双侧子宫动脉化疗栓塞术治疗剖宫产子宫切口妊娠

目的探讨双侧子宫动脉化疗栓塞术治疗剖宫产子宫切口妊娠的临床应用价值。方法 2004年3月2009年10月确诊剖宫产子宫切口妊娠的患者25例。首先行双侧子宫动脉超选择插管,注入甲氨喋岭,再用明胶海绵条栓塞双侧子宫动脉,48～72h内在B型超声监测下行清宫术。结果 25例子宫动脉化疗栓塞术后复查B型超声,提示孕囊血供明显减少。22例在B型超声监测下一次性清除胚胎组织,出血量少;2例因胚胎植入肌层突向浆膜层栓塞术后加用氟尿嘧啶,未行清宫,自行排出;1例因术后切口处形成大血肿行手术治疗。结论双侧子宫动脉化疗栓塞术是治疗剖宫产子宫切口妊娠一种有效方法,既保留子宫,又保留其生育功能。     

剖宫产术后子宫瘢痕处妊娠20例临床分析

回顾性分析2005年1月~2008年12月我院收治的20例子宫下段剖宫产瘢痕处妊娠患者临床资料。结果20例患者均有剖宫产史及停经史,血HCG升高,14例临床干预前经超声检查发现,7例先行子宫动脉栓塞术,术后行超声下清宫术;7例肌注MTX或胎囊内注射MTX后,在超声监测下行清宫术。6例于术后发生异常情况时经超声检查发现,其中4例行子宫动脉栓塞术后好转,2例切除子宫。18例患者均保留生育功能。     

双侧子宫动脉化疗栓塞术联合清宫术治疗剖宫产术后子宫瘢痕妊娠的效果

目的探讨清宫术前行双侧子宫动脉化疗栓塞术治疗剖宫产子宫瘢痕妊娠的临床疗效。方法选取剖宫产子宫瘢痕妊娠患者67例,按是否行双侧子宫动脉化疗栓塞术分为A组(n=35)例和B组(n=32);A组清宫术前先行双侧子宫动脉甲氨蝶呤灌注栓塞术,B组采用肌内注射甲氨蝶呤化疗后行清宫术,比较2组患者清宫术中出血量、住院时间,随访2组患者不良反应发生率。结果2组患者均顺利完成清宫术。A组清宫术中出血量、住院时间少于B组(P<0.05);A组发热、腹痛、恶心及呕吐、肝功能异常发生率低于B组(P<0.05),均未见子宫感染、穿孔、破裂发生。结论双侧子宫动脉化疗栓塞术后联合清宫术治疗子宫瘢痕妊娠,较单纯甲氨蝶呤化疗联合清宫术术中出血量更少,住院时间更短,且安全性高,未见严重并发症发生。     

剖宫产术后子宫瘢痕处妊娠10例临床分析

目的探讨剖宫产术后子宫瘢痕处妊娠的诊治情况。方法回顾性分析2003年9月～2006年9月中国医科大学附属盛京医院收治的10例子宫下段剖宫产瘢痕处妊娠患者临床资料。结果10例患者均有剖宫产史及停经史，血HCG升高，6例临床干预前经超声检查发现，4例于人流或药流术中发生异常情况时经超声检查发现。1例人流术中大出血者急诊行子宫动脉栓塞术，术后行宫腔镜下二次清宫术；6例先口服米非司酮或肌注MTX后在超声监测下行宫腔镜下妊娠病灶电切术；3例先行子宫动脉栓塞术后再行超声监测下宫腔镜下妊娠病灶电切术。电切术时3例出血较多，经相应处理后好转。10例患者均保留生育功能。结论超声检查在剖宫产瘢痕处妊娠的诊断中占有重要地位，子宫动脉栓塞术及超声监测下宫腔镜下妊娠病灶电切术联合应用在剖宫产术后子宫瘢痕处妊娠的治疗中发挥重要作用。     

