李墨林按摩正骨临床经验总结

李墨林先生是20世纪50、60年代河北一代推拿按摩名老中医,在推拿按摩方面造诣颇深,创立了"李氏按摩"流派,对当代按摩技术的发展有很深远的影响。"李氏按摩"流派传人李墨林长孙李建文先生多年运用"李氏按摩"技术于临床实践,对"李氏按摩"精华体会深刻,研究整理了李墨林先生生前的着作,对他的临床经验进行了总结。1)在中医基础理论的指导下,"李氏按摩"手法注重整体,辨证施治。2)"李氏按摩"以经络学说为指导,按摩手法以点穴手法为中心。3)手法点穴可以疏通经络,激发人体经气,促进机体自身机能修复。     

Symptomatic cardiomyopathy as a presentation in Whipple's disease.

A patient presenting with congestive cardiac failure and anaemia underwent investigation which led to the diagnosis of Whipple''s disease, associated with dilated cardiomyopathy. Conventional antibiotic therapy for Whipple''s disease resulted in resolution of the traditional features of Whipple''s disease and a marked improvement in the patient''s heart failure.     

Serum bone Gla protein and carboxyterminal cross-linked telopeptide of type I collagen in patients with Cushing's syndrome.

Serum bone Gla protein, a marker of bone formation, and carboxyterminal cross-linked telopeptide of type I collagen levels, an index of bone resorption, were evaluated in eight patients with active Cushing''s syndrome and in four with ''preclinical'' Cushing''s syndrome, before and after surgery. In basal conditions, serum bone Gla protein levels were significantly lower (p < 0.0001) in patients with active Cushing''s syndrome (1.0 +/- 0.35 ng/ml) than in controls (5.4 +/- 0.15 ng/ml); two out of four patients with the ''preclinical'' form had reduced bone Gla protein levels, while in the other two cases levels were in the normal range. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (3.0 +/- 0.4 ng/ml), although slightly reduced, were similar to those recorded in controls (4.1 +/- 0.3 ng ml), both in patients with active and with preclinical Cushing''s syndrome. After surgery serum levels of both marker proteins significantly increased in seven out of eight patients with active Cushing''s syndrome; in one patient, who was not cured after surgery, bone Gla proteins levels remained lower than in normals, while levels of carboxyterminal cross-linked telopeptide of type I collagen had a transient increase after six months. In the two patients with a ''preclinical'' Cushing''s syndrome who underwent surgery, a significant rise of the levels of both marker proteins was observed, similar to that observed in patients with active Cushing''s syndrome. It was concluded that serial determinations of these new markers of bone formation and resorption may be usefully employed to follow-up the clinical course of Cushing''s syndrome and provide information on the rate of bone turnover in response to medical and/or surgical therapies. Moreover, the evaluation of these markers in preclinical states of Cushing''s syndrome might suggest the need for surgery.     

Malignant lymphomas: results and observations from St George's Hospital.

With both Hodgkin''s and non-Hodgkin''s lymphoma, the results documented compared well with reference series. Hence the advantages of a modest clinic need not be at the cost of recovery or of survival. A major factor attenuating the scale of therapy in Hodgkin''s disease is the risk of inducing second malignancies. Four such complications have been observed amongst 27 patients with Hodgkin''s disease. Amongst the patients with non-Hodgkin''s lymphoma better results were noted than the designation ''poor prognosis histology'' had led the authors to expect. These findings suggest that the concept of histologically based prognosis may be over-subscribed and that contemporary therapeutic strategies can be extremely effective in this group.     

Schmidt's syndrome associated with sarcoidosis.

We present a case of Schmidt''s syndrome (autoimmune Addison''s disease and hypothyroidism) associated with sarcoidosis. There have been only four previous reports of Schmidt''s syndrome with sarcoidosis, and a possible fifth with negative autoantibodies. We have been able to find only four other reports of adrenal failure (without hypothyroidism) in sarcoidosis. It is important to be aware of the potential for masking the diagnosis of Addison''s disease by steroid treatment.     

