不同麻醉方法在支气管镜患者检查中的效果分析

目的探讨不同麻醉方法在支气管镜患者检查中的效果。方法临床统计96例支气管镜患者,随机分为4组,分别采用不同方法进行麻醉,观察统计4组患者的麻醉效果、平均耗药量、达到有效麻醉的时间。结果第1组优20例,良4例,中0例,差0例;第2组优11例,良6例,中4例,差3例;第3组优10例,良7例,中5例,差2例;第4组优7例,良5例,中8例,差4例。结论含漱法联合空气压缩雾化吸入麻醉法效果最好,值得临床推广应用。     

原发性十二指肠恶性肿瘤44例临床分析

原发性十二指肠恶性肿瘤发病率低 ,临床表现缺乏特异性 ,早期明确诊断困难 ,本文就 1991～2 0 0 0年安徽医科大学附属医院普外科收治的 4 4例经病理确诊的原发性十二指肠恶性肿瘤进行回顾性分析 ,探讨该病的诊治。临床资料(一 )一般资料 4 4例中男 32例 ,女 12例 ,年龄2 9～ 72岁 ,平均 5 2 .2 7岁 ,从症状出现到就诊的时间为 1周～ 3年 ,平均 4个月。主要临床表现有梗阻性黄疸 2 9例 ,上腹痛或不适 2 4例 ,上消化道出血10例 ,纳差消瘦 8例 ,呕吐 6例 ,其中 1例呕吐有胆汁 ,胆道感染 4例。(二 )辅助检查Ｂ型超声检查 38例 ,有 34例(89.4 7% …     

闭合性十二指肠损伤的处理体会

我院 1991年～ 2 0 0 3年共收治闭合性十二指肠损伤病人 2 1例 ,现报告如下。临床资料本组 2 1例中 ,男 16例 ,女 5例 ;年龄 17～ 6 2岁。其中 ,车祸伤 13例 ,击伤 4例 ,跌伤 2例 ,坠落伤 2例。手术距受伤时间 6h12例 ,8～ 12h4例 ,12～ 2 4h3例 ,2 4～ 4 8h2例。 2 1例均有外伤史 ,伤后均出现不同程度的上腹疼痛。呕吐咖啡样物 5例 ,向右腰及会阴部放射痛 4例 ,有腹膜刺激征 18例。其中 ,有肠鸣音改变者 3例。腹腔穿刺抽出胆汁样物 6例 ,B型超声示腹膜后血肿 4例 ,X线示左腰大肌轮廓模糊 3例 ,CT示右肾旁前间隙游离气体和积液 3例。术前…     

12例骶髂关节脱位合并耻骨联合分离、骨折的治疗

<正>自2002年2月至2007年5月,本院骨科采用前路重建钢板固定治疗骶髂关节脱位合并耻骨联合分离、骨折12例,疗效满意,现报告如下。1临床资料1.1一般资料:本组男8例,女4例;年龄20～52岁,平均39岁。左侧6例,右侧4例,双侧2例。合并耻骨联合分离4例,耻骨骨折6例,合并髋臼骨折4例,肋骨骨折3例。车祸伤8例,坠落伤4例。按Tile【1】分类,B12例,B22例,C13例,C25例。     

腰椎间盘突出症手术治疗280例疗效分析

我院自1990年12月-2003年6月共手术治疗腰椎间盘突出症280例,随访246例中优良率达97.55%,收到满意效果,现报告如下:1临床资料1.1一般资料本组男186例,女94例;年龄17～73岁,平均45岁,有损伤或重体力劳动史者占64.5%,病程10d～26年。腰腿痛型254例,其中有5例按摩不当而症状突然加重,腿痛型26例;单侧症状214例,双侧症状66例;单纯椎间盘突出212例,合并有侧隐窝狭窄51例、软骨板破裂骨化10例、腰椎不稳4例、腰椎滑脱1例、椎板骨折2例。节段分布情况:L3-422例,L4-5108例,L5S186例,L3-4 L4-519例,L4-5 L5S139例,L3-4 L5S15例,L3-4伴L5滑脱1例…     

