内镜黏膜下剥离术治疗28例上消化道肿瘤病人的围术期护理

对28例上消化道肿瘤内镜黏膜下剥离术（ESD）病人,针对性地给予术前、术中、术后护理,总结ESD围术期护理经验。ESD是治疗上消化道黏膜下肿瘤较好的微创治疗方法,良好、得当的围术期护理是ESD手术成功的保证。     

内镜下吸引结扎治疗上消化道黏膜下肿瘤47例分析

目的：探讨内镜下吸引结扎法治疗上消化道黏膜下肿瘤（submucosal tumors,SMT）的临床价值。方法：47例上消化道SMT患者采用内镜下透明帽吸引结扎方法治疗。结果：47例患者经治疗后,能成功阻断肿瘤的血液供应使其自行脱落,术后4周手术部位疤痕愈合。病理报告示食管平滑肌瘤37例,胃平滑肌瘤5例,黏膜下间叶源性肿瘤4例,脂肪瘤1例。结论：吸引结扎法能阻断血流使肿瘤坏死脱落,是一种治疗上消化道SMT安全有效的内镜治疗方法。     

内镜黏膜下剥离术治疗上消化道肿瘤的护理配合

总结内镜黏膜下剥离术治疗15例上消化道肿瘤的护理配合,认为术前护理、术前准备、术中护理配合和术后护理对提高手术疗效和安全性非常重要.     

内镜黏膜下剥离术治疗上消化道肿瘤的护理配合

总结内镜黏膜下剥离术治疗15例上消化道肿瘤的护理配合，认为术前护理、术前准备、术中护理配合和术后护理对提高手术疗效和安全性非常重要。     

内镜下黏膜剥离术治疗消化道黏膜下肿瘤56例围术期护理

目的:探讨内镜下黏膜剥离术(ESD)治疗消化道黏膜下肿瘤的围术期护理方法。方法:对56例消化道黏膜下肿瘤患者行ESD,给予精心术前、术中、术后护理。结果:56例患者均成功进行ESD治疗,3例术中出现穿孔,经及时处理后,病情稳定。术后随访6个月～1年,创面基本愈合,无一例出现复发。结论:做好内镜下黏膜剥离术治疗消化道黏膜下肿瘤患者的术前、术中、术后护理,可减少并发症的发生,提高治愈成功率。     

食管黏膜下肿瘤的超声内镜诊断与内镜下微创治疗

目的 评价超声内镜对食管黏膜下肿瘤的诊断及治疗价值,探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管黏膜下肿瘤的疗效和安全性.方法 对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查.2例起源于黏膜层的食管息肉;34例起源于黏膜肌层的食管平滑肌瘤;4例起源于黏膜下层,包括脂肪瘤2例,食管囊肿1例,孤立静脉瘤1例(内镜下呈蓝紫色,未予处理).根据食管黏膜下肿瘤的起源层次、性质及病变大小决定行内镜下EMR或ESD治疗,完整切除病变.结果 40例食管黏膜下肿瘤,病变最大直径0.4～2.5 cm,平均1.45 cm.29例行内镜下EMR治疗,6例病变最大直径超过1.5 cm者行内镜下ESD治疗,ESD手术时间15～45min,平均30min.4例起源于固有肌层的食管黏膜下肿瘤考虑穿孔可能性大未予内镜下治疗.2例术中出血较多,经内镜下喷洒止血药物、电凝、氲离子凝固术治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔.所有EMIL、ESD切除病变全部送检病理确诊,基底和切缘未见病变累及.术后1.5及6个月随访,创面愈合,无病变残留和复发.结论 超声内镜能够对食管黏膜下肿瘤进行起源和定性诊断,可指导黏膜下肿瘤的治疗.大多数食管黏膜下肿瘤行EMR治疗简便、安全,对于痛灶较大、EMR难以完整切除的病变行ESD治疗安全、有效,可以完整切除食管病变,提供完整的病理诊断资料.     

