超早期小骨窗微创手术治疗高血压脑出血62例临床分析

目的 探讨超早期小骨窗开颅直视下治疗高血压脑出血的可行性及优点.方法 回顾性分析脑出血后6~7 h内超早期小骨窗开颅治疗高血压脑出血62例患者的手术经验.结果 术后6个月按日常生活活动分级,Ⅰ级9例,Ⅱ级23例,Ⅲ级13例,Ⅳ级6例,植物生存3例,死亡8例.结论 超早期小骨窗开颅血肿清除治疗高血压脑出血手术创伤小,时间...     

早期小骨窗开颅治疗高血压脑出血疗效分析

目的:探讨早期小骨窗开颅手术治疗高血压脑出血的临床效果.方法:回顾性分析我科2007年1月至2009年7月应用早期小骨窗开颅手术治疗高血压脑出血23例的临床资料.结果:23例中术后存活22例,1例死于肺部感染.结论:早期小骨窗开颅手术是治疗高血压脑出血的有效方法之一.     

小骨窗开颅治疗高血压性脑出血

目的：评价小骨窗开颅在治疗高血压性脑出血中的作用。方法：对采用小骨窗开颅治疗的90例高血压脑出血病例进行分析。结果：单纯采用小骨窗开颅者86例，4例小骨窗开颅压后改为骨瓣开颅或扩大骨窗开颅，术后28天死亡率18.9%。结论：小骨窗开颅是治疗高血压性脑出血良好手术方法之一，具有视野清楚，清除血肿彻底，减压快，创伤小等优点，但是有其局限性，外科医生应根据病人的情况选择使用。     

小骨窗手术治疗高血压脑出血的疗效观察与分析

目的总结小骨窗开颅治疗高血压脑出血的经验。方法回顾性分析56例小骨窗开颅治疗高血压脑出血患者的临床资料。结果ADLⅠ～Ⅲ级28例；死亡16例。结论小骨窗开颅是一种创伤小，能有效清除血肿的术式。     

显微镜下微创小骨窗法开颅治疗高血压脑出血临床研究

目的 探讨小骨窗开颅显微手术治疗高血压脑出血的临床疗效.方法 对行小骨窗开颅显微手术治疗64例高血压脑出血患者的临床资料进行回顾性分析.结果 本组64例行小骨窗开颅血肿穿刺引流术,术后2～3 d复查头颅CT示血肿清除率均在80%以上.随访6个月,ADL分级:Ⅱ级21例(32.81%),Ⅱ级24例(37.50%),Ⅲ级8例(12.50%),Ⅳ级2例(3.12%),Ⅴ级3例(4.69%),死亡6例(9.38%).结论 小骨窗开颅术是目前治疗高血压脑出血较理想的方法.     

显微镜下微创小骨窗法开颅治疗高血压脑出血临床研究

目的 探讨小骨窗开颅显微手术治疗高血压脑出血的临床疗效.方法 对行小骨窗开颅显微手术治疗64例高血压脑出血患者的临床资料进行回顾性分析.结果 本组64例行小骨窗开颅血肿穿刺引流术,术后2～3 d复查头颅CT示血肿清除率均在80%以上.随访6个月,ADL分级:Ⅱ级21例(32.81%),Ⅱ级24例(37.50%),Ⅲ级8例(12.50%),Ⅳ级2例(3.12%),Ⅴ级3例(4.69%),死亡6例(9.38%).结论 小骨窗开颅术是目前治疗高血压脑出血较理想的方法.     

小骨窗开颅手术治疗高血压脑出血74例体会

目的:评价小骨窗开颅皮层小切口手术治疗高血压脑出血的疗效。方法:74例采用小骨窗开颅皮层小切口清除血肿治疗高血压脑出血。结果:小骨窗开颅皮层小切口清除血肿较常规开颅清除血肿手术简便,手术历时30min～1h。手术后再出血5例,全部74例手术后死亡4例,占5.4%。出院后获得随访51例,随访时间3个月,51例存活者的ADL分别为:ADLⅠ级9例(17.6%)、Ⅱ级24例(47.1%)、Ⅲ级16例(31.7%)、Ⅳ级2例(3.9%)。结论:显微镜下小骨窗开颅皮层小切口清除血肿是治疗高血压脑出血较理想的方法,手术损伤小,可迅速达到血肿并清除血肿,开颅时间明显缩短,而且操作简便,有利于各级医院尤其是基层医院开展。     

小骨窗开颅治疗高血压脑出血

目的 探讨小骨窗开颅在高血压脑出血中的临床价值.方法 回顾性总结2005年7月至2008年5月67例经小骨窗开颅治疗高血压脑出血患者的临床资料.结果 本组血肿清除85%以上者52例,70%～85%者15例;术后死亡4例(5.97%);63例.术后随访6月至3年,日常生活能力(ADL)分级1级14例、2级31例、3级10例、4级5例、5级3例,ADL 1～3级者占82.1%.结论 小骨窗开颅治疗高血压脑出血安全、有效.     

超早期小骨窗治疗高血压性脑出血围手术期护理43例

目的:探讨小骨窗治疗高血压性脑出血围手术期护理要点.方法:以本院接受超早期小骨窗开颅配合自制自动冲洗装置结合普通内窥镜(改制的膀胱内窥镜)下治疗高血压性脑出血的患者43例为研究对象,对其进行周密的护理并严密观察病情及前瞻性地采取预防措施.结果:治愈40例,死亡1例(＜12 h入院患者),2例术后放弃治疗.出院后日常生活能力分级(ADL法)中Ⅰ级7例,恢复日常生活自理;Ⅱ级12例,部分恢复生活自理;Ⅲ级20例,需扶拐行走;Ⅳ级1例,完全依赖,日常生活完全需要帮助.结论:超早期实施小骨窗开颅清除颅内血肿治疗高血压性脑出血,同时配合周密的护理,严密观察病情,前瞻性地采取预防措施,可减少并发症,降低致死致残率,提高患者生存质量.     

中小骨窗开颅加骨瓣复位术治疗幕上高血压脑出血87例临床分析

目的探讨中小骨窗开颅＋骨瓣复位术治疗幕上高血压脑出血的技巧及疗效。方法回顾性分析我院2009年4月至2011年4月采用中小骨窗开颅＋骨瓣复位术治疗的87例幕上高血压脑出血患者的临床资料。结果87例患者术后死亡3例，余84例术后6个月进行随访，按日常生活能力（ADL）分级评定：I级26例，Ⅱ级28例，Ⅲ级22例，Ⅳ级6例，V级2例。结论中小骨窗开颅＋骨瓣复位术治疗幕上高血压脑出血，暴露良好，视野广，脑组织损伤小，血肿清除彻底，无颅骨缺损，并发症少，为理想的幕上高血压脑出血手术治疗方式。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.