股骨干骨折交锁髓内针内固定术后局部出现骨化性肌炎5例

股骨干骨折交锁髓内针固定术后局部出现骨化性肌炎(Myositis ossificans)鲜有报道,我科自2003年1月-2005年9月共发生5例,报告如下。1临床资料切开复位交锁髓内针内固定治疗股骨干骨折患者61例,术后均放置引流管(24～72h拔管)。术后发生局部骨化性肌炎的5例,均为男性,年龄22～46     

胃癌术后膳食纤维和早期肠内营养与消化道并发症的关系

目的探讨胃癌术后膳食纤维和早期肠内营养(EN)与消化道相关并发症的关系。方法采用随机对照的方法,把56例胃癌术后患者随机分成能全素组和能全素加膳食纤维组,经鼻肠管进行早期肠内营养(EN),观察两组EN常见消化道并发症的发生情况。结果两组患者在临床资料方面具有可比性(P>0.05)。两组患者的术后腹胀、腹泻的发生率相似,均P>0.05,差异无统计学意义。1例能全素加膳食纤维组患者因吻合口水肿、输入袢不完全性梗阻而发生恶心、呕吐,其余患者均未发生恶心和呕吐。结论胃癌术后的早期膳食纤维EN并不增加EN消化道并发症的发生率。     

工作作为药物及酒精滥用者有效的干预策略和治疗方法

1Introduction Substanceabusecontinuestobeamongthemostsevereso cialandcostlyhealthproblemsdevastatingindividualsandtheir familiesintheUnitedStates.Initssimplestdefinition,sub stanceabuseisthecontinueduseofalcoholorotherdrugsde spiteknowledgeofhavingapersistentsocial,vocational,psy chologicalorphysicalproblemthatiscausedorexacerbatedby theuseofalcoholorotherdrugs(DSMIV TR,1994).All drugsofabuse,includingalcohol,aretoxicandcannegatively impacteverysysteminthehumanorganism.Protractedsub stance…     

结直肠癌手术死亡相关因素分析

目的:研究旨在探讨结直肠癌手术死亡相关的临床病理影响因素.方法:回顾中山大学肿瘤防治中心1964年1月至2004年12月经手术治疗的4498例结直肠癌患者的临床病理资料,应用单因素和多因素Logistic回归分析手术死亡的相关影响因素.结果:全组手术死亡者共62例,手术死亡率为1.38%,主要死亡原因为多器官功能衰竭、中毒性休克、心血管疾病、急性肾功能衰竭、吻合口漏等.单因素分析显示,性别、术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症等为影响手术死亡的因素,而年龄、肿瘤部位、组织类型、病理分级与手术死亡无关.多因素分析表明,术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症是结直肠癌手术死亡的独立影响因素.结论:术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症是结直肠癌手术死亡的独立影响因素.     

A Paradigm for Design of Closed Loop Neuromuscular Electrical Stimulator Control Systems

Abstract: The use of neuromuscular electrical stimulation (NMES) for rehabilitation of gait in spinal patients is widely known. The best results can be obtained with the use of biomechanical sensors and a closed loop NMES system. One of the biggest problems faced in the design of control systems for closed-loop operation, in gait rehabilitation, is the variation of the mechanical conditions during the phases of gait. This work presents a new approach to ease the design of rule-based closed loop systems for operation in conditions such as gait rehabilitation.     

胫骨延长术后的功能康复程序初探

胫骨延长术是矫治小儿麻痹后遗症下肢短缩最常见的术式，但如何恢复或改善术后的功能，目前尚无一套系统的程序。本文作者根据自行设计的胫骨延长休后功能康复的临床观察，作较系统地介绍，并就该程序的合理性，进行了讨论与论证。     

床上体操训练对偏瘫患者的效果观察

目的：观察偏瘫患者早期床上训练的效果。方法：对５８例脑血管意外致偏瘫患者随机分成２组：观察组３０例，护理中指导早期床上体操训练；对照组２８例，按常规护理。以上、下肢肌力和日常生活活动能力（ＡＤＬ）为评价指标，于训练开始时、训练４周、训练８周各评价１次。结果：观察组训练４周、８周时患侧上肢肌力以及ＡＤＬ水平明显增加，与对照组比较有显著差异（Ｐ＜００１）。患侧下肢肌力训练４周及８周时均增加，与对照组比较，４周时无明显差异（Ｐ＞００５），８周时有显著性差异（Ｐ＜００１）。结论：对早期偏瘫患者实施床上功能训练，不仅可以提高患者的生命质量，而且可以减少、甚至解除患者及家属的经济和精神负担。     

