局麻下应用岛状臀大肌肌皮瓣修复高龄患者骶尾部褥疮

探讨研究不能耐受全麻和硬膜外麻醉的高龄骶尾部褥疮患者的手术治疗。方法：局部麻醉,以髂后上棘到大转子尖端连线为轴心线,该线中上1/3处旋转点。根据缺损部位及大小进行肌皮瓣设计,形成内含臀上动脉浅支岛状肌皮瓣,皮瓣蒂宽1.5~2.0cm,含部分臀大肌外缘肌肉。然后通过皮下隧道转移修复骶尾部褥疮。结果：局麻下,应用臀上动脉浅支的岛状臀大肌肌皮瓣修复高龄患者骶尾部褥疮5例,术毕安返病房,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均满意,供区臀大肌保持良好的伸髋功能。结论：高龄骶尾部褥疮患者难以耐受全麻或硬膜外麻醉,局麻安全、方便;岛状臀大肌肌皮瓣血供丰富,血管恒定,抗感染能力强;供区无需植皮;具有操作简单,并发症少,成功率高等优点,可一期完成骶尾部褥疮修复,减少工作量,缩短住院时间。     

Experience with the operation of a panoramic tomograph]

The first results obtained by clinical trials of a panoramic tomograph of the Soviet design and make are discussed. The apparatus has a movable armchair, this making it convenient to examine seriously ill or debiliated patients. The pictures of the jaws, teeth, maxillotemporal articulations, nasal cavity, maxillary sinuses are fully suitable for diagnosing major diseases of the dentomaxillary system.     

负压封闭引流结合对偶皮瓣修复骶部巨大压疮17例体会

目的:探讨负压封闭引流(VSD)结合臀部对偶筋膜皮瓣修复瘫痪患者骶部巨大压疮的临床疗效.方法:17 例骶部巨大Ⅲ~Ⅳ期压疮截瘫患者,创面缺损行负压封闭引流7~12d 后,均行臀部对偶筋膜皮瓣修复创面.结果:行负压封闭引流7~12d 后,创面均逐渐缩小,缺损处肉芽组织新鲜,为皮瓣提供良好的受区床;33 个皮瓣全部成活,1 个皮瓣的边缘部分坏死,经换药治愈.17 例患者经4~28 个月随访,均无复发,患者生活质量明显提高.结论:VSD 结合臀部对偶筋膜皮瓣是修复瘫痪患者骶部巨大Ⅲ~Ⅳ期压疮具有切取面积大、旋转角度大、不臃肿,组织相近、具有一定耐磨度、有利于防止压疮再发,同时具有缩短病程等优点.     

Experience with the operation of a device for roentgeno-endoscopic examination]

An appliance for roentgeno-endoscopic investigation permitting rotation of the patient is made in the shape of a crable that turns through 130 degrees and is firmly held in all positions of the X-ray apparatus mounting. The appliance provides good conditions for a multifarious roentgenological control over the manipulations with the bronchoscope, catheters, biopsy instruments and allows it to perform selective bronchography, pneumomediastinography angio- and lymphography. The appliance facilitates the arrest of the intrabronchial hemorrhage after biopsy and does not hamper the performance of reanimation procedures in cases of cardiac arrest. The use of the appliance increases the irradiation (absorbed) dose to which the service staff is exposed at their workplace by no more than 10 per cent.     

Experience with improving child health services in a rural region]

In order to reduce morbidity and especially infant mortality, alongside the state tasks, a number of health activities have been carried out in the region which to some extent helped reduce infant morbidity and mortality. But there are a number of social, medical and general culture problems the solution of which would be conducive to still better results: (a) problems related to living conditions; (b) child nutrition problems; (c) the increase of vacancies for children in preschool establishments; (d) the improvement of hospital care for children; (e) the improvement of out-patient activities; (f) the raising of volume and quality of curative and preventive measures; (g) the improvement of hygienic habits of population. The complex solution of social, medical and educational problems taking into consideration the specific conditions of the region, population residing in these regions, traditions and experience gained in organizations responsible for children's health would drastically improve the level of children's health.     

A comparison of the information obtained in a health survey by interview with primary care registries]

To estimate the levels of underreporting of medical visits and to compare the reporting of chronic restrictive diseases, 203 individuals who had been visited in a Primary Health Center were interviewed in the period of two weeks following the medical visit. Underreporting of a medical visit was identified in 31 (15.3%) of the users. The level of underreporting was not related with age, sex, education or socioeconomic status. Reporting of chronic restrictive illness was compared with the information recorded in the user's medical record. The highest global agreement (91.6%) was observed for hypertensive disease (kappa index = 0.71), while the lowest agreement was found for chronic back pain (global agreement = 77.8% and kappa index = 0.14). Since underreporting of medical visits was moderate, the results suggest that this question can be used for the analysis of social differences in the access to health services. Nevertheless, estimation of the prevalence of chronic limiting conditions in a health interview survey should be done with great caution.