局部放疗与球后注射治疗Graves眼病的临床疗效观察

【目的】寻找治疗Graves眼病较为有效的方法 ,研究联合应用眶内局部放疗与长效糖皮质激素球后注射治疗Graves眼病的疗效。【方法】随机选取在本科住院治疗的Graves眼病患者 5 2例 90眼 ,根据治疗方法不同随机分为联合治疗组 (糖皮质激素球后注射治疗 +眶内放疗 ) 2 6例 4 6眼 ,对照组 (糖皮质激素球后注射治疗 ) 2 6例 4 4眼。治疗前后分别测量两组患者患眼的眼球突出度与睑裂宽度并观察症状及眼征情况。【结果】对照组治疗前后眼球突出度差异有显著性 (P <0 .0 5 ) ;睑裂宽度差异无显著性 (P >0 .0 5 )。联合治疗组治疗前后眼球突出度及睑裂宽度差异均有显著性 (均P <0 .0 5 )。同时 ,联合治疗组眼球突出度及睑裂宽度下降均较对照组明显 ,两组比较差异均有显著性 (均P <0 .0 5 )。联合治疗组症状改善率为 96 .2 % ,对照组症状改善率为 84 .6 %。【结论】联合应用眶内局部放疗与长效糖皮质激素球后注射治疗Graves眼病是一种较为有效的治疗方案 ,其治疗效果优于单独使用糖皮质激素。     

高压氧综合治疗Graves眼病9例

一、资料与方法Graves眼病患者 9例 ,均为我院住院或门诊患者 ,均为女性 ;年龄 2 5～ 5 8岁 ,平均 43 .5岁 ;所有患者均有弥漫性甲状腺肿伴甲状腺功能亢进病史。甲亢病程为 6个月～ 3年 ,平均 18个月 ;出现Graves眼病的时间为 2周～ 10个月 ,平均 5 .75个月。患眼 18只 ,主要临床表现为 :突眼、复视、畏光、流泪、结膜充血、眼睑水肿或下垂 ,眼球胀硬感、眼球运动障碍等。根据患者甲亢程度给予甲状腺素片、他吧唑等药物 ,在服药同时均以高压氧治疗。高压氧治疗方案 :采用多人空气加压舱 ,治疗压力 0 .12MPa ,戴面罩吸纯氧 2次 ,每次 3 0mi…     

甲状腺内局部注射免疫调节剂治疗Graves眼病的临床研究

目的观察经皮B超引导下甲状腺内局部注射地塞米松和生长抑素类似物（善宁）免疫调节剂治疗Graves眼病（GO）的有效性和安全性。方法将40例GO患者按随机数字表法分为对照组和观察组各20例,对照组给予口服抗甲状腺药物（甲巯咪唑）,疗程1年;观察组在口服甲巯咪唑基础上,经皮B超引导下甲状腺内局部注射地塞米松5 mg及善宁0.1 mg,每周1次,共4次。所有患者均行低碘饮食。比较2组临床疗效及治疗前后突眼度变化与不良反应发生情况。结果观察组与对照组总有效率分别为60%与35%,2组相比差异有统计学意义（P〈0.01）,治疗前后及2组之间突眼度比较差异均无统计学意义（P〉0.05）。结论经皮B超引导下甲状腺内局部注射地塞米松和生长抑素类似物治疗GO,可有效缓解眼睛局部刺激症状,降低GO分级,且安全性良好;但对突眼度无明显改善。     

己酮可可碱联合强的松治疗Graves眼病的疗效观察

目的：观察己酮可可碱联合强的松治疗Graves眼病的疗效。方法：将60例Graves眼病患者随机分成两组。对照组给予抗甲状腺药物及强的松;治疗组增用己酮可可碱。结果：两组总有效率分别为80.65%、44.83%（P〈0.01）;治疗组突眼度及血流变学指标改善明显。结论：己酮可可碱联合强的松治疗Graves眼病可提高临床疗效,改善血流变学指标。     

