KTP／YAG激光经尿道前列腺切除术后随访观察

自１９９５年５月～１９９７年６月，采用ＫＴＰ／ＹＡＧ激光经尿道切除前列腺术治疗前列腺增生症７３例。术后７０例随访０．５～２．５年。应用最大尿流率、残余尿量及国际前列腺症状评分进行评价，各项指标术后１个月与术前比较有显著性差异（Ｐ＜０．０１），术后６个月与术后１个月比较也有显著性差异（Ｐ＜０．０１）。     

Intraepithelial neoplasia of the lower genital tract

The incidence of CIN, VIN, and VAIN has increased dramatically in recent years due to a true increase in disease incidence as well as improved screening methods. Associated high-risk factors in the development of intraepithelial neoplasia are known, and effective treatment modalities are available. With the use of diagnostic techniques, patient education, and selection and utilization of appropriate therapies, intraepithelial neoplasia of the lower genital tract remains a disease that should not affect long-term morbidity, social status, or mortality of female patients.     

KTP／Nd：YAG激光治疗慢性泪囊炎术后两种冲洗方法的对比观察

目的：探讨KTP激光治疗慢性泪囊炎术后的冲洗方法。方法：389例慢性泪囊炎行泪道KTP激光鼻泪管阻塞疏通术的患者随机分为A组（178例）和B组（211例）。术后A组常规用易妥芬眼液滴眼,每周生理盐水冲洗泪道;B组常规易妥芬眼液滴,加易妥芬眼液每天1次连续冲洗7d,观察两组疗效。结果：A组治愈87例（48．88％）,好转14例（7．87％）,无效67例（37．64％）,有效率56．74％。B组治愈134例（63．51％）,好转37例（17．54％）,无效40例（18．96％）,有效率81．04％。两组疗效比较P〈0．05,差异有显著性意义。结论：KIP激光泪道疏通是治疗慢性泪囊炎的有效方法,联合术后应用易妥芬眼液冲洗泪道,可进一步提高手术疗效。     

重症监护病房患者下呼吸道院内感染细菌及其耐药性分析

目的探讨重症监护病房患者院内感染细菌分布特点及耐药情况。方法回顾性总结2004年5月至2006年6月本院重症监护病房103例院内感染(nosocomial infection,NP)患者的临床资料、感染病原菌谱及耐药性,并对相关因素进行分析。结果103例感染患者共分离出细菌117株,以G-杆菌为主(占68.4%),球菌比例较低(占21.4%)。G-杆菌中铜绿假单胞菌占第一位(31.6%),其次为大肠埃希氏菌(18.8%)、肺炎克雷伯菌(17.1%)。球菌主要为金黄色葡萄球菌,其中耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)占46.2%。G 菌占35.2%,真菌占18.3%。结论ICU患者下呼吸道感染的病原菌以G-杆菌为主,病原菌显示多重耐药,G-杆菌对亚胺培南敏感性较好,而G 菌对万古霉素敏感应根据药敏选择抗菌素。     

Female genital mutilation (FGM) and the lower urinary tract

Female genital mutilation (FGM) is defined by the World Health Organisation (WHO) as comprising various procedures which remove or damage the external female genital organs for no medical reason. FGM has no health benefits and is recognized to cause severe short and long term damage to both physical and psychological health. Although FGM is primarily performed in Africa, Asia and the Middle East, migration of FGM practising communities means that the health professionals worldwide need to be aware of the impact of FGM on health. FGM is almost always performed on children but the health implications of FGM are life‐long. FGM can cause immediate and long term damage to urinary function. In addition FGM may be detected during investigations for urinary symptoms which may be related or unrelated to the patient's FGM. Health professionals caring for girls and women with urinary symptoms must be aware of the clinical presentation of FGM and management options. They must also understand the legal implications of FGM and the role of health professionals in safeguarding girls from FGM as well as their own responsibilities for recording and reporting information about FGM.     

Comparative outcome of Holmium: YAG and KTP laser disc ablation in degenerative cervical disc disease: results of an ongoing study

Objective. This prospective study was designer to identify the relative efficacy of Holmium2100: YAG and KTP532 laser wavelengths in the treatment of broad based cervical disc protrusions presenting with cervical axial pain with compressive or non compressive radicular symptoms.
Methods. Patients with chronic cervical pain and radicular symptoms unresponsive to conservative treatment were assessed with MR scans. Those with broad based disc bulges were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performad as a day case procedure on 105 patients at 108 levels under X-ray control via the anterior approach with side firing probes. Vernon-Mior cervical disability and visual analogue pain indices were used to assess the outcome of the procedures.
Results. At a minimum follow up of 12 months 50% of patients demonstrated a sustained significant (excellent to good) clinical benefit with an index value of 50% or more while an additional 25% demonstrated functional improvement. No difference in outcome was identified with either wavelength utilized or with laser annealing or painful discal tears. At this juncture the cohort integrity of the study is 74%.
Conclusion. The outcome of treatment for cervical degenerative disc disease with compressive or non compressive radicular symptoms with KTP or Holmium: YAG laser is identical. The sustained nature of the benefit after long term preoperative symptoms (mean 3,4 years) rules out placebo effect.     