20例消化道黏膜及黏膜下病变行内镜黏膜下剥离术的护理

目的：探讨内镜胃黏膜下行剥离术(ESD)治疗消化道黏膜及黏膜下病变疾病的护理。方法对20例内镜下行ESD治疗患者的护理进行回顾性分析。结果20例患者除1例患者术后出现穿孔并皮下气肿,其余患者均顺利手术、痊愈出院。结论对ESD治疗患者做好术前准备、术中护理配合、术后监测生命体征及早期发现并处理并发症是ESD手术治疗成功的重要保证。     

内镜下尼龙绳套扎术治疗上消化道黏膜下肿瘤18例围术期护理

目的:探讨内镜下尼龙绳套扎治疗上消化道黏膜下肿瘤的围术期护理效果。方法:对18例患者术前做好手术准备,进行心理护理;术中与手术医生密切配合;术后进行饮食护理、用药指导等。结果:手术均成功完成,治疗后4周内复查胃镜,12例肿物完全消失,局部有瘢痕形成;4例患者进行2次套扎,肿物完全消失;2例坏死物脱落不完全,有肿瘤残留,在内镜下行高频电切除术。结论:对上消化道黏膜下肿瘤患者行内镜下尼龙绳套扎术并加强围术期护理可提高手术成功率,促进患者康复。     

上消化道平滑肌瘤行内镜黏膜切除或剥离术30例围术期护理

目的：探讨内镜黏膜切除术（EMR）或内镜黏膜下剥离术（ESD）治疗上消化道平滑肌瘤患者围术期的护理方法。方法：对30例上消化道平滑肌瘤患者行EMR或ESD,并给予精心围术期护理。结果：本组术中出现出血8例、穿孔1例,经严密观察、治疗、护理后病情稳定。术后随访1～8个月,复查胃镜,创面基本愈合,无病变残留及复发。结论：做好上消化道平滑肌瘤行EMR或ESD患者的围术期护理,可减少并发症的发生,提高治疗成功率。     

内镜黏膜下剥离术在上消化道相关病变的应用

目的探讨内镜黏膜下剥离术(ESD)治疗上消化道黏膜及黏膜下病变的疗效和安全性。方法经胃肠镜及超声内镜检查确诊为上消化道黏膜及黏膜下病变患者26例(其中6例为黏膜病变、20例为黏膜下病变),应用内镜黏膜下剥离术治疗,并对病理、治疗效果进行评估,术后内镜随访1周～2年不等。结果 26例入选病例中食管9例,胃15例,残胃1例,十二指肠球部1例。治疗情况:22例完整剥离,4例部分剥离。术中4例少量出血、1例食管轻度穿孔经术中及术后保守治疗均有效,1例出血较大予以外科手术治疗。病理:平滑肌瘤8例,间质瘤1例,纤维瘤1例,异位胰腺3例,脂肪瘤2例,潴留囊肿1例,异型增生7例,癌变3例。完成随访10例,其中1例早期食管癌复发,其余愈后良好。结论 ESD治疗上消化道黏膜及黏膜下病变安全、有效,术前严格评估及术中对切除范围及深度严密把握对减少病灶残留和病变复发、降低并发症发生率尤为重要。     

Pathophysiology of prenatal drug-exposure: in utero, in the newborn, in childhood, and in agencies

Medical communities are documenting an increase in the numbers of infants being born with prenatal drug exposure. Medical, educational, and social agencies are serving large numbers of these infants, toddlers, and their families. These infants and toddlers constitute a population whose short-term and long-term needs have not been adequately identified or addressed in the health, social, emotional, or developmental domains. This article discusses the pathophysiology in prenatal drug exposure and the role of the nurse when providing services to these infants, toddlers, and their families.     

Comparison of Tobramycin, Gentamicin, Colistin, and Carbenicillin in Pseudomonas Sepsis in Monkeys

Intravenous inoculation of 3.4 x 10(10) to 7.4 x 10(10)Pseudomonas aeruginosa organisms into rhesus monkeys 4 days after intravenous or intratracheal inoculation of 2.0 to 2.5 mg of vincristine sulfate resulted in fatal sepsis in eight of nine monkeys. After intramuscular administration, in two equal doses, of 5 mg of tobramycin, gentamicin, and colistin per kg per day beginning 16 hr after challenge, 4 of 11, 4 of 11, and 3 of 10 monkeys died, respectively. Administration of daily doses of 100 to 400 mg of carbenicillin per kg was followed by death in 5 of 12. Duration of illness in the surviving monkeys in each therapy group was similar. Under the conditions of this study, prior administration of vincristine sulfate resulted in a decrease in leukocytes and enhanced susceptibility to Pseudomonas infection. Using this model for studies of comparative efficacy of antibiotics, we observed comparable results after treatment with tobramycin, gentamicin, colistin, and carbenicillin.     

Use of Primary Health Care in Spili,Crete, and in Dalby,Sweden

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC).

In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%), but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%).

There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.     

Comparative distribution of gentamicin, tobramycin, sisomicin, netilmicin, and amikacin in interstitial fluid in rabbits.

