口腔摄影技术的探讨

目的:探讨口腔摄影技术,以期提高口腔摄影的影像质量.材料与方法:利用R - 500型500mA普通X线机进行口腔内摄影50例,利用AutoⅢECM口腔曲面全景体层摄影机进行口腔曲面全景体层摄影50例,分析对比影像质量.结果:口腔内摄影显示牙齿数目少,并且被检者不易配合摄影;口腔曲面全景体层摄影,影像质量高,被检者体位舒适,易配合完成摄影.结论:口腔摄影宜采用口腔曲面全景体层摄影为宜.     

Approach to rhinitis

Rhinitis is a common affliction of humans that can cause significant morbidity. Distinction between allergic and nonallergic varieties has important prognostic and therapeutic implications. Newer, nonsedating antihistamines and intranasal steroid preparations have greatly enhanced the treatment of these disorders. Distinguishing factors of viral and bacterial rhinitis have been reviewed. Early recognition of nasal cellulitis and mucormycosis with aggressive therapy is necessary to prevent serious complications. Multiple processes, including structural and drug-induced reactions, can mimic rhinitis. An orderly approach, including a good history and physical examination, coupled with use of the nasal smear, will allow the emergency physician to master this frequent complaint.     

Approach to supraglottitis

In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.     

经神经内镜手术治疗脑积水

目的：探讨神经内镜治疗脑积水的适应症，方法及技巧。方法：回顾性总结了经神经内镜手术治疗的脑积水52例，手术方法包括三脑室底造瘘术，透明膈造瘘术，脉络丛烧灼术及内镜下置分流管。结果：随访2月－48月。16例原发性导水管狭窄性脑积水15例疗效满意；12例肿瘤压迫导水管性脑积水10例疗效满意；7例单侧室间孔堵塞性脑积水均有效。3月后复查CT提示脑室缩小30例。17例交通性脑积水术后症状均有明显改善。结论：神经内镜手术治疗脑积水微创，安全，疗效好，适用于所有类型的脑积水；三脑室底造瘘术应作为梗阻性脑积水的首选方法，内镜引导下脑室腹腔分流术治疗交通性脑积水可降低分流管堵塞的机会。     

Approach to ophthalmologic emergencies

This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment. Acute conditions are categorized according to urgency of intervention.     

Approach to septic arthritis

Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. In the absence of peripheral leukopenia or prosthetic joint replacement, synovial fluid white blood cell count in patients with septic arthritis is usually greater than 50,000 per mm3. Isolation of the causative agent through synovial fluid culture is not only definitive but also essential before selecting antibiotic therapy. Synovial fluid analysis is also useful to help distinguish crystal arthropathy from infectious arthritis, although the two occasionally coexist. Almost any microorganism can be pathogenic in septic arthritis; however, septic arthritis is caused by nongonococcal pathogens (most commonly Staphylococcus species) in more than 80 percent of patients. Gram stain results should guide initial antibiotic choice. Vancomycin can be used for gram-positive cocci, ceftriaxone for gram-negative cocci, and ceftazidime for gram-negative rods. If the Gram stain is negative, but there is strong clinical suspicion for bacterial arthritis, treatment with vancomycin plus ceftazidime or an aminoglycoside is appropriate. Evacuation of purulent material with arthrocentesis or surgical methods is necessary. Special consideration should be given to patients with prosthetic joint infection. In this population, the intraarticular cutoff values for infection may be as low as 1,100 white blood cells per mm3 with a neutrophil differential of greater than 64 percent.