Long-Term Function After Restorative Proctocolectomy

PURPOSE Early functional outcome after restorative proctocolectomy and formation of an ileoanal pouch is known to be good, but there are minimal data on the long-term function of the pouch. The aim of this study was to look at the long-term functional outcome in patients who had undergone restorative proctocolectomy and formation of an ileoanal pouch.METHODS A total of 151 consecutive patients (96 males, 55 females) who underwent ileoanal pouch surgery between April 1983 and May 1993 were identified. Functional outcomes from the previous 12 months were appraised by a standardized questionnaire.RESULTS The median age at surgery was 31 years (range, 6–63 years), with a median follow-up of 142 months (range, 100–221 months). Eighteen patients have had their pouches excised, with another patient being defunctioned. Therefore 19 patients (13 percent) had suffered pouch failure. Altogether, 115 patients were available for follow-up, and 98 patients (85 percent) returned questionnaires. The median pouch-emptying frequency was five times (range, 1–17) during the day and one time (range, 0–6) at night. A total of 74 percent of patients had perfect continence during the day. Most of the patients had no life-style restrictions related to the pouch, and 98 percent of patients would recommend a pouch to others.CONCLUSIONS Long-term functional outcome after ileoanal pouch surgery is good in most patients. For patients requiring proctocolectomy, ileoanal pouch surgery can now be recommended as an excellent long-term option.Presented at the Association of Coloproctology of Great Britain and Ireland, Manchester, United Kingdom, July 2 to 5, 2002 Reprints are not available.     

Consequences of multiple withdrawals from alcohol

This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL, organized by Theodora Duka and chaired by Dai Stephens. The purpose of the symposium was to examine the effects of multiple experiences of withdrawal from alcohol in animals made dependent on alcohol and in humans who are alcohol dependent. Parallels were drawn to the effects of repeated short-lived high-content alcohol exposures in animals and in humans who are social drinkers but indulge in binge drinking. The presentations were (1) Multiple detoxifications and risk of relapse in abstinent alcoholics, by John Gentry and Robert Malcolm; (2) Emotional and cognitive impairments after long-term use of alcohol: relationship to multiple detoxifications and binge drinking, by Theodora Duka; (3) The effect of repeated withdrawal from ethanol on conditioning to appetitive stimuli, by Tamzin Ripley, Gilyanna Borlikova, and Dai Stephens; (4) Alcohol withdrawal kindling: electrographic measures in a murine model of behavioral seizure sensitization, by Lynn Veatch and Howard Becker; and (5) Binge drinking induced changes in CNS, by Fulton Crews.     

中西医结合序贯治疗支气管哮喘64例疗效观察

目的：观察中西医结合序贯治疗对支气管哮喘患者的临床疗效。方法将128例支气管哮喘患者随机分为观察组与对照组,均分发作期、缓解期、稳定期三期序贯治疗。对照组64例予西医常规治疗,观察组64例在对照组基础上配合中药,应用中西医结合疗法,每一期疗程结束评价疗效。结果观察组在发作期病情平均缓解时间,以及肺功能指标、症状体征积分、临床总有效率、1年内复发率等方面与对照组比较,差异有统计学意义（P ﹤0.05,P ﹤0.01）。结论中西医结合序贯疗法能有效改善哮喘患者肺功能,临床近期、远期疗效高,复发率低,提高患者生活质量,值得推广应用。     

洛汀新与缬沙坦对老年急性心肌梗死患者心室重塑及心功能的影响

目的：对洛汀新（盐酸贝那普利片）与缬沙坦治疗老年急性心肌梗死患者对心室重塑及心功能的影响进行探讨。方法回顾性分析从2013年1月—2014年12月期间的90例在该院接受治疗的心肌梗死老年患者的临床资料,并根据随机数字表法将患者分成观察组与对照组两组,各为45例。观察组使用洛汀新治疗,对照组使用缬沙坦治疗。对比两组临床治疗效果以及对患者心功能的影响。结果两组患者治疗后心室重塑指标改善明显,对比两组改善情况发现使用洛汀新治疗的观察组患者情况优于对照组,P＜0.05;观察组患者治疗后心功能指标水平改善情况显著优于对照组,且差异有统计学意义,P＜0.01;治疗后观察组临床症状评分与对照组比较明显降低,P＜0.05;对照组NYHA分级显著低于观察组,P＜0.05。结论对于老年急性心肌梗死患者采用洛汀新与缬沙坦治疗,可有效改善患者心功能,并帮助心室重建,临床具有推广意义。     