粪石性肠梗阻24例诊治体会

粪石性肠梗阻少见 ,且其症状常不典型 ,容易引起误诊。我们 1 989年～ 2 0 0 2年共收治粪石性肠梗阻 2 4例 ,占同期 1 0 5 1例肠梗阻病例的 2 .3%。为引起重视 ,现将我们的诊治经验报告如下。临床资料1 .一般资料 :本组 2 4例中 ,男 1 6例 ,女 8例。年龄 4～ 6 8岁 ,其中 ,4～ 2 0岁 1 7例 ,男 1 3例 ,女 4例 ;2 5～ 4 4岁 2例 ,均为男性 ;6 0岁以上 5例 ,男 1例 ,女 4例。本组有 1 7例是在 9～ 1 2月份入院 ,其余 7例为散发。发病时间在一次性进食过多柿子、山楂等食物后 ,最短 2d ,最长 4年。2 .早期症状 :①腹痛 :本组均有。呈阵发性绞痛…     

SMAD4蛋白免疫组织化学反映幼年性息肉病综合征遗传状态

幼年性息肉综合征(JPS)可能由SMAD4基因的生殖缺陷导致。研究者利用SMAD4蛋白的免疫组织化学方法研究了20例有SMAD4生殖缺陷的息肉,并采用38例无生殖缺陷息肉作对照。20例中有9例为SMAD4基因表达缺失,有5例为     

安舒栓可吸收血管夹在LC手术中的应用体会

1999年 3月至 2 0 0 0年 12月 ,我们在实施腹腔镜胆囊切除术 (ＬＣ)中 ,使用一次性安舒栓可吸收ＰＤＳ血管夹 16 5例 ,现报道如下。1　临床资料本组男 37例 ,女 12 8例 ,男女比例为 1∶3 4 6。 19～ 75岁 ,平均 4 6岁 ,年龄分布为 :19～ 30岁 2 0例 ,31～ 4 0岁 38例 ,4 1～ 5 0岁 5 0例 ,5 1～ 6 0岁 4 3例 ,6 1～ 75岁 14例。术后诊断 :胆囊结石并慢性胆囊炎 15 5例 ,胆囊结石慢性胆囊炎急性发作 6例 ,胆囊息肉 4例。合并症有 :胰腺炎 2例、高血压 1例、肾积水 1例、肝硬化 1例、矽肺 1例、陈旧性宫外孕 1例。使用可吸收止血夹数量分布为 …     

克氏针加掌指托治疗陈旧性锤状指

2018年1月～2019年1月,我科采用克氏针加掌指托治疗20 例陈旧性锤状指患者,疗效满意,报道如下. 1 材料与方法 1. 1 病例资料 本组20 例,男16 例,女4例,年龄6 ～60 岁.左手16 例,右手4例.小指11 例,环指4 例,中指2例,示指3 例.伤后至手术时间4 ～9周.     

胰腺囊肿的诊断与治疗

我院 1 993年 1 2月～ 2 0 0 0年 1 2月共收治胰腺囊肿 2 4例 ,现报告如下。临床资料本组共 2 4例 ,男 1 4例 ,女 1 0例。 2 4例中假性胰腺囊肿 1 8例 ,其中外伤所致 3例 ,胰腺炎后引起 1 5例 ;囊性肿瘤 6例 ,其中囊腺病 4例 ,囊腺癌2例。临床表现主要为上腹部胀痛 ,腹部包块。胰腺囊肿单发者 2 0例 ,多发者 4例。单发囊肿位于胰头部 6例 ,胰体尾部 1 4例。囊肿体积最大 1 8ｃｍ×1 6ｃｍ× 1 0ｃｍ ,最小 2ｃｍ× 2ｃｍ× 3ｃｍ。囊内容物为白色或褐色液体 ,囊液量最多达 1 0 0 0ｍｌ,最少30ｍｌ。囊液淀粉酶含量在 60 0～ 2 4 0 0Ｕ。囊液…     

The ileocoecal valve changes in chronic constipation in children

There were analyzed the results of treatment of 574 children, suf fering anatomic anomalies of a large bowel, in whom a chronic constipation was revealed. In 61 patients the ileoceocal valve (IV) insufficiency was noted. To all the patients together with complex conservative treatment there was prescribed a preparation, containing magnesium orotat, for restoration of the IV insufficiency. In 56 (91.8%) patients conservative treatment was effective and in 5--surgical intervention was conducted as a consequence of ineffective conservative treatment. Negative correlation dependence was established between a patient age and results of treatment.     