经导管子宫动脉灌注化疗序贯栓塞术治疗异位妊娠

目的 探讨经子宫动脉灌注化疗序贯栓塞术在治疗异位妊娠中的价值。 方法 对65例异位妊娠患者行超选择性双侧子宫动脉插管,灌注氨甲蝶呤,后用聚乙烯醇颗粒栓塞双侧子宫动脉,l周后行刮宫手术。 结果 65例患者均成功接受双侧子宫动脉灌注化疗栓塞术,术后l周行刮宫术,手术顺利。 结论 子宫动脉灌注化疗序贯栓塞术是保守治疗异位妊娠的一种安全、有效的微创方法。     

双侧子宫动脉化疗栓塞术治疗宫颈妊娠的临床观察

目的 评估双侧子宫动脉化疗栓塞术（UACE）治疗宫颈妊娠的临床价值.方法 回顾性分析40 例宫颈妊娠患者双侧子宫动脉化疗栓塞前后的临床资料.结果 40 例患者中,8 例患者因宫颈妊娠行清宫术发生阴道大出血而采用急诊子宫动脉化疗栓塞介入治疗,32 例患者采用子宫动脉化疗栓塞序贯超声引导下清宫术治疗.所有存在阴道出血患者于介入术后均停止出血.UACE 术后行清宫术治疗过程中,所有患者均未出现大出血等严重并发症.1个月后复查,所有患者血茁-HCG 均完全降至正常水平.结论 UACE 术可用于宫颈妊娠患者清宫术中大出血的紧急止血治疗,而UACE 术序贯超声引导下清宫术治疗可以作为一种安全有效治疗宫颈妊娠的新策略.     

球囊成形术治疗膝下动脉闭塞性病变的疗效评价

目的 评价并对比应用单纯子宫动脉栓塞(UAE)和子宫动脉化疗栓塞(UACE)技术治疗异位妊娠的疗效。方法 34例异位妊娠患者,包括宫颈妊娠15例,瘢痕妊娠18例,肌壁间妊娠1例。患者年龄23~42岁,平均32.8岁。入院时患者停经时间35~75天,平均49.6天。入院检查:患者血β-HCG水平28~123353IU/L,平均25382.16IU/L;超声检查:26例患者可见卵黄囊,17例存在胎心搏动。按患者是否有氨甲蝶呤(MTX)使用禁忌证或拒绝使用MTX将患者分为两组,UACE组14例,UAE组20例。UAE材料选用明胶海绵颗粒。UACE组中,单次MTX用量为1mg/kg体质量。8例患者接受UAE的同时于子宫动脉内给予MTX,6例患者在UAE 后给予MTX 肌注或胎囊内注射治疗(6例中包括UACE术中给予MTX化疗者2例)。34例患者中,28例在介入治疗后1~5天内接受宫腔镜检查及超声引导下清宫术。结果 20例UAE组患者中,19例接受双侧UAE及超声引导下清宫术,3例瘢痕妊娠患者在清宫术的同时还接受了宫腔镜下瘢痕妊娠组织切除术,1例患者则仅接受双侧UAE。UACE 组中,8例患者在接受UAE 的同时于子宫动脉内给予MTX,6例于UAE术中未经动脉给予MTX者,于UAE术后1周内给予1~2次MTX肌注或胎囊内注射治疗。34例患者的子宫动脉均一次栓塞成功,27例入院时有阴道出血的患者,栓塞后出血明显减少或中止。UAE和UACE组分别有19例和9例患者于UAE术后接受了超声引导下清宫术,术中出血分别为(15.56±14.34)ml及(20.63±20.60)ml。刮出物经病理检查证实为坏死的绒毛及蜕膜组织。其余6例患者随访超声检查显示妊娠囊于栓塞后呈不同程度坏死、萎缩、脱落。所有患者均成功保留子宫并于栓塞后1.0~4.5个月恢复正常的月经周期,12例患者在治疗后再次受孕。UAE 和UACE组患者的血β-HCG水平分别于治疗后(26.8±8.3)天及(34.5±22.9)天恢复正常。两组患者的血β-HCG水平及正常月经周期恢复时间相比差异均无统计学意义(P均>0.05)。与UAE组相比,UACE组患者的住院时间明显较长(P<0.05)。所有患者均未发生严重的围手术期不良反应及并发症。22例患者在治疗过程中出现不同程度的发热、恶心、呕吐及腹痛,经对症治疗后于2周内缓解。UAE和UACE组在不良反应发生率方面差异无统计学意义(P>0.05)。UACE组中,1例患者(MTX剂量75mg)在用药后出现皮肤角化,未经特殊治疗,1年后缓解。3例患者出现轻度转氨酶升高(MTX剂量100~150mg),均于停用MTX1周后恢复正常。MTX治疗的其他不良反应如肾功能不全、白细胞减少、肺炎、胃炎等均未发生。结论 UAE及UACE是异位妊娠保守治疗的有效方法。UAE有望取代UACE,成为异位妊娠的标准介入治疗方案。     

