Treatment of streptococcal pharyngitis revisited

Penicillin has remained the drug of choice for treatment of patients with streptococcal pharyngitis for the past four decades. From the early 1950s into the 1970s, a single injection of intramuscular penicillin G benzathine, alone or in combination with penicillin G procaine, was the preferred treatment. Because this regimen consistently produced the highest cure rate and because compliance was assured, it evolved as the gold standard with which other treatment regimens were compared. In the late 1960s and the 1970s, studies showed that in private practice settings with counseling as to the need to take oral penicillin for a full ten days to prevent rheumatic fever, good compliance with results equal to intramuscular penicillin G benzathine could be achieved. By the early 1980s, oral treatment was preferred by most primary physicians in the United States. Oral penicillin V in a dosage of 250 mg, twice daily for ten days, affords optimal treatment for children. In areas where rheumatic fever is still prevalent, particularly in poor and crowded inner-city populations where medical care is episodic, follow-up may be lacking, and compliance in taking oral penicillin cannot be relied on, treatment with intramuscular penicillin G benzathine remains preferred. Studies now confirm that early treatment of streptococcal pharyngitis can reduce the duration of symptoms to less than 24 hours in most cases, decrease the incidence of suppurative complications, limit spread of the disease in the family and community, and permit earlier return of the child to school. Recently developed tests that permit rapid, laboratory-confirmed diagnosis of streptococcal pharyngitis directly on the throat swab at the initial clinic visit may soon guide early treatment with these inherent benefits.     

阑尾切除术后残端出血的诊治体会(附12例报告)

目的 探讨阑尾切除术后残端出血的机理和防范措施,为临床诊治提供决策.方法 回顾分析近年来收治的12例阑尾切除术后残端出血病例,对其出血的原因、防范的措施以及诊治的方法进行了必要的认识.结果 本组所有病例均再次行剖腹探查术证实为阑尾残端出血,并行相应处理;本组治愈10例,病死2例.结论 凡阑尾切除术后早期无明显原因的发生下消化道大出血者,在排除其它疾病所致出血的同时,首先应考虑阑尾残端出血之可能,如经短时间积极非手术治疗无效者,其明智之举是尽快的施行剖腹手术并予相应的处理;牢固的解剖学知识、规范的手术操作、娴熟的手术技巧,对于防止阑尾残端出血极为关键.     

Food-borne streptococcal pharyngitis in a hospital pediatrics clinic

After a potluck luncheon, more than half the staff of a hospital pediatrics clinics became ill. Group A Streptococcus (M precipitin, nontypable; T agglutination type, 8/25; and serum opacity reaction, positive) was isolated from 12 of the 20 ill persons. Food-consumption analysis implicated a rice dressing as the vehicle of transmission. The dressing was prepared by a clinic employee in whom pharyngitis had developed three weeks before the luncheon. This is an unusual outbreak in that the implicated food product was not institutionally or commercially prepared and was not preponderantly composed of milk, eggs, or meat.     

儿科临床实践中可能的A族链球菌性咽炎与快速抗原检测试验的敏感性之间的关系

目的:快速抗原检测试验(RADT)对A族链球菌性(GAS)咽炎的敏感性对该试验是否具有成本效益和是否需要确认的咽喉拭子培养等至关重要。作者评估了一项第2代RADT以确定其敏感性是否随儿科门诊实践中对GAS检测的患者的临床类型范围的改变而改变。方法:作者采用了来自一家儿科诊所的实验室记录以确认到该诊所就诊并接受了RADT的连续的1184例患儿。在一项盲法图表回顾中,对就诊的RADT结果为阳性的患儿(n=384)和对就诊的结果证实为假阴性的患儿(n=65)计算了M cIsaac计分以分别评估实验前的GAS咽炎的临床可能性。阳性RADT结果被假定为真…     

电子胃镜代替腹腔镜在诊断治疗腹部疾病中的临床应用

目的探讨电子胃镜在诊治腹部疾病中的可行性。方法采用严格消毒的电子胃镜对 15例腹部疾病进行检查 ,并对其中 2例腹内带状粘连和 2例腹膜壁层出血采用射频治疗仪进行了镜下治疗。结果总确诊率为 93.3% ,肉眼观与病理诊断符合率为 86 7% ,2例腹内粘连带被灼断 ,2例腹壁出血被点灼止血 ,无 1例发生肠穿孔及大出血。结论电子胃镜代替腹腔镜诊治腹部疾病操作简单、安全可靠 ,可以一镜多用 ,有推广运用价值     

射频和复方碘甘油治疗慢性咽炎327例

1　临床资料　慢性咽炎患者 32 7(男 12 4 ,女 2 0 3)例 ,年龄2 2～ 6 8(平均 4 5 )岁 .病程为 3ｍｏ～ 5ａ .诊断与疗效判断参照人民军医出版社《临床疾病诊断依据治愈好转标准》 .诊断为慢性单纯性咽炎 (16 8例 )和萎缩性 (2 3例 )或干燥性咽炎 (87例 )者采用咽后壁涂复方碘甘油 ,每周 1～ 2次 ,结合中西药治疗 .诊断为慢性肥厚性咽炎者 ,患者坐位 ,先用 10 ｇ·Ｌ-1的卡因喷雾咽部 2～ 3次进行表面麻醉 .将射频五官治疗仪的负极板垫湿纱块贴置于颈前皮肤 ,接通电源 ,时间设置定在 5ｓ,功率选择第 3档 (15 0Ｗ ) ,选直长圆球形治疗针安于…