单纯疱疹病毒性脑炎

目的 探讨单纯疱疹病毒性脑炎(HSE)的早期临床诊断和治疗。方法 回顾2例以不常见临床症状起病的HSE的临床资料并结合文献复习进行分析。结果 在病毒学检查结果为阴性的情况下，根据临床表现、脑电图和MRI的异常所见作出临床诊断；应用抗病毒和抗癫痫药物治疗效果好。结论 HSE以不常见精神异常、Kluver-Bucy综合征为唯一临床表现，根据脑电图(EEG)、核磁共振检查(MRI)可作出早期临床诊断，定期的MRI随访有利于进一步证实诊断和判断预后。在治疗时，无环鸟苷的治疗时间应依据临床症状的恢复和EEG的改善情况灵活掌握；卡马西平对精神异常及Kluver-Bucy综合征有良好的控制作用。     

儿童急性淋巴细胞白血病治疗过程中发生可逆性后部白质脑病综合征的抢救与护理

可逆性后部白质脑病综合征 （reversible posterior leukoen- cephalopathy syndrome, RPLS） 是一组最近才被认识的独特的临床综合征，是由多种原因引起的以神经系统异常为主要表现的综合征，临床表现以迅速进展的颅内高压症状、癫痫发作、视觉障碍、意识障碍、精神异常为特征，影像学主要表现为可逆性大脑后部白质损害，常显示以双侧大脑后部白质为主的水肿区，     

脑性瘫痪患儿闪光视觉诱发电位及其与影像学的关系

脑性瘫痪是未成熟脑受损而导致的运动障碍和姿势异常综合征，常伴有其他障碍，其中视觉障碍（包括斜视、低视敏度、眼震和视感知障碍等）常见，发病率约为9％。我们以闪光视觉诱发电位（flash visual evoked potential，F-VEP）检查脑瘫患儿视觉通路功能状态，以了解患儿脑性视觉损害情况。     

可逆性后部白质脑病综合征的急救与护理

可逆性后部白质脑病综合征(RPLES)又可称逆性大脑后部脑病综合征和可逆性后部脑水肿综合征[1]。主要表现头痛、癫痫发作、视觉障碍、意识障碍以及精神异常。神经影像学主要表现为可逆性大脑后部白质损害。由于本病的临床和影像学改变的可逆性,及时确诊、迅速控制血压或停用引起     

镜像疗法治疗肩手综合征所引起疼痛的效果分析

目的分析镜像疗法治疗脑卒中肩手综合征引起疼痛的效果。方法采用随机数字表法将86例患者分为对照组44例与观察组42例,对照组给予常规康复治疗,观察组在对照组的基础上给予镜像疗法训练。治疗前、治疗后1周及治疗后3周采用视觉模拟评分量表及简化McGill疼痛问卷进行评估。结果在不同测量时间点观察组视觉模拟评分量表及简化McGill疼痛问卷评分均低于对照组,两组比较具有统计学意义(P0.05)。结论镜像疗法可改善脑卒中肩手综合征引起的疼痛,有利于患者康复。     

一例肾病综合征并发可逆性后部白质脑病患儿的护理

肾病综合征是一组由多种病因引起的肾小球滤过膜对血浆蛋白通透性增高,大量血浆蛋白自尿中丢失,导致一系列病理生理改变的临床综合征[1].以大量蛋白尿、低清蛋白血症、高脂血症,不同程度的水肿为临床表现.可逆性后部白质脑病综合征(Reversible Posterior Leukoen Cephalopathy Syndrome RPLS) 1996年由Hinchey首先报道[2],它以头痛、癫痫发作、视觉障碍、恶心、呕吐、智力下降、意识障碍以及精神异常为主要临床表现.     

踝足矫形器与脑瘫的康复

小儿脑瘫是指出生前到生后一个月内各种原因所引起的脑损伤或发育缺陷所致的运动障碍及姿势异常,具有不同临床表现的一组综合征,而不是一种单一的疾病。临床症状主要表现为上运动神经元受损引起的四肢运动功能障碍,并发有智力低下、惊厥、听觉和视觉障碍、行为异常等。常用的综合性康     

老年性谵妄的研究现状

谵妄一词由Hood于1870年首先命名，是一种由多种因素引起的急性的可逆性的脑器质性疾病综合征，临床上以急性意识障碍为基本特征，合并意识、注意力、认知、精神运动性行为以及情感的障碍，是常见的、可危及患者生命的临床综合征。老年性谵妄是指在老年人中由各种致病因素引起的器质性脑病综合征，多见于65岁以上的人群，尤其多见于老年住院患者。     

