双气道喉罩的研制及应用

目的：设计一种应用于纤支镜检查和治疗的双气道喉罩.方法：该双气道喉罩由环状罩囊、罩体、主导管和副导管组成.主导管用于麻醉过程中连接呼吸机控制呼吸,副导管头端设有带中央孔的密封帽,中央孔的内壁上设有橡胶密封环,纤支镜可通过中央孔经喉罩进入气道进行纤支镜检查和治疗.结果：借助双气道喉罩全麻技术,成功地进行了纤支镜检查和治疗,扩大了纤支镜治疗范围和治疗途径.结论：双气道喉罩用于纤支镜诊疗具有方便简单、舒适安全、副作用小等优点.     

Ramsay Hunt syndrome

Ramsay Hunt syndrome is a special form of herpes zoster which is typically characterized by peripheral facial palsy and unilateral herpetic vesicles on the ear. These symptoms are often accompanied by vestibulocochlear dysfunction and other neurological and ophthalmological symptoms. The diagnosis and therapy requires a multidisciplinary approach. The authors present a typical case where the early administration of combined antiviral and systemic corticosteroid therapy led to complete recovery. The authors emphasize the importance of early diagnosis and adequate combination therapy, which improves the prognosis of this disease.     

初诊2型糖尿病应用胰岛素强化治疗的护理

胰岛素治疗是对初诊2型糖尿病患者控制高血糖的一个有效手段.通过对21例初诊2型糖尿病患者使用胰岛素治疗及护理的总结,就有关问题进行探索,得出使用胰岛素治疗前病人的心理准备、合理的膳食、胰岛素应用的护理及血糖监测,是初诊2型糖尿病患者控制血糖的关键的结论.     

Headache: diagnosis and treatment

Headache is the most common reason why patients visit a neurologist. Approximately 70% of the population suffer from headache. The symptoms in this condition are rather simple and a well-controlled therapy is mostly available, but there are still frequent failures in the diagnosis and therapy of headaches. Failures in the treatment are caused mainly by the fact the doctors are not able to set the appropriate diagnosis. It is recommended that patients with persisting headache should turn to headache centers. The therapy should be determined by the frequency and duration of the headache, its severity, the accompanying symptoms and preceding therapeutic history. This survey may be of assistance on the state-of-the-art diagnostics and therapy of headaches in neurological practice.     

急性肺栓塞的诊断与治疗进展

急性肺栓塞(APE)作为一种非常危重的呼吸系统疾病,也可以称为心血管系统疾病。APE是致死性胸痛急症之一,其发病率在逐年升高。在过去临床工作中由于其症状不典型,缺乏经验及检查手段,以及对其重视不够,造成其漏诊率、误诊率和死亡率均较高。尽早明确疾病诊断并及时诊治非常重要,可以挽救更多危重症患者生命。现在临床医师对该病越来越重视,使本病的漏诊率逐年下降。本文详细介绍了APE的易患因素、临床表现以及诊断,包括疑似诊断,及进一步确诊的各种方法。最后讲述该病的治疗方案,从轻症患者抗凝治疗,到危重患者溶栓治疗,详细展示了APE的最新诊断及治疗进展。     

不明原因慢性咳嗽的诊断与治疗

目的:研究慢性咳嗽的病因分布及针对病因实施治疗的有效率.方法:91例慢性咳嗽患者应用慢性咳嗽解剖学诊断程序 诱导痰细胞学分类进行病因诊断,并针对病因实施特异性治疗.结果:病因诊断率为90%(82/91),病因未明10%(9/91),其中咳嗽变异性哮喘占31%(29/91),病毒感染后咳嗽占18%(17/91),嗜酸细胞性支气管炎占14%(13/91),鼻后滴漏综合症占8%(7/91),胃食管反流性咳嗽占5%(4/91).82例明确诊断患者实施针对性治疗,治疗有效率93.3%(77/82).结论:慢性咳嗽解剖学诊断程序 诱导痰细胞学分类能使大部分慢性咳嗽患者病因明确,针对性治疗有效.     