曲安奈德球周注射联合夏枯草胶囊口服治疗甲状腺相关性眼病的疗效观察

目的：探讨曲安奈德球周注射联合夏苦草口服治疗甲状腺相关性眼病（TAO）的治疗效果。方法选择2010年11月～2012年12月在本院确诊的30例（50眼）初发期甲状腺相关性眼病患者,参考患者病情程度及依从性将其分为2组：即曲安奈德球周注射联合夏枯草口服组15例（24眼）及大剂量泼尼松口服组15例（26眼）。2组患者的性别、年龄比较差异均无统计学意义（P＞0．05）。分别比较2组患者组内和组间治疗前后临床活动度积分（CAS）及眼外肌厚度,并分析治疗效果。结果曲安奈德球周注射联合夏枯草口服组治疗前后积分分别为（5．1±1．3）分和（2．6±1．4）分;泼尼松口服组为（5．0±1．5）分和（2．4±1．4）分,2组治疗前后组间CAS无显著差异（t=0．24,P＞0．05）,治疗前后组内比较差异均有统计学意义（P＜0．01）。球周注射联合夏枯草口服组治疗前后眼外肌厚度分别为（6．6±1．4）mm和（2．6±1．4）mm,泼尼松口服组为（6．5±1．7）mm和（2．5±1．5）mm,2组间比较无统计学意义（t=0．17,P＞0．05）,2组患者治疗后病情均有不同程度的缓解。结论对TAO初期患者,曲安奈德球周注射联合夏枯草组与大剂量泼尼松口服组具有相近的治疗效果,而前者无明显副作用,故初步认为,曲安奈德球周注射联合夏枯草方案在临床上值得推广应用。     

地塞米松及氨甲喋呤静脉冲击与单用强的松治疗Graves眼病的临床疗效观察

Graves眼病 (GO)的治疗方法较多 ,疗效不一 ,曾有使用地塞米松 (D)、氨甲喋呤 (MTX)、强的松 (P)及硫唑嘌呤 (A)的强化治疗方案 (DMPA)的研究报道 ,但这方面研究较少。本文观察了我院 1998年 2月至 2 0 0 2年 4月期间 78例GO用DMPA治疗与 6 9例GO单用强的松治疗的临床疗效 ,现报道如下。1　对象和方法1 1　对象1 1 1　治疗组 78例 ,男 2 1例 ,女 5 7例 ,年龄 2 2～ 5 6岁 ,平均 39岁 ;突眼病程 1月至 5年 ,平均 8月。对照组 6 9例 ,男 17例 ,女 5 2例 ,年龄 2 3～ 5 9岁 ,平均 4 1岁 ;突眼病程 1月至 4 312 年 ,平均 6月。均排除其…     

球后注射治疗Graves眼病的护理

突眼性甲状腺肿（Graves）眼病为眼眶常见病，居成人眼眶病的首位。目前，治疗方法众多，主要是药物、手术治疗、眼局部治疗、免疫抑制剂治疗及放疗。球后注射是局部给药的重要方法和途径，具有疗效快、给药准确，同时又可避免全身用药不良反应等优点。我科自2004年以来，对783例Graves眼病患者施行球后注射治疗。现将护理操作及体会介绍如下。     

环磷酰胺联合甲泼尼龙静脉冲击治疗中、重度Graves眼病的疗效

目的探讨环磷酰胺联合甲泼尼龙静脉冲击治疗中、重度Graves眼病的有效性和安全性。方法将66例中、重度Graves眼病患者随机分为甲泼尼龙冲击组30例和环磷酰胺联合甲泼尼龙冲击组36例。比较治疗前后2组患者的眼征评分、眼部彩超检查结果和不良反应。结果 2组患者治疗后CAS评分、眼睑水肿、结膜充血、突眼、视力、复视、球后面积及球后体积等指标均较治疗前有显著改善(P0.05)。环磷酰胺联合甲泼尼龙治疗组不良反应发生率显著低于单纯甲泼尼龙治疗组(P0.05)。结论环磷酰胺联合甲泼尼龙治疗中重度Graves眼病安全有效。     

直线加速器照射结合球后注射曲安奈德治疗Graves恶性突眼的护理

目的 总结直线加速器照射结合球后注射曲安奈德治疗Graves恶性突眼的护理方法。方法 对87例Graves恶性突眼患者109眼应用直线加速器照射结合球后注射曲安奈德治疗后的临床疗效及护理进行系统性回顾总结。结果 87例患者109眼眼球突出度及睑裂宽度在治疗1个月和3个月后与治疗前相比均有显著差异;畏光、流泪、眼胀、结膜充血水肿、视力下降、复视等均得到明显改善或消失。结论 直线加速器照射结合球后注射曲安奈德治疗Graves恶性突眼加上精心护理配合,疗效显著。     

应用甲氨喋呤,地塞米松冲击治疗Graves眼病10例观察

Graves眼病是甲亢病组中较为常见的一组并发症.目前,各级医院在治疗这种疾病的方法上,主要采用眼部局部治疗,双眼对称性局部区域放射治疗,眼部减压手术,大剂量白蛋白静滴冲击治疗和应用肾上腺皮质激素、环磷酰胺、硫唑嘌呤、环孢素A等药物治疗.对这些方法的疗效报道不一.笔者对10例Graves眼病应用甲氨喋呤和地塞米松进行联合冲击治疗,辅以口服强的松治疗,并观察疗效和随访6～12个月,报道如下.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.