The treatment of snoring in the armed forces

Snoring is a common problem, which may have widespread medical and social implications. This is particularly true in the setting of the armed forces where snoring may have significant effects in terms of personal performance, social interaction and security. This paper discusses the general management of snoring in the military environment and in particular the clinical effectiveness of one surgical procedure, uvulopalatopharyngoplasty. In this study, the procedure proves to be an effective surgical option in the management of snoring.     

激光悬雍垂腭咽成形术术后并发症分析

目的　评价激光悬雍垂腭咽成形术 (LAUP)治疗阻塞性睡眠呼吸暂停综合征 (OSAS)的安全性。方法　将 1994年 4月至 1999年 11月接受LAUP手术的 2 4 3例OSAS患者的术后并发症进行回顾性研究。结果　患者术后均感疼痛 ,平均疼痛期为 13 7天 ,平均剧痛期 (不敢吞咽 )为 3 6天。 2 4例患者出现暂时性鼻咽返流。 1例患者出现严重的鼻咽狭窄。未发现任何开放性鼻音、吞咽困难和发音困难。结论　对于严格掌握适应证的轻度或中度OSAS患者 ,LAUP仍然不失为安全有效的治疗方法。     

MEBO在激光祛斑创面中的治疗作用

目的 观察美宝湿润烧伤膏(MEBO)对激光祛斑术后创面愈合的效果.方法 将120例激光祛斑术后的患者,随机分为治疗组和对照组,各60例,治疗组术后在创面涂抹MEBO,每天4次～6次,保持创面呈湿润状态直至创面愈合;对照组创面涂以红霉素软膏,每天4次～6次,直至创面愈合.观察2组在术后的止痛效果、创面愈合时间、色素沉着及其消退等方面的疗效.结果 治疗组术后疼痛和创面愈合时间与对照组比较有显著差异(P<0.01);术后创面色素沉着情况两组相比差异无统计学意义,但在创面色素沉着的消退时间上,治疗组比对照组明显缩短,差异显著(P<0.01).结论 MEBO对激光祛斑术后创面具有快速止痛、缩短创面愈合时间、促进色素沉着消退的作用,是处理激光术后创面的理想方法.     

CO2激光治疗肛瘘185例报告

为总结ＣＯ２激光治疗肛瘘的方法及经验，应用ＣＯ２激光治疗１８５例肛瘘患者。低位单纯性肛瘘１６５例、低位复杂性肛瘘１４例、高位单纯性肛瘘３例、高位复杂性肛瘘３例。采用布比卡因、亚甲蓝肛管部浸润麻醉，持ＣＯ２激光沿瘘管外壁剔除全部瘘管；或者切开全部瘘管后，用激光光束汽化、凝固管腔内的腐烂组织及管壁的瘢痕组织。高位瘘管应与挂线疗法相结合，范围广泛的肛瘘应分期手术。经１～６年临床观察，痊愈者１８３例（治愈率９８．９％）、复发２例（复发率１．１％）。该法具有止血效果好、抗感染作用强、术后痛苦小、瘢痕小、肛门不变形、操作简单、不需住院等优点。     

Optical correction and quality of vision of the French soldiers stationed in the Republic of Djibouti in 2009

To ensure vision readiness on the battlefield, the French military has been providing its soldiers with eyewear since World War I. A military refractive surgery program was initiated in 2008. A prospective questionnaire-based investigation on optical correction and quality of vision among active duty members with visual deficiencies stationed in Djibouti, Africa, was conducted in 2009. It revealed that 59.3% of the soldiers were wearing spectacles, 21.2% were wearing contact lenses--despite official recommendations--and 8.5% had undergone refractive surgery. Satisfaction rates were high with refractive surgery and contact lenses; 33.6% of eyeglass wearers were planning to have surgery. Eye dryness and night vision disturbances were the most reported symptoms following surgery. Military optical devices were under-prescribed before deployment. This suggests that additional and more effective studies on the use of military optical devices should be performed and policy supporting refractive surgery in military populations should be strengthened.     

