趋势，而且它对我国中年妇女的威胁最大。乳腺癌二级预防已被公认是降低死亡率的有效途径。综合应用宣教、自检、体检、Ｘ线摄影、近红外线摄影、超声检查、针吸活检、手术活检等方法对年龄在３０～６０岁的城市妇女定期进行分层筛检、监检可以使乳腺癌患者早期被发现，降低乳腺癌死亡率。     

E-cadherin、β-catenin、γ-catenin基因在胃癌组织中表达与侵袭转移的相关性

目的探讨上皮型钙粘蛋白(E-cadherin)、连接素-β(β-catenin)及连接素-γ(γ-catenin)基因在胃癌组织中表达与侵袭转移的关系。方法采用免疫组织化学SP方法对60例胃癌、20例癌前病变(包括10例肠化生胃粘膜和10例异型增生胃粘膜)及20例正常组织进行E-cadherin、β-catenin、γ-catenin基因表达情况的检测。结果正常胃粘膜及肠化生胃粘膜组织中E-cadherin、β-catenin、γ-catenin的细胞膜均呈清晰的棕褐色染色;胃异型增生组织中,E-cadherin及β-catenin在同1例细胞膜表达基本丢失,γ-catenin表达未见异常,即在异型增生胃粘膜三者异常表达率为10%(1/10),在胃癌原发灶为80%(48/60),与胃癌Ming分型、TNM分期、淋巴结转移密切相关(P<0.05)。E-cadherin、β-catenin、γ-catenin基因异常表达率分别为61.67%、55.00%、58.33%。结论E-cadherin、β-catenin、γ-catenin基因异常表达导致细胞间粘附性下降,影响了细胞接触性生长抑制等信号的传导,从而参与细胞的恶性转化,与胃癌的生长类型、侵袭转移密切相关,是判断胃癌生物学行为的良好指标。     

Current practice patterns in pancreatic surgery: Results of a multi-institutional analysis of seven large surgical departments in germany with 1454 pancreatic head resections, 1999 to 2004 (german advanced surgical treatment study group)

Despite decreasing mortality rates, morbidity is still high after pancreatic head resection. Comparative data in the United States and Europe show a relationship between hospital volume and mortality. Treatment strategies vary frequently, partially because of the lack of evidence-based data. We performed a multi-institutional analysis in Germany evaluating current numbers, indications, techniques, and complication rates of pancreatic head resection. Questionnaires were completed by seven high-volume surgical departments regarding quantitative and qualitative aspects of pancreatic head resections in the period from 1999 to 2004 (five prospective and two retrospective institutional databases). A total of 1454 pancreatic head resections (944 for malignancy) were reported. Mean annual hospital volume ranged from 14 to 52 (10 to 43 in malignancy). Mortality was between 1.1% and 4.8%, morbidity was between 24% and 46%, and pancreatic leakage was between 9% and 20%. In malignant disease, all centers perform standard lymphadenectomy and regard arterial infiltration as a contraindication for resection. However, the rate of portal vein resection varied from 0% to 28%. No consensus is seen on the type of surgery for malignancy and chronic pancreatitis. After resection for pancreatic cancer less than one fourth of the patients receive adjuvant therapy. The results of our analysis in Germany confirm that pancreatic head resection can be performed with low mortality in specialized units. Variations in indications, operative technique, and perioperative care may demonstrate the lack of evidence-based data and/or personal and institutional experience. The low number of patients receiving adjuvant therapy after resection of pancreatic cancer suggests that more efforts must be made to establish novel adjuvant therapies under randomized study conditions. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

河南省传染性非典型肺炎患者胸部X线表现

目的 :探讨传染性非典型肺炎的X线表现及变化规律。方法 :对河南省临床诊断的 1 5例患者发病后不同时间的系列胸片和CT进行回顾性分析。结果 :1 5例胸部X线病灶初始形态为斑片状 1 1例 (73.3% ) ,大片状 4例 (2 6 .7% ) ;双侧 9例 (6 0 .0 % ) ,单侧 6例 (4 0 .0 % ) ,均为中、下肺野 (1 0 0 % )。动态观察发现病变进展快 ,病变发展到高峰期时间为 4～ 1 4d , x±s(7.7± 3.2 )d ,双侧 1 3例 (86 .7% ) ,单侧 2例 (1 3.3% ) ,两肺叶及两肺叶以上病变者 1 4例 (93.3% )。病变开始吸收时间为 6～ 2 1d , x±s(1 1 .3± 4 .1 )d ;完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )d。1 5例经治疗均痊愈出院。住院时间 1 8～ 4 2d , x±s(31 .9± 7.9)d。 结论 :传染性非典型肺炎的胸部X线特点为急性双侧或单侧多叶炎性浸润阴影 ,以中、下野常见 ,进展迅速 ,及时复查胸部X线对临床诊断及判断病情具有重要价值。     

Screening of HIV-1 isolates by reverse heteroduplex mobility assay and identification of non-B subtypes in Italy

OBJECTIVE: The increasing prevalence of HIV-1 transmission through heterosexual contacts and the growing number of immigrants from non-Western countries, where non-B subtypes and recombinant forms are prevalent, suggest the possible emergence in Italy of a new epidemic wave of HIV-1 non-B subtypes as well as recombinant forms. METHODS: The distribution of HIV-1 subtypes has been evaluated in 63 seropositive individuals residing in Italy, most of whom were infected through a sexual route during the last 5 years. A modified heteroduplex mobility assay (HMA) strategy, reverse HMA (rHMA), has been developed in our laboratory, allowing rapid identification of divergent-from-B-subtype isolates, which have been subsequently characterized by detailed molecular and phylogenetic analyses. RESULTS: Five samples show, on rHMA, an electrophoretic pattern compatible with a non-B subtype classification. Their phylogenetic analysis, performed on both env and gag regions, confirms the rHMA subtyping prediction, given that 3 samples fall into the "A-family" subtype and 2 into the G subtype. The 5 non-B-subtype HIV-1 isolates have been identified among 23 variants (prevalence, 21.74%) isolated during the 2000 to 2001 period in heterosexuals. In parallel, B-subtype isolates show high levels of intrasubtype nucleotide divergence, compatible with a constant HIV-1 molecular diversification. CONCLUSION: The Italian HIV-1 epidemic is still mostly attributable to the B subtype, which shows an increasing nucleotide heterogeneity. Heterosexual transmission and the interracial blending, however, are slowly introducing novel HIV-1 subtypes, and the data indicate that rHMA represents a powerful tool for HIV-1 biomolecular screening in epidemics characterized by a mono-/dual-subtype predominance.