Évaluation médico-économique du baclofène intrathécal chez les patients présentant une spasticité chronique sévère

A medicoeconomic evaluation of continuous intrathecal baclofen (Lioresal^®) infusion for symptomatic treatment of severe spinal spasticity was realised using a monocentric, comparative, retrospective approach where subjects were their own controls (n = 22). Study results confirm the efficacy of baclofen on symptoms, functional status of patients and on a non specific quality of life scale. Conversely, use of baclofen lead to a 67% increase of average annual costs of care for these patients and reaches around 173,500 French francs (~29,000 US$)/year. Such a cost seems to be acceptable with respect to clinical benefits. © 1998 Elsevier, Paris     

皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑的临床疗效观察

目的 观察皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑的临床疗效,并总结临床经验.方法 应用皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑380例,根据评定标准对治疗结果进行评价.结果 380例黄褐斑患者经治疗后基本治愈272例,显效57例,好转51例,无效0例,有效率86.58%.结论 皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑疗效确切,该技术值得临床推广.     

Internal jugular venous thrombosis after in vitro fertilization

Internal jugular vein thrombosis is an uncommon entity with high morbidity and an increased risk of mortality. Spontaneous clotting of the internal jugular vein without any known risk factors is virtually unheard of, and intravenous drug use is the most common cause for thrombosis. Assisted reproductive techniques alone or in conjunction with ovarian hyperstimulation syndrome seem to predispose patients for thrombosis of the internal jugular vein. We present the case of a patient who, after in vitro fertilization, developed ovarian hyperstimulation syndrome and clotted the internal jugular vein. In the setting of the Emergency Department, the norm should be to "rule out internal jugular venous thrombosis" in pregnant patients who have undergone in vitro fertilization and present with neck pain, with or without swelling or distended collaterals.     

腹腔镜手术在异位妊娠中的应用

目的 探讨腹腔镜下异位妊娠手术的疗效及应用前景。方法 对145例开腹行异位妊娠（输卵管妊娠142例，卵巢妊娠2例，残角子宫妊娠1例）手术的患者及168例腹腔镜手术的异位妊娠患者（均为输卵管妊娠）资料进行回顾性分析。结果 两组患者在异位妊娠类型的构成比、年龄、体重、孕产次等方面差异无显著性；在术中失血量、术后恢复、术后止痛药应用、住院时间及术后输卵管复通等方面差异有显著性。结论 腹腔镜下异位妊娠手术完全可安全有效地用于临床，且具有创伤小、恢复快的特点。     

异位支气管囊肿的CT、MRI表现(附19例报告并文献复习)

目的探讨异位支气管囊肿的CT及MRI表现。资料与方法回顾性分析19例经手术及病理证实的异位支气管囊肿患者资料,讨论并复习其CT及MRI表现。结果椎管内8例,颈部3例,颅内3例,皮下组织2例,左侧肾上腺区、腹膜后及蝶窦内各1例。病变多为类圆形及椭圆形,偶有分叶,边界清楚,在CT像上呈较高密度影或囊性密度影,在MRI上呈长T1、长T2信号或双高信号,均无强化。异位支气管囊肿可继发感染并伴有先天畸形或肿瘤。结论异位支气管囊肿发病部位及临床表现缺乏特异性,CT及MRI有助于病变定位,明确病变性质,但要发现其支气管来源需依靠病理。     

The discriminatory zone of beta-hCG for vaginal probes.

Recent developments in both laboratory measurements and ultrasound technology have revolutionized the management of early pregnancy. The discriminatory zone concept is a direct result of these developments. By correlating the serum beta-hCG values to the size of an intrauterine gestational sac, a value can be chosen that corresponds to the threshold of visualization of the sac. If the beta-hCG is above this value, a sac must be seen, and if it is not, aggressive steps should be taken to determine whether the pregnancy is abnormal or ectopic. The discriminatory zone may vary among institutions due to different equipment and assays. Thus, its value should be calculated individually at each institution. A proper discriminatory zone and a management protocol such as the one above can eliminate much of the uncertainty in the management of suspected ectopic and early pregnancies.     

实时三维超声心动图容积-时间曲线测定冠心病患者左室峰值排空率的价值

目的探讨实时三维超声心动图（TR-3DE）容积-时间曲线（VTC）测定冠心病患者左室峰值排空率（PER）的应用价值。方法应用TR-3DE的左室VTC测量34例冠心病患者和34例正常人的PER,并进行比较;分析冠心病患者左室PER与射血分数（EF）的相关性。结果冠心病患者的PER明显小于正常对照组（P〈O．001）．与EF呈显著正相关（r=0．875）。结论TR-3DE VTC可以准确测量左室PER。能反映冠心病患者左室整体收缩功能状况。     

彩色多普勒超声在诊治剖宫产子宫疤痕妊娠中的价值

目的探讨剖宫产子宫疤痕妊娠(CSP)的声像图特征,评价彩色多普勒超声在诊治CSP中的价值。方法对19例CSP病例的超声图像进行回顾性分析。结果根据19例CSP的声像图特征,可将其大致分为两种类型:妊娠囊型(12例),混合回声包块型(7例),初诊误诊率21.1%(4/19),超声诊断符合率78.9%(15/19)。结论 CSP具有特征性的超声图像表现,经彩色多普勒超声在诊断CSP和判断治疗效果中起了重要作用。     

Complete resolution of diffuse placenta increta in a primigravida with twin pregnancy: sonographic monitoring

We report a case of timely diagnosis of placenta increta by sonography during the third stage of labor, which avoided any attempt at manual removal of a retained placenta and thus prevented additional postpartum bleeding. The use of intra-cervical injection of vasopressin and methotrexate and application of transcatheter arterial embolization of bilateral uterine arteries and right internal iliac arteries resulted in a good outcome.     

羊水过少胎心监护无应激试验异常图形与新生儿结局的关系

【目的】探讨胎心监护无应激试验（NST）异常图形与羊水过少孕妇分娩的新生儿结局的关系。【方法】回顾分析在本院足月单胎头位分娩的1680名孕产妇中,羊水过少140例NST监护的波形,并随机抽查同期住院分娩的140例羊水正常的孕妇作为对照,所有孕妇均在产前1～2 d进行NST监护20～40 min,对比分析NST监护波形及新生儿结局,所有病例均无其他病理因素。【结果】羊水过少组中NST基线变异消失和NST自然减速等异常常见,剖宫产率增加,新生儿窒息率增加及病死率增高。【结论】对羊水过少孕妇NST监护波形分析,可及时发现胎儿窘迫的危险信号,基线变异消失或NST自然减速与新生儿窒息的发生相关。择期剖宫产不失是处理羊水过少较为安全的手段之一。