钬激光内切开术治疗输尿管狭窄的临床分析

目的探讨输尿管镜下钬激光内切开加留置7-12F外套式双J管治疗输尿管狭窄的效果。方法2001年3月-2004年10月采用经输尿管镜钬激光内切开治疗56例62次输尿管狭窄，术中留置7-12F外套式双J管，术后2、3个月拔除双J管，拔管后4周、12周、0．5a进行超声、排泄性尿路造影及肾图检查。结果术后56例共随访了50例，随访率89．2％，随访3-40个月；42例／50例治愈（治愈率84．0％），36例／50例一次内切开治愈（1次切开治愈率72．0％），6例／50例行2次以上内切开治愈（占12．0％）。IVP检查提示：输尿管狭窄段消失。B超示：肾孟集合系统分离从术前平均31mm缩小到术后平均16mm（P〈0．01）。2例因肾脏无功能伴感染行肾切除术；1例术后出现大出血；1例行输尿管膀胱移植。结论输尿管镜下钬激光内切开加留置7-12F外套式双J管治疗原发性和继发性输尿管狭窄具有创伤小，疗效较佳的优点。     

Q型双波长YAG激光治疗太田痣56例临床观察

目的 探讨Q型双波长YAG激光治疗太田痣的效果。方法应用Q型双波长YAG激光治疗不同形态的太田痣，观察效果及注意事项。结果56例中，治愈6例（10．7％），显效36例（64．3％），改善14例（25．0％），总有效率100％。结论Q型双波长YAG激光治疗太田痣安全有效，不良反应轻微短暂。     

门诊经输尿管镜钬激光治疗输尿管中下段结石

目的 探讨门诊经输尿管镜钬激光治疗输尿管中下段结石的有效性和安全性.方法 该组57例经B超或静脉肾孟造影(IVU)确诊的输尿管中下段结石,体积0.7～1.5 cm,其中急性肾绞痛43例,腰部胀痛14例,31例体外冲击波碎石((ESWL)后排石不佳.术前肌肉注射苯巴比妥钠,术中尿道表面麻醉,直视下进镜,钬激光功率20～25 W碎石及取石,术毕留置双J管.采用语言描述评分法评佑疼痛耐受性,痛感明显者肌肉注射低剂量杜冷丁.结果 该组病例全部成功完成手术,急性肾绞痛均立即缓解,手术时间10～60 min.术后1周结石清除率91.2%(52/57例),2例1周后二次手术清石,3例结石返回至肾内经ESWL后排出.随访1～3个月,结石排净率100%(57/57例).术中Ⅱ级疼痛占49.1%(28/57),Ⅲ级38.6%(22/57),Ⅳ级13.3%(7/57).结论 门诊钬激光治疗输尿管下段结石微创、高效、安全、可靠,尤其适合结石体积较小、肾绞痛反复发作、ESWL失败的患者.     

Clinical application of Er:YAG laser for cavity preparation in children

OBJECTIVE: The purpose of this study was to determine the clinical usefulness of Er:YAG laser for cavity preparation in children. BACKGROUND DATA: The conventional methods for cavity preparation instill fear and discomfort in pediatric patients. The Er:YAG laser is a new tool developed for cavity preparation; however, there are few reports of its clinical application. MATERIALS AND METHODS: A clinical evaluation using an Er:YAG laser was carried out using 32 subjects (with 16 deciduous and 19 permanent teeth) with ages ranging from 2 to 12 years. All cavities were restored with light-cured composite resin following the application of bonding agent, but without acid etching or primer conditioning. RESULTS: During laser treatment, the pediatric patients were very cooperative and hardly complained of any pain, and no tooth showed undesirable effects during the 3-year period of observation. CONCLUSION: It can be concluded from the results of this study that an Er:YAG laser would be a useful alternative method for cavity preparation for composite resin restoration in children.     

Clinical pharmacodynamics of meropenem in patients with lower respiratory tract infections

Studies of beta-lactam pharmacodynamics in infected patients are sparse. In this study, classification and regression tree (CART) and logistic regression analyses were used to identify which pharmacodynamic indices and magnitudes were significant predictors of meropenem efficacy for 101 adult patients with lower respiratory tract infections (LRTI). Using demographic data, a validated population pharmacokinetic model was employed to predict pharmacokinetic parameters and free serum concentrations in the studied patients. Pharmacodynamic indices [percentage of the dosing interval that free drug concentrations remain above the MIC (% fT > MIC), f(maximum concentration of drug in serum) (fC(max))/MIC, fC(min)/MIC, and f(area under the concentration-time curve) (fAUC)/MIC] were calculated based on the baseline pathogen with the highest drug MIC for each patient. The median (range) of percent fT > MIC, fC(max)/MIC, fC(min)/MIC, and fAUC/MIC were 100% (0 to 100%), 728.8 (0.8 to 15,777), 19.9 (0.01 to 278), and 3,605.4 (2.7 to 60,865.9), respectively. CART identified the following breakpoints as significant predictors for microbiological response: >54% fT > MIC, a fC(max)/MIC > 383, and a fC(min)/MIC > 5; fC(min)/MIC > 5 was the only significant predictor of clinical response. Due to 100% fT > MIC achieved in the majority of LRTI patients, fC(min)/MIC was the statistically significant parameter associated with meropenem clinical and microbiological response in the adults with LRTI. The findings for LRTI patients can be applied to optimize meropenem dose regimens to achieve clinical success and microbiological eradication in clinical practice.     

