支气管结核48例临床分析

目的：探索支气管结核的临床特征及诊断方法。方法：分析48例1995-2001年支气管结核临床表现，影像学及纤支镜检查结果。结果：48例患者中青年女性明显高于其他组占66.7%(32/48)，咳嗽42例（87.5％），咯血10例（20.8％），胸痛13例（27%），气促28例（58.3%），发热12例（25%），乏力盗汗19例（39.5%）。胸片及CT示：肺内浸润渗出性病灶32例（66.7），空调6例（12.5%），肺不张20例（41.7%），阻塞性肺炎18例（37.5%），肺门及纵隔淋巴结肿大9例（18%），痰涂片结核菌阳性率为37.5%，纤支镜刷检结核菌阳性率为45.8%，组织活检中57.5%证实为结核。结论：当有支气管结核临床表现时，应行胸部X线、CT检查，有条件者行张支镜检查，纤支镜检查是诊断支气管结核最重要的方法。     

Repetitive lifting and spinal shrinkage, effects of age and lifting technique

The assumed advantages of the so-called leg-lifting technique over the back-lifting technique are still the subject of much debate. The present study was aimed at studying the consequences of performing both lifting techniques on net lumbar moments and spinal shrinkage. Furthermore, the relation between age and spinal shrinkage was studied. Five subjects approximately 40 years old and six subjects 20 years old performed six 5-min bouts of repetitive lifting using each technique on a separate day. Net lumbar moments were calculated using a two-dimensional dynamic linked segment model. Spinal shrinkage was measured at T₁₂ and at the head after each bout of lifting and every 5 min during 1 h preceding the lifting bouts. The peak moments were marginally but significantly higher in the leg-lift. No differences in mean moments and shrinkage between lifting techniques were found. The shrinkage after the back-lift was more pronounced in the older subjects and a similar tendency was found after the leg-lift. The creep rate, i.e. the rate at which the shrinkage approaches its equilibrium was higher in the older subjects. No clear relations of anthropometrical variables and net moments with shrinkage was found. The common advice of using a leg-lift rather than a back-lift was not supported by the present study. Both the mechanical load on the low back (net moments) and the resulting shrinkage show considerable interindividual variation, the causes of which need further elucidation.

The leg-lifting technique is still widely advocated, thought its merits from a biomechanical point of view have been questioned. In this study spinal shrinkage and lumbar moments calculated by means of a dynamic linked segment model are used to compare the leg-lift to the more commonly used back-lift.     

Functional anatomy and biomechanics of the meniscus

The meniscus is no longer considered the evolutionary remnant in the knee joint.Rather, it is now well established as an important structure that is integral to the complex biomechanics and proper functioning of the knee. The medial and lateral menisci form two crescent-shaped wedges of fibrocartilage between the femoral condyles and tibial plateaus.The knee joint biomechanics are based on a complex interaction of these intra-articular structures. The functions ascribed to the menisci include load transmission, shock absorption, stability, proprioception, joint lubrication, and joint nutrition. Load transmission generally is accepted as one of its primary functions. The menisci transmit a portion of the axial forces across the knee joint by converting this load into “hoop stresses.” This is accomplished by their unique shape, composition, and anatomic attachments. The menisci are relatively mobile structures and their motion during knee flexion also is determined by their shape and soft tissue attachments/constraints. Preservation of the meniscal functions is essential, and the authors review the basic anatomic and biomechanical concepts necessary to understand techniques for repair and restoration of these functions.     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Blood platelets in severely injured burned patients

Unbelievable decrease of blood-platelet in the severely burned patients during the treatment of skingrafting caused two patients to unexpected death. From the records of changes of platelet number, a certain ‘platelet curve’ was made. By observing the curve, our treatments of skingrafting were carried out during the stable period and from then on we had no death cases.     

Burns during pregnancy: a gloomy outcome

The effect of burns on fetal and maternal survival is known to be detrimental. This prospective study describes the performance of pregnant burned patients who were managed and followed up for fetal and maternal outcomes at Ain Shams University's burn unit and Maternity Hospital during the period from October 1995 to September 1996. During the 12-month period, 27 pregnant burned patients were managed. Fetal and maternal mortality correlated with the total body surface area (TBSA) burned, the mortality rate being 63 per cent for both mothers and fetuses in the 25–50 per cent TBSA group. A fetal loss of 56 per cent with no maternal loss were recorded in the 15–25 per cent TBSA group. Experience in dealing with pregnant burned patients proves that early surgical excision and skin grafting, with timely termination of pregnancy are the best lines of treatment. Prevention or minimizing the effects of the burns may be achieved by proper education and guidance of the pregnant woman.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservarive treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision.

Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at −180°C for 30–48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required.

It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days.

Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

A role for lasers in the treatment of pigmented skin grafts

The development of aberrant pigmentation represents an unwelcome complication to an otherwise successful split skin graft resulting in a loss of colour match and, so it follows, of cosmesis. We present two cases where lasers have been successful in the treatment of this problem.