纤维支气管镜介入治疗纤维素性支气管炎大咯血7例

目的观察经纤维支气管镜(简称纤支镜)钳取纤维素性支气管炎患者管腔内剥离脱落的支气管管型及经纤支镜注入肾上腺素稀释液、凝血酶对纤维素性支气管炎大咯血的治疗效果。方法经纤支镜引导经鼻腔气管插管后或直接行纤支镜检查,发现管腔内剥离脱落的支气管管型后应用活检钳反复钳取并经活检孔向病变管腔内注射肾上腺素稀释液、凝血酶。结果7例患者经上述治疗均立即止血,配合病因治疗并静脉应用止血药物观察均未再咯血,总有效率100%。结论纤维素性支气管炎大咯血患者,在静脉应用止血药物治疗无效情况下,经纤支镜剥离钳取管腔内的支气管管型及经纤支镜应用止血药物治疗,止血作用迅速,效果确切。     

经纤支镜局部用药治疗咯血的疗效观察

目的：探讨经纤支镜局部应用冷盐水、肾上腺素、凝血酶对咯血的疗效。方法：54例咯血患者，经纤支镜定位依次以生理盐水、肾上腺素液、凝血酶500—1000u局部用药治疗。结果：总有效率90．7%。追踪观察2个月，复发5例，复发率9-3名。结论：经纤支镜局部用药治疗咯血操作简便、安全，疗效可靠，有一定的临床实用价值。     

支气管镜下注入立止血和凝血酶治疗支气管扩张咯血的效果

目的分析支气管扩张咯血患者采用支气管镜下立止血与凝血酶止血的临床效果。方法选择符合条件的64例支气管扩张导致咯血患者,按照随机数字表法将其分成观察组与对照组,各32例。对照组在支气管镜下给予肾上腺素止血;观察组在支气管镜下给予立止血和凝血酶治疗。观察2组的止血情况和复发咯血情况,比较2组止血效果。结果观察组总有效例数为32例,总有效率为100.00%,对照组总有效例数为28例,总有效率为87.50%。2组总有效率比较,差异有统计学意义(P<0.05)。2组止血平均用时、复发出血时间以及复发出血量比较,差异均有统计学意义(P<0.05)。结论支气管镜下注入立止血和凝血酶治疗支气管扩张咯血止血效果佳,止血用时短,止血时间长,出血量少。     

纤维支气管镜对大咯血患者手术止血定位的价值

目的 评价纤维支气管镜对大咯血患者手术止血定位的价值.方法 11例因大咯血而内科治疗无效的患者,6例患者利用纤维支气管镜经气管插管或开胸后气管侧切口入支气管,判断出血部位后行肺段或肺叶切除术止血;5例患者通过肺部多层螺旋CT和临床体征判断出血部位,再行肺段或肺叶切除术止血.结果 经纤维支气管镜定位后的6例大咯血患者,术后未出现大咯血;经肺部多层螺旋CT和临床体征定位的5例大咯血患者,有2例因再次大咯血二次手术,1例因再次大咯血死亡.结论 纤维支气管镜可以准确判定大咯血所在肺段或肺叶的位置,对确定手术治疗方案有很大辅助作用.     

凝血酶联用酚妥拉明和垂体后叶素治疗肺结核顽固性咯血临床对比观察

目的：观察凝血酶雾化吸入联用酚妥拉明治疗肺结核顽固性咯血的临床效果。方法：将47例住院肺结核顽固性咯血患者随机分为两组,治疗组采用凝血酶超声雾化吸入联用酚妥拉明静滴,对照组采用垂体后叶素静滴。结果：治疗组总有效率87.50%,对照组总有效率86.96%。结论：在常规止血治疗无效的基础上,加用凝血酶超声雾化吸入联用酚妥拉明止血快,副作用少,是治疗肺结核顽固性咯血的有效药物。     

