TriVex微创旋切术治疗下肢静脉曲张的应用及临床效果评价

目的探讨TriVex微创旋切术在大隐静脉曲张疾病治疗中的应用效果。方法选取2010年3月-011年9月于本院进行治疗的60例大隐静脉曲张患者为研究对象,将其随机分为对照组(传统手术组:高位结扎加分段切除术)30例和观察组(TriVex微创旋切术组)30例,后将两组患者的住院时间、手术时间、出血量、手术并发症发生率、患者满意度及治疗前后的CIVIQ生活质量评分、VCSS评分进行统计分析及比较。结果观察组住院时间及手术时间均短于对照组[(7.70±0.33)d,(54.27±4.45)minvs(11.50±0.59)d,(71.30±3.74)min],出血量少于对照组[(45.30±3.15)mlvs(74.6±4.4)ml],并发症发生率低于对照组(10.00%vs16.70%),患者满意率高于对照组(97.00%vs83.00%),CIVIQ生活质量评分、VCSS评分均优于对照组[(85.57±1.96)分,(2.77±0.37)分vs(92.77±1.18)分,(0.83±0.17)分],P<0.05或P<0.01,有显著性差异或有非常显著性差异。结论 TriVex微创旋切术在大隐静脉曲张疾病治疗中应用效果明显较佳,值得临床推广。     

微创旋切治疗下肢静脉曲张30例分析

<正>2009年2～10月,我院采用美国施乐辉公司生产的TrivexⅡ微创旋切系统,手术治疗下肢静脉曲张30例,疗效满意,现将手术配合体会报道如下。1资料与方法1.1一般资料本组共有下肢静脉曲张患者30例,男24例,女6例,23～72岁,平均56岁,疗程3～15年,合并血栓性静脉炎5例,踝上足靴区溃疡形成3例,曲张破裂出血9例。     

电凝术治疗下肢静脉曲张33例体会

下肢静脉曲张是外科临床常见疾病，以大隐静脉曲张最多见，长期以来。其主要治疗手段为大隐静脉高位结扎分段剥脱术，因其创伤大。术后恢复周期长，遗留疤痕严重，难为部分病人接受，作者医院自2000年3月至2003年5月采用电凝术治疗大隐静脉曲张33例，疗效满意，现报道如下。     

电凝术治疗下肢静脉曲张的疗效

目的观察并评价电凝术在治疗下肢静脉曲张方面的临床疗效以及手术方法,以期能够为类似病例提供有益的指导。方法我院在2011年1月至2012年2月共收治下肢静脉曲张患者共22例(共29条患肢),全部患者均进行顺行性下肢深静脉造影,出现深静脉返流患者共有22条,其中Ⅰ级患肢共14条,Ⅱ级患者共8条;所有患肢均采用电凝术进行治疗,所有患者均进行1-6个月的术后随访;同时保留了完整的手术前后的临床资料,对上述资料进行回顾性分析。结果所有患者经过治疗之后的卧床休养时间均低于3d,住院时间最短3d,最长15d,平均5.8d;所有患者均没有出现切口感染问题,但是3例患者出现皮下硬结,经过局部物理治疗之后恢复良好,1例患者在随访1个月时大腿中部大隐静脉曲张呈节段性复发,经过硬化剂注射-加压恢复良好。结论研究结果表明电凝术在治疗下肢静脉曲张方面具有优秀的临床效果,同时,是一种创口很小的微创手术,符合手术发展潮流;另外,电凝量化指标、手术指征地严格掌握是避免临床并发症、提升临床效果的重要保证。     

下肢静脉曲张手术期的护理体会

目的：探讨下肢静脉曲张的围手术期护理。结果：55侧患者均痊愈出院,术后近期效果良好,术前症状和体征完全或基本消失。术后随访（6～48）个月,平均14．5个月,疗效良好52例（94．54％）,2例（3．63％）患者术后复发下肢静脉曲张,1例（1．81％）患者出现下肢肿胀、乏力等症状。Ⅲ结论：精心的护理和术后正确的健康指导越不可少,是患者早日康复、预防复发、减少并发症的关键。     

Trivex~(TM)系统光照条件下治疗下肢浅静脉曲张手术配合体会

目的　探讨TrivexTM系统光照条件下治疗下肢浅静脉曲张的手术配合。方法　通过 30例TrivexTM系统光照条件下治疗下肢浅静脉曲张的手术配合 ,分析术前准备、术中配合、术后器械的保养对手术的影响。结果　所有病例手术过程均顺利 ,手术护理效果满意 ,病人 1周内均痊愈出院。结论　有先进的仪器设备、充分的器械及物品准备、手术护士熟练配合医生是手术成功的关键。     

