多级图像对比度放大技术在膝关节摄影中的应用

目的:分析评价膝关节摄影中多级图像对比度放大技术(MUSICA)参数设定的成像效果,为实际临床应用提供理论指导。方法:随机抽取膝关节侧位软拷贝图像70例,以骨皮质、骨小梁、肌间隙、髌上囊、皮下脂肪为比对目标,由三位观察者对其显示情况进行分析,并对结果进行统计分析。结果:MUSICA处于较小值(0～2)时,适合于软组织显示,但图像锐利度欠缺;处于较高值时(4～6)适合于观察骨皮质、小梁等细节信息,但较多地出现伪影,共25例;处于2～4时整体影像对比度适中,如实反映人体密度结构。结论:作图像处理时应将MUSICA为2～4设定为常规,实际应用通常情况下可以选择该处理方法,但应根据具体要求适当调整MUSICA参数值。     

宫颈癌放疗后家庭阴道冲洗效果观察

目的:为寻找一种院外阴道冲洗的有效方法,从而帮助一些由于各种原因不能来医院行阴道冲洗术的患者继续完成治疗。方法:对204例宫颈癌放疗结束后的患者随机分实验组与对照组,实验组实施家庭阴道冲洗,对照组未行阴道冲洗,通过放疗结束后1个月、3个月、6个月门诊随访,观察阴道粘膜急性放射反应治疗后消退情况,对家庭阴道冲洗患者和未行阴道冲洗者进行对照研究。结果:行家庭阴道冲洗者在阴道粘膜急性放射反应方面与未冲洗者差异有显著性(P<0.05)。结论:家庭阴道冲洗是对因各种原因出院后不能来医院行阴道冲洗的患者可以采取的一种行之有效的方法。     

岗位业绩导向的医院薪酬设计

基于现代管理理论和医院的实际情况，设计了一种以岗位和业绩为导向的医院薪酬制度。该设计的主要特点是：①薪酬结构以岗位工资和绩效工资为主体，同时兼顾稳定和逐步过渡原则，原档案工资的固定部分(约占档案工资的60％)保留。②岗位工资采用全院统一的等级薪酬结构，等级的评定基于全院统一的指标体系和权重，岗位工资每年随绩效考核结果在工资带宽中升降；③绩效工资与岗位等级和绩效考核紧密挂钩，考核的依据是全院统一模式的岗位绩效合同；④整个薪酬设计建立在岗位调查、岗位评价和岗位说明书等的科学规范的工作基础之上。     

The Post Therapy Breast

Both systemic and local therapy, for conditions of the breast and unrelated to it, may produce manuno-graphic changes. Some of these are characteristic, such as the pattern of scarring seen in reduction mammo-plasty. In many other instances, however, the changes produced overlap features commonly seen in malignancy. A knowledge of the timing, natural history and spectrum of these changes will aid mammographic interpretation.     

Induced abortion in China and the advances of post abortion family planning service

<正>This is a review of current situation of induced abortion and post abortion family planning service in China. Induced abortion is an important issue in reproductive health. This article reviewed the distribution of induced abortion in various time, areas, and population in China, and explored the character, reason, and harm to reproductive health of induced abortion. Furthermore, this article introduces the concept of Quality of Care Program in Family Planning, and discusses how important and necessary it is to introduce Quality of Care Program in Family Planning to China.     

Post-renal transplant erythrocytosis in a child

We report the case of a 7-year-old boy who developed severe erythrocytosis 4 months after successful kidney transplantation, with a well-functioning graft. When the haematocrit rose above 60%, phlebotomy had to be performed once to twice a week in order to keep the haematocrit below 50%. A 3-month course of theophylline therapy did not influence the erythrocytosis significantly. There were 5 further patients with erythrocytosis out of 186 children who had undergone kidney transplantation at our centre.     