大肠癌术后早期肠梗阻的临床特点和治疗

目的：探讨大肠癌术后早期肠梗阻的诊断与治疗。方法：回顾分析在肠癌手术412例术后早期肠梗阻29例的临床资料。结果：20例经手术探查发现以机械性梗阻占多数（18/20)，手术治愈18例；死亡2例，死亡原因均为延误手术时机造成；非手术治愈9例。结论：大肠癌术后早期肠梗阻虽有梗阻症状，但由于术后诸多因素的影响，大多缺乏典型机械性肠梗阻的临床表现。处理中先进行适当时间的非手术治疗，无缓解者再手术。     

Grip and pinch strength among selected adult occupational groups

A survey of 402 normal subjects (203 men, 199 women) was conducted to assist in distinguishing potential differences in norms of hand strength. Norm data had previously been collected from mixed occupational groups, but in the present study it was hypothesised that people involved in heavy manual work on a daily basis might possess greater hand strength than others. The volunteers were adults working in industry and agriculture; they were subdivided into occupational categories. Measurements of grip, key and palmar pinch using the Jamar dynamometer and B and L pinch gauge were collected, using the protocol described by Mathiowetz. Volunteers also rated their individual hand strength job requirements subjectively. Mean values were established with regard to age, sex, dominance, occupational group and subjective rating. Significant differences were found with regard to age and sex but not to dominance; there was no evidence of differences between occupational groups or between subjective rating and individual scoring, i.e. volunteers who perceived their job as requiring a high degree of strength did not achieve higher test measurements than others. A high interrater reliability was demonstrated when comparing these follow-up measurements with the original data. It was concluded that, for clinical and rehabilitative purposes, therapists can interpret assessment of outcome most accurately by comparing patients' results with the existing norm data.     

Endometrial carcinoma: Does the addition of intracavitary vault caesium to external beam therapy postoperatively result in improved control or increased morbidity?

A retrospective analysis of treatment for endometrial carcinoma is reported here. From 1987 to 1989, 138 patients were referred to the oncology department following total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer. Forty-seven patients were not prescribed postoperative radiotherapy; 31 had Stage I well differentiated adenocarcinoma with minimal myometrial invasion, while the remaining 16 patients were considered unfit for postoperative radiotherapy. There were no instances of local relapse amongst the 31 patients with minimal myometrial invasion.The remaining 91 patients all received external beam irradiation to the pelvis and, according to the preference of the individual therapist, 51 were prescribed additional intracavitary vault caesium-137. Patients receiving postoperative radiotherapy were analysed according to whether or not they received additional intracavitary vault caesium. The two groups were also analysed for incidence of vaginal vault recurrence and treatment related morbidity.In the group receiving additional intracavitary treatment more patients had Stage II or III disease (P<0.05), and had greater depth of myometrial invasion (P<0.05). Vaginal vault recurrence was not observed in patients receiving intracavitary therapy in addition to external beam therapy. Four patients (10%) receiving external beam therapy alone developed vaginal vault recurrence.The incidence of Kottmeier-Perez grade 2 or 3 bowel toxicity following treatment was significantly higher in those patients receiving combined treatment (18% vs. 2.5%; P<0.03). There was also a higher incidence of vaginal stenosis in the group receiving both external beam and intracavitary therapy (21% vs. 3%; P<0.05). There was only one instance of grade 2 bladder toxicity in the external beam and intracavitary treatment group and none in the external beam therapy alone group.In conclusion, postoperative radiotherapy for Stages I-III endometrial carcinoma was carried out in a non-randomized manner by two regimens; either external beam therapy alone or external beam therapy with additional intracavitary vaginal caesium. The combined therapy gave significantly better local control but resulted in significantly more late bowel and vaginal morbidity.