手部感染的康复治疗

目的：观察综合康复疗法对治疗急、慢性手部感染的作用。方法：对50例手部感染患者，早期采用超短波电疗和紫外线疗法进行抗炎治疗以促进伤口愈合，后期通过蜡疗，超声波疗法及运动疗法达到恢复手部功能的目的。结果：50例的感染均得到早期控制，总有效率达98％，伤口愈合手功能完全恢复者急性感染占82．93％，慢性感染占44．44％，结论：治疗手部感染时同时积极采用康复治疗，可有效地控制炎症，促进伤口愈合，恢复手功能。     

前臂中段离断伤再植保留手功能及加强肌力的方法

目的探讨前臂中段离断伤再植保留手功能及加强肌力的方法。方法断肢再植时将离断肢体以远失神经支配的肌肉组织切除,切取髂胫束条桥接远端肌腱和近端肌肉组织,并桥接肱二头肌加强屈腕屈指,桥接肱三头肌加强伸腕伸指功能,同时完好地接神经,以恢复手的感觉和手内在肌肌力。结果共治疗4例,术后随访19个月～28个月,平均24个月。平均肌力屈腕屈指M4;伸腕伸指M4。腕平均活动度屈腕60°,伸腕48°,桡偏20°,尺偏40°,手指总活动度（TAM）2例属优,2例属良,TAM＞80%。手部感觉恢复至S     

足跗外侧皮瓣游离移植在手部软组织缺损修复中应用效果观察

目的 探讨足跗外侧皮瓣游离移植修复手部软组织缺损临床疗效和安全性. 方法 应用随机数字表法将2007年5月至2011年5月在本院住院治疗的120例手部软组织缺损患者分为对照和实验组,对照组患者给予足背带肌腱的复合组织瓣修复,而实验组患者则给予足跗外侧皮瓣修复,其他治疗措施相同.比较对照组和实验组患者手术时间、术中出血量、术后感染率和伤口Ⅰ期愈合率,并进行为期1年的随访,参照关节主动活动度法(TAM)评定患者的手指功能. 结果 实验组患者手术时间和术中出血量均明显少于对照组患者,差异有显著性(P＜0.05),实验组患者术后感染和伤口Ⅰ期愈合率明显低于对照组患者,而手功能优良率(93.33％)明显高于对照组患者(81.67％),差异有显著性(P＜0.05). 结论 足跗外侧皮瓣修复手部软组织缺损临床疗效确切,具有手术时间短、术中出血量少、感染宰低、伤口愈合好和手功能恢复好等特点,值得进一步推广.     

探讨开放性手外伤的早期处理方法

目的探讨开放性手外伤的早期处理方法。方法对74例开放性手外伤患者给予清创手术。术中处理骨折和肌腱、神经、血管及皮肤软组织损伤,术后早期进行康复治疗。6个月后随访,对比治疗前后TAM评分和手皮肤感觉分级。结果治疗后TAM评分优良率为77.03%,明显高于治疗前的20.27%,治疗后患侧手部皮肤感觉明显得以恢复。结论对开放性手外伤进行早期处理,可降低术后功能障碍的发生率,最大限度恢复手部功能。     

手部高压注射伤伴发感染的治疗

目的探讨应用VSD引流技术及皮瓣移植术治疗手部高压注射伤伴发感染的效果及应用价值。方法2017年12月-2018年12月应用VSD引流结合皮瓣移植治疗伴发感染的手部高压注射伤5例,行扩大清创术后,予VSD引流治疗1~2周,更换VSD敷料2~3次,引流期间每日行2~3次手功能康复训练,去除VSD后残余创面行皮瓣修复。术后对伤口愈合情况及手功能进行随访。结果所有感染创面经VSD治疗后,炎症反应均控制良好,为皮瓣覆盖创造条件;皮瓣修复术后随访6~12个月,皮瓣外形良好,手功能恢复满意。结论对伴发感染的手部高压注射伤,经扩大清创术后,应用VSD引流结合皮瓣修复,可明显缩短治疗周期,减少继发性组织损伤,更好地恢复肢体功能。     