半导体激光门诊治疗阻塞性睡眠呼吸暂停综合征的临床研究

为了安全、方便地治疗阻塞性睡眠呼吸暂停综合征，自１９９３年１１月到１９９５年１０月，我们在门诊用ＣＯ２激光行悬雍垂软腭成形术治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）１０４例，术中少量出血８例，术后无出血。用Ｄｉｏｍｅｄ半导体激光治疗ＯＳＡＳ４２例，术中与术后无出血。全部病例术前经多导仪行睡眠监测后诊断、分类，术后一个月或术后一个月和四个月重复多导仪监测后进行疗效判定，结果：ＣＯ２激光组８９例有效，有效率８５．６％，Ｄｉｏｍｅｄ半导体激光组３７例有效，有效率８８．１％。     

A review of the surgical treatment options for the obstructive sleep apnea/hypopnea syndrome patient

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a medical condition that has received significant attention within the medical community and mainstream media due to its potentially serious physiological consequences and relatively frequent occurrence within the general population. From the military perspective, the impact on individual readiness for deployment, and the potential degradation of performance in critically important military duties, often results in tremendous expenditures of training resources, time, and expertise to replace the military member with a suitable substitute or release of the individual from active duty. This article reviews common surgical techniques for clinical management of OSAHS patients in a presentation format for primary care and sleep medicine specialists, as well as surgeons interested in the philosophies of surgical management of sleep disordered breathing. Presentation of risks and benefits of surgical treatment are discussed in a manner to facilitate communication between patient and health care provider.     

MRI of the postoperative shoulder

Pain in the postoperative shoulder is difficult for all individuals involved. The patient has already undergone a surgical procedure and is presenting now with pain possibly relating to a complication of the procedure or reinjury. In addition, the patient typically has undergone a series of maneuvers, from physical therapy to cortisone injection, without relief of the symptoms. For the orthopaedic surgeon the possibility of a complication of the procedure is disheartening. Finally, for the radiologist the postoperative shoulder usually is more difficult to interpret because of a change in the normal anatomy, not knowing exactly what was accomplished at surgery or what techniques or types of equipment were used, and, more typically, the presence of artifact.     

大隐静脉传统剥脱术与激光治疗大隐静脉曲张的前瞻性随机对照研究

目的比较大隐静脉曲张的激光治疗术和传统剥脱术的治疗效果。方法大隐静脉曲张患者（单侧）40例随机分为两组,每组20例,一组行传统剥脱手术,另一组行大隐静脉高位结扎联合激光治疗术。比较两组术中出血量、术后恢复时间,术后复发率和术后并发症发生率。结果激光治疗组的术中出血量、术后恢复时间较传统静脉剥脱组显著减少（P〈0.05）。但两组患者的术后复发率和并发症发生率差异无显著意义（P〉0.05）。术后3个月两组CEAP分级均比术前明显改善（术前为C4,术后为C1,P〈0.05）。两组大隐静脉闭塞率均为90%,差异无显著意义。结论大隐静脉高位结扎联合激光治疗大隐静脉曲张是一种安全有效的大隐静脉曲张的微创手术方法。     