基于M-ANNHEIM评分系统评价慢性胰腺炎不同治疗方式的临床疗效

目的基于M-ANNHEIM评分系统评价慢性胰腺炎不同治疗方式的临床疗效。方法采用回顾性横断面研究方法。收集2008年7月至2018年7月2家医疗单位收治的177例慢性胰腺炎患者(四川省人民医院95例、四川大学华西医院82例)的临床病理资料;男100例,女77例;年龄为(49±5)岁,年龄范围为29~72岁。根据M-ANNHEIM慢性胰腺炎临床分期系统进行疾病分期。不同临床分期患者分别选择单纯药物、内镜以及手术治疗。观察指标:(1)患者总体情况及随访情况。(2)无症状期患者治疗情况。(3)Ⅰ期患者治疗情况。(4)Ⅱ期患者治疗情况。(5)Ⅲ期患者治疗情况。(6)Ⅳ期患者治疗情况。(7)糖尿病加重及新发情况。(8)并发症情况。采用门诊、电话、信件、问卷星方式进行随访,随访内容为M-ANNHEIM评分所需要的相关数据。随访时间截至2018年12月。正态分布的计量资料以±s表示,多组间比较采用单因素方差分析。重复测量资料采用重复测量方差分析。计数资料以绝对数表示,组间比较采用χ2检验。结果(1)患者总体情况及随访情况:177例患者治疗前M-ANNHEIM慢性胰腺炎分期无症状期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别为11、72、55、31、8例。177例患者施行单纯药物治疗、内镜治疗、手术治疗分别为49、49、79例。177例患者均获得随访,随访时间为(2.4±0.5)年。(2)无症状期患者治疗情况:11例无症状期患者均行单纯药物治疗,治疗前M-ANNHEIM评分为(1.91±0.21)分,治疗后1、12、24个月M-ANNHEIM评分分别为(1.27±0.14)分、(1.73±0.19)分、(2.09±0.16)分。(3)Ⅰ期患者治疗情况:72例Ⅰ期患者中,行单纯药物治疗13例,行内镜治疗26例,行手术治疗33例。患者行单纯药物治疗前,治疗后1、12、24个月M-ANNHEIM评分分别为(8.11±1.05)分,(6.31±0.31)分、(7.69±0.24)分、(10.00±0.23)分。行内镜治疗患者上述指标分别为(8.42±0.93)分、(5.13±0.25)分、(6.89±0.20)分、(8.27±0.24)分。行手术治疗患者上述指标分别为(8.13±0.77)分、(4.79±0.15)分、(5.42±0.22)分、(7.76±0.20)分。3种治疗方式治疗前M-ANNHEIM评分比较,差异无统计学意义(F=1.23,P>0.05)。Ⅰ期患者治疗后1个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=2.94,4.98,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=1.26,P>0.05)。Ⅰ期患者治疗后12个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=2.43,5.99,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异有统计学意义(F=4.80,P<0.05)。Ⅰ期患者治疗后24个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=4.61,6.29,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=1.63,P>0.05)。(4)Ⅱ期患者治疗情况:55例Ⅱ期患者中,单纯药物治疗8例,内镜治疗15例,手术治疗32例。患者单纯药物治疗前,治疗后1、12、24个月M-ANNHEIM评分分别为(12.61±1.16)分,(11.63±0.26)分、(12.57±0.30)分、(14.50±0.27)分。行内镜治疗患者上述指标分别为(12.42±1.43)分、(8.47±0.24)分、(11.07±0.21)分、(11.93±0.30)分。行手术治疗患者上述指标分别为(12.53±1.22)分、(8.78±0.15)分、(9.94±0.21)分、(11.00±0.24)分。