手部热压伤的早期修复

目的：探讨早期清创、修复手部热压伤的临床疗效。方法：通过分析37例不同程度手部热压伤患的病损特点并行临床分度，以便准确诊治、判断预后；全部病例采用早期手术治疗，轻度热压伤早期行切痂全厚或中厚皮片修复；中度和重度热压伤早期彻底清创，保留间生态组织，应用血循环丰富的组织瓣修复创面。结果：36例创面一期愈合，手功能和外形恢复满意；1例创面二期愈合，手功能恢复差。结论：手部热压伤应早期手术清创，据病损程度选择治疗方法及时修复组织缺损，可最大限度地恢复手功能和外形，减少致残率，缩短疗程，获得较好的临床疗效。     

一期植骨加内固定治疗手部开放性骨缺损

目的探讨应用一期植骨加内固定治疗手部开放性骨缺损的手术疗效。方法2000-2003年治疗手部开放性骨缺损12例；急诊采用彻底清创，自体髂骨植骨加钢板或克氏针内固定术治疗。其中7例因伴有皮肤软组织缺损同时行皮瓣移植术。结果11例创面I期愈合，其中6例皮瓣完全存活；1例皮瓣远端部分坏死，钢板外露，经皮瓣提升覆盖创面处理后愈合。术后随访1-3年，骨折愈合时间为2-6个月，平均3.5个月。手功能按TAM评定，优良率达82%。结论一期植骨加骨固定治疗手部开放性骨缺损能缩短病程，防止指体短缩，有利于手功能的恢复，彻底清创和良好的创面覆盖是手术成功的关键。     

手部屈肌腱松解术后早期微波辅助治疗的疗效观察

目的观察手部屈肌腱粘连松解术后早期使用微波辅助治疗的临床疗效．评价微波治疗对屈肌腱松解术后手指功能恢复的影响。方法将40例40指指屈肌腱松解术后患者,随机分为A,B两组。A组20例,术后24h开始功能训练;B组20例,术后24h功能训练的同时,给予微波治疗,疗程为2周。术后随访12周,第2周末进行疼痛评价和TAM评定,第12周末进行TAM评定,对所有资料进行统计分析和疗效评定。结果术后第2周末,对两组间疼痛评分、TAM评定两项指标进行统计分析,有明显的统计学意义（P〈0．05）。术后12周末,B组的手功能均明显优于A组,TAM评定的统计学分析差异有显著性（P〈0．01）。结论手部屈肌腱粘连松解术后,在功能训练的基础上,早期使用微波辅助治疗,对缓解疼痛、消炎消肿、减轻粘连形成、改善手指ROM、提高TAM、恢复手功能有显著的疗效。     

海洋生物刺伤致手部感染45例临床分析

目的探讨海洋生物刺伤致手部感染的发病机制以及治疗体会。方法对45例海洋生物刺伤致手部感染患者给予手术清创、引流、冲洗,术后应用换药、局部理疗、抗炎等综合措施治疗。结果38例较好的恢复功能,4例恢复一般,1例较差,2例截指。结论海洋生物刺伤手部致“海洋生物性指头炎”发病与分支杆菌感染关系密切,有反复发作趋向。彻底地清创引流和术后综合措施是治疗关键。     

休克期切削痂植皮修复手部深度烧伤

目的 报道手部深度烧伤休克期切削痂植皮的治疗结果。方法 对16例25只手采取休克期切削痂、中厚皮移植。结果 休克期切痂植皮减少了感染，皮片成活良好，愈合时间明显缩短，手的外形及功能恢复满意。结论 手部深度烧伤应尽早切削痂，积极消灭创面，对大面积烧伤，应优先实施手部切痂。     

Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) and epidermidis (MRSE) infections in orthopaedic surgery. Importance, prophylaxis and therapy

Summary MRSA/MRSE infections are a major problem in hospitals and although in orthopaedic units the incidence is low awareness of this problem is necessary. Once a MRSA strain has been isolated the strict use of the hygiene precautions has to be applied to avoid epidemic spread of the strain. The patient has to be isolated. The staff has to use gloves and gowns whilst treating the patient. A antimicrobiel hand wash solution has to be used after taking off the gloves and before leaving the isolation room. Patient and staff have to be informed about the pathogenity and the way of infection spread so that infection precaution rules are fulfilled. Antibiotics should only be used in clinically well defined cases and the overall use of antibiotics should be reduced to lower the incidence of MRSA/E isolates. The problems of an MRSA case and its successful treatment are demonstrated.      

