改良全管道灌流器对副送水内镜消毒效果的影响

 目的 探讨改良的全管道灌流器对副送水内镜清洗消毒的效果。方法 选取某院消化内镜清洗消毒工作站患者使用后的奥林巴斯副送水肠镜，采用随机数字表法将其随机分为3组：A组和C组各30根，B组32根。A组使用改良前的普通灌流器，且未对副送水管道进行特殊处理；B组使用改良前的普通灌流器，但使用外接连接管（MAJ-855），对每个清洗消毒步骤均使用30 mL注射器对副送水管道手工注气注液最少3次；C组使用改良后的全管道灌流器。3组内镜均按照标准步骤进行清洗消毒及干燥，比较3组内镜各管道的消毒合格率，清洗消毒工作人员（以下简称洗消员）手工操作时间以及躯体疲劳程度。结果 A组内镜整体消毒合格率为30.0%，B组为78.1%，C组为100.0%。3组内镜整体消毒合格率比较，差异有统计学意义（χ²=36.414，P<0.001）。3组内镜的送气送水管道和钳子管道的消毒合格率比较，差异均无统计学意义（均P>0.05）。3组内镜副送水管道的消毒合格率比较，差异有统计学意义（χ²=33.473，P<0.001）。洗消员清洗消毒手工操作时间A、B、C组分别为：（4.81+0.63）、（6.72+0.42）、（4.88+0.66）min，3组比较差异有统计学意义（F=105.149，P<0.001）。洗消员清洗消毒3组内镜的躯体疲劳量表评分A、B、C组分别为：（4.67+1.32）、（5.83+0.91）、（4.33+1.03）分，洗消员清洗消毒3组内镜的躯体疲劳量表评分比较，差异有统计学意义（F=15.348，P<0.001）。结论 改良的全管道灌流器可提高副送水管道的消毒合格率，节约洗消员的手工操作时间，降低洗消员的躯体疲劳程度。     

结肠灌洗在左半结肠急性梗阻一期切除术中的应用

目的：探讨结肠灌洗在左半结肠梗阻急诊一期切除吻合术的应用价值。方法：１９９２年－１９９８年对２８例选择性病例常规行全结肠顺行灌洗，术中切除病变后切除阑尾，从阑尾残端插入一根２４Ｆ的Ｆｏｌｅｙ导管，钳夹末端回肠，结导管注入３７℃生理盐水至结肠流出液清洁为止，最后用０．５％灭滴灵２００ｍｌ加入生理盐水１０００ｍｌ中行最后灌洗，以此作为术肠道准备后，完成左半结肠一期切除吻合，结果：全组均痊愈，２６例伤口     

An in vitro comparison of root canal content extrusion using ultrasonic and hand instrumentation

Abstract The purpose of this study was to evaluate apical extrusion of root canal content using ultrasonic and hand instrumentation. Forty-nine tooth models were fabricated with clear resin. Each model contained a canal in the center. Each tooth model was mounted in a plastic cube (1 × 1 × 2 cm) with white dental plaster so that the coronal 2–3 mm of the model was exposed for instrumentation. Methylene blue dye with glycerin was used as a marker for root canal content. The study consisted of three groups. In group I, Enac ultrasonic instrumentation was used 1 mm from the apex; in group II, Enac ultrasonic instrumentation was used 3 mm from the apex; in group III, K Files were used with a push-pull instrumentation technique, 1 mm from the apex. After instrumentation the resin models were extracted and the plaster blocks were sectioned through the long axis of the models. Photographs were made of the area of apical leakage and the amount of dye penetration was measured using a planimeter. There were no differences between hand instrumentation and both ultrasonic groups. At p<0.05, ultrasonic instrumentation 3 mm from the apex leaked significantly more than the ultrasonic instrumentation 1 mm from the apex.     

慢性硬膜下血肿钻孔冲洗引流术后并发症临床分析

目的：探讨慢性硬膜下血肿（chronic subdural hematoma,CSDH）钻孔冲洗引流术（burr-hole irrigation and drainage, BHID）后并发症发生的原因及其防治措施。方法：回顾性分析了2002年1月至2009年12月经BHID手术的99例CSDH患者的临床资料。结果：98例治愈出院，1例（0．97％）死于肺部感染，8例（8．08％）出现术后并发症，其中血肿复发5例，癫痫发作2例，张力性气颅1例。结论：BHID是治疗CSDH的首选且较为安全。其术后并发症应引起足够的重视并得到恰当的治疗。     

Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study

Aim  To study using computer simulation the effect of irrigant flow rate on the flow pattern within a prepared root canal, during final irrigation with a syringe and needle.
Methodology  Geometrical characteristics of a side-vented endodontic needle and clinically realistic flow rate values were obtained from previous and preliminary studies. A Computational Fluid Dynamics (CFD) model was created using FLUENT 6.2 software. Calculations were carried out for five selected flow rates (0.02–0.79 mL sec⁻¹) and velocity and turbulence quantities along the domain were evaluated.
Results  Irrigant replacement was limited to 1–1.5 mm apical to the needle tip for all flow rates tested. Low-Reynolds number turbulent flow was detected near the needle outlet. Irrigant flow rate affected significantly the flow pattern within the root canal.
Conclusions  Irrigation needles should be placed to within 1 mm from working length to ensure fluid exchange. Turbulent flow of irrigant leads to more efficient irrigant replacement. CFD represents a powerful tool for the study of irrigation.     