3种治疗方式治疗前M-ANNHEIM评分比较,差异无统计学意义(F=1.38,P>0.05)。Ⅱ期患者治疗后1个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=8.37,8.48,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=1.13,P>0.05)。Ⅱ期患者治疗后12个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=4.13,8.48,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异有统计学意义(F=3.33,P<0.05)。Ⅱ期患者治疗后24个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=5.61,6.83,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异有统计学意义(F=2.26,P<0.05)。(5)Ⅲ期患者治疗情况:31例Ⅲ期患者中,单纯药物治疗9例,内镜治疗8例,手术治疗14例。患者单纯药物治疗前,治疗后1、12、24个月的M-ANNHEIM评分分别为(17.25±0.89)分,(17.11±0.35)分、(18.44±0.41)分、(17.33±0.44)分。行内镜治疗患者上述指标分别为(17.38±1.06)分、(15.00±0.53)分、(16.50±0.33)分、(16.88±0.44)分。行手术治疗患者上述指标分别为(17.63±1.06)分、(14.64±0.34)分、(16.00±0.35)分、(16.57±0.33)分,3种治疗方式治疗前M-ANNHEIM评分比较,差异无统计学意义(F=1.19,P>0.05)。Ⅲ期患者治疗后1个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=3.37,4.82,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=0.59,P>0.05)。Ⅲ期患者治疗后12个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均有统计学意义(F=3.63,4.48,P<0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=0.95,P>0.05)。Ⅲ期患者治疗后24个月,单纯药物治疗分别与内镜治疗、手术治疗M-ANNHEIM评分比较,差异均无统计学意义(F=0.73,1.41,P>0.05);内镜治疗与手术治疗M-ANNHEIM评分比较,差异无统计学意义(F=0.55,P>0.05)。(6)Ⅳ期患者治疗情况:8例Ⅳ期患者均行单纯药物治疗,治疗前,治疗后1、6、12、24个月M-ANNHEIM评分分别为(17.94±0.59)分,(18.01±0.34)分、(17.54±0.19)分、(17.34±0.26)分、(17.88±0.43)分。(7)糖尿病加重及新发情况:49例内镜治疗患者中,治疗前17例合并糖尿病,治疗后糖尿病加重5例,治疗后新发糖尿病11例;79例手术治疗患者中,治疗前31例合并糖尿病,治疗后糖尿病加重21例,治疗后新发糖尿病7例;两种治疗方式糖尿病加重和新发糖尿病比较,差异均有统计学意义(χ2=2.07,2.04,P<0.05)。(8)并发症情况:49例单纯药物治疗患者中,未发生治疗相关并发症。49例内镜治疗患者中,支架相关并发症4例经内镜重新安置支架后治愈,急性胰腺炎6例,消化道出血2例(1例经内镜下止血治愈),其余并发症经对症支持治疗后好转。79例手术治疗患者中,术后胰瘘17例(生化漏11例、B级胰瘘5例、C级胰瘘1例),术后胃瘫3例,术后腹腔感染3例,深静脉血栓形成1例,术后出血2例(1例合并C级胰瘘经再次开腹止血缝合后好转、1例经介入治疗后好转),其余并发症经对症支持治疗后好转。结论慢性胰腺炎应根据不同病情分期制订个体化治疗方案,M-ANNHEIM评分系统可用于评价单纯药物、内镜及手术治疗的临床疗效。     