1例妊娠合并马凡氏综合征病人的护理

马凡氏综合征（MPS）是1896年由法国医生Marfan首先描述，是一种常染色体显性遗传性疾病^[1]，及一组因先天性间质组织缺陷导致的临床综合征，具有潜在的致命性，可以累及骨骼系统、视觉系统以及心血管系统等，主要危害是心血管病变，易合并主动脉瘤，女性平均寿命只有46岁，手术是治疗该病的唯一手段^[2]。     

儿童急性淋巴细胞白血病治疗过程中发生可逆性后部白质脑病综合征的抢救与护理

可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)是一组最近才被认识的独特的临床综合征,是由多种原因引起的以神经系统异常为主要表现的综合征,临床表现以迅速进展的颅内高压症状、癫痫发作、视觉障碍、意识障碍、精神异常为特征,影像学主要表现为可逆性大脑后部白质损害,常显示以双侧大脑后部白质为主的水肿区,经及时有效治疗后临床表现和神经影像学改变可以完全恢复,一般不遗留有神经系统后遗症.     

Klüver-Bucy syndrome as a result of minor head trauma

Klüver-Bucy syndrome (KBS) has been described as a disconnection of the temporal lobes from the remainder of the brain. Its presence in minor head trauma has not been previously reported. We therefore report what we believe to be the first case of KBS due to mild head trauma and unilateral injury to a temporal lobe.     

INFORM: Development of information management and decision support systems for high dependency environments

The long-term aim in the INFORM Project is to develop, evaluate and implement a new generation of Information Systems for hospital High Dependency Environments (HDE — Intensive Care Units, Neonatal Units, Burns Units, Operating and Recovery Rooms, and other specialised areas). The distinguishing feature of the HDE is the very large amount of data that is collected through monitors and paper records about the state of critically ill patients; this has made the role of the staff a technical one in addition to a caring one. The INFORM System will integrate Decision Support with on-line, off-line and observed patient data and, in addition, will incorporate and integrate unit management features.In the Exploratory Phase of the Project, functional requirements have been set out. These are based on four components: conceptual model of the HDE; evaluation of existing HDE Information Systems; development of a novel software architecture using a Knowledge-Based Systems (KBS) methodology, and based on a critical review of KBS applied to the HDE; monitoring of appropriate leading-edge technological developments.The conceptual model has two components: a patient-related information model, and a department-related cost model. The patient-related model is identifying key and difficult areas of decision making. A key aspect of INFORM is integration of clinical Decision Support for these areas into the Information System through a layered software architecture. The lower layers are concerned with monitoring and alarming and the higher levels with patient assessment and therapy planning. The functionality and interconnection of these layers are being determined.     

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior

AimThe purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients.BackgroundPhysical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes.MethodsThis quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010–June 2016 (N = 419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined.ResultsYounger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p < 0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n = 1639) or Surveillance (n = 1183). Few were Case Management (n = 46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p = 0.03) and change in Physical activity Knowledge (p < 0.001).ConclusionThis study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.     

中孕期大畸形筛查漏诊完全性肺静脉异位引流一例

胎儿期间,因胎儿心脏较小,心率较快,产前常规超声对TAPVC的诊断非常困难,只有在左房后方形成较为明显的肺总静脉,产前超声才较容易发现[3],所以一般产前常规超声容易漏诊。特别是最为重要的中孕大畸形筛查期间,假如超声检查图像不规范,也比较容易漏诊。 总结分析漏诊TAPVC原因可能有以下几种：1.胎儿期间因特殊的血流动力学影响,左右心房及心室基本对称,没有出现明显的右心房扩大,左心房缩小等较为明显的间接心脏改变。2.左房后方肺静脉与左心房存在空间的重叠,容易误认为肺静脉角存在,而认为肺静脉血流引流至左房,导致对TAPVC的漏诊。3.彩色多普勒技术应用不规范,通常情况下,将彩色血流速度标尺下降至 20 cm/s 左右,以便能更好地观察肺静脉血流。假如标尺过高,容易屏蔽低速肺静脉血流,而导致漏诊的发生。4.超声筛查时,技术不规范,切面不标准,左心房后方明显光滑,未仔寻找其明确原因,而导致漏诊的发生[4]。本例胎儿中孕期筛查图像,心脏图像较小,未进行充分放大,彩色标尺过高,未显示明显肺静脉血流,也未明显看到明显的肺静脉角,所得导致漏诊,误诊的发生。随着产前超声图像的标准化管理,完全性肺静脉异位引流得到了越来越多的关注,检出率也有了明显的提高。     