Vestibular evoked blood flow response in the basilar artery

BACKGROUND AND PURPOSE: Monitoring of the basilar artery (BA) is difficult and has been sparsely performed. The aim of this study was to present physiological data of functional transcranial Doppler sonography (TCD) of the BA during caloric vestibular stimulation in healthy volunteers. METHODS: TCD of the BA was performed in 26 healthy volunteers (14 women, 12 men, age 25.1+/-3 years) during caloric vestibular stimulation. Vertigo was documented using electronystagmography (ENG) and a subjective vertigo scale ranging from 0 to 10 points. Simultaneously, capnogpraphy was performed. RESULTS: All subjects experienced vertigo, nausea and oszillopsia during vestibular irrigation. The average subjective vertigo was for a period of 106 s (+/-65.4); the average subjective estimated degree of vertigo was 6.7 points (+/-1.5). In all subjects, ENG demonstrated horizontal nystagm to the left non-irrigated side. In 14 subjects the subjective vertigo was rated by the individuals as extreme (point score > or =7) and in 12 subjects as low (point score <7). Mean flow velocity (MFV) in the BA increased significantly during vestibular irrigation, being more prominent in the initial irrigation and vertigo phase (5.8+/-5.9%, P<0.05) than in the second vertigo phase (2.2+/-8.8%, P<0.05). The calculated pulsatility index (PI), which indicates the condition of the small resistance vessels, decreased significantly (-4.9+/-8.1%; 4.3+/-8.9%, P<0.05) during both phases of vestibular activation. End tidal pCO2 did not change significantly (constant 5.4+/-0.4 Vol%), but respiration frequency was significantly increased during vestibular stimulation (12.3+/-3.8 min(-1) to 16.4+/-5.3 min(-1) and 16.3+/-4.8 min(-1), P<0.05) probably as a vegetative sign of vertigo. The observed MFV- and PI-changes were more prominent, although not quite significant, in the subgroup of subjects who experienced extreme subjective vertigo than in the subgroup who experienced low subjective vertigo. CONCLUSION: These observations indicate that MFV increase in the posterior circulation is due to activation of the vestibulocerebellum. In addition, it is possible that the previously elaborated MFV increase in the MCA might contribute to MFV increase in the BA via the posterior communicating artery. The difference in the 2 subgroups (extreme vertigo vs. low vertigo) may reflect the great variety of anatomical and physiological conditions of the peripheral vestibular organ, the brainstem anatomy and the corresponding blood supply. For clinical purposes this TCD-test may contribute to the investigation of the vasomotor reserve of the posterior circulation, e.g. in patients with vertebrobasilar ischemia, bilateral vestibular loss or local neurodegenerative disease.     

Irrigation with chlorhexidine to resolve naturally occurring gingivitis A methodologic study

This study compared oral irrigation and rinsing with chlorhexidine (CHX) and placebo in the treatment of naturally occurring chronic gingivitis. 44 subjects with at least 6 interproximal sites which bled on probing were randomly distributed on a double-blind basis into 4 treatment groups, placebo-rinse, CHX-rinse (0.12%), placebo-irrigation and CHX-irrigation (0.06%). A half-mouth was scaled 2 weeks prior to therapy in all groups. Rinses were performed 2 times daily and irrigation was performed once a day by means of an oral irrigator with the tip directed at a right angle to the tooth. Subjects continued with routine oral hygiene without instruction. The active treatment period was 2 months. Parameters were recorded at baseline and at 60 days. At the conclusion, marginal plaque was cultured for predominant microbial types. CHX-rinse (0.12%) and CHX-irrigation (0.06%) significantly reduced (p less than 0.05) plaque. Gingival bleeding decreased by 26% in both scaled and unscaled sites following CHX (0.12%) rinses and by 40% at both types of sites following CHX (0.06%) irrigation. Bleeding was reduced with CHX-irrigation greater (p less than 0.05) than with the placebo-irrigation. The mean log of colony-forming units of Actinomyces species was significantly lower (p less than 0.05) in the CHX (0.12%) rinse and CHX (0.06%) irrigator groups than in the placebo groups. These data therefore indicate that delivery of CHX (0.06%) by an oral irrigator is an effective means of treating naturally occurring gingivitis.     

Effect of sanguinaria extract on established plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator

Sanguinaria extract (sanguinaria) solutions were evaluated in 44 subjects in a 2-week, no oral hygiene study as a 300 micrograms/ml manual rinse, and the results compared to supragingival irrigation with 22.5 micrograms/ml sanguinaria concentration and supragingival irrigation with water. Both the manual use of sanguinaria and supragingival irrigation of dilute sanguinaria produced significantly less plaque growth than supragingival irrigation with deionized water. In terms of % changes from baseline, manual rinsing and supragingival irrigation with sanguinaria limited plaque growth to 17.7% and 24.2%, respectively, while irrigation with water had a 51.5% growth. For gingivitis, control supragingival irrigation with sanguinarine and with water were statistically different from manual rinsing with sanguinaria. Compared to baseline, the groups irrigating with sanguinaria and with water had gingivitis reductions of 68.7% and 73.3%, respectively, while manual rinsing with sanguinaria had a 29.6% reduction. The results suggest that dilute solutions of sanguinaria delivered via rinsing or supragingival irrigation are effective in controlling plaque as an additional benefit to the use of supragingival irrigation to control gingivitis. Supragingival irrigation with sanguinaria as part of a home care routine for patients with plaque and gingivitis is suggested.