男性不育诊断要略和系统治疗

正确而规范的诊断对男性不育的治疗至关重要。男性不育的诊断包括：疾病诊断、病理诊断及病因诊断。应在全面细致的病史采集、体格检查及辅助检查的基础上进行。治疗应根据不育的病因，采取个体化的方案，以求增加自然妊娠机会或提高辅助生殖技术的成功率。对男性不育的诊断要略和系统治疗进行讨论，重点讨论常用的治疗方法、特别是辅助生殖技术的适应证及其安全性问题。     

A case of subprimary suprarenal tuberculosis

In spite of the current availability of new and more up-to-date methods of prevention, diagnosis and therapy, specific forms in general and the ability to perform rapid, efficacious and resolutory operations, a number of cases of subprimary or secondary tuberculosis still exist which are most probably the result of delayed diagnosis, contagious episodes or the failure to adhere to recommended treatment protocols and, often, less than optimum medical therapy. A rare case of adrenal tuberculosis diagnosed in a patient hospitalized for left renal calculosis is reported. Routine tests indicated a specific form of diagnosis, and during surgery for left renal calculosis the patient underwent left adrenalectomy. Histological tests confirmed the initial diagnosis. For 180 days after the operation the patient received pharmacological treatment directed specifically against Koch's bacillus.     

低磷抗维生素D佝偻病25例临床分析及随访

为探讨低磷抗维生素D佝偻病早期诊断及适宜治疗方法以减轻严重骨骼畸形及发育迟缓.方法 以生长发育监测,血尿生化检查,骨骼X线改变及治疗反应综合判断.结果 12例坚持正确治疗,生长发育接近正常;8例未能系统治疗者明显发育落后,留有严重骨骼畸形.结论 成功治疗本病的关键在于早期诊断,长期应用磷酸盐合剂及中等量维生素D.     

定量检测降钙素原在感染性疾病诊疗中的研究进展

降钙素原是一项高敏感性和特异性的炎症指标,在感染性疾病的诊断、鉴别诊断和治疗中有着重要价值.目前,临床上应用的多为降钙素原定性检测方法,其在结果判读和检测范围上有一定的限制,而降钙素原定量检测应用酶联荧光分析原理,能及时准确地检测血清降钙素原水平,更加适用于感染性疾病的诊断及治疗效果评估.此文就降钙素原的构成、特性、定量检测方法及其在感染性疾病诊疗中的应用等进行了综述.     

Late presenters to HIV care and treatment,identification of associated risk factors in HIV-1 infected Indian population

Background  

Timely access to antiretroviral therapy is a key to controlling HIV infection. Late diagnosis and presentation to care diminish the benefits of antiretrovirals and increase risk of transmission. We aimed to identify late presenters in patients sent for first CD4 T cell count after HIV diagnosis, for therapy initiation evaluation. Further we aimed at identifying patient factors associated with higher risk of late presentation.     

男性不育诊断要略和系统治疗

正确而规范的诊断对男性不育的治疗至关重要。男性不育的诊断包括：疾病诊断、病理诊断及病因诊断。应在全面细致的病史采集、体格检查及辅助检查的基础上进行。治疗应根据不育的病因,采取个体化的方案,以求增加自然妊娠机会或提高辅助生殖技术的成功率。对男性不育的诊断要略和系统治疗进行讨论,重点讨论常用的治疗方法、特别是辅助生殖技术的适应证及其安全性问题。     

儿童心理问题的家庭治疗原则与策略

儿童心理问题的常规治疗包括心理治疗和药物治疗,但是两者具有一定的局限性和社会不适性。家庭对儿童的成长具有重大影响,也是儿童出现心理问题的重要源头,所以家庭的介入对于心理问题儿童的治疗非常关键。家庭治疗的主要原则包括培养儿童的独立性、解决儿童与外界之间的冲突以及重视家庭成员间的和谐关系。家庭治疗所采取的策略主要是转变家庭内部态度、重视家庭的整体性、心理治疗和家庭治疗的互相配合以及对医学诊断的重视。在专业医学诊断指导下,通过家庭介入传统的心理治疗,从而更好地改善儿童所面临的心理问题。本文回顾了现有的儿童心理问题的研究成果,强调了家庭对儿童心理问题的影响,总结了儿童心理问题的家庭治疗原则和策略。     

Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates

IntroductionHealth care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old.MethodsProspective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling.ResultsOccupational therapy time-use was significantly associated with all variables included in analysis (p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score).ConclusionsManagement of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.     

宫腔妊娠组织物残留的诊疗进展

宫腔妊娠组织物残留（retained products of conception，RPOC）指妊娠后产生或发育的妊娠组织物在分娩或终止妊娠后仍然存在的现象。超声检查是诊断RPOC的主要方法，血流信号是其超声诊断的要点，局灶性子宫内膜增厚、宫腔内高回声团块或其周围具有低阻力动脉血流时高度提示RPOC。子宫内膜厚度及回声以及超声血管分级对于RPOC的临床诊断起到重要作用；宫腔镜检查是进一步明确诊断的主要方法。RPOC的鉴别诊断主要包括子宫动静脉畸形及妊娠滋养细胞疾病，计算机断层扫描（CT）和磁共振成像（MRI）可有助于其鉴别。治疗方法分为药物治疗和手术治疗。常用药物为米非司酮及米索前列醇。手术治疗从超声引导下的清宫术治疗逐渐发展为宫腔镜下病灶清除，后者具有完全清除率高、术后并发症发生率低的优点，是目前治疗RPOC的主要方法。     

一种关于医学图像融合的新思想探讨

医学图像融合技术在临床诊断和治疗、计算机辅助诊断、远程医疗、放射治疗及制定手术计划等方面有着广泛的应用前景。本文将详细介绍图像融合的技术、方法以及医学上的应用，并针对其局限性提出一种新思想。     

The diagnosis and treatment of transvestites and transsexuals.

Transvestism and transsexualism are defined. The incidence of both as well as male versus female ratios are discussed. Etiology of each is considered. Psychotherapists can be used for proper diagnosis and couseling and, on occasion, for therapy for transvestites. Methods for this therapy are suggested. The need for establishing rapport is emphasized, and items to cover in a sex history are enumerated. Reality factors in sex changes are items that the therapist must grapple with. Factors that delineate differential diagnosis of transvestism and transsexualism are pointed out. Prevention of transsexualism in younger children is discussed.     

Systemic Lupus Erythematosus

SLE often presents such a confusing clinical picture that diagnosis is long delayed, and it remains a disease of unknown cause. But early diagnosis and carefully planned therapy can enable many patients to lead nearly normal lives. Recent advances are outlined.     

Tuberculosis of the pancreas in a HIV-seropositive patient]

A 34-year-old man from Nigeria who had resided permanently in the Netherlands for five years had experienced fever, upper abdominal pain and weight loss for several months. He did not give the impression of being ill. A CT scan gave cause to suspect pancreatitis. An HIV test gave a positive result. Puncture of the accumulated fluid around the pancreas led to the diagnosis 'tuberculosis' (infection by Mycobacterium tuberculosis). Once the patient had made a good recovery with antituberculosis therapy, antiretroviral therapy was initiated, whereupon the number of CD4+ cells in the blood increased. Extrapulmonal tuberculosis is not unusual in HIV seropositive patients from countries with a high prevalence of tuberculosis. However, in such patients isolated tuberculosis of the pancreas is unusual and has not previously been described in the Netherlands. The diagnosis can be established following a CT guided puncture; tuberculosis is instantly suspected if the Ziehl-Neelsen stains are positive and the diagnosis can then be confirmed by a polymerase chain reaction (PCR) analysis and by culturing. Anti-retroviral therapy is withheld until response to anti-tuberculosis treatment is satisfactory.