脑瘫患儿照料者生活质量影响因素分析

目的 探讨脑瘫患儿照料者生活质量影响因素。方法 对2014年10~12月198例脑瘫患儿及照料者,采用SF-36量表和自制调查表进行生活质量调查和基本资料收集,采用相关性分析、单因素分析、多元回归进行统计分析。结果 患儿年龄与照料者生活质量躯体疼痛、活力、精神健康领域及总分呈负相关(P<0.05);照料者年龄与照料者生活质量生理职能领域得分呈正相关(P<0.05);照料者文化水平与照料者生活质量总体健康外的其他领域及总分呈正相关(P<0.05);照料者经济水平与照料者生活质量生理职能领域得分呈负相关(P<0.05),与生活质量除生理功能、总体健康外的其他领域得分呈正相关(P<0.05)。单因素分析示患儿年龄、康复机构,亲属关系,照料者性别、年龄、文化及经济水平、婚姻状态8个因素对照料者生活质量有影响(P<0.05)。多元回归分析示患儿年龄、亲属关系、照料者性别3个因素进入回归方程(P<0.05)。结论 患儿年龄、亲属关系、照料者性别为影响脑瘫患儿照料者生活质量的3个主要因素,现实中需改善脑瘫照料者生活质量,保证他们更好地参与脑瘫患儿的康复。     

A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias

Background

Bassini''s repair and the Lichtenstein''s tension free mesh hernioplasty are commonly used hernia repair techniques. A prospective randomized controlled study of Lichtenstein''s tension free versus modified Bassini repair in the management of groin hernias was undertaken to compare the technique and postoperative course in the two procedures.

Methods

A prospective study was conducted on patients reporting to Command Hospital (SC) Pune with inguinal hernia. One hundred and ninety six patients were included in the study, operated upon by either of technique and followed up.

Results

Study involved 196 patients with 216 primary inguinal hernias, studied over a period of 24 months. A total of 118 Bassini repair and 98 Lichtenstein''s repair were done. Of the 196 patients, four were females. Bassini Repair took more time than Lichtenstein''s repair, though the difference was not statistically significant (p>0.05). Direct hernias took lesser time to operate than the indirect hernias. Pain on the operative day, in the evening, was similar in both the groups. The commonest complication in both the groups was scar tenderness followed by erythema, scrotal swelling, neuralgia, superficial wound infection, funiculitis and seroma formation in the order of frequency. The average hospital stay was 5.74 days for Bassini''s repair as compared to 4.97 days for Lichtenstein''s repair. Patients undergoing Bassini''s repair took longer (mean 28.4 days) to return to work as compared to those who underwent Lichtenstein''s repair (mean 21.4 days) and the difference was statistically significant (p < 0.05). The recurrence rate was similar in Bassini''s (6.78%) and Lichtenstein''s repair (5.10%).

Conclusion

The Lichtenstein''s tension free mesh hernioplasty was comparatively better than modified Bassini''s repair due to its simplicity, less dissection and early ambulation in the postoperative period. Surgeons in training found the technique easier to master than the Bassini''s repair.Key Words: Inguinal hernia, Lichtenstein''s tension free mesh repair, Modified Bassini''s repair     

Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.

The surviving spouses of 34 patients who died of cancer at St Christopher''s Hospice have been interviewed about 13 months after the patient''s death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher''s group. Patients at St Christopher''s were less often thought to have suffered severe pain and other distress than at other hospitals, but pain relief was not bought at the cost of drug-induced confusion and patients at St Christopher''s remained more mobile than at other hospitals. Hospice patients were more aware of chapel services and prayers than at other hospitals. None was said to have been upset by these and 66% were glad of them. Despite the frequency of deaths in the Hospice, patients at St Christopher''s were no more likely to be thought to have been ''upset'' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.     