先锋美他醇治疗泌尿生殖系感染：附150例报告

自１９９４年８－１０月，单儿采用先镁美他醇治疗泌尿生殖系统感染患者１５０例取得较好疗效。剂量：每日２－４ｇ溶于０．９％生理盐水或５％葡萄糖溶液中分两次静脉滴入，每次１０－１５分钟，连续用药３－１０天，结果：症状缓解有效率达９４％以上，对脓尿的效率为９５．３％，中段尿细菌培养阴转率为８１．４％，总有效率８７．３％。     

Symptomatic cytomegalovirus (CMV) infections identified by image cytometry and other parameters for CMV infection

Abstract. Thirty-eight renal transplant recipients were followed during the first 3 months after transplantation. Once weekly, cultures of urine and buffy coat for cytomegalovirus (CMV) were taken and an immunocytochemical assay for immediate early antigens of CMV (IEA assay) was performed. Thirty patients had evidence of a CMV infection and 11 had a symptomatic CMV infection. All symptomatic patients had one or more positive urine cultures or a positive IEA assay. However, 15 patients with positive urine cultures and 12 patients with a positive IEA assay lacked any signs of symptomatic CMV disease. Moreover, 6 out of 15 patients with positive buffy coat cultures for CMV did not have symptomatic CMV disease. Using a computerized system to quantify IEA-positive granulocytes, we show that the absolute number of positive cells per million correlates very well with the occurrence of symptomatic CMV disease.     

双肺移植术后呼吸道并发症的防治一例

目的探讨双肺移植术后呼吸道并发症的防治。方法为1例终末期肺淋巴管平滑肌瘤病合并双肺感染的患者施行体外循环下序贯式双侧单肺移植手术。结果术后患者发生肺部细菌和真菌混合感染,纤维支气管镜检查发现右侧支气管吻合口愈合不良,术后第14d发生急性排斥反应,第29d因气管内大出血而死亡。结论肺移植术后的呼吸道并发症较为严重,应通过控制肺部感染、预防急性排斥反应及提高手术技巧等综合防治。     

Symptomatic cytomegalovirus (CMV) infections identified by image cytometry and other parameters for CMV infection

Thirty-eight renal transplant recipients were followed during the first 3 months after transplantation. Once weekly, cultures of urine and buffy coat for cytomegalovirus (CMV) were taken and an immunocytochemical assay for immediate early antigens of CMV (IEA assay) was performed. Thirty patients had evidence of a CMV infection and 11 had a symptomatic CMV infection. All symptomatic patients had one or more positive urine cultures or a positive IEA assay. However, 15 patients with positive urine cultures and 12 patients with a positive IEA assay lacked any signs of symptomatic CMV disease. Moreover, 6 out of 15 patients with positive buffy coat cultures for CMV did not have symptomatic CMV disease. Using a computerized system to quantify IEA-positive granulocytes, we show that the absolute number of positive cells per million correlates very well with the occurrence of symptomatic CMV disease.     

The Occurrence of Simple and Mixed Fungal Infections in Patients at the Departement of Andrology / Hamburg (1972–1976)

Vom Januar 1972 bis zum Dezember 1976 wurden bei 228 Patienten, die sich in der Abteilung f. Andrologie vorstellten, Hautschuppen wegen des Verdachtes auf eine Pilzinfektion mykologisch untersucht.
In 48 Fällen waren Dermatophyten, in 7 Fällen Hefen die Erreger.
In 138 Fällen wurde Nocardia minutissima, in 25 Fällen Malassezia furfur gefunden. Bei 12 Patienten wurden Mischinfektionen gefunden.
46,2% der Hefen, 11,1% Dermatophyten, 8% Malassezia furfur und 6,2% Nocardia minutissima wurden in Mischinfektionen gefunden.
Das klinische Bild allein genügt nicht zur exakten Diagnose. Zur gezielten Therapie ist die Erregerisolierung notwendig, um den Einsatz unwirksamer Medikamente zu verhindern.
Es wird darauf hingewiesen, daß bei alien Patienten neben der andrologischen Untersuchung auf Hautveränderungen, z.B. durch Pilzinfektionen, geachtet werden muß. Die Genitocrural-Region wird häufig kontaktinfiziert, z.B. durch das Kratzen mit einem infizierten Fingernagel. Daher müssen auch die Körperregionen untersucht werden, von denen Pilze übertragen werden können, z.B. Hände, Nägel, der Stamm und manchmal auch die Mundhöhle.
Das Ziel aller Untersuchungen muß die Behandlung sein. Daher ist die exakte Identifizierung der Dermatophyten, Hefen, Schimmelpilze oder auch Bakterien notwendig. Nur die mikroskopische und kulturelle Identifikation ermöglicht eine spezifische Behandlung. Besonders wichtig erscheint die Verifizierung von Mischinfektionen, die dann eine gezielte differenzierte Therapie notwendig machen.     

