关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎疗效观察

目的 探讨关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎的临床疗效。方法 2010年4月至2014年4月,采用关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎患者20例。观察手术时间、踝关节的融合时间、关节融合率、术中及术后并发症,比较分析术前及末次随访时的疼痛视觉模拟评分（VAS评分）、AOFAS踝-后足功能评分。结果所有患者均获得随访,随访时间（26.3±7.4）个月。手术时间（109.4±22.6）min,均获得骨性融合,平均融合时间（10.3±2.1）周。仅1例患者发生1枚螺钉断裂,给予石膏固定后获得骨性融合。所有患者均未出现神经血管损伤、创口感染等并发症。术前及末次随访VAS评分分别为（5.80±1.67）、（1.70±1.03）分,差异有统计学意义（P=0.000）。术前及末次随访AOFAS评分分别为（54.55±7.02）、（78.95±5.59）分,差异有统计学意义（P=0.000）。结论关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎具有创伤小,并发症少,融合时间短,功能恢复好等优点。对于踝部无严重畸形的患者,该方法具有一定优势。     

Minimalna choroba resztkowa w ostrych białaczkach u dzieci i dorosłych

Biological and genetic heterogeneity of acute leukemias is a major cause of therapeutic difficulties. Response to chemotherapy is one of the most important prognostic factors in this group of diseases. In acute lymphoblastic leukemia (ALL), and progressively more in acute myeloid leukemia (AML), the best parameter of that response is the presence of minimal residual disease (MRD). MRD monitoring is performed based on the flow cytometer analysis of leukemic immunophenotypes or detection of gene rearrangement by PCR. Both methods are characterized by high sensitivity and specificity, which clearly distinguishes them from the standard morphologic examination. This review presents the current state of knowledge of the importance and use of MRD in children and adults, in ALL and AML, emphasizing similarities and differences. Current opinions show that the MRD is the most important prognostic factor in ALL and an important factor in AML. Based on current data in children and adults, it seems that in acute lymphoblastic leukemia, presence of MRD is a continuous variable; the older the patient, the higher the risk of MRD and therapy failure. This paper presents also a new insight to the concept of MRD, because of the presence of leukemic stem cells that survive chemotherapy in AML and any of the maturational stages of leukemia-propagating cells in ALL. This idea combines the phenomenon of drug resistance of tumor stem cells and the presence of residual cells undetectable by methods of optical microscopy after applied chemotherapy. The concept of leukemic stem cells explains the occurrence of resistant clones both in ALL and AML. Based on studies of genetic profiles, there is growing evidence to suggest that acute leukemia is a highly heterogeneous disease, which goes hand in hand with the hierarchy of leukemic stem cells and leukemia initiating cells. In the light of the current knowledge based on MRD, it seems necessary to review the concept of complete remission in MRD-positive leukemic patients.     

外侧入路关节镜辅助微创距下关节融合

目的 探讨外侧入路踝关节镜辅助微创距下关节融合术(ASA)的临床效果。 方法 对21例距下关节炎的患者行单肢外侧入路踝关节镜辅助微创距下关节融合(ASA)术。观察汇总患者术前及术后美国足踝外科协会评分(AOFAS)、视觉模拟评分(VAS)、融合率、优良率、并发症及融合时间。行X线及CT检查观察距下关节融合情况。 结果 21例患者均成功随访。随访12~41个月,平均(22.7±4.2)个月。随访期间无感染、坏死、退行性关节炎、血管神经损伤、螺钉断裂等并发症发生,出现踝外侧撞击疼痛1例、螺钉尾帽刺激1例、胫后神经部分损伤1例。21例患者X线均提示骨性融合,平均融合(8.3±0.5)周。AOFAS评分由术前的(41.73±3.87)分提高至末次随访的(83.24±3.65)分,差异有统计学意义(P<0.01);末次随访评分较差1例、中1例、良1例、优18例,优良率为90.48%。VAS评分由术前的(6.5±1.2)分变为末次随访的(1.5±0.4)分,差异有统计学意义(P<0.01)。 结论 外侧入路踝关节镜辅助微创距下关节融合具有创伤小、术后恢复快、并发症少、融合率高、效果确切等优点,是治疗距下关节病变的有效方法。     

机械通气患者两种气管导管气囊压力管理方法的临床研究

目的通过比较机械通气患者容量-时间曲线指导的气囊充气法（以下简称容量-时间曲线法）与最小闭合容量（minimalocclusivevolume,MOV）法的气囊充气量及气囊压力,探讨两种气囊压力管理方法的优劣。方法80例患者纳入研究。在相同的机械通气模式、参数条件下,每例患者在研究开始时完全消气囊,在先后用MOV法及容量-时间曲线法重新充气直至完全闭合气道。两次气囊充气间相隔20min,分别记录并比较两者方法的气囊充气量及压力值。结果容量一时间曲线法的气囊充气量及气囊压力明显小于MOV法（PdO．01）,12．5％（10／80）患者用MOV法充气后从容量-时间曲线观察仍存在漏气。结论容量一时间曲线指导的气管导管气囊法较MOV法精确、客观,是一种更可靠的指导气囊压力管理的方法。     

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?—a prospective clinical study of 15 cases

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5–8 mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0–2 mm in 8 cases and 2–9 mm in 9. Postoperatively adequate mouth opening of 30–40 mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.     