We compared the penetration of five aminoglycosides into interstitial fluid (IF). IF was obtained in rabbits from Silastic tissue cages. Intramuscular injections were made: 1.5 mg/kg per dose for gentamicin (G), tobramycin (T), sisomicin (S), and netilmicin (N) and 7.5 mg/kg per dose for amikacin (A). Serum levels and IF concentrations were studied for 12 h after a single injection. IF levels were also compared in a six-injection study (one injection every 8 h). Peak serum levels were significantly higher with A than with G, T, S, and N, which gave similar concentrations. In IF, G gave the highest levels 1 h after the first injection. At 4 and 8 h, the concentrations achieved with G and A were similar but significantly greater than those achieved with T, S, and N. Twelve hours after a single injection, N gave higher IF levels than the other drugs except A. In the six-injection study, the IF levels of G and A reached 4.6 +/- 1.5 and 5.27 +/- 1.1 microgram/ml, respectively, at 48 h. S and N gave identical concentrations (2.07 +/- 0.25 and 2.42 +/- 0.42 microgram/ml, respectively). T induced the lowest levels (1.17 +/- 0.30 microgram/ml). Thus, in this rabbit model, the IF concentrations achieved with G and A were above the minimal inhibitory concentrations for most susceptible strains. Possible relations between IF aminoglycoside concentrations and therapeutic efficiency or toxicity are pointed out but deserve further studies.     

Postnatally Induced Inactivation of gp130 in Mice Results in Neurological,Cardiac, Hematopoietic,Immunological, Hepatic,and Pulmonary Defects

The pleiotrophic but overlapping functions of the cytokine family that includes interleukin (IL)-6, IL-11, leukemia inhibitory factor, oncostatin M, ciliary neurotrophic factor, and cardiotrophin 1 are mediated by the cytokine receptor subunit gp130 as the common signal transducer. Although mice lacking individual members of this family display only mild phenotypes, animals lacking gp130 are not viable. To assess the collective role of this cytokine family, we inducibly inactivated gp130 via Cre-loxP–mediated recombination in vivo. Such conditional mutant mice exhibited neurological, cardiac, hematopoietic, immunological, hepatic, and pulmonary defects, demonstrating the widespread importance of gp130-dependent cytokines.     

梅州市客家人群ABO、Rh、MN系统血型分布

为了解梅州市客家人群血型分布情况,笔者调查统计了7125名无偿献血者的ABO、Rh血型系统和405名无偿献血者的 MN血型系统,报告如下. 1 材料与方法 1.1 调查对象梅州市客家地区无偿献血人群(父母双方上溯三代均为客家人). 随机抽样,不分性别和年龄. 1.2 试剂抗-A及抗-B单抗血清(长春生研所);抗-C、-c、-D、-E,抗-M、-N血清(广州血液中心);Polymatching试剂(Baso公司). 1.3 方法按<中国输血技术操作规程>(血站部分)进行.同时用标准红细胞作对照试验,以确认抗血清的可靠性.各血型系统基因频率的计算公式见文献[1]. 2 结果(见附表).     

Absorption, distribution, metabolic fate, and elimination of pefloxacin mesylate in mice, rats, dogs, monkeys, and humans

Pefloxacin mesylate is well absorbed by the oral route. The antimicrobial activity in dog, cynomolgus monkey, and human plasma was essentially due to unchanged drug which respectively accounted for 64, 94, and 84% of the total activity (ratios derived from relative area under the curve [AUC] values). Half-lives ranged from 1.9 h in mice to 8.6 h in humans. Protein binding was weak, about 20% in plasma. Except in brain, concentrations in most of the organs and tissues tested in rats and dogs were higher than the plasma levels. Microbiological activity in urine was mainly due to pefloxacin and norfloxacin, the N-desmethyl metabolite. The norfloxacin/pefloxacin ratios were 0 in mice, ca. 1 in rats and dogs, 1.6 in cynomolgus monkeys, and 2.3 in humans. The principal urinary compounds were unchanged drug in mice, pefloxacin glucuronide and pefloxacin N-oxide in rats and dogs, norfloxacin and pefloxacin in monkeys, and pefloxacin N-oxide and norfloxacin in humans. The urinary recovery of identified metabolites was 29.5% of the dose in mice, 37.8% in rats, 36.3% in dogs, 26.5% in monkeys, and 58.9% in humans. Biliary excretion occurred and was extensive in rats and dogs, mainly as a glucuronide conjugate of the drug. In rat and human bile, the main active compound was unchanged pefloxacin.