子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠112例临床分析

目的 探讨子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果.方法 对宁波市妇女儿童医院2012年1-12月收治的112例接受双侧子宫动脉栓塞术治疗的子宫瘢痕妊娠患者的临床资料进行回顾性分析.结果 112例患者入院前均经阴道超声检查,101例明确诊断,11例怀疑为CSP;94例患者治疗前行核磁共振成像检查以明确子宫瘢痕肌层厚度、孕囊大小.所有患者均成功行双侧子宫动脉栓塞术,术中双侧子宫动脉灌注甲氨蝶呤50～100 mg,术后95例患者在B超引导下行清宫术,17例患者在宫腔镜下行妊娠物清除术,手术顺利,术后痊愈,随访均无严重并发症出现.结论 子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠可保留患者生育功能,安全有效,值得临床推广应用.     

子宫切口瘢痕妊娠的诊断与治疗

目的讨论剖宫产术后子宫切口瘢痕妊娠的诊断及治疗方法。方法回顾性分析天津市中心妇产科医院2007年1月至2009年12月间收治的128例剖宫产术后子宫切口瘢痕妊娠患者的临床资料。其中98例清宫术前采用明胶海绵、甲氨喋呤(MTX)进行双侧子宫动脉选择性栓塞治疗,治疗后7 d内超声监护下进行清宫手术,观察术中出血量和术后伴发症状及血β2-HCG下降情况。30例给予MTX子宫妊娠部位注射后,择期超声下行清宫术。结果 98例介入治疗后7 d内给予清宫术,均使子宫切口处妊娠包块明显减小,术后血β2-HCG下降明显。30例超声提示包块血流不丰富,包块≤4 cm。切口瘢痕厚度4 mm,子宫浆膜层完整;血β2-HCG≤2000 mIU/L。给予MTX治疗后,在有介入治疗条件、超声下行清宫术,28例清宫顺利。2例清宫术时大出血,立即行介入治疗,治疗后第7天行清宫术,术后2个月包块消失,血β2-HCG降至正常。结论子宫切口瘢痕妊娠在清宫手术前进行双侧子宫动脉栓塞的辅助治疗,安全性好,并发症少,操作简单,可有效地控制切口妊娠清宫术中的出血量,保留了患者的生育功能。如超声提示包块血流不丰富、包块≤4 cm、血β-HCG≤2000 mIU/L、切口厚度4 mm,可给予MTX治疗,在有介入治疗条件、超声下行清宫术。     

植入型子宫瘢痕妊娠的血管介入治疗

目的:探讨植入型子宫瘢痕妊娠的子宫动脉栓塞术的介入治疗方法。方法:回顾性分析2009～2011年在我院施行子宫动脉栓塞术联合清宫术治疗的5例植入型子宫瘢痕妊娠患者的临床资料。结果:5例子宫动脉栓塞术后清宫术出血平均64mL,β-HcG术后明显下降,术后14d下降至较低水平,术后1～2个月阴道超声复查子宫下段瘢痕处结构基本恢复正常。结论:子宫动脉栓塞术联合清宫术治疗植入型子宫瘢痕妊娠微创、高效、可重复性,是一种行之有效的治疗方法。     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.