Clinical study on anti-fungal drug activity against clinically isolated strains of oral Candida species

ObjectivesThe present study was undertaken to evaluate the anti-fungal activity of amphotericin B (AMPH-B), flucytosine (5-FC), fluconazole (FLCZ), miconazole (MCZ), itraconazole (ITCZ), and micafungin (MCFG) against clinically isolated Candida strains from oral candidiasis (OC) patients and to collect information useful for the treatment of OC.Subjects and methodsThe study includes 116 strains of Candida isolated from patients. The Candida species were identified by polymerase chain reaction. The minimum inhibitory concentration (MIC) of each drug against each Candida species was determined.ResultsOf the 106 participants (30 males and 76 females), 57 had OC, including 42 cases of pseudomembranous OC, 11 cases of erythematous OC, 2 cases of hypertrophic OC, and 2 cases of mixed pseudomembranous/erythematous OC. The Candida species isolated were Candida albicans (93 strains), C. glabrata (19 strains), and C. tropicalis (4 strains). AMPH-B and 5-FC had low MIC values against all species of Candida and a low incidence of resistance development. In some species of Candida, FLCZ and ITCZ showed high MICs, but MCZ had a low MIC value. AMPH-B, MCZ, and ITCZ prescribed to OC patients were effective against OC with respect to alleviation of OC symptoms.ConclusionMIC values of anti-fungal drugs against Candida strains isolated from OC patients were obtained and the 3 anti-fungal drugs given to OC patients were found to be effective against OC in spite of differences in their MIC values and in the number of resistant strains (or strains with a high MIC value).     

隐匿性肝性脑病的诊疗进展

隐匿性肝性脑病(minimal hepatic encephalopa-thy,MHE)又称亚临床肝性脑病(subclinicalhepatic encephalopathy,SHE),是慢性肝病和肝硬化最常见的严重并发症,是一种具有渐进性、可逆性的神经精神病学异常和运动功能失调特点的疾病.尽管其发病机制仍未明确,血清和中枢神经系统(central nervoussystem,CNS)血氨升高仍被认为是肝性脑病(hepatic encephalopathy,HE)的致病机制和治疗核心,并受血脑屏障改变、神经递质紊乱、氨基丁酸和苯二氮异常等因素影响.因此明确其诱发因素是HE治疗的关键.治疗药物包括抗生素、二糖类、益生菌、门冬氨酸鸟氨酸(L-ornithine-L-aspartate,LOLA)、苯甲/苯乙酸盐等.因此,对MHE的发病机制、临床诊断和治疗研究进展进行归纳,为临床诊疗提供前沿性、系统性信息,具有重要意义.     

微创胸腔闭式引流治疗自发性气胸的疗效分析

探讨微创中心静脉导管行胸腔闭式引流治疗自发性气胸的临床疗效。2013年1月至2015年10月在我院就诊的初次发作的自发性气胸56例,随机分为观察组和对照组,每组28例,观察组采用中心静脉导管行胸腔闭式引流,对照组采用24或26号“蘑菇头”硅胶管行胸腔闭式引流,对比分析2组疗效、并发症、症状缓解时间、带管时间、住院时间及住院费用。观察组疗效、症状缓解时间、带管时间、住院时间与对照组无显著性差异（P＞0.05）,观察组并发症发生率及住院费用均明显低于对照组（P＜0.05）。微创中心静脉导管行胸腔闭式引流治疗自发性气胸疗效好,操作简单,创伤小,并发症少,住院费用低,患者易于接受,值得临床选择性推广。     

The “Territorial Self:” Theoretical Propositions for a Phenomenological Understanding of Schizophrenia

ObjectivesThis theoretical paper discusses the integration of a “territorial self” alongside the minimal and narrative selves most commonly described by contemporary phenomenology and used by phenomenological psychopathology.MethodsWe start from the schizophrenic experience and the tools for understanding it, in order to highlight some limitations in the use of vocal communication within the clinical system to evoke phenomena that are a priori pre-linguistic.ResultsThis theoretical path, which requires an openness to clinical observation and intersubjectivity, leads to nosographic and therapeutic implications that seem useful to us from a phenomenological perspective.DiscussionFrom a nosographic standpoint, we discuss the (non- systematic) crossovers between the schizophrenic experience and the psychotic experience; whereas, from a therapeutic standpoint, the proposal of the territorial self allows us to insist on the fact that the clinical relationship is characterized as much by an analysis of experience and a discussion about it as it is by a joint practice and an experiential experience requiring a common ground.ConclusionsThe “territorial self” proves to be a fruitful and heuristic theoretical proposal, enriching nosographic debates in the field of psychosis, and contributing to a reflection on the practice of psychotherapy.     

Beiträge der Österreichischen Fußchirurgie zum Thema Osteotomien an den distalem Metatarsalia 2-5

Metatarsalgia is a common and well-known problem in the orthopedic office. Since 1916 metatarsal osteotomies are described for the treatment of this pathology. Austrian orthopedic surgeons and Foot & Ankle specialists have worked on this topic. A special focus was on the clinical and biomechanical analysis of the Weil osteotomy. Also, the next step of the evolution of the treatment of metatarsalgia, the DMMO (Distal Metaphyseal Metatarsal Osteotomy) was accompanied with clinical studies. Recent literature shows that if the criteria of indications are respected, the DMMO is a reproducible and safe technique. Since this technique has shown a learning curve, thorough training is necessary.