腔内激光治疗下肢静脉曲张的手术配合

传统方法治疗下肢静脉曲张,是通过结扎剥脱的形式切除静脉,切口多、恢复时间长、留有疤痕、易复发。腔内激光治疗下肢静脉曲张具有住院时间短,痛苦少,不影响美观等优点,有较好的临床应用价值。本文笔者就腔内激光治疗下肢静脉曲张的手术配合进行了探讨。     

腔内激光治疗下肢静脉曲张的手术配合

传统方法治疗下肢静脉曲张,是通过结扎剥脱的形式切除静脉,切口多、恢复时间长、留有疤痕、易复发。腔内激光治疗下肢静脉曲张具有住院时间短,痛苦少,不影响美观等优点,有较好的临床应用价值。本文笔者就腔内激光治疗下肢静脉曲张的手术配合进行了探讨。     

静脉腔内激光联合手术治疗下肢静脉曲张的临床分析

目的：探讨静脉腔内激光联合手术治疗下肢静脉曲张的效果。方法：EVLT联合高位大隐静脉结扎术、股浅静脉包窄和大隐静脉高位结扎术、大隐静脉高位结扎和局部曲张浅静脉剥离术、大隐静脉高位结扎和交通结扎术。结果：45例患者,治愈28例,好转9例,并发症8例,总有效率82．22％。结论：静脉腔内激光联合手术治疗静脉曲张效果满意,具有切口小、手术安全、时间短、患者恢复快等优点,但目前在临床上使用还会发生并发症,需要进一步研究和探索。     

大隐静脉小切口微创治疗的效果评价

目的 总结和评价应用大隐静脉小切口微创治疗的经验和疗效.方法 对我院自2005年5月至2013年5月应用小切口微创治疗大隐静脉曲张患者67例临床资料进行回顾性分析.结果 每条肢体手术时间平均50 min,术后并发症的发生率5.5％.患者术后症状显著减轻或消失,随访3～12个月未见曲张静脉复发.结论 小切口微创手术是治疗大隐静脉曲张的一种有效措施,因其创伤小、出血少、患者痛苦小、康复快,兼有美容效果,符合目前微创外科要求,且费用低,值得在基层医院推广.     

Quality of Life and Coping Following Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery

Minimally invasive direct coronary artery bypass (MIDCAB) surgery has been shown to be a promising technique for surgical treatment of single or double vessel disease. However, little is known about quality of life, mood state or coping in this group of patients. The records of 55 consecutive patients who underwent MIDCAB surgery at Harefield Hospital between April 1999 and May 2001 were reviewed. In order to assess quality of life, mood state and coping, patients were contacted by telephone to conduct a semi-structured interview and were subsequently sent four questionnaires. The measures used were the Hospital Anxiety and Depression Scale, the Short Form Health Survey, the WHOQoL-BREF and the COPE. Forty-eight patients were contacted by telephone, forty-four of whom returned the completed questionnaires. Overall ratings of quality of life were excellent for the majority of patients, and rates of anxiety and depression were lower than previously found following coronary artery bypass surgery. It is concluded that following MIDCAB surgery quality of life and mood state outcomes are encouraging. However, a prospective, longitudinal study is now required to further elucidate the relationship between quality of life, mood state and coping and to identify predictive factors for physical and psychological outcome following this new surgical technique.     

Representations of Low(er) Alcohol (Craft) Beer in the United States

Given increasing social interest in health and wellness, rising cultural trends toward sobriety and moderating alcohol intake, and improvements in brewing technology, low(er) alcohol beer is a rising segment in the beer industry for both craft and larger-scale producers. In this paper, we assess the representation of low(er) alcohol beer among craft brewers in the United States. Using a novel quantitatively-informed qualitative analytical approach, we surveyed a randomized, non-representative sample of 400 craft brewery websites in the United States to assess the relative presence of low(er) alcohol beers as well as how these brews are represented by the breweries themselves. To do so, we recorded, both numerically and via website screenshots, the lowest ABV beverage on offer and noted the beer type, the beer name, and the ABV. Ales were the most prominent style of beer on offer, accounting for 62% of the low(er) ABV beers identified. Only 15.5% of the breweries surveyed in this study offered a beer with an ABV of less than 4%; however, an additional 67.9% offered a beer with an ABV of less than 5%. The representations of these low(er) alcohol products focused mostly on taste, health, and demographic indicators.     