Advantages of CO2 laser use in surgical management of otosclerosis

BACKGROUND: Otosclerosis is a progressive osteo-destructive disorder of the bony labyrinth in which the fixation of the stapes causes the hearing loss. The aim of this study was the postoperative determination of parameters of the effect of surgical intervention on hearing and the incidence of complications and, on the basis of the differences in the examined parameters of the study, the estimation of the efficacy of the two mentioned surgical techniques in the treatment of otosclerosis. METHODS: In our research 40 patients with conductive hearing loss caused by otosclerosis underwent surgery with CO2 laser. Functional results were compared postoperatively with the results of 40 patients operated by the classical technique without the use of CO2 laser. The research was accomplished as a prospective comparative study. RESULTS: The air-bone interval (gap) as the difference between the rim of air and bone conductivity for separate frequencies did not significantly differ between the control and the experimental group. Both methods were effective in closing the air-bone gap with the rates of closure to within 10 dB in 82.6% and 75.3% for the laser and drill, respectively. The incidence of tinnitus was significantly lower in patients who underwent surgery with CO2 laser. The frequency of intraoperative and postoperative complications was significantly lower in the laser group. Differences were statistically significant for all parameters (p < 0.05). CONCLUSION: On the basis of the degree of postoperative hearing improvement, tinnitus and the incidence of complications it can be concluded that the use of CO2 laser during inverse stapedoplasty represents an effective and safe method, justifying the promotion of its use in the surgical management of otosclerosis.     

Subchondral marrow changes after laser diskectomy in the lumbar spine: MR imaging findings and clinical correlation

OBJECTIVE: We examined MR imaging findings and determined the clinical significance of subchondral bone marrow changes in the lumbar spine of holdium:yttrium aluminum garnet laser diskectomy patients. MATERIALS AND METHODS: We retrospectively reviewed the pre- and postoperative MR images of 109 patients with recurrent radiculopathy, lower back pain, or both 1 year after laser diskectomy of 178 disks. From this group of patients, MR images were also obtained in 11 patients with subchondral marrow changes 5-7 years after surgery. These patients were interviewed regarding residual lower back pain. Thirteen asymptomatic laser diskectomy patients also underwent follow-up MR imaging within 1 year of surgery. RESULTS: After surgery, subchondral marrow abnormalities were identified in 41 of 109 laser diskectomy patients. The remaining 68 patients had no postoperative subchondral bone marrow changes. Postoperative subchondral marrow changes were not associated with inflammation of the adjacent disk space and did not affect surgical outcome. Bone marrow changes decreased in size in the 11 patients examined 5-7 years after laser diskectomy, and eight of these patients described their lower back pain as improved. In 13 asymptomatic laser diskectomy patients, one new subchondral marrow abnormality was identified. CONCLUSION: Subchondral marrow abnormalities may occur in the vertebral end plates after holmium:yttrium aluminum garnet laser diskectomy. However, these changes probably do not affect surgical outcomes and appear to resolve over time.     

Influence of oral health on combat readiness in the Croatian army

The impact of the acute stomatological conditions on the reducing of the combat readiness is an important responsibility for the military planners. Classification of dental health is the primary condition for research and assessment of the army dental readiness for combat. Clinical examination of teeth and mouth included 912 soldiers, 650 of whom were recruits and 262 active duty military personnel. According to their oral status, the examinees were divided into three classes. Class 1 included all those examinees that did not require any dental treatment or reevaluation within 12 months. Class 2 included all of the examinees whose oral health was such that if regularly controlled or followed up, they were not expected to have a dental emergency within 12 months. Class 3 included all of the examinees that required dental treatment to correct both their dental and oral health because the present condition was likely to cause acute stomatological conditions during the 12-month period. This survey designated 130 (14.3%) of the examinees to class 1,178 (19.5%) to class 2, and 604 (66.2%) to class 3. The combat readiness of the 604 (66.2%) examinees in the third class was reduced because a dental emergency can cause the need for dental treatment. The recruits do not have satisfactory dental status even at the beginning of their army service. Unfortunately, active duty military personnel do not have satisfactory dental status either, although they have access to cost-free dental care (prosthetics and orthodontics are not included). This increases the possibility for development of dental emergencies that would have a negative impact on combat readiness.     

