Ojective To study the diagnosis and treatment of upper extremity edema after radical mastectomy. Methods Diagnosis depended on B type ultrasoundgraphy, CT, lymphography, venography, biopsy and axilla exploration. Lymphaticovenous anastomosis (LVA) with microsurgery technology was used for the treatment of simple lymphoedema. Results In 40 cases of lymphoedma after radical mastectomy, 7 patients were diagnosed as metastasis of cancer. 3 patients were diagnosed obstrcution of lymphatic and vein. 30 patients with simple lymphedema were treated with LVA. Short term efficacy was observed in all patients.The efficacy at 3～12 years was 83.3%. Conclusion The diagnosis of upper limb edema after radical mastectomy is essential. Metastasis and obstruction of vein are the causes. Biopsy conducted under high frequency B type ultrasoundgraphy may be a good method for the diagnsosis of matastasis, but a few patients were diagnosed only by axilla exploration. LVA may be given first priority to the theraphy of lymphedema after radical mastectomy.

The main feature of acute steroid-resistant rejection (ASRR) after liver transplantation is a lack of response to steroids.Although some effective immunosuppressants are available,there is no uniform treatment presently available.This paper will focus on exploring the mechanism of ASRR and formulating individually approached strategies.

ObjectiveTo study the methods,techniques,content about standardized induction training of pharmacists.Methods49 pharmacy recruits are accepted standardized 3-month pre-service training.ResultsThe new team of pharmacists enhance their self-confidence,improve skills and can adapt to the hospital environment faster and enter the role of pharmacists.ConclusionThe implementation of standardized training is conductive to increasing the overall quality of pharmacists and practice skills rapidly,in order to meet the clinical role,avoid health risks and ensure drug safety of patients.

The standardized resident training is an important part of continuing medical education in China,which plays a vital role in the cultivation and development of doctors.At present,the standardized resident training system in our country is at an exploratory stage and different from those advanced countries.This paper contrastively analyzed the domestic and foreign standardized resident training modes from the perspectives of education patterns,training years,training organizations,training contents,assessments,and financial sources.By learning from the advanced experience of those foreign countries,it provided the reference for the standardized resident training system in China.

Objective: To establish a HPLC method to determinate the content of rocuronium bromide. Methods: NH2-bonding silica gel was used as the stationary phase. The mobile phase consisted of 0.04 mol/L tetramethyl ammonium hydroxide (pH adjusted to 7.4 by phosphoric acid) and acetonitrile (10:90). The column temperature was 35°C. The detection wavelength was 207 nm. Results: The relation between concentration and peak area was linear in the range of 0.1251-2.0065 mg/ml with r2 of 0.9999. The average recovery rate was 99.9% with RSD of 0.1%. Conclusion: This method is exclusive, sensitive and is reliable for the determination of rocuronium bromide.

Objective To evaluate the diagnosis and therapy of intestinal lymphangiectasia.Methods In this study 15 patients were admitted in our hospital during recent 7 years.Clinical manifestations included hypoalbuminemia,symmetrical edema,emaciation,diarrhea and lymphopenia.Lymphangiography,lympanscintigraphy and biopsy were performed for diagnosis.Therapy conducted included conservative therapy,low-fat and medium-chain triglycerides(MCT)diet,albumin infusions,diuretics,total parenteral nutrition and octreotide.Surgical therapy ineluded thoracic duct-vein anastomasis and segmental resection.Results In this group 8 patients receiving conservative therapy were followed-up from 1.5 to 7 years(average 2.5 years).Symptoms were alleviated in 6 patients.Seven patients underwent operative therapy,among them,4 patients received thoracic duct-exterior jugular vein anastomasis and followed-up from 1 to 5 years,with symptoms mitigated in 2 patients.3 patients underwent local intestinal resection,follow-up from 1 to 3 years found one patient was cured,one was improved,and 1 patient died 3 months afterthe operation. Conclusion Intestinal lymphangiectasia is rather rare and there was no definite and effective therapy.