Non-Tropical Pyomyositis Caused by Methicillin-Resistant Staphylococcus aureus: An Unusual Cause of Bilateral Leg Pain

Background: Pyomyositis (PM) is a primary suppurative infection of skeletal muscles that was originally described as a tropical disease and is now being seen with increasing frequency in temperate regions. Although PM is classically described as a disease of young, healthy individuals, its incidence is increasing in immunocompromised patients, particularly those with human immunodeficiency virus infection. Staphylococcus aureus is the etiologic agent in the majority of cases of PM worldwide, with methicillin-resistant Staphylococcus aureus (MRSA) being reported with increasing frequency. Mortality from PM is as high as 10%, and complications include metastatic abscesses, septicemia, and shock. Early signs and symptoms of PM are usually subtle and may be easily overlooked or misdiagnosed as a more benign condition. Case Report: A case of non-tropical PM due to MRSA in a young man is presented. This is followed by a review of the epidemiology, clinical findings, pathophysiology, diagnosis, differential diagnosis, treatment, and prognosis of this challenging and unusual condition. Conclusion: Because PM presents with subtle symptoms that are easily misunderstood as signs of more common and more benign conditions, it is often missed early in its course. By recognizing PM early in its course, it is possible to treat it before surgical drainage is required and before complications develop.     

溃疡性结肠炎的中西医治疗

溃疡性结肠炎是一种具体病因尚未明确的结肠黏膜及黏膜下炎症性疾病,其治疗仍是一个难题。西医治疗一般采用氨基水杨酸类、皮质类固醇、免疫调节剂和抗菌药物,效果较确切,但不良反应较大、患者耐受性较差、容易复发。中医则采用中药复方口服、灌肠、外敷离子导入多途径联合治疗,多管齐下,标本兼顾,气血同治,有一定疗效,在一定程度上减少了西药治疗所带来的不良反应,且费用低廉,患者依从性好,但对重症溃疡性结肠炎的疗效不确切。该文就西医及中医的治疗观点作一介绍。     

Is recreational drug use normal?

The purpose of this paper is to define drug use and differentiate this behaviour from drug abuse. We argue that one fundamental principle of the War on Drugs, namely that all use of illicit drugs is harmful and must be prohibited, is invalid. Statistically, clinically, and socio-culturally, drug use is normal behaviour. Current drug policy is based on the flawed premise that any use of illicit drugs is unhealthy. A public health model emphasizing demand reduction (as opposed to supply reduction), individual freedom, reason, and tolerance is recommended.     

门诊肠道寄生虫病感染状况的纵向观察

本文对 1981-2 0 0 0年门诊病人肠道寄生虫感染资料进行统计分析 ,总感染率为 30.89% ( 33607/ 10 8795 ) ;其中肠道蠕虫感染占 78.14% ,肠道原虫感染占 21.86 %。主要感染虫种为蛔虫、蓝氏贾第鞭毛虫、钩虫、肠滴虫、猪带绦虫和阿米巴。 2 0年间肠道寄生虫感染率呈明显下降趋势 ,由 1981年的 46.61%下降到 2000年的 12.82 % ;但近年来肠道蠕虫感染率下降速度变缓 ,而肠道原虫感染率呈现上升趋势 ,优势虫种亦由蛔虫、钩虫为主转为蓝氏贾第鞭毛虫、蛔虫居前。虽然肠道寄生虫感染 2 0年间变化较大 ,但每年的季节分布仍未打破 ,感染率以第三季度最高 ,第一季度最低。结果表明 ,目前人体肠道寄生虫病感染率还比较高 ,尤其是肠道原虫。因此 ,仍需根据季节、虫种、人群等具体情况 ,搞好肠道寄生虫病的防治工作.     

距骨骨折及其并发症的治疗进展

距骨骨折是一种比较少见的损伤,手术治疗距骨骨折的指征是距骨颈或距骨体骨折移位明显,其目的是使骨折部位达到解剖复位。距骨解剖结构特殊,表面大部分被关节面所覆盖,所以损伤常累及关节面,因此治疗难度较高且骨折术后并发症发生率高,容易发生缺血性坏死及创伤性关节炎。我们以距骨的解剖结构为基础,综述了目前距骨骨折及其并发症最新的治疗方法、不同治疗方法的优缺点及存在的问题。