磁疗椅对慢性盆腔疼痛综合征的治疗作用

目的：观察磁疗椅对慢性盆腔疼痛综合征（CPPS）的疗效。方法：2005年6月～2007年4月,我院收治ⅢB型CPPS患者40例,随机分为两组,一组单用α-受体阻滞剂坦索罗辛（O．2mg／d）（单用组）治疗;另一组并用坦索罗辛（0．2mg／d）和磁疗椅（并用组）治疗,磁疗椅每周2次,每次约30min,4周为1个疗程;治疗前后作前列腺炎症状评分（NIH—CPSI）。结果：所有患者均按要求完成治疗。与单用组比较,并用组NIH—CPSI、疼痛评分、排尿评分、严重程度和生活质量评分均有显著下降（P〈0．05）。结论：磁疗椅对CPPS有显著疗效,且操作简单,患者无明显不适,依从性好,值得在临床上推广运用。     

Pain in the head and neck cancer patient: changes over treatment

The incidence, severity, and location of pain was evaluated in 30 head and neck cancer patients prior to treatment after the first phase of their treatment and upon the completion of treatment. The incidence of pain was relatively high (40%-70%) and tended to increase slightly over treatment. Patients having advanced disease (stage III or IV) had a higher incidence of pain. Pain severity ratings were stable over treatment. Pain was located close to tumor or incision sites, and a trend for patients to report a greater number of pain sites over treatment was noted. While medical status variables (disease stage and site) were found to predict pain status after the initial phase of cancer treatment, initial pain measurements were more likely to predict pain status at the completion of treatment.     

Experience in the application of iodine-diceryn in the treatment of purulent wounds]

Comparative results of treatment of 103 patients with purulent-inflammatory diseases of soft tissues are presented. In patients of a main group iodine-dicerin was applied locally and in control group generally accepted treatment was conducted. Using iodine-dicerin the results of treatment were significantly better, the stationary treatment course was two times shorter than in a control group of patients.     

A randomized trial of choice of treatment in prostate cancer: the effect of intervention on the treatment chosen

OBJECTIVE: To determine whether different approaches in the choice of treatment affect the treatment chosen by the patient for prostate cancer. PATIENTS AND METHODS: We conducted a randomized trial with 210 men who had a histologically confirmed diagnosis of prostate cancer in 1993-94 at four major hospitals in Finland. After obtaining informed consent the men were randomized either to an intervention arm, in which there was greater patient participation in the choice of treatment following a structured procedure, or a control arm in which the standard approach, i.e. a standardized treatment protocol, was used. The main outcome measure of the analysis was the primary treatment chosen for prostate cancer. RESULTS: In the enhanced participation arm patients not eligible for radical prostatectomy chose orchidectomy less frequently and favoured nonsurgical endocrine treatment than in the treatment protocol arm. Radical prostatectomy was the most commonly chosen treatment option in both arms among men with operable cancer. The way treatment options were presented affected the treatment chosen for prostate cancer. CONCLUSION: Patients with prostate cancer are willing and able to take an active role in making decisions. The preferences of patients with prostate cancer in the choice of treatment may differ from the priorities of the physicians.     

THE COSTS OF TREATING BREAST CANCER IN AUSTRALIA AND THE IMPLICATIONS FOR BREAST CANCER SCREENING

The aim of the study was to determine if there is a relationship between the stage of breast cancer at the time of detection and the costs of treatment and to assess whether any such relationship would have an influence on the cost of a mammographic screening programme. A retrospective analysis of the stage at presentation for primary breast cancer and the treatment costs over the duration of treatment was made. Multiple regression analysis was employed, with treatment cost as the dependent variable and categorical variables to represent stage at detection. A total of 301 women whose treatment for breast cancer commenced at the Royal Brisbane Hospital participated in the study. A statistically signficiant relationship was found between the stage of disease at the time of detection and subsequent treatment costs; more advanced stages of disease incurred higher treatment costs. This relationship was robust even after taking into account the age of patients, their discharge status, and differences between patients in the duration of treatment. When the effect of earlier detection on treatment cost was assessed in relation to a breast screening programme, cost savings were estimated to be in the range of 8–36% of total screening costs. There are treatment cost savings to be gained from breast cancer screening as a result of the detection of earlier stages of disease. These treatment cost savings should be offset against the cost of a mammographic screening programme.     