支气管镜检查并发大出血原因分析和救治方法探讨

目的探讨支气管镜检查并发大出血的原因和救治方法。方法回顾性分析1983年12月￣2004年12月内进行的23826例支气管镜检查并发37例大出血患者的临床资料和救治方法。结果支气管镜检查并发大出血比例为1.6‰。37例大出血患者原发病为肺癌18例,肺结核7例,支气管结核3例,支气管扩张并感染5例,支气管息肉2例,支气管结石和支气管异物各1例。37例病人中行病灶或支气管黏膜活检术26例,肺组织活检术8例,刷检术3例,钳取结石和异物各1例。37例大出血患者均经支气管镜下局部灌入4℃冷盐水+1∶10000肾上腺素+凝血酶(500￣20000u)或使用OlympusPSD-30型高频电刀电凝止血成功。结论支气管镜检查并发大出血的原因主要是因为气管内新生物、支气管黏膜或肺组织活检时用力过度引起组织撕裂或血管破裂。经支气管镜局部注入止血药物或高频电刀电凝止血效果显著,并能清除积血,防止窒息,是一种安全有效的止血方法,值得临床推广应用。     

经电子支气管镜介入治疗老年支气管扩张咯血的临床观察

目的 寻求治疗老年支气管扩张并咯血更有效的方法及药物。方法 将90例老年支气管扩张并中、大量咯血患者随机分成3组。组1：肾上腺素液＋凝血酶经电子支气管镜于出血部位局部灌注。组2：单用凝血酶（方法同上）。组3：垂体后叶素或氨甲环酸静脉点滴。结果 3种治疗方法疗效差异有显著性（P〈0．01）；组1、组2的治疗方法优于组3（P〈0．05）；组1较组2疗效更优（P〈0．05）；且无明显不良反应。结论 经电子支气管镜局部灌注凝血酶的止血效果优于静脉用药；肾上腺素液加凝血酶联合使用疗效优于单用凝血酶者。     

肺结核顽固性咯血的栓塞治疗

目的:研究支气管动脉栓塞(bronchial artery embolization,BAE)治疗肺结核顽固性咯血的临床意义。方法:38例经内科反复治疗无效的肺结核顽固性咯血患者,采用Seldinger穿刺插管技术,胸主动脉造影发现病理性支气管动脉或其它供血血管,行病理性支气管动脉及供血动脉栓塞,栓塞材料选择明胶海绵条、PVA、钢圈。结果:38例患者均发现病理性支气管动脉或并有其它供血血管,一并栓塞止血。即刻止血97%(37/38),治愈74%(28/38),显效18%(7/38),有效8%(3/38),无效3%(1/38),总有效率97%(37/38),随访6月~7年10例(26%)复发,再次BAE即刻止血100%,治愈6例,2例肺毁损择期手术切除,无效2例,无严重并发症。结论:BAE是治疗肺结核顽固性咯血的首选、有效、可重复的治疗方法。     

纤维支气管镜下注入凝血酶与立止血救治咯血疗效对比分析

目的对比分析经纤维支气管镜下注入立止血和凝血酶对咯血患者的止血治疗作用，观察并发症及危险性。方法324例咯血患者，常规局麻下应用Olympus BFIT-40型、Olympus BF P-20型纤维支气管镜检查并镜下注入立止血和（或）凝血酶，观察止血情况及并发症。结果总体止血率高达99％（321／324），复发率26．5％（86／324），无严重并发症及死亡病例发生。立止血组、凝血酶组及立止血联合凝血酶组差异均无统计学意义。结论经纤维支气管镜下注入立止血和（或）凝血酶是治疗咯血患者安全而可靠的方法，值得临床推广应用。     

纤维支气管镜对大咯血的应用价值

目的：总结纤支镜在大咯血治疗及诊断中的应用价值。方法：利用纤支镜对２０例大咯血进行检查及治疗。观察大咯血患者的出血部位、血块阻塞情况、向出血部位注入生理盐水＋凝血酶＋去甲肾上腺素，并观察止血效果。结果：１４例可见活动性出血，１６例可见不同范围的血块阻塞（其中４例广泛血块阻塞伴极度呼吸困难），１５例经１次纤支镜治疗后止血，４例经２次治疗后止血，４例经２次治疗后止血，１例经１次治疗无效后拒绝再次治疗。     

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.     

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.     

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.     

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."