急性胰腺炎病因和诊治十年变迁(附725例报道)

急性胰腺炎的病因和早期诊治一直是临床医师关注的问题。目的：探讨近十年来急性胰腺炎病因、诊断和治疗的变迁及其对预后和住院费用的影响，总结急性胰腺炎的治疗经验。方法：采用回顾性临床研究方法，将725例人选患者分为两组．1993年4月～1998年12月就诊的患者为第一组，1999年1月～2002年8月就诊的患者为第二组：分析两组患者病因、诊断指标、治疗方案、并发症、预后、住院费用方面的变化。结果：比较两组病因，两组患胆囊炎胆结石者分别占72．3％和75．8％，高脂血症者分别占25．3％和25．8％，酗酒者分别占10．6％和9．7％。血清淀粉酶水平高于正常上限3倍的总检出率为66．9％．CT诊断总阳性率为92．0％。第一组46．9％的患者应用生长抑素，31．1％的重症患者发生胰腺假性囊肿，2．2％发生胰腺脓肿，死亡率为15．6％。第二组72-3％的患者应用生长抑素，13．2％的重症患者发生胰腺假性囊肿，2．2％发生胰腺脓肿，死亡率为6．5％。第二组的住院费用与第一组相比呈下降趋势，但无显著差异。结论：胆道疾病仍为急性胰腺炎的主要病因，血清淀粉酶和CT是急性胰腺炎较常用和可靠的检查手段。通过早期足量应用胰酶抑制剂(尤其是生长抑素)、肠道去污和改善胰腺微循环，可改善急性胰腺炎的预后，降低并发症发生率、死亡率和住院费用。     

产后出血159例临床分析及护理

目的　探讨产后出血的原因与影响因素。方法　回顾分析收治的产后出血 15 9例 ,数据处理采用χ2 检验。结果　产后出血发生率 3.5 % ,产后 2小时内出血者 88.6 7% ,出血原因宫缩乏力为 6 6 .6 7% ,影响因素有手术产、流产史、分娩史、妊娠合并症及产程延长等 ,统计学处理P <0 .0 1。结论　重视产后出血的影响因素 ,正确评估出血量及产妇产后 2小时留置产房观察是产后出血早期诊断的关键 ,其预防重点在于早期发现并针对不同原因及时正确处理     

良性淋巴上皮病、淋巴上皮癌、MALT淋巴瘤的关系

良性淋巴上皮病(benign lymphoepithelial lesion)、淋巴上皮癌(lymphoepithelial carcinoma)、黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(MALT淋巴瘤)(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT lymphoma)是3种性质不同但又存在某些关联的病变,本文对3种病变的病因、组织病理学表现及三者之间的关系进行了介绍,并结合叶为民等论文中的一些内容进行了简要探讨。     

Infective endocarditis at a Hospital of the University of Kiel, 1958–1987

Summary The clinical courses of 214 patients with infective endocarditis treated between 1958 and 1987 at the First Medical Hospital of the University of Kiel (FRG) were analyzed retrospectively. A decrease in the incidence of endocarditis occurred during the 30-year observation period. The mean age of patients was 48 years, and men were more frequently affected than women. In the course of the investigation, a rise in isolated aortic valve disease was noted, whereas the number of patients with isolated involvement of the mitral valve and combined mitral-aortic valvular defects declined. Streptococci (57%) were the most frequent pathogens isolated; as opposed to their increase, the percentages ofStaphylococcus aureus and enterococci decreased. Otolaryngological, dentogenic and urogenital diseases were most frequently held to be responsible for the development of infective endocarditis. Prior cardiosurgical interventions became increasingly significant as a cause of the disease. In this connection, a rising percentage of endocarditis cases was linked with prosthetically replaced heart valves. Complications and concomitant symptoms of endocarditis included the development of heart failure, cerebral embolism and encephalitis, splenomegaly, and renal inflammation. Finally, the marked decrease in mortality contrasted with a simultaneous rise in the number of endocarditis cases achieving full recovery.     