MECKEL'S DIVERTICULUM – REVISITED

Twenty five cases of Meckel''s diverticulum were studied between 1985-1995. Eight of these were symptomatic and in the remaining 17 it was an incidental finding. The symptomatic patients presented with intestinal obstruction (5 cases), perforated peritonitis (2 cases) and intussusception (1 case). All cases of acute appendicitis were also subjected to a search for Meckel''s diverticulum. Of the 25 Meckel''s diverticuli encountered, 22 were resected and in 3 patients it was left in situ. Both the patients with perforated Meckel''s diverticulum showed ectopic gastric mucosa. Complications occurred only after surgery for symptomatic Meckel''s diverticulum. All patients undergoing incidental diverticulectomy had a smooth and uncomplicated recovery.KEYWORDS: Incidental diverticulectomy, Meckel''s diverticulum     

Intestinal permeability and orocaecal transit time in elderly patients with Parkinson's disease.

The aetiology of weight loss in patients with Parkinson''s disease is likely to be multifactorial. We studied 15 patients with Parkinson''s disease and 15 age- and sex-matched controls and looked for evidence of malabsorption due to small bowel bacterial overgrowth or alteration of intestinal permeability. There was a marked increase in orocaecal transit time in the patients with Parkinson''s disease, although lactulose hydrogen breath testing did not show evidence of small bowel bacterial contamination. Intestinal permeability measured by the differential sugar absorption test was also deranged. There was reduced absorption of mannitol in patients with Parkinson''s disease while lactulose absorption was similar in both groups, suggesting decreased non-mediated uptake across the enterocyte brush border membrane in patients with Parkinson''s disease.     

帕金森病的异常姿势研究进展

帕金森病患者常出现姿势异常,这些异常姿势限制了患者的日常生活能力。本文将对帕金森病常见的异常姿势及其治疗研究进展进行综述。     

英国考文垂大学护理学专业硕士培养研究及思考

本文以作者在英国考文垂大学学习经历为例，对英国考文垂大学护理学硕士专业学位教育的课程设置、教学模式、考核方式、教学理念等方面进行了详细的介绍。此外，结合我国护理硕士专业学位教育现状进行探讨，为我国培养高水平的护理人才提供参考。     

俞景茂教授运用止嗽散治疗小儿慢性咳嗽经验

[目的]探讨俞景茂教授运用止嗽散治疗儿童慢性咳嗽的经验。[方法]分别以感染后咳嗽、咳嗽变异性哮喘、上气道咳嗽综合征为例,举例介绍俞景茂运用止嗽散治疗儿童慢性咳嗽临床经验。[结果] 俞景茂教授运用止嗽散加减治小儿疗感染后咳嗽、咳嗽变异性哮喘、上气道咳嗽综合征之风痰恋肺证者疗效确切。[结论]俞景茂教授运用止嗽散治疗儿童慢性咳嗽经验需要进一步继承发扬。     

Hepatic sinusoidal ectasia in association with Hodgkin's disease

A patient developed abnormal liver function tests in association with hepatic sinusoidal ectasia concurrently with relapse of Hodgkin''s disease. Tests returned to normal following successful chemotherapy for the Hodgkin''s disease. Sinusoidal ectasia and the related condition, peliosis hepatis, should be recognized as rare non-infiltrative manifestations of Hodgkin''s disease.     

Turner's syndrome with coeliac disease, thin bones and abnormal liver function tests

A patient is described with 45 XO Turner''s syndrome and thin bones. It transpired that the patient had osteomalacia due to gluten sensitive enteropathy rather than the osteroporosis usually expected with Turner''s syndrome. In addition, she had unexplained liver dysfunction. Causes for thin bones other than the osteoporosis associated with ovarian agenesis should be considered in patients with Turner''s syndrome.     