鸡精促进产后乳汁分泌效果的临床观察

目的观察鸡精用于产后乳汁分泌的临床效果。方法产后每日早晚各服白兰氏鸡精70ml，共服3d，并与对照组、中药材催乳组对比。结果鸡精有促进早泌乳与增加泌乳量的作用。结论鸡精用于产妇有滋养身体，恢复产妇体力，促进早泌乳和增加泌乳量的作用，且饮用方便，效果好，无不良反应。     

Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Despite low end dialysis serum phosphate levels (P_e) the control of phosphate retention remains often unsatisfactory in dialyzed patients. In order to assess the value of P_e in dialyzed children as an indicator of dialytic phosphate removal, we studied serum phosphate kinetics over the period of dialysis and post dialysis and compared these with urea kinetics. A multicenter study was conducted in the 21 French pediatric hemodialysis units and included 144 children under 15 years of age. Blood urea and phosphate concentrations were measured at the beginning, at 45 min later, at the end of dialysis, and 30 min post dialysis. At 60 min and at 360 min post dialysis measurements were made only for a subgroup of 12 children. From the serum levels, reduction ratios for urea (URR) and phosphate (PRR) and post dialysis rebound for urea (PDUR) and phosphate (PDPR) were calculated. URR (over the dialysis session, 72%±9%) was higher than PRR (47%±12%). Moreover, urea removal continued throughout the dialysis period, while most of the reduction in phosphate occurred in the initial dialysis period. Post dialysis urea rebound was limited to the 60th min post dialysis, whereas post dialysis phosphate rebound occurred until the 360th min post dialysis; by this time the serum phosphate levels had almost reached the predialysis levels. In summary, serum phosphate kinetics over dialysis and post dialysis periods in children appear to be misleading for the quantification of phosphate removal, i. e., phosphate clearance is a poor indicator of dialytic phosphate removal. Received September 21, 1995; received in revised form and accepted June 11, 1996     

Reforming the coroner and death certification service

The intention of the Home Office is to introduce a new system that combines an independent check on all deaths and a professional oversight of death patterns, with, for the majority of cases, the minimum of bureaucracy. No public consultation is intended, so that reforms are not delayed. However as the proposals are developed in the coming months, the details, practicalities and costs will be discussed “with relevant professionals (not defined) and those with experience of the existing arrangements”. The imperfections of the present system are outlined. It is hoped the medical profession will have an input, since statements such as “ ‘hospital post mortems’, which are for medical research and public health protection purposes” need amendment. There should be a change in perception of the audit value of this procedure to BOTH the family and the treating doctor. Unfortunately it is proposed the new system in total should cost no more than at present. “Professionals” (not defined) will be involved in the financial detail.All deaths, after verification and certification of the medical cause of death (if known) would then be referred to the ‘medical examiner’ based in the coroner's office. He/she would be a qualified doctor employed by the new coroner service and independent of the Health Service. The medical examiner could provide supplementary advice on medical matters required by the coroner. “Retention of tissue should only take place where absolutely necessary and the coroner and his or her other staff should take account of the needs of families and friends carefully throughout the process.” “Coroners could take advice from their medical examiner to ascertain and prescribe the minimum level of invasiveness to establish the cause of death.” This issue is far from resolved, as signified by a recent call from the DoH giving a grant to study the value of MRI versus a full post mortem. No thought is given to systemic diseases, which may present in one organ system or another disease process, other than that causing death. Medical examiners will have to keep abreast of current developments in medicine BUT will be outside the NHS, which could cause problems. Medical examiners will be appointed (with an input from Regional Directors of Public Health) and managed from within the coroner service. They would work closely with the registrar of births and deaths.Deaths from unnatural causes or when the medical cause of death is unknown will result in judicial inquests. The medical examiner will have an input into causes of death and relevant investigations.Details of the proposed structure of the system are given, as well as the investigative and other roles of Coroner's officers.The establishment of medico-legal centres, as “examples of good practice” is advocated. The drawbacks of this system are stressed in this paper. There is at present an on-going review of forensic pathology services and it is hoped thought will be given to the increasing trend for sub-specialisation in medicine.