Clinical investigation of acute lower gastrointestinal haemorrhage

Over a four-year period (1984-1987) nine consecutive patients presented with acute lower gastrointestinal haemorrhage requiring emergency investigation with scintigraphy (using radionuclide-labelled blood-pool agent), angiography or colonoscopy or a combination of these. Angiography in two patients was unhelpful. Of three colonoscopic examinations, two were technically unsatisfactory. In two patients with persistent bleeding requiring urgent surgery, scintigraphy located the bleeding site pre-operatively, while in five patients with negative scintigraphy bleeding settled spontaneously without operative intervention. The relative merits of the above investigations are discussed.     

ICU病房老年患者下呼吸道院内感染病原菌及其耐药性分析

目的探讨综合性重症监护病房(ICU)老年患者下呼吸道感染的病原菌分布及其耐药情况。方法收集2004年7月至2004年12月入住ICU的73例老年患者的痰标本进行细菌学培养及药物敏感性试验。结果老年患者下呼吸道感染发病率高,广谱抗生素使用是细菌耐药的主要原因之一。73例老年患者中35例发生下呼吸道感染,共分离出菌株71株,其中产超广谱β内酰氨酶(ESBLs)菌株15株。下呼吸道中最常见病原菌为铜绿假单胞菌、肺炎克雷伯杆菌、表皮葡萄球菌、真菌。在71株病原菌中,G-杆菌占46.5%,G+菌占35.2%,真菌占18.3%。结论ICU内老年患者下呼吸道感染的病原菌以G-杆菌为主,病原菌显示多重耐药。G-杆菌对亚胺培南敏感性较好,而G+菌对万古霉素有较高的敏感性,白色念株菌对大扶康的敏感性较好。     

Clinical evaluation of cefotaxime for therapy of lower respiratory tract infections

A clinical trial was designed to evaluate the efficacy and safety of cefotaxime, a new semisynthetic, broad-spectrum cephalosporin, in the therapy of community-and hospital-acquired pneumonias. Thirty-nine males (mean age, 65 years) were treated for 41 episodes of pneumonia. Only five patient did not have a serious underlying disease; 15 had two or more significant disorders. Sixty-six percent of these pneumonias were due to Streptococcus pneumoniae or Haemophilus influenzae. The minimal inhibitory concentrations for all bacterial isolates ranged from 0.008 to 4 micrograms/ml. Peak serum cefotaxime levels during therapy ranged from 12 to 124 micrograms/ml 1 h after a 1-g dose. Satisfactory bacteriological and clinical responses were observed in 85% of the cases. Four episodes of pulmonary superinfections due to cefotaxime-resistant gram-negative bacilli were noted, each in a patient being mechanically ventilated. Pseudomonas was involved in each of these superinfections, and three were fatal. No serious toxicity or adverse reaction to cefotaxime was seen. The results of this study suggest that cefotaxime is an affective and well-tolerated new cephalosporin antimicrobial agent for the therapy of pneumonia due to susceptible organisms.     

Endoscope-assisted KTP laser sinus clear-out procedure for recurrent ethmoid polyposis

BACKGROUND DATA AND OBJECTIVE: Surgery for recurrent sinusitis with diffuse polyposis is challenging since tortuous sinus anatomy and bleeding tendency can make revision surgery particularly difficult. We report the efficacy in using KTP laser under the assistance of endoscope to perform sinus clear-out procedure for patients with recurrent ethmoid polyposis. MATERIALS AND METHODS: Thirteen patients with recurrent ethmoid polyposis underwent this procedure between November 1996 and July 2000. All were available for follow-up. Patients all had a KTP sinus clear-out procedure (15-20 W continuous mode, spot size 0.4-0.8 mm, contact or near-contact approaches) assisted by endoscope. Sinus endoscopic findings, CAT scan data, operation records and perioperative courses were retrospectively reviewed. The mean follow-up period was 24.7 +/- 11 months. RESULTS: Surgeries all went smoothly with minimal bleeding incurred. All patients demonstrated significant improvement in their sinonasal symptoms. Two cases (15.4%) had localized recurrent polyps. CONCLUSION: With its excellent capabilities in hemostasis, great intra-nasal maneuverability, and flexible operation modes, KTP laser is an ideal alternative to manage recurrent ethmoid polyposis for selected cases.     

单/双光纤激光治疗下肢静脉曲张的观察及护理

下肢静脉曲张是血管外科常见病和多发病,不及时治疗约有5%的患者会出现下肢斑疹,肤色素沉着甚至下肢静脉性溃疡;般人群中的发病率约为20%,性略高于男性.