妇科肿瘤术后患者下肢深静脉血流动力学变化及血栓形成原因分析

目的 探讨妇科肿瘤术后患者合并下肢深静脉血栓（DVT）血流动力学改变及血栓形成原因.方法 对常规妇科肿瘤术后的156例患者行下肢静脉超声检查,观察下肢深静脉二维图像、彩色血流情况及双侧股静脉流速.结果 彩色多普勒超声诊断为下肢静脉血栓者31例（血栓组）,未发现血栓者125例（对照组）;与对照组相比,血栓组患者发病前平静呼吸时的股静脉最大血流速度明显减低（P＜0.05）;平静呼吸时股静脉最大流速＜12 cm/s的患者与＞12cm/s的患者相比,其血栓发生率明显增高（P＜0.01）.结论 彩色多普勒超声可以准确地判断妇科肿瘤术后下肢静脉血栓形成血流动力学变化,具有较高的临床应用价值.     

彩色多普勒技术分析穿静脉形态与功能变化

目的探讨彩色多普勒技术评估下肢穿静脉曲张患者穿静脉形态与功能变化的相关性。方法从2017年10月-2019年9月于本院治疗的下肢穿静脉曲张患者中筛选出62例患者,对其进行彩色多普勒技术诊断。分析穿静脉形态与功能变化的相关性。结果62例患者中,彩色多普勒检查显示有115支穿静脉开放。其中显示有77支出现反流。大腿下部和小腿下部内径比较,有统计学意义(t=6.432,P=0.000)。穿静脉反流随着穿静脉的内径增加而增加(r=0.712,P=0.000)。结论小腿是下肢穿静脉血栓的多发部位,大腿穿静脉内径大于小腿穿静脉内径,小腿穿静脉更容易形成反流。穿静脉开放的数量,与穿静脉内径成正比,穿静脉反流与穿静脉内径密切相关。反流静脉的内径越宽,其反流情况越严重。     

Construction and validation of a quality of life questionnaire in Chronic Lower Limb Venous Insufficiency (CIVIQ)

Quality of life may be considerably reduced in patients who are suffering from chronic lower limb venous insufficiency, although existing generic quality of life instruments (NHP, SF-36 or SIP) cannot completely identify their specific complaints. The Chronic Venous Insufficiency Questionnaire (CIVIQ) has been developed by iterative process. First, a pilot group of 20 patients was used to identify a number of important features of quality of life affected by venous insufficiency, other than physical symptoms of discomfort. A second study involving 2,001 subjects was used to reduce the number of items. Subjects were asked to score both the severity of their problems and the importance they attributed to each problem on a 5-point Likert scale. The importance items found in patients with venous insufficiency were subjected to factorial analyses (PCA, PAF). The final version is a 20-item self-administered questionnaire which explores four dimensions: psychological, physical and social functioning and pain. Internal consistency of the questionnaire was validated for each dimension (Cronbach's alpha > 0.820 for three out of four factors). Reproducibility was confirmed in a 60 patient test-retest study. Pearson's correlation coefficients for both the four dimension subscales and for the global score at 2-week intervals were greater than 0.940. Finally, the questionnaire was tested in a randomized clinical trial of 934 patients in order to assess responsiveness and the convergent validity of the instrument, together with the patient's own quality of life. This study demonstrated that convergence was valid: Pearson's correlation coefficients between clinical score differences and quality of life score differences were small (from 0.199–0.564) but were statistically different from 0 (p<0.001). Standardized response mean (SRM) and effect size (ES) were calculated to assess sensitivity to change. SRM and ES both demonstrated considerble responsiveness to change (>0.80). Reliability, face, content, construct validity and responsiveness were also determined for this specific quality of life questionnaire relating to venous insufficiency. Results suggest that this questionnaire may be used with confidence to assess quality of life in clinical trials on chronic venous insufficiency.     

Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Years Experience in Early Detection of Cervical Cancer and Pre-Cancers in Rural South India

Cervical cancer continues to be a major public health problem in India in the absence of wide spread organised cervical screening programs. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions, provided by trained health workers. We report 7 years experience in early detection of cervical cancer and pre-cancers using the VIA test in a community-based program in rural Andhra Pradesh, India where there are no existing organised cervical screening programs.

Materials and Methods:

Eligible women aged between 26 and 60 were opportunistically screened by trained health wor kers using the VIA test. Women who tested positive were further evaluated and those with cervical lesions were treated either by cryotherapy in the screening clinic or referred to a higher center.

Results:

A total of 18,869 women were screened by a single round of VIA testing with a positive rate of 10.75%. Biopsy proven high-grade squamous intraepithelials (HSILs) were 90 (0.48%) and low-grade squamous intraepithelials (LSILs) were 43 (0.28%). The overall prevalence of cervical intraepithelial neoplasia (CIN) 2+ lesion rate is 1.05%. A total of 312 (1.65%) cryotherapies were done and 49 women underwent hysterectomy.

Conclusions:

VIA by trained female health workers is a safe, acceptable, and effective test that can save lives from cervical cancer even in remote areas with few resources. These results have important implications for efficient service delivery in cervical screening programs in low-resourced settings.     