现代生物科技未来军事应用对军事安全的影响

现代生物科技在治疗疾病、改进后勤装备和提高、维持士兵军事作业能力的过程中,逐渐具备了可通过有目的地改造人体微观结构、进而使人体部分功能丧失的能力,这一发现可用于未来的军事前沿并实现武器的＂非致死＂和＂可控＂性能,但同时也将使现行的军事安全出现机遇与挑战并存的局面,如暴力程度的降低与暴力危机并存、新的＂生物微边疆＂争夺以及更激烈的信息对抗等,应及早认清形势并预先做好防范准备。     

CT-guided percutaneous laser photocoagulation of osteoid osteomas of the hands and feet

Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet.     

Diagnosis and treatment of patients with patellofemoral pain

The patient-athlete with patellofemoral pain requires precise physical examination based on a thorough history. The nature of injury and specific physical findings, including detailed examination of the retinacular structure around the patella, will most accurately pinpoint the specific source of anterior knee pain or instability. Radiographs should include a standard 30 degrees to 45 degrees axial view of the patellae and a precise lateral radiograph. Nonoperative treatment is effective in most patients. Prone quadriceps muscle stretches, balanced strengthening, proprioceptive training, hip external rotator strengthening, patellar taping, orthotic devices, and effective bracing will help most patients avoid surgery. When surgery becomes necessary, indications must be specific. Lateral release is appropriate for patella tilt (abnormal rotation). Painful scar or retinaculum, neuromas, and pathologic plicae may require resection. Proximal patellar realignment may be accomplished using arthroscopic or a combined arthroscopic/mini-open approach. Symptomatic articular lesions and more profound malalignments may require medial or anteromedial tibial tubercle transfer. Clinicians should be particularly alert for symptoms of medial subluxation in postoperative patients and should use the provocative medial subluxation test followed by lateral displacement patellar bracing to confirm a diagnosis of medial patellar subluxation. This problem may be corrected in most patients using a lateral patellar tenodesis. Current thinking emphasizes precise diagnosis, rehabilitation involving the entire kinetic chain, restoration of patella homeostasis, minimal surgical intervention, and precise indications for more definitive corrective surgery.     

以术后快速康复理念为导向无管道置入在达芬奇机器人纵隔手术中应用

目的探讨在术后快速康复(ERAS)理念引导下应用达芬奇机器人手术系统(DVSS)行纵隔手术中无管道置入应用的可行性及临床效果。方法将60例采用DVSS辅助下纵隔疾病手术的患者随机分A组和B组,每组各30例患者。A组患者给予常规手术流程,B组患者采用无管道置入方法完成手术。通过优化手术配合流程,对两组患者术后相关指标进行比较。结果两组患者均顺利完成手术。与A组比较,B组患者术后发生躁动、声音嘶哑、咽喉疼痛、尿路感染的概率以及住院时间等方面,差异均有统计学意义(P<0.05)。结论以ERAS理念为导向的无管道置入的手术方法应用在DVSS纵隔手术中,不仅是安全、有效、经济的,而且可以促进患者术后快速康复,缩短住院时间,提高患者满意度。     

Pain after elective arthroscopy of the knee: a prospective, randomised, study comparing conventional NSAID to coxib

Although outpatient knee arthroscopy is probably by far the most frequently performed orthopaedic procedure, there are limited guidelines or consensus concerning the peroral postoperative pain management. A diversity of analgesics both in potency and action is prescribed. The purpose of the present investigation was to grade the pain and need for rescue medication during the first 4 days after the knee arthroscopy, comparing a conventional nonsteroidal anti-inflammatory drug (NSAID) with a selective cox-II-inhibitor (coxib) as postoperative pain medication. One hundred and twenty-two patients scheduled for primary elective knee arthroscopy in general anaesthesia were randomised to either a NSAID (lornoxicam) or a selective cox-II-inhibitor (rofecoxib) postoperatively. Pain ratings and the need for rescue medication were followed for four consecutive days. Side effects were also registered. The need for rescue analgesics was highest the evening after surgery, when 42% of patients required one, or more, oral additional analgesics. The use of rescue medication decreased with time and 30, 25, 16 and 11% of the patients required additional analgesics for day 1 to 4, respectively, still 50% of all patients required at some point one or more rescue analgesics. Overall pain ratings were low, and showed similar pattern with evening and day, 50% of all patients required at some point one or more rescue analgesics. We found, however, no differences in pain ratings, or need for rescue analgesics between the two groups, conventional NSAID and coxib as well as no difference in side-effect profile. In conclusion, patients do require proper pain management also after minor outpatient surgical procedures such as knee arthroscopy. The traditional NSAIDs seem to be the first choice for analgesic and anti-inflammatory effects, when needed after elective arthroscopy of the knee.     