护理干预对股骨干骨折内固定术后膝关节功能与疼痛的影响

目的：探讨股骨干骨折内固定术后患者采用护理干预对膝关节功能和疼痛的影响。方法选取该院于2012年4月—2014年2月间收治的采用内固定术治疗的股骨干骨折患者86例为研究对象,按照其护理方式的不同,分为常规护理组和针对护理干预组,每组各43例,其中,常规护理组患者采用普通护理方式,针对护理组患者采用针对性的护理措施进行干预,比较两组护理干预对股骨干骨折患者内固定术后膝关节功能与疼痛的影响。结果两组患者护理效果相比,常规护理组优35例（81.40%）,良2例（4.65%）,一般4例（9.30%）,差2例（4.65%）,优良率为37例（86.05%）;针对护理组优39例（90.70%）,良2例（4.65%）,一般2例（4.65%）,差0例,优良率为41例（95.34%）,针对护理组的护理效果明显优于常规护理组,且差异明显,具有统计学意义。同时,记录两组患者的VAS评分值（视觉模拟疼痛评分法）及HSS评分值（膝关节损伤标准评分法）。结论对股骨干骨折患者在内固定术后采用针对性的护理措施干预可有效减轻患者痛苦,加快患者膝关节功能的恢复,降低患者术后疼痛,提高患者生活质量,临床护理效果显著。     

固有淋巴细胞研究进展

长期以来,自然杀伤(NK)细胞被认为是固有免疫系统中唯一属于淋巴谱系的细胞群体,然而近来研究揭示人和小鼠体内存在着多种类型的固有淋巴细胞(ILC)。这些新发现的ILC群体主要分布于黏膜屏障部位,尽管数量较少,但在抵抗病原体入侵和维持组织器官稳态等方面发挥重要作用。ILC发育分化早期存在着共同前体,但在后期阶段受不同转录因子调控,成为表型和功能不同的ILC成员。不同ILC亚群有着不同的细胞因子分泌谱,依据辅助性T细胞亚群的分类方法,ILC家族可以分成三类。ILC多样性的发现极大地丰富了固有免疫的内涵,也为我们研究固有免疫和适应性免疫之间的联系开辟了新途径。     

Long-term renal and cardiovascular effects of antihypertensive treatment regimens based upon isradipine, perindopril and thiazide

The aim of this study was to describe the renal function (renal hemodynamics, water and sodium handling) and its relation to cardiovascular structural changes in a population of essential hypertensive patients before and after antihypertensive treatment. Glomerular filtration rate and renal plasma flow were measured by a constant infusion technique. The reference substances used were [¹³¹I]iodohippurate (Hippuran) and [¹²⁵I]iothalamate. The lithium clearance method was used for measuring renal water and sodium handling. Microalbuminuria was measured. A subcutaneous gluteal biopsy was taken and the media thickness to lumen diameter ratio of small resistance vessels was determined. Left ventricular mass index was determined by echocardiography. Thirty-seven patients with newly diagnosed or poorly controlled essential hypertension were randomized to treatment with regimens based upon either isradipine, perindopril or hydrochlorothiazide-amiloride. Atenolol and hydralazine were added as secondary and tertiary drugs, respectively, when needed for normalization of diastolic blood pressure. Investigations were performed before and after 9 months of normalization of blood pressure. Renal function in untreated hypertensive patients was characterized by increased renal vascular resistance, decreased renal blood flow, normal glomerular filtration fraction and normal serum creatinine. No association was found between peripheral resistance vessel structure in subcutaneous vessels and renal hemodynamic parameters. Patients with severe left ventricular hypertrophy (left ventricular mass >360 g) had lower glomerular filtration fraction, greater renal vascular resistance, lower renal blood flow and increased microalbuminuria in comparison with patients with less pronounced cardiac changes. After 1 year of treatment, which had a profound effect on heart and vessel structure, renal hemodynamics were unchanged in patients receiving antihypertensive treatment regimens based on the ACE inhibitor perindopril or the Ca-antagonist isradipine, whereas renal plasma flow was reduced, glomerular filtration rate preserved and filtration fraction significantly increased in those treated with a regimen based on diuretics. The serum creatinine concentration was decreased in the former group, whereas it was unchanged in the latter two. Significantly detrimental effect on uric acid homeostasis was only found in patients treated with a regimen based on diuretics.     

手部动力支具在多区肌腱损伤修复术后的应用

【】目的：探讨手部动力支具在多区肌腱修复术后的临床应用效果。方法：选取2016年6月～2018年6月我院收治的81例肌腱损伤患者,采用随机数表法分为支具治疗组45例和对照组36例,分别予安装手部动力支具功能锻炼及常规治疗,患指肌腱修复后功能用TAM[总主动活动度测定法(total active movement,TAM)]评定。结果：随访3个月,支具组综合优良率为87.9％,对照组综合优良率为63.9％ ,两组间差异有显著性意义(P<0．05);支具治疗组二次松解手术率明显低于常规治疗组,组间数据对比差异显著(X₂=3.854,p=0.048),且未发生不良反应。结论：手部动力支具能较明显地减轻肌腱修复术后粘连的发生,降低二次手术的几率,由此可见手部动力支具在在肌腱修复术后的康复治疗是安全有效的。