以头颈部疼痛为主诉的颞下颌关系功能紊乱综合征184例临床报告

根据本科１５年临床统计资料表明，在５７２例颞下颌关节综合征２中，约有１＝／３因头颈部疼痛就诊，本文地１８４例此类患者的临床表现及诊断治疗进行了分析，发现上肌痉挛型性发生率最高，翼外肌功能亢地型较少发生，于前者，钙了子导入法的疗效优于电针疗法。而对后者，电针治疗则取得更好的疗效。     

肌肉训练矫治法治疗儿童牙颌畸形

目的:介绍肌肉训练矫治法对牙颌畸形的治疗。方法 :进行口轮匝肌、翼外肌、嚼肌、颞肌等肌肉训练为治疗手段。结果 :25例牙颌畸形患者均收到良好疗效。结论 :肌肉训练矫治法治疗儿童简单牙颌畸形疗效可靠     

钙离子导入治疗翼外肌痉挛的肌电变化

目的：观察翼外肌痉挛钙离子导入治疗前后的肌电变化情况，探讨此评价治疗效果的可行性。方法：以35例单侧翼外肌痉挛成人患者为研究对象，采用ZEP-500型诱发电位仪(中科电器高技术公司)测试在最大牙尖交错位(intereuspal position，ICP)紧咬及张口1．0，2．5cm时钙离子导入治疗前后的肌电变化。结果：ICP紧咬时，翼外肌上、下头治疗前后的肌电电位经统计学检验t值分别为0．31和0．24，均P&;gt;0．05，差异无显著性意义；张口2．5cm时翼外肌上、下头治疗前后经统计学检验t值分别为0．34和0．16，均P&;gt;0．05，无显著性差异；张口1．0cm时，翼外肌上、下头治疗前后经统计学检验t值分别为2．00和2．32，均P&;lt;0．05，差异有显著性意义。结论：钙离子导入治疗翼外肌痉挛能明显降低肌电电位，可为评价治疗效果提供理论依据。     

翼腭窝病变的综合治疗

目的：探讨翼腭窝病变综合治疗的可能性。方法：10例患者病变累及翼腭窝．采用手术、放疗及手术与放疗相结合的综合治疗。结果：治疗后疗效满意，良性肿瘤复发率低，无并发面部畸形及功能障碍，恶性肿瘤患者生存期延长，生存质量提高。结论：翼腭窝解剖部位深在，内容复杂重要，应用综合治疗可减轻患者痛苦，提高生存质量。对需手术治疗患者采用合理的手术径路可清晰暴露手术视野，清除病灶，并有利于外观的保持和术后功能的恢复。     

中药浸泡治疗脚癣的临床疗效观察

目的观察中药浸泡治疗脚癣的疗效。方法采用中药外洗法对试验组 3 46例脚癣患者进行治疗 ,对照组 3 3 5例患者用 3 %克霉唑软膏外搽患处 ,观察两组患者的疗效。结果试验组患者的疗效显著优于对照组 (P <0 .0 0 0 1)。结论中药浸泡治疗脚癣方法简便 ,对糜烂型和水疱型脚癣疗效明显。     

宫颈糜烂适宜的治疗与护理方法探讨

为探讨宫颈糜烂适宜的治疗和护理方法，2000年7月～2003年9月，我院除对单纯型宫颈糜烂用CO2激光和冷冻治疗外，对宫颈糜烂的颗粒型、乳头型，采用射频消融治疗。对486例宫颈糜烂患者的疗效和副作用进行分析，现报告如下。     

扩大翼点入路治疗重型额颞部颅脑损伤85例

扩大翼点入路是由Yasargil翼点入路演变的，扩大翼点入路现已成为严重额颞部颅脑损伤的常用手术入路。作者采用扩大翼点入路大骨瓣开颅治疗85例额颞部重型颅脑损伤患者，获得较好的疗效，现报告如下。     

钙离子导入治疗翼外肌痉挛的肌电变化

目的观察翼外肌痉挛钙离子导入治疗前后的肌电变化情况,探讨此评价治疗效果的可行性.方法以35例单侧翼外肌痉挛成人患者为研究对象,采用ZEP-500型诱发电位仪(中科电器高技术公司)测试在最大牙尖交错位(intercuspalposition,ICP)紧咬及张口1.0,2.5 cm时钙离子导入治疗前后的肌电变化.结果ICP紧咬时,翼外肌上、下头治疗前后的肌电电位经统计学检验t值分别为0.31和0.24,均P＞0.05,差异无显著性意义;张口2.5 cm时翼外肌上、下头治疗前后经统计学检验t值分别为0.34和0.16,均P＞0.05,无显著性差异;张口1.0 cm时,翼外肌上、下头治疗前后经统计学检验t值分别为2.00和2.32,均P＜0.05,差异有显著性意义.结论钙离子导入治疗翼外肌痉挛能明显降低肌电电位,可为评价治疗效果提供理论依据.     

正常翼外肌与翼外肌痉挛的肌电变化

目的：对正常翼外肌、翼外肌痉挛患者进行研究，探讨正常翼外肌、翼外肌痉挛的肌电特征。方法：以35例单侧翼外肌痉挛成人患者为实验组，35例正常人为对照组。采用ZEP-500型诱发电位仪(中科电器高技术公司)测试翼外肌上下头在最大牙尖交错位(intercuspal position，ICP)紧咬及张口1．0，2．5cm的肌电变化情况。结果：对照组翼外肌上、下头在ICP及开口运动中均有肌电活动；张口1．0cm时，翼外肌上头肌电变化较ICP时低，张口2．5cm时较张口1．0cm时升高，有显著性差异(P&;lt;0．05)。实验组ICP，翼外肌上、下头的肌电电位经统计学检验t值分别为0．60，0．74，无显著性差异(P&;gt;0．05)；张口2．5cm时，低于对照组，翼外肌上、下头的肌电电位经统计学检验t值分别0．49，0．24，无显著性差异(P&;gt;0．05)；张口1．0cm时，实验组肌电电位明显高于对照组，翼外肌上、下头的肌电电位经统计学检验t值分别2．15，2．31，有显著性差异(P&;lt;0．05)。结论：支持翼外肌上下头是协同肌肉，均表现为开口时收缩的观点；翼外肌痉挛时，张口1．0cm的电位明显高于正常翼外肌电位，可为临床诊断提供参考指标。     

翼管神经切断术治疗过敏性鼻炎的探讨

目的：为探讨治疗顽固性过敏性鼻炎的有效方法及快速寻找和确定翼管神经的简便途径。方法：对２３例（４６侧）严重的过敏性鼻炎患者采用Caldwell-Luc法进行了上凳窦，手术显微镜下于上凳窦后壁内上１／３处切开后壁进入翼腭窝，找出蝶腭神经节作为标志，在其深层寻找翼管神经并切断之，以治疗过敏性鼻炎，观察术后鼻涕、鼻塞、打喷嚏、鼻痒和泪液分泌情况。结果：２３例近期效果达１００％，经５a-8a随访，３例复发（复发率为１３％）远期疗效为８７％。结论：翼管神经切断术对治疗顽固性过敏性鼻炎有较好疗效。     

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.     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.