食管癌术后并发急性呼吸衰竭64例临床分析

探讨食管癌术后并发急性呼吸衰竭的原因，预防及治疗方法。方法：回顾分析1995年1月—2002年12月，756例食管癌切除术后并发急性呼吸衰竭64例病例资料(男49例，女15例，平均62岁)，分析术后出现呼吸衰竭的相关因素及术后处理。结果：756例食管癌术后64例(8．5％)并发急性呼吸衰竭，16例气管插管呼吸机辅助，48例行气管切开，58例治愈，6例死亡，病死率9．4％，高龄，肺功能受损，合并心肺基础疾病，手术方式为术后出现急性呼衰的高危因素。结论：急性呼吸衰竭为食管术后严重并发症，病死率高，术前应充分评估选择适应症及手术方式，治疗应及早使用呼吸机辅助通气。     

胆道术后胆漏36例临床分析

文章对1614例肝外胆道手术出现的36例胆漏的临床资料分析，对胆漏的发生率、原因、预防、诊断及处理进行了较深入的讨论，提出手术者应对胆漏有所警惕，在手术中能准确地认清正常的、变异的及病理性解剖结构避免粗疏所致的手术损伤，即能降低胆漏的发生率，使胆漏不易发生。     

不经意的“小手术”

在前不久举行的青岛市农村小学英语教研会上，张坤霞老师的一堂语音课折服了在场的所有听课老师。课堂上流淌着新课改的理念，如缕缕春风，吹进了老师们的心田。在课后反思时，张老师特别提到在上课前一两个小时才改动的一个教学细节。这看来不经意的一个“小手术”，却是教师灵感的闪现，是对新理念的实践，使整个课堂教学焕发出一种生命的活力，值得我们思考、品味。     

巨型嗅沟脑膜瘤的手术治疗体会

本文报告4例巨型嗅沟脑膜瘤的手术治疗情况。本组病例肿瘤最小为7.5×8.0cm,最大为11.5×10.0cm。均采用前额冠状头皮切口,双额骨瓣开颅,肉眼直视下分块完全切除肿瘤,术后恢复良好,无死亡,随访1～5年情况良好。文中重点对本病的早期诊断和手术治疗方法进行了讨论。     

邢更彦：重建骨科治疗

肩周炎、网球肘、高尔夫球肘、肩峰下滑囊炎、跟痛症、股骨头无菌性坏死、疲劳骨折以及骨不连及骨折延迟愈合等是骨科的常见病和多发病。长期以来,对这些骨科疾病的治疗主要以保守治疗及外科手术治疗为主,保守治疗对轻症,病史较短者尚有效,对病情较重、保守治疗无效者只能进行手术治疗。而手术治疗虽然疗效较好,但是因其有创伤,并发症较多,使许多患者难以接受。因此,寻找安全、有效、无创的治疗方法一直是临床医疗工作者孜孜以求     

守护生命的妙手仁心

国际上一致认为,直接手术切除巨大脑血管畸形,将可能导致严重的脑水肿、有时会造成病人死亡。首都医科大学附属天坛医院神经外科赵继宗教授带领的课题组让这疑团烟消云散,并攻克了一次性手术切除巨大脑动静脉畸形的医学难题。     

悲情布鲁斯

这个故事马哥至少当着我的面讲过了不下五次，我知道，因为我的在场可以证明这个故事的真实性。马哥是写小说的，对富有戏剧性的故事有偏爱，何况他又是一个很性情的人，事关爱憎一吐为快，不像我这样拖泥带水。     

高龄大肠癌患者围手术期护理

结直肠癌是我国常见的消化道恶性肿瘤之一，近年来的发病率呈上升趋势。虽然它随生长部位不同所引发的临床表现各异，但均严重影响着患者的营养状态和生存质量。同时随着社会的发展，国人的寿命越来越长，需要接受大肠癌手术治疗的老年病人逐年增加，而老年人随年龄老化，机体重要脏器功能退行性变，生理储备和代偿功能减退，应激能力、免疫功能和手术耐受性均下降，发生并发症的危险性和死亡率都明显高于其他人群。     

Short Report： Cyclic patterns of incidence rate for skin malignant melanoma： association with heliogeophysical activity

Background: Our previous studies revealed cyclicity in the incidence rate of skin malignant melanoma (SMM; ICD9, Dx: 172) in the Czech Republic (period T=7.50～7.63 years), UK (T=11.00 years) and Bulgaria (T=12.20 years). Incidences com-pared with the sunspot index Rz (lag-period dT= 2, 4, 6, 10 or 12 years) have indicated that maximal rates are most likely to appear on descending slopes of the 11-year solar cycle, i.e., out of phase. We summarized and explored more deeply these cyclic variations and discussed their possible associations with heliogeophysical activity (HGA) components exhibiting similar cyclicity. Methods: Annual incidences of SMM from 5 countries (Czech Republic, UK, Bulgaria, USA and Canada) over various time spans during the years 1964～1992 were analyzed and their correlations with cyclic Rz (sunspot number) and aa (planetary geomagnetic activity) indices were summarized. Periodogram regression analysis with trigonometric approximation and phase-correlation analysis were applied. Results: Previous findings on SMM for the Czech Republic, UK and Bulgaria have been validated, and cyclic patterns have been revealed for USA (T=8.63 years, P<0.05) and Canada (Ontario, T=9.91 years, P<0.10). Also, various 'hypercycles' were established (T=45.5, 42.0, 48.25, 34.5 and 26.5 years, respectively) describing long-term cyclic incidence patterns. The association of SMM for USA and Canada with Rz (dT= 6 and 7 years, respectively) and aa (dT=-10 and 9 years, respectively) was described. Possible interactions of cyclic non-photic influences (UV irradiation, Schumann resonance signal, low-frequency geomagnetic fluctuations) with brain waves absorbance, neuronal calcium dynamics, neuro-endocrine axis modulation, melatonin/serotonin disbalance and skin neuro-immunity impairment as likely causal pathways in melanoma appearance, were also discussed. Conclusion: The above findings on cyclicity and temporal association of SMM with cyclic environmental factors could not only allow for better forecasting models but also lead to a better understanding of melanoma aetiology.