全日制公共卫生硕士培养体系的构建与实践

从全日制公共卫生硕士专业学位研究生教育综合改革试点的相关工作入手,介绍北京大学和复旦大学自2010年以来,在全日制公共卫生硕士培养定位、招生选拔、课程体系、师资队伍、实践教学、科研以及学位论文等方面的经验。比较美国约翰·霍普金斯大学、哈佛大学与试点院校在公共卫生硕士培养模式的异同,为完善我国全日制公共卫生硕士培养体系提出意见和建议。     

False belief and the refusal of medical treatment.

May a doctor treat a patient, despite that patient''s refusal, when in his professional opinion treatment is necessary? This is the dilemma which must from time to time confront most physicians. An examination of the validity of such a refusal is provided by the present authors who use the case history of a patient refusing treatment, for cancer as well as for a fractured hip, to evaluate the grounds for intervention in such circumstances. In such a situation the patient is said to have a ''false belief'' and it is the doctor''s duty to try to change that belief in the patient''s interest. The false belief is considered here in terms of the liberty principle, the patient''s mental competence and on what is called the ''harm principle'' (harm to other individuals or to society). Finally the concept of paternalism is examined. The authors conclude that the doctor must attempt to change a false belief, and if this fails he must examine the patient''s mental competence to make the decision to refuse treatment. But in the last analysis the doctor may be under an obligation to respect the patient''s refusal. Readers might like to look at (or read again) the papers on ''Liberty'' and ''Conscience'' published in this Journal under the heading Analysis.     

King指数无创诊断慢性HBV感染患者肝纤维化程度的预测价值

目的 评价无创诊断模型King指数对慢性HBV患者纤维化程度的预测价值。方法 选择185例于2018年7月至2019年11月在安徽医科大学第一附属医院接受治疗,谷丙转氨酶（ALT）小于2倍正常值上限的慢性HBV患者进行常规实验室检查及肝脏活检检查,分析King指数、FIB-4和APRI与肝纤维化病理分期的相关性,并绘制三者的受试者工作特征曲线（ROC）,探究King指数对HBV患者肝脏纤维化程度的预测价值。结果 King指数、FIB-4和APRI与肝纤维化程度的相关系数分别为0.488、0.404和0.440。King指数、FIB-4和APRI对显著肝纤维化（肝纤维化分期≥S2期）的曲线下面积（AUC）分别为0.764、0.710和0.737,对严重肝纤维化（肝纤维化分期≥S3期）的AUC分别为0.774、0.732和0.746。当King指数截断值为10.946时,诊断显著肝纤维化的敏感度和特异度分别为61.05%、79.10%;当King指数的截断值为12.315时,诊断严重肝纤维化的敏感度和特异度分别为69.54%、74.67%。结论 King指数对ALT小于2倍正常值上限的慢性HBV感染患者的肝纤维化具有一定的预测价值。     

王新昌运用银翘散加减治疗早期干燥综合征经验

[目的]探讨王新昌教授治疗早期干燥综合征的临床经验。[方法]通过跟师学习、聆听教诲,分析、探究王新昌教授对早期干燥综合征病因病机的认识,总结其学经验,并分析其二则典型医案以佐证。[结果]王新昌教授认为早期干燥综合征的主要病机为燥毒郁肺,阻遏气机,津液失布,可运用银翘散加减治疗,从而祛邪外达,标本兼治,临床取得了满意的治疗效果。所举二则医案,充分应证了其上述学术观点。[结论]王新昌教授在临床上采用辨病与辩证相结合的方法,注重辛散热结与凉解热毒,在银翘散的基础上加减治疗早期干燥综合征,疗效显著,见解独到,值得临床借鉴和推广。     

Crohn's disease of the colon with takayasu's arteritis

A case of Crohn''s disease of the colon with Takayasu''s arteritis in a young woman is presented. A possible pathogenetic mechanism whereby circulating immune complexes associated with Takayasu''s arteritis could lead to a chronic colitis is proposed.