A decade of great progress in medical readiness

The 1980s were times of extensive real growth in military capability of the Armed Forces of the United States. In concert with this growth, the ability to provide direct medical mission support and combat casualty care was greatly enhanced. Because medical equipment and supplies are worth little without qualified health care personnel, enhanced medical readiness training programs were created early in the build. The training programs, coupled with expanded inventories of medical equipment and supplies, were key elements in the decade-long quest to enhance medical readiness. This decade must be remembered for the success in building medical readiness capability and for the lessons learned while doing it.     

歼击机飞行员准分子激光角膜屈光手术后放飞一例并文献复习

目的 探讨飞行员角膜屈光手术治疗的飞行适应性及航空医学的鉴定原则.方法 分析1例歼轰-7飞行员双眼近视的临床诊断、治疗过程及医学鉴定情况,复习相关文献.结果 本例飞行员诊断为近视性屈光不正2年,保守治疗无效.本人要求手术治疗.眼科检查未见手术禁忌证,经过准分子激光上皮下角膜磨削术治疗,术后常规局部抗炎、促进角膜伤口愈合等药物治疗约1个半月,3个月后复查视功能（包括视力、立体视觉、对比敏感度）恢复正常;双眼角膜伤口愈合良好,电脑验光屈光度稳定;角膜地形图示切削区居中.经低压舱模拟航空低压缺氧环境检查,视功能稳定,给予特许飞行合格.术后正常参加双座机飞行40 h. 结论 军事飞行员近视角膜屈光手术治疗后,角膜伤口愈合良好,视功能恢复正常者可以考虑放飞.飞行适应性评价除常规定期视功能、屈光度、角膜等检查外,应进行对比敏感度、眩光等与飞行环境相关的特殊视功能检测.准分子激光角膜屈光手术是解决军事飞行员近视的有效方法.     

点阵激光联合湿润烧伤膏治疗痤疮凹陷性瘢痕疗效观察

目的 对比观察湿润烧伤膏治疗痤疮凹陷性瘢痕点阵激光术后创面的临床疗效。方法 将64例痤疮凹陷性瘢痕患者随机分为治疗组32例和对照组32例,治疗组在点阵激光治疗后采用湿润烧伤膏治疗,对照组则在点阵激光治疗后采用红霉素眼膏治疗,对比观察两组术后疼痛程度、创面愈合时间及不良反应。结果治疗组显效11例,有效18例,无效3例,总有效率90.63%;对照组显效9例,有效19例,无效4例。总有效率87.5%,两组疗效比较差异无显著性（P〉0.05）。患者随着治疗次数的增加,疗效逐渐提高。术后30min疼痛程度评价：治疗组为3.23±0.31,对照组为6.54±0.35,治疗组疼痛程度与对照组相比,差异有显著性意义（P〈0.05）;创面愈合时间：治疗组为5.24d±1.32d,对照组为9.94d±0.45d,治疗组创面愈合时间与对照组相比,差异有显著性意义（P〈0.05）。术后治疗组出现暂时性色素沉着1例,红斑2例,对照组出现暂时性色素沉着2例,红斑3例,均1月内消退。两组创面均未见感染。结论点阵激光联合MEBO治疗痤疮凹陷性瘢痕疗效确切,安全性高,不良反应少,术后疼痛轻,创面愈合时间短,对患者的学习及工作影响小,值得临床推广应用。