ObjectiveTo evaluate the value of early secretory antigenic target 6 (ESAT-6) in monocytes of cerebrospinal fluid (CSF) in the early diagnosis and judgment of the tuberculous meningitis (TBM). MethodsForty cases with TBM (TBM group) and 40 patients with other meningitis patients (control group,9 cases with purulent meningitis,24 cases with viral meningitis,3 cases with cryptococcal meningitis,3 cases with cerebral cysticercosis, 1 case with neurosyphyilis) were involved in this study.Conventional examination of CSF was inspected after admission, and the ESAT-6 in monocytes of CSF was detected by immunocytochemical stain. ResultsThe positive rate of ESAT-6 was 24％ in TBM group and 0 in control group (P ＜ 0.01 ). In ROC curve, if the rate of ESAT-6 ≥8.5％ judged as positive, and ＜ 8.5％ judged as negative, 35 patients of TBM group and 4 patients of control group were ESAT-6 positive. The sensitivity of the ESAT-6 in the diagnosis of TBM was 87.5％, and the specificity of TBM was 90.0％. Thirty patients in TBM group were not given anti-tuberculosis drug treatment, and the positive rate of ESAT-6 was 93.3％ (28/30) before treatment, and was 46.7％ (14/30) after treatment of 2 weeks (P =0.000).ConclusionsESAT-6 in monocytes of CSF detected by immunocytochemical stain has higher sensitivity and specificity in the diagnosis of TBM in early stage. Observing the positive rate of ESAT-6 dynamicly has practical value in judgment the severity of TBM.

Objective A comparative study of clinical factors and dose-volume histogram (DVH)parameters on the impact of radiation pneumonitis occurred in the three-dimensional conformal radiotherapy of lung cancer (lung target)and mediastinal tumors and esophageal (mediastinal target).Methods Review 83cases lung cancer,mediastinal tumors and esophageal patients,and analyzed with chi-square tests on the correlation of the clinical factors (gender,age,tumor location,stage,chemotherapy) with radiation pneumonitis;have relevance analysis between the DVH parameters of two targets and radiation pneumonitis; lung target and mediastinal target volume DVH parameters compared to the t-test.Results ≥2 radiation pneumonitis was 36.5 ％.≥2 radiation pneumonitis occurred in various clinical factors had no significant effect.DVH parameters of the two targets,V5,V10,V20,V30,whole lung dose (MLD) were significantly related to RP.Two targets of RP patients V5 [(50.9±17.8) ％,(69.9±20.4) ％],V10 [(38.6±15.2) ％,(53.5±18.8) ％] were statistically significant by t-test (t =2.434,P ＜ 0.05),while V20 (t =0.388,P ＞ 0.05),V30 (t =0.005,P ＞ 0.05) and MLD (t =0.138,P ＞0.05) were no significant difference (P ＞ 0.05),so the same results with the two targets of patients without RP obtained.Conclusion In the lung target and mediastinal target of radiotherapy radiation pneumonitis is related with DVH parameters,especially V20,V30 and MLD impact on the occurrence of RP.

Objective To evaluate the clinical efficacy and security of retroperitoneal laparoscopic ureterolithotomy(RLUL) for impacted ureteral calculi after radical cystectomy and ileal conduit.Methods 5 patients with unilateral impacted ureteral calculi after radical cystectomy and ileal conduit received RLUL were selected,and a retrospective study was performed for manner,duration of surgery,complications and length of stay and other indicators,and the treatment effect was evaluated.Results All procedures were successful and the mean operation time was (82.0±27.7)min,the extubation time was (5.4±1.1)d,hospitalization time was (10.0±2.9)d.Postoperative follow up for 6-48 months,there were no obvious complications.Conclusion The RLUL showed satisfactory availability and security for management ureteral calculi after radical cystectomy and ileal conduit.