肾放免联检在严重烧伤临床的应用及分析

本文对52例烧伤病人（面积30－90％，Ⅲ度0－66％）各时相的肾功能作了放射免疫七项联检测定。经多方元差分析逐步回归分析的统计学处理结果为：1．血β2-m（β2-微球蛋白）各时相均明显升高。2.尿ALb（尿蛋白）伤后二周明显升高。3．血IgG（免疫球蛋白）伤后前二周明显下降。4．尿IgG（免疫球蛋白）伤后排出增多。5.血THp（粘蛋白）各时相在正常范围内。6.尿THP在伤后两周内升高明显．7．Ⅲ度烧伤面积＞50％BSA，THP升高明显。经验检和统计学处理，得出烧伤面积、血β2-m、血THP升高、血IgG下降与死亡机率显著性相关，对严重烧伤患者的予后判断有一定的临床意义和参考价值。

胸肺恶性肿瘤心包转移10例临床观察

胸肺恶性肿瘤心包转移如不及时诊治会增加死亡机率，因心包填塞导致循环衰竭可在短时间内死亡，若及早诊治不但解除心包填塞，亦给治疗原发病争取了时间．现笔者特将我科收治的怖癌、胸膜恶性间皮瘤．纵隔恶性淋巴瘤心包转移的患者报告分析如下？

Incidence and mortality of gastric cancer in China

Gastric cancer is one of the most frequent cancers in the world; almost two-thirds of gastric cancer cases and deaths occur in less developed regions. In China, based on two national mortality surveys conducted in 1970s and 1990s, there is an obvious clustering of geographical distribution of gastric cancer in the country, with the high mortality being mostly located in rural areas, especially in Gansu, Henan, Hebei, Shanxi and Shaanxi Provinces in the middle-western part of China. Despite a slight increase from the 1970s to early 1990s, remarkable declines in gastric cancer mortality were noticed in almost the entire population during the last decade in China. These declines were largely due to the dramatic improvements in the social-economic environment, lifestyle, nutrition, education and health care system after economic reforms started two decades ago. Nevertheless, gastric cancer will remain a significant cancer burden currently and be one of the key issues in cancer prevention and control strategy in China. It was predicted that, in 2005, 0.3 million deaths and 0.4 million new cases from gastric cancer would rank the third most common cancer. The essential package of the prevention and control strategy for gastric cancer in China would focus on controlling Helicobacter pylori （H pylori infection, improving educational levels, advocating healthy diet and anti-tobacco campaign, searching for cost-effective early detection, diagnosis and treatment programs including approaches for curable management and palliative care.

Acute upper gastrointestinal bleeding in octοgenarians:Clinical outcome and factors related to mortality

AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presenceof severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients＇ data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis： age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time （PT）, gastric ulcer （small curvature）, duodenal ulcer （bulbus back wall）, Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy. RESULTS： Seventy male （58%） and 51 female （42%） patients with a median age of 70 （range： 21-96） years were treated. Their in-hospital mortality was 14%. While 12% （11/91） of the patients died after conservative therapy, 20% （6/30） died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer （n = 36; 30%）, gastric ulcer （n = 35; 29%）, esophageal varicosis （n = 12; 10%）, Mallory-Weiss syndrome （n = 8, 7%）, erosive lesions of the mucosa （n = 20; 17%）, cancer （n = 5; 4%）, coagulopathy （n = 4; 3%）, lymphoma （n = 2; 2%）, benign tumor （n = 2; 2%） and unknown reason （n = 1, 1%）. A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer （bulbus back wall） were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer （bulbus back wall） andpatients＇ gender （male） were of prognostic importance for the clinical outcome （mortality） of patients with a bleeding ulcer.CONCLUSION： Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient＇s vital threat posed by an UGI bleeding.Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.

Severe acute pancreatitis: Pathogenetic aspects and prognostic factors

Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.

Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis

AIM： To determine factors related to disease severity, mortality and morbidity in acute pancreatitis.METHODS： One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis （AP） in a 5-year period （1998-2002）. In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insufficiency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems （Ranson, Imrie and APACHE Ⅱ） and patients＇ outcome were determined by using invariable tests and the receiver operating characteristics curve.RESULTS： One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis （53% and 26%, respectively）. Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate 〉 20/min, pulse rate 〉 90min, increased C-reactive protein （CRP）, lactate dehydrogenase （LDH） and aspartate aminotransferase （AST） levels, organ necrosis 〉 30% on computed tornography （CT） and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1%, 24.8% and 13.6%, respectively. CRP 〉 142 mg/L, BUN 〉 22 mg/dL, LDH 〉 667 U/L, base excess 〉 -5, CT severity index 〉 3 and APACHE score 〉 8 were related to morbidity and mortality.CONCLUSION： APACHE Ⅱ score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

Heart failure research in China： current status and future direction

Heart failure is a major public health problem worldwide. Despite advances in the therapy and care of heart failure, morbidity and mortality remain persistently high. Recent years have witnessed major breakthroughs in the investigations of pathogenesis, prevention, and treatment of heart failure in China. It is noteworthy that the continuing and growing support from funding agencies in China including the National Natural Science Foundation of China has yielded substantial effects on the basic and clinical research in heart failure in the last decade. In this review, we provide an update on the current status of heart failure research, both basic and translational/clinical, in China, including funding and publications. We also discuss the future challenges and possible strategies in improving our understanding and management of heart failure in China.

Outcome of penetrating cardiac injuries in southern Iran, Shiraz

Objective： Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. Methods： From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. Results： The study consisted of 37 patients, including 1 gunshot wound （2.7%）, 35 stab wounds （94.6%） and 1 （2.7%） shotgun wound. The overall survival rate was 76% （28 in 37） and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed sig- nificant correlation between mortality and electrocardio- graphic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type （gunshot more than stab wound）. Conclusion： Our results show that injury mechanism and initial cardiac rhythm are significant predictors of out- comes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.