Magnitude and causes of blindness and low vision in Anambra State of Nigeria (Results of 1992 point prevalence survey)

A survey to determine the prevalence and causes of blindness in Anambra State of Nigeria was conducted. The aim was to provide baseline data for the planning, implementation and evaluation of both the state's and the National Programme for Prevention of Blindness.A multistage cluster random sampling technique was used. The World Health Organization/Prevention of Blindness (WHO/PBL) Eye Examination Record Form was used. The WHOs definitions of blindness and low vision were adopted for the analysis.The prevalence of blindness in the state is estimated to be 0.33%±0.27%. Visual acuity of from 3/60 to less than 6/60 has a prevalence of 0.41%±0.30% while visual acuity of from 6/60 to less than 6/18 has a prevalence of 0.67%±0.39.There are equal numbers of blind males as females, although the prevalence among males is 0.44%±0.26% while among females it is 0.24%±0.15%. Most of the blind are above 50 y of age with prevalence of blindness in this age group being 2.62%±1.31% (3.27%±2.1% for males and 2.02%±1.58% for females).Cataract caused most of the blindness (70.59%), followed by glaucoma (17.65%). Macular degeneration is becoming important (5.88%) while obvious infective causes are rare. Errors of refraction are important public eye health care problems.Methods of tackling the cataract problem (both backlog and incident), and other eye health needs within the primary eye/health care are recommended. The need to extend refraction services to the rural areas is emphasized.     

电容器拆解区儿童静脉血持久性有机污染物与促甲状腺素含量研究

目的电容器拆解区儿童静脉血中多氯联苯(PCBs,二英(DIOXIN)、多溴联苯醚(PBDE)暴露水平与促甲状腺素(TSH)分泌情况,并分析以上3种污染物含量与儿童TSH水平的相关性。方法在路桥和龙游二地抽查了108和123名6～8岁儿童的健康状况,并检测静脉血中PCB、DIOXIN、PBDE、TSH水平,用SPSS软件得到PCBs、DIOXIN、PBDE与促甲状腺素水平之间相关性结果及两地之间以上指标的差异性。结果路桥儿童静脉血PCB、DIOXIN、PBDE、TSH的测量结果为(484.00±84.86)、(26.00±19.58)、(664.28±262.38)ng/g lipid weight和(1.88±0.42)mIU/L;龙游儿童静脉血PCBs、DIOXIN、PBDE、TSH的测量结果为(255.38±95.12)、(39.64±31.86)、(375.81±262.43)ng/g lipid weight和(3.31±1.04)mIU/L。TSH测量值两地均在正常参考值范围内;PCB、DIOXIN、PBDE与TSH指标之间相关性差异较大,路桥地区PCB和PBDE与TSH显示出较强正相关,但DIOXIN与TSH有弱的负相关;龙游地区3种污染物与TSH水平都显示出强的正相关;除路桥和龙游地区TSH水平有显著性差异外,其余均无显著性差异。结论 PCBs、DIOXIN、PBDE这3种物质对TSH的分泌有一定的影响。     

A Randomized Trial of Alerting to Low Glycated Hemoglobin Level in Older Adults: Results of the Low Indexes of Metabolism Intervention Trial B (LIMIT-B)

ObjectivesThe benefit of alerting clinical staff to low plasma glycated hemoglobin (HbA1c) in patients aged 75 years and older who receive antidiabetic drugs remains uncertain.Design, Setting, and ParticipantsIn a randomized controlled trial, 1684 patients with HbA1c ≤ 6.5% who received antidiabetic drugs were assigned to have an e-mail alert sent to their physician, and 1643 were assigned to have no such alert (control group). The primary outcome of the trial was annual death. Secondary outcomes included antidiabetic drug dose reduction and HbA1c change.ResultsIn the first quarter, antidiabetic drug-defined daily doses were reduced on average by 10.4 ± 35.8 (16% ± 55%) in the intervention group and by 6.4 ± 36.1 (10% ± 56%) in the control group (difference −4.1 ± 1.2, 95% confidence interval [CI] −6.5 to −1.6; P = .001). Measured HbA1c levels were raised by a mean (± standard deviation) of 0.28 ± 0.77 in the intervention group and by 0.18 ± 0.57 in the control group (difference 0.10 ± 0.02, 95% CI –0.15 to −0.059, P < .001). One year after the alerts, 121 patients (7.2%) died in the intervention group and 107 patients (6.5%) died in the control group (relative risk 1.1, 95% CI 0.86-1.42; P = .44).Conclusions and ImplicationsIn this trial, alerting clinical staff to low HbA1c in patients aged 75 years and older treated with antidiabetic medicines was associated with mildly reduced antidiabetic doses and increased HbA1c but was not associated with a significant difference in survival rate compared with usual clinical care.