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61.
Objective
Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed.Design
A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients’ symptoms.Participants
One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997.Intervention
All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic.Main outcome measures
Relief or reduction of epiphora and discharge.Results
One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week–9 months), and the mean postoperative follow-up was 8 months (range, 2–24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms.Conclusions
Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube. 相似文献62.
Marigo FA Esaki K Finger PT Ishikawa H Greenfield DS Liebmann JM Ritch R 《Ophthalmology》1999,106(11):2131-2135
BACKGROUND: To describe the ultrasound biomicroscopic (UBM) features of anterior segment cysts. DESIGN: A retrospective case series. PARTICIPANTS: One hundred eighteen eyes with anterior segment cysts examined by UBM at The New York Eye and Ear Infirmary between August 1992 and November 1997 were included in this study. INTERVENTION: The authors reviewed demographic and diagnostic data from the medical record including ocular and medical history, age, race, gender, and intraocular pressure. Ultrasound data concerning the type, number, position, and acoustic characteristics of cysts were recorded. The authors then correlated the written, clinical, and UBM characteristics. RESULTS: One hundred eyes (92.6%) had neuroepithelial cysts. Ninety (83.3%) of these had primary neuroepithelial cysts, 10 (9.3%) had cysts associated with uveitis, 7 (6.5%) had implantation cysts, and 1 (0.9%) had a cavitated ciliary body tumor. Neuroepithelial cysts typically were round or ovoid, thin-walled, and echolucent. Of the 90 eyes with primary neuroepithelial cysts, 56 (62.2%) had 3 or fewer cysts; multiple cysts (>3 per eye) were found in 34 eyes (37.8%). The multiple cysts occupied more than 180 degrees in 12 patients (13.3%). Primary neuroepithelial cysts were located at the iridociliary junction (74.2%), pars plicata (14.0%), pars plana (6.8%), and iris (5.0%). Implantation cysts (seven eyes) tended to have thicker walls and two contained a copious, echogenic material. CONCLUSION: The UBM results provide important information regarding location and extent of anterior segment cystic lesions. Ultrasound characteristics may help differentiate between neuroepithelial, implantation, and neoplastic cysts. 相似文献
63.
Neutropenia, fever, and infection 总被引:5,自引:0,他引:5
A E Brown 《The American journal of medicine》1984,76(3):421-428
With the advances in the management of various neoplastic diseases and subsequent improvement in "disease-free" states, complications of therapy--particularly, infectious complications--have evolved as stumbling blocks to survival. Among neutropenic (absolute neutrophil count below 1,000/mm3) patients with cancer, infection is the major autopsy-determined cause of death. With expected "cure rates" of childhood leukemia approaching 60 to 70 percent, it seems unreasonable to lose such patients to an infectious cause of death, yet this, indeed, happens. The purpose of this review is to (1) define the magnitude of the problem; (2) describe the various agents responsible for infections in neutropenic patients; (3) attempt to more sharply define degrees of neutropenia and mechanical defenses; and (4) consider various approaches to studying and treating these infections. 相似文献
64.
65.
38所综合医院病种质量管理调查分析 总被引:7,自引:1,他引:7
搜集整理吉林省 38所二、三级综合医院为期一年的 31个病种3.4万份病例的信息资料,对其治疗转归、平均住院日和平均住院费用进行了统计分析,为制定病种质量控制标准和深入广泛开展病种质量管理提供了可靠依据。 相似文献
66.
67.
参合农民对新农合定点医疗机构服务质量的评价 总被引:7,自引:4,他引:7
目的现场调查参合农民对新农合定点医疗机构服务质量的评价情况,为有关卫生主管部门改进新农合定点医疗机构服务质量提供科学依据.方法随机整群抽样,以问卷方式调查抽取的部分云南省寻甸县参合农民对新农合定点医疗机构服务质量的意见和建议.结果参合农民对各级定点医疗机构医疗技术水平、服务态度、收费、卫生资源配置情况的评价分布差异分别都有统计学意义(P<0.001).经非条件Logistic回归分析表明,村卫生室虽然设备较差,只有部分需要的药,但医务人员治疗一些常见病的医疗技术水平尚可,距离近,收费低,可信度和满意程度较高,参合农民选择就诊的可能性相应较高.结论各级定点医疗机构服务质量一般,卫生资源配置不合理,县级医疗机构服务态度较差,收费过高.建议有关卫生主管部门大力提高乡村医生的医技水平,合理配置卫生资源,改善县级医疗机构的服务态度,降低并统一新农合定点医疗机构的收费. 相似文献
68.
张雪燕 《中华现代医院管理杂志》2005,3(8):684-685
我院在确立了研究型医院的定位后,采取了一系列的科研改革举措,如重新整合科研力量,发展重点学科,加大对科研的投入,设立院所青年科研启动基金,强调人才建设,加强科研管理工作等,这些举措对促进原始创新,增强我院核心竞争力将起到重要作用,从而使我院发展成国内最大、国际知名的心脏病研究中心。 相似文献
69.
Samuel R. Friedman Barbara Tempalski Hannah Cooper Theresa Perlis Marie Keem Risa Friedman Peter L. Flom 《Journal of urban health》2004,81(3):377-400
This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas
to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and
human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area.
We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among
large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity
and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile
range 42–87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling
and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy
of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of
drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service
provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services. 相似文献
70.
目的了解公共场所服务业人员对艾滋病及其传播途径的认知情况。方法2005年9月,采用匿名自填式问卷调查方法,调查深圳市公共场所服务业人员的一般人口社会学特征,对艾滋病的认知情况及影响因素进行分析。结果服务业人员对艾滋病知识有一定的了解,对其主要传播途径有较好的掌握,但在非传播途径的了解方面仍存在一些模糊认识。对安全套的预防作用认识不足。多数愿意接受艾滋病的健康检查。结论应进一步加强公共场所服务业人员的艾滋病教育,使其对艾滋病基本知识有一个全面的了解。推广使用安全套。同时加强预防艾滋病措施的宣传,出台相关的政策。 相似文献