手烧伤后的综合康复治疗对手功能恢复的作用

对63例不同时期的手烧伤患者进行规范的康复评定,根据评定结果采取以防为主的综合治疗,有效的预防瘢痕挛缩、增生、关节僵硬、强直和继发畸形;淡化色素沉着、减轻瘙痒等多种并发症。最大限度提高患手功能。     

左下肢巨大瘢痕癌1例

患者,男,50岁,40年前左下肢被沸水烫伤后在当地用中草药治疗,于烫伤后近2月创面渐以瘢痕愈合,左膝关节瘢痕挛缩屈曲畸形.半年前患者自觉瘢痕部位瘙痒,抓破后瘢痕中心发生溃烂、流血、流脓,自用中药粉外敷,溃烂逐渐扩大,并反复出血,使左下肢不能承重入我院治疗.     

瘢痕移除后瘢痕皮回植原位皮肤再生治疗增生性瘢痕

背景:已有的研究表明原位皮肤再生法可使深Ⅱ度以内烧伤创面和供皮区刨面生理愈合无瘢痕,可促进Ⅲ度烧伤创面坏死组织液化排除、移植皮生长、减少减轻瘢痕,在瘢痕移除创面使用原位皮肤再生法以达到明显减轻瘢痕症状、减少瘢痕的效果,未见相关报道.目的:观察搬痕移除原位皮肤再生法治疗增生性瘢痕的效果.方法:选择烧伤或刨伤后出现多处增生性瘢痕的患者32例,男25例,女7例;年龄16～52岁;瘢痕病程1～11年.每例选择2处瘢痕相似的部位,进行自身对照.实验组采用瘢痕移除、瘢痕皮回植后应用美宝湿润烧伤膏药纱覆盖的原位皮肤再生法治疗:对照组采用瘢痕移除、瘢痕皮回植后应用传统凡士林覆盖治疗.观察比较疗效,应用温哥华瘢痕评估量表评估瘢痕增生情况.结果与结论:两组回植的瘢痕皮均成活.实验组创而愈合速度和质量优于对照组(P<0.05):瘢痕移除后6个月,实验组温哥华瘢痕评估量表评估均优于对照组(户<0.05,P<0.01),瘢痕所致的疼痛、瘙痒等症状消失,皮片平整且颜色较回植前明显改善,与周围皮肤接近.结果提示对自体皮源不足、瘢痕面积大的增生性瘢痕患者或不愿增加新的供皮区创面患者,应用瘢痕移除瘢痕皮回植原位皮肤再生的方法治疗是一种较理想的方法.     

手烧伤后的综合康复治疗对手功能恢复的作用

对63例不同时期的手烧伤患进行规范的康复评定，根据评定结果采取以防为主的综合治疗，有效的预防瘢痕挛缩、增生、关节僵硬、强直和继发畸形；淡化色素沉着、减轻瘙痒等多种并发症。最大限度提高患手功能。     

烧伤后增生性瘢痕康复治疗的护理体会

增生瘢痕组织高出皮肤,色红、质硬,除影响功能与外形外,患者的疼痛、瘙痒、灼热等症状较为显著,严重者影响生活与工作.江苏省苏北人民医院2001年1月～2005年12月间,进行综合康复治疗与护理27例烧伤增生性瘢痕,取得满意护理效果,现报告如下.……     

驻极体薄膜在烧伤创面的临床应用

目的 :观察FEP驻极体薄膜是否具有促进烧 (烫 )伤创面愈合作用。方法 :3 8例烧 (烫 )伤患者 ,浅Ⅱ°烧 (烫 )伤创面 2 6处 ,薄层皮片供皮区 12处 ,治疗面积 1%～ 3 %。实验组用 -70 0V驻极体薄膜覆盖创面 ,对照组分别用 0 0 5 %洗必泰液纱布及用凡士林纱布覆盖 ,外用多层纱布敷料包扎。结果 :与对照组相比创面疼痛明显减轻 ,点状出血增多 ,愈合提前 ;渗液印片检查治疗组创面中性粒细胞、巨噬细胞、淋巴细胞均较对照组提早出现且数量多 ;计算机灰度积分法计算结果 ,治疗组创面面积缩小率大于对照组。结论 :驻极体薄膜具有促进创面愈合作用。     

对烧伤患儿家属进行健康教育的体会

健康教育是促使医院由单纯治疗功能向预防、治疗、护理康复一体化功能转变的重要手段，同时也促进护士由患者的照顾者向患者的管理者、教育者转变。小儿烧（烫）伤是临床常见的儿童意外伤害之一。据有关报道，在所有儿童意外伤害中，烧（烫）伤比例最高，占34％。而小儿烧（烫）伤与家属的关系非常密切。烧伤患儿的健康教育，不仅面对患儿，还要面对家属，为了使患儿早日康复，预防烧伤的再次发生，我科对住院的烧伤患儿家属适时进行健康教育。现总结如下。     

功能康复指导对手烧伤患者的作用

手部深度烧伤创面愈合后局部瘢痕增生，致使患者活动功能障碍。最大限度恢复手功能是烧伤康复的重点。我院近3年来，配合烧伤治疗对238例手烧伤患者进行了功能康复指导，收较为满意,现报道如下。1 资料与方法1.1 资料本组238例，女79例，男159例，年龄8～63岁，平均32岁。烧伤部位为1指至全手。均为手部深Ⅱ度烧伤。住院天数14～98d。1.2 康复指导方法(1)心理调护：针对烧伤后患者各阶段的心理困扰，以倾听、解释、指导、保证等支持性心理治疗措施，帮助患者渡过心理危机，使其从认知与行为上变被动接收他人护理为主动参与的自护行为。(2)烧…     

深度烧伤病人关节早期功能锻炼与康复护理

[目的]探讨深度烧伤病人关节早期功能锻炼与康复护理效果。[方法]对72例深度烧伤病人康复早期使用体位疗法、关节功能锻炼,必要时行激素局部注射。出院后予以弹力套穿戴及使用瘢痕霜或瘢痕贴,坚持3个月～6个月。[结果]72例均进行了早期功能锻炼,63例使用了弹力套及弹力绷带等,关节功能恢复良好,效果满意。9例因经费困难,未坚持治疗,肢体瘢痕增生明显,其中6例手部瘢痕挛缩明显,呈爪形手,3例腘窝瘢痕挛缩严重畸形。[结论]在烧伤创面基本愈合的情况下,尽早综合采取康复护理和功能锻炼,能有效的防治关节部位瘢痕增生与挛缩畸形。     

烧伤后增生性瘢痕康复治疗的护理体会

增生瘢痕组织高出皮肤，色红、质硬，除影响功能与外形外，患者的疼痛、瘙痒、灼热等症状较为显著，严重者影响生活与工作。江苏省苏北人民医院2001年1月-2005年12月间，进行综合康复治疗与护理27例烧伤增生性瘢痕，取得满意护理效果，现报告如下。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."