Botulinum toxin A for treatment of neurogenic detrusor overactivity and incontinence in patients with spinal cord lesions

OBJECTIVE: To evaluate the efficacy of intravesical botulinum toxin A (BTA) in the treatment of severe neurogenic detrusor overactivity (NDO) with incontinence in patients with spinal cord lesions (SCLs). MATERIAL AND METHODS: Fifteen SCL patients suffering from NDO and incontinence were included in the study. The volume of urine leakage during episodes of incontinence was quantified, and filling cystometry was performed before and after BTA treatment. During BTA treatment, a total of 300 IU of BTA was injected cystoscopically into the detrusor muscle, excluding the trigone region. Antibiotic prophylaxis was given. RESULTS: Thirteen of 15 patients (87%) reported that they were fully continent after treatment and the volume of leakage in the two incontinent patients was significantly reduced. Anticholinergic medication was stopped in all patients after BTA treatment. Cystometry showed a marked reduction in pressures after treatment in all patients, with the maximum detrusor pressure during filling being significantly reduced (p < 0.0005) and the maximum volume at a detrusor pressure of <40 cmH2O being significantly increased (p < 0.0005) in all patients. The maximum bladder capacity was increased, although not significantly. The period during which the patients remained continent following treatment ranged from 4 to 12 months (median 7 months). With the exception of slight haematuria, which resolved spontaneously, no side-effects were observed, and no cases of autonomic hyperreflexia were seen during treatment. CONCLUSION: BTA proved to be a highly effective treatment modality for NDO and incontinence in SCL patients. Treatment was easy to perform and the duration of effect was acceptable. Furthermore, BTA treatment was associated with virtually no side-effects.     

糖化血红蛋白与血脂在老年糖尿病治疗中的应用

目的：探讨糖化血红蛋白与血脂在老年糖尿病治疗中的应用效果。方法老年糖尿病患者120例根据随机抽签原则分为治疗组与对照组各60例,对照组给予格列齐特缓释片进行治疗,治疗组采用二甲双胍结合格列齐特缓释片治疗,治疗周期为1个月。结果对照组血糖达标时间为（24.83±5.34）d,治疗组血糖达标时间为（13.64±4.19）d,组间对比差异明显（P＜0.05）。治疗后治疗组的糖化血红蛋白值明显低于对照组（P＜0.05）,治疗组的TG、TC和LDL-C值明显高于对照组,而HDL-C值明显低于对照组,对比差异都有统计学意义（P＜0.05）。结论糖化血红蛋白与血脂在老年糖尿病治疗中的应用能有效判断疾病状况,而二甲双胍的应用能更加有效改善预后。     

Early intervention in whiplash-associated disorders: a comparison of two treatment protocols

STUDY DESIGN: A prospective randomized trial in 97 patients with a whiplash injury caused by a motor vehicle collision. OBJECTIVES: The study evaluates early active mobilization versus a standard treatment protocol and the importance of early versus delayed onset of treatment. SUMMARY OF BACKGROUND DATA: There is no compelling evidence to date on the management of acute whiplash-associated disorders. The few studies describing treatment, however, provide evidence to support the recommendation that an active treatment in the acute stage is preferable to rest and a soft collar in most patients. METHODS: Patients were randomized to four groups. Active versus standard treatment and early (within 96 hours) versus delayed (after 2 weeks) treatment. Measures of range of motion and pain were registered initially and at 6 months. RESULTS: Eighty-eight patients (91%) could be followed up at 6 months. Active treatment reduced pain more than standard treatment (P < 0.001). When type and onset of treatment were analyzed, a combined effect was seen. When active treatment was provided, it was better when administered early, and if standard treatment was provided, it was better when administered late for reduction of pain (P = 0.04) and increasing cervical flexion (P = 0.01). CONCLUSIONS: In patients with whiplash-associated disorders caused by a motor vehicle collision treatment with frequently repeated active submaximal movements combined with mechanical diagnosis and therapy is more effective in reducing pain than a standard program of initial rest, recommended use of a soft collar, and gradual self-mobilization. This therapy could be performed as home exercises initiated and supported by a physiotherapist.