广东省人群中人嗜T细胞病毒Ⅰ型感染的血清流行病学调查及其与人类疾病的关系

收集广东省各类人群血清标本２２２４份，用间接免疫荧光法检测人类嗜Ｔ细胞病毒Ⅰ型（ＨＴＬＶ－１）抗体，结果：ＨＴＬＶ－１抗体阳性３５份，总阳性率为１．５７％；其中健康人群血清１８１０份，抗体阳性２３份，阳性率为１２７％；献血员血清２４８份，抗体阳性１份，阳性率０４０％；白血病患者血清１０９份，阳性８份，阳性率７３４％，与健康人群比较，有非常显著性差异（Ｐ＜０００５）；神经系统疾病患者血清５７份，阳性３份，阳性率５２６％。     

宫颈癌患者血清硒含量分析

目的　探讨微量元素硒在子宫颈癌发生中所起的作用。方法　采用AFS12 0 1型原子荧光光度计对4 4例宫颈癌患者 ,18例宫颈良性疾患及 2 0例健康人血清硒含量进行了检测。结果　宫颈癌患者血清硒含量1 0 6± 0 18μmol/l明显低于宫颈良性疾患 1 2 8± 0 17μmol/l及健康人 1 2 8± 0 2 4 μmol/l,差异有显著性 (P <0 0 5)。结论　宫颈癌发病与硒缺乏有关 ,对宫颈癌患者适当补硒 ,可能是一种合理、有效的治疗手段     

巯甲丙脯酸用于流行性出血热治疗临床观察

目的观察巯甲丙脯酸用于流行性出血热治疗的临床效果。方法病人随机分为A、B、C3组,A组在进入少尿期口服巯甲丙脯酸25mg,日3次;B组在少尿期并发高血压时开始服用,剂量方法同A组。C组在少尿期并发高血压时口服复方降压片1～2片,每日3次。其他治疗相同。结果A组无1例发生高血压;B组用药后4～6小时血压开始下降,72小时后血压稳定且正常。C组血压偏高。A、B组肾功能恢复快,并发症少,病程短。结论巯甲丙脯酸用于治疗流行性出血热可减少或防止急性肾功能衰竭,减少并发症。     

先天性巨结肠发病的部分影响因素调查

目的 采用调查问卷的方式,对先天性巨结肠患儿母孕期状况及家庭史进行调查分析,探讨先天性巨结肠发病的部分影响因素,以期为防病提供临床参考。方法 对60例先天性巨结肠和40例正常儿童进行统一问卷调查,采用逐步回归分析的方法发现与先天性巨结肠的发病部分可能有关的因素。结果 先天性巨结肠的发病部分可能有关的因素是母孕期被动吸烟状况、患儿性别、母孕期有害物质接触史和家庭恶性肿瘤病史。结论环境和遗传因素与先天性巨结肠的发生有一定关系。     

噬血细胞综合征研究进展

噬血细胞综合征 ( HPS)是 T细胞介导的组织细胞异常增生 ,部分病例已证实 TCRγ或 β基因的单克隆重排。半数病例进展急剧 ,预后不良 ,缺乏特效治疗 ;重症病例早期异基因骨髓移植优于常规化疗或免疫抑制治疗。临床和细胞形态学、组织学与恶性组织细胞增生症 ( MH )十分相似 ,尚缺乏特异鉴别标记。 HPS比 MH多见 ,部分病例常误认为 MH。本文就 HPS有关资料 ,对该病的发病学、临床表现、实验室检查、治疗及转归进行系统复习     

Prevalence survey of movement disorders, epilepsy, hypertension and smoking habit in Vejer de la Frontera, Southern Spain-I. Methodology

A prevalence survey of movement disorders, epilepsy, hypertension and smoking was undertaken in Vejer de la Frontera, Southern Spain in 1988. A validated screening instrument designed for door-to-door tracing of specific disorders was used. Neurological diagnoses were based on: (1) direct anamnesis and examination by a senior neurologist; (2) perusal of existing medical records; and (3) in a proportion of cases, a hospital-based complementary study. This experience suggests that, while door-to-door surveys of neurological disorders have focused on multiple major outcomes: (1) scientific and logistic reasons can exist for screening for specific neurological disorders, and (2) scientific and public health-related interventional objectives can be combined advantageously when such costly investigations are conducted.