鼻咽癌放疗后分泌性中耳炎的治疗方法

目的:探讨鼻咽癌放射治疗后分泌性中耳炎的治疗方法.方法:将57例(67耳)鼻咽癌放疗后分泌性中耳炎患者随机分为两组,A组每周行1次鼓膜穿刺抽液后注入盐酸氨溴索与曲安奈德注射液的混合液,且每日行鼻腔冲洗1次;B组行鼓膜切开鼓室置管术.对治疗分泌性中耳炎的有效率和并发症发生率进行比较.结果:治疗后随访6个月,治疗分泌性中耳炎的有效率A组为88.23％,B组为63.63％,差异有显著性意义(P＜0.05);治疗分泌性中耳炎并发症发生率A组为11.76％,B组为36.36％,差异有显著性意义(P＜0.05).结论:与鼓膜切开置管术相比较,鼻咽癌放疗后分泌性中耳炎的治疗采用鼓膜穿刺抽液及鼓室注药加鼻腔冲洗更加安全、有效.     

咽鼓管吹张术后导管给药治疗分泌性中耳炎

目的探讨经咽鼓管鼓室注药治疗分泌性中耳炎的疗效。方法将70例(84耳)分泌性中耳炎患者按随机数字表法分为2组:对照组38例(42耳),仅行咽鼓管吹张术;注药组32例(42耳)行咽鼓管吹张后经导管向鼓室内注入甲泼尼龙琥珀酸钠20 mg,2周为一疗程,比较2组的疗效。结果对照组42耳显效22耳,有效11耳,无效9耳,有效率为78.6%;注药组42耳显效28耳,有效12耳,无效2耳,有效率为95.2%,注药组有效率高于对照组(χ2=5.12,P<0.05)。结论经咽鼓管吹张术后导管给药治疗分泌性中耳炎视野清晰,操作简单易掌握,准确率及成功率高,不破坏鼓膜解剖生理结构的优点,无后遗症。患者无明显的不适感,容易接受。     

鼻内镜在鼻咽癌放疗后分泌性中耳炎中的应用

目的 探讨鼻内镜在鼻咽癌放疗后分泌性中耳炎治疗中的应用价值。方法 对47例68耳放疗后确诊为分泌性中耳炎的患者，在鼻内镜下清除鼻咽脓痂，鼻咽冲洗，分离咽鼓管咽口粘连，咽鼓管导管吹张，鼓膜穿刺、切开，鼓室置管等。结果 随访1年后，47例存活39例，存活患者中分泌性中耳炎治疗的有效率为89．1％。结论 鼻内镜是治疗鼻咽癌放疗后分泌性中耳炎较为理想的辅助工具。     

鼓室冲洗注药治疗分泌性中耳炎疗效观察

目的：观察鼓室冲洗注药治疗分泌性中耳炎（secretory otitis media，SOM）的疗效。方法：应用前瞻性随机分组方法将208例分泌性中耳炎患者分为鼓室注药冲洗治疗组和常规鼓膜穿刺治疗对照组进行临床治疗效果观察。结果：鼓室冲洗注药治疗组的总有效率为91．24％，明显高于常规治疗组的63．7％（p〈0．01），且患者的治疗时间显著缩短。结论：鼓室冲洗注药治疗较常规治疗可明显提高疗效。     

鼻内镜下咽鼓管吹张给药治疗分泌性中耳炎

目的观察鼻内镜电视监视下咽鼓管吹张给药治疗分泌性中耳炎的疗效,并探讨分析分泌性中耳炎的发病机制。方法对分泌性中耳炎患者67例(71耳)采取鼻内镜下咽鼓管检查、吹张及注药进行治疗,并进行疗效评价。结果治愈率60.56%(43/71),好转率22.54%(16/71),无效率16.90%(12/71);总有效率为83.10%(59/71)。结论鼻内镜下咽鼓管吹张给药有利于听力提高和咽鼓管功能恢复,是治疗分泌性中耳炎的有效方法。     

纤维鼻咽镜下经咽鼓管鼓室内注药治疗分泌性中耳炎

目的：探讨纤维鼻咽镜下经咽鼓管口鼓室内注药治疗分泌性中耳炎的疗效。方法：回顾性分析50例(58耳)分泌性中耳炎患者，纤维鼻咽镜下用直径1mm的塑料管从咽鼓管咽口插入，行咽鼓管扩张和疏通后抽液并在鼓室内注入α-糜蛋白酶和地塞米松混合液1ml，每2周1次，治疗2次。结果：随访3个月后痊愈29耳(29／58)，好转13耳(13／58)，无效16耳(16／58)，总有效率是72．4％(42／58)。结论：纤维鼻咽镜下经咽鼓管口鼓室内注药治疗分泌性中耳炎安全有效；操作简便，可作为分泌性中耳炎的治疗选择之一。     

分泌性中耳炎内镜下复方丹参注射液鼓室冲洗疗效观察

目的：探讨耳内窥镜下鼓膜穿刺冲洗，鼓室注射复方丹参注射液对分泌性中耳炎的治疗效果。方法：对分泌性中耳炎治疗组27例30耳，对照组30例36耳。分别给予耳内窥镜下鼓膜穿刺抽液冲洗，鼓室注射复方丹参注射1ml或地塞米松注射液1ml，依据病情酌情每周进行1次治疗．3月后复查纯音测听、声导抗并记录患者自觉症状。结果：治疗3月后，治疗组治愈率66．6％，总有效率83．3％；对照组治愈率44．4％，总有效率58．3％，经x。检验，总有效率存在差异性（P〈0．05）。未发现毒副作用和并发症。结论：耳内窥镜下鼓膜穿刺冲洗，鼓室注射复方丹参注射液优于地塞米松注射液。能有效治疗分泌性中耳炎，预防中耳粘连。该方法有较广泛应用前景，具体药理作用还需要进一步研究。     

鼓室注入盐酸氨溴索治疗分泌性中耳炎的疗效分析

目的:探讨鼓室注入盐酸氨溴索对分泌性中耳炎的治疗效果。方法:将150例16岁以上的分泌性中耳炎患者随机分为治疗组和对照组,治疗组78例(84耳),采用鼓室注入盐酸氨溴索结合常规治疗;对照组72例(84耳),采用盐酸氨溴索口服结合常规方法治疗。治疗1～3周后比较两组的治疗效果。结果:治疗1～3周后,治疗组的治愈率和总有效率均高于对照组,两组间差异有统计学意义(P<0.05)。结论:鼓室注入盐酸氨溴索治疗分泌性中耳炎安全有效。     

纤维镜下咽鼓管吹张治疗分泌性中耳炎观察

目的：探讨更有效治疗分泌性中耳炎的方法。方法：通达纤维镜直视咽鼓管插入导管法与传统导管吹张法、鼓膜穿刺法比较疗效。结果：发现纤维镜法组62例患者，总有效率89％，明显高于传统法组。结论：纤维镜下咽鼓管插管法能显著提高分泌性中耳炎治愈率。     

鼻内窥镜下咽鼓管插管的护理33例

2002年8月-2005年3月，我院五官科对33例患者于鼻内窥镜下行咽鼓管插管，进行鼓室吹张、注药，同时口服抗生素治疗分泌性中耳炎，获得了较满意的治疗效果，现报道如下。     

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.     

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.     

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.     

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.