腺性膀胱炎经尿道汽化电切加丝裂霉素膀胱灌注与单纯丝裂霉素膀胱灌注疗效比较

目的 比较腺性膀胱炎的两种治疗方案。方法 43例腺性膀胱炎患者行经尿道汽化电切加膀胱灌注丝裂霉素，另38例腺性膀胱炎患者单纯行丝裂霉素膀胱灌注。结果 经尿道汽化电切加丝裂霉素膀胱灌注比单纯行丝裂霉素膀胱灌注治愈率明显提高。结论 经尿道汽化电切加丝裂霉素膀胱灌注治疗腺性膀胱炎优于单纯行丝裂霉素膀胱灌注。     

经尿道汽化电切术联合丝裂霉素C膀胱灌注治疗腺性膀胱炎32例

目的:探讨腺性膀胱炎的诊断、治疗及预防复发的方法.方法:经尿道膀胱镜检及活组织检查确诊32例腺性膀胱炎患者,均行经尿道汽化电切术,术后6 h内丝裂霉素C进行膀胱灌注治疗.结果:随访6～24个月,26例治愈,膀胱黏膜逐渐恢复为移行上皮覆盖;6例于术后6～12个月复发,无癌变.结论:经尿道膀胱镜检加活组织检查是早期确诊和术后随访复查腺性膀胱炎的最可靠方法,经尿道汽化电切术联合术后6 h内丝裂霉素C膀胱灌注是治疗腺性膀胱炎的有效方法.     

经尿道等离子电切加丝裂霉素膀胱灌注治疗腺性膀胱炎56例

【目的】提高腺性膀胱炎的临床治疗效果.【方法】对56例经膀胱镜及病理学检查确诊的腺性膀胱炎行经尿道等离子电切,术后丝裂霉素膀胱灌注.【结果】56例患者随访1～3年,49例临床治愈,7例好转患者均于两年内复发,其中5例经再次电切及丝裂霉素膀胱灌注后治愈,2例无效行膀胱部分切除后治愈,无一例恶变.【结论】经尿道等离子电切加丝裂霉素膀胱灌注是治疗腺性膀胱炎的有效方法.     

经尿道腺性膀胱炎电灼术加膀胱灌注的护理

目的 探讨经尿道腺性膀胱炎电灼术加膀胱灌注药物治疗腺性膀胱炎的护理措施。方法 回顾性分析24例腺性膀胱炎患者的临床资料，通过经尿道腺性膀胱炎电灼术加膀胱灌注药物治疗，同时做好心理护理、术前、术后护理，以及丝裂霉素膀胱灌注化疗的护理，加强健康宣教，改变其不良生活习惯。 结果 24例均行4～18个月随访，平均11个月，全部治愈，无复发。 结论 对腺性膀胱炎患者进行有效护理对于疾病的治疗和预后非常重要。     

腺性膀胱炎的临床治疗观察(附66例报告)

目的 探讨腺性膀胱炎的诊断和治疗方法。方法 对66例腺性膀胱炎患者行经尿道汽化电切及膀胱药物灌注治疗。结果 随访6～36个月，平均18个月，其中治愈60例，6例12～18个月内复发。结论 经尿道电切汽化术加膀胱药物灌注是治疗腺性膀胱炎的首选办法，该法既可以消除临床症状，又可以预防复发和恶变。     

经尿道电切术加卡介苗及白细胞介素Ⅱ膀胱灌注治疗腺性膀胱炎(附17例报告)

目的：评价经尿道电切术加卡介苗及白细胞介素Ⅱ膀胱灌注治疗腺性膀胱炎的临床价值。方法：1993年5月－1999年12月采用经尿道电切术加卡介苗及白细胞介素Ⅱ膀胱灌注治疗腺性膀胱炎17例，其中单纯性腺性膀胱炎15例，合并前列腺增生2例。结果：治愈14例，好转3例；13例获随访6－73个月，无复发。结论：经尿道电切术加卡介苗及白细胞介素Ⅱ膀胱灌注治疗腺性膀胱炎，疗效满意。     

经尿道电切术加膀胱灌注治疗腺性膀胱炎

目的评估经尿道电切术联合膀胱化疗药物灌注治疗腺性膀胱炎的临床疗效。方法2006年1月-2009年1月,对16例经膀胱镜及病理检查确诊的腺性膀胱炎患者行经尿道电切加术后吡柔比星膀胱灌注治疗。结果16例均随访4～36个月,13例临床治愈,3例好转,1例复发经再次电切及吡柔比星膀胱灌注后治愈,无恶变病例。结论经尿道电切联合吡柔比星膀胱灌注治疗腺性膀胱炎是一种可行有效的方法。     

经尿道电切加术后联合膀胱灌注治疗腺性膀胱炎52例体会

目的探讨提高腺性膀胱炎治疗效果的方法。方法经膀胱镜检查结合组织活检确诊52例腺性膀胱炎患者,经尿道膀胱汽化电切以及术后丝裂霉素膀胱灌注治疗。术后依灌注方式不同分为两组：一组26例给予术后3d丝裂霉素20mg灌注,然后每周一次,共8次;另外26例患者术后6h内灌注丝裂霉素40mg一次。结果全部52例患者随诊3～46个月,治愈43例,好转7例,无效2例。两组患者治愈率无明显差异。结论经尿道电切术联合膀胱灌注丝裂霉素是治疗腺性膀胱炎较好的方法。术后6h内灌注丝裂霉素40mg一次与多次灌注效果相当,但一次灌注节省治疗费用及时间,值得推广。     

经尿道双极等离子电切联合丝裂霉素灌注治疗腺性膀胱炎35例分析

目的：探讨经尿道双极等离子电切联合膀胱灌注丝裂霉素治疗腺性膀胱炎的疗效。方法：对35例腺性膀胱炎患者行经尿道双极等离子电切电灼术及术后膀胱内丝裂霉素等药物灌注治疗。结果：35例随访6～24个月,治愈31例,好转2例,2例于术后6个月复发。结论：经尿道双极等离子电切加膀胱丝裂霉素灌注是治疗腺性膀胱炎的较好方法,既可消除临床症状,又可预防复发和恶变。     

双极汽化电切术加膀胱灌注化疗药物治疗腺性膀胱炎78例

目的：探讨腺性膀胱炎的治疗及预防复发的疗效。方法：对非手术治疗症状无明显改善的78例腺性膀胱炎患者，根据不同病变类型，采用经尿道等离子电灼或电切术，术后行丝裂霉素或羟基喜树碱膀胱灌注，并定期膀胱镜检查。结果：78例经尿道等离子汽化治疗顺利。随访1年-3．5年，76例患者膀胱刺激症等症状消失或明显缓解，2例患者症状无明显改善。7例患者在术后6个月～2年内复发，行二次等离子汽化治疗，未再复发和癌变。结论：经尿道等离子汽化加化疗药物膀胱灌注是治疗腺性膀胱炎的有效方法。     

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.