Catheter-associated urinary tract infections: prevalence of uropathogens and pattern of antimicrobial resistance in a UK hospital (1996-2001)

OBJECTIVE: To assess the change in the bacterial profile and pattern of antibiotic resistance of catheter-associated urinary tract infections (CAUTIs, the most prevalent form of nosocomial infections) between 1996 and 2001. MATERIALS AND METHODS: Catheter samples of urine (CSUs) submitted in 1996, 1998 and 2001 (2451, 2460 and 3349 specimens, respectively) were analysed. The distribution of different uropathogens in bacterial CAUTIs and their in vitro antimicrobial resistance was evaluated over the study interval. The likelihood ratio test was used to assess whether there was a linear trend according to calendar year. RESULTS: Escherichia coli was the most frequently isolated pathogen in all years, but its frequency declined over time (35.6%, 32.5% and 26.6%, respectively). Enterococcus was the second most frequent overall, with a significant increase in frequency with time (11.8%, 15.3% and 22.0%, respectively). There was also a considerable change in resistance patterns to antibiotics. As a result, in 1996, CAUTIs were least often resistant to ciprofloxacin (8.0%) followed by co-amoxiclav (18.5%) and cephalexin (25.4%). In 2001, CAUTIs were least often resistant to co-amoxiclav (22.5%), followed by ciprofloxacin (27.2%) and nitrofurantoin (28.8%). CONCLUSION: The types of organisms associated with CAUTI have changed over the last 5 years in a UK institution, as have the patterns of antibiotic resistance. Currently, the most appropriate agents for the empirical management of CAUTIs seem to be co-amoxiclav, ciprofloxacin and nitrofurantoin.     

Mismatch in Capture of Periprosthetic Joint Infections Between the Dutch Arthroplasty Register (LROI) and a Detailed Regional Periprosthetic Joint Infection Registry

BackgroundNational arthroplasty registries are important sources for periprosthetic joint infection (PJI) data and report an average incidence ranging from 0.5% to 2.0%. However, studies have shown that PJI incidence in national arthroplasty registries may be underestimated. Therefore, the incidence of PJI in the Dutch Arthroplasty Register (LROI) was evaluated.MethodsWe matched revisions due to infection within 90 days of index procedure in the LROI database (prospectively registered in 2014-2018) with acute PJI cases registered in a Regional Infection Cohort (RIC) and vice versa. The RIC comprised of 1 university hospital, 3 large orthopedic teaching hospitals and 4 general district hospitals, representing 11.3% of all Dutch arthroplasty procedures with a similar case mix.ResultsFrom the 352 acute PJIs in the RIC, 166 (47%) were registered in the LROI. Of the 186 confirmed PJI cases not registered in the LROI, 51% (n = 95) were a unregistered Debridement, Antibiotics, and Implant Retention procedure without component exchange. The remaining missing PJI cases (n = 91, 49%) were of administrative origin. The acute PJI incidence in the RIC was 1%, compared to a 0.6% incidence of revision <90 days due to infection from LROI data.ConclusionBesides unregistered Debridement, Antibiotics, and Implant Retention procedures without component exchange, administrative errors are an important source of missing PJI data for the LROI, leading to underestimation of PJI incidence in the Netherlands. A national arthroplasty complication registry, linked to the LROI, might decrease the number of missing PJI cases. Although our study concerns Dutch data, it supports the scarce literature on PJI incidence obtained from national arthroplasty registries, which also reports an underestimation.