显微手术切除颅咽管瘤

目的：探讨切除颅咽管瘤的手术入路和显微手术技巧。方法：本组颅咽管瘤5例。其中2例为实质性视交叉后肿瘤、1例为实质性鞍内鞍上型肿瘤、2例为囊性肿瘤。采用不同的手术入路(双侧额、翼点和经蝶窦手术入路)进行肿瘤切除。结果：4例经颅手术的病例皆达全切除，1例鞍上鞍内型肿瘤采用经蝶窦手术次全切除。所有病例恢复良好。结论：根据肿瘤不同质地、部位和范围，采用恰当的手术入路，结合应用熟练的显微技巧，可以取得良好的临床疗效。     

经胼胝体-穹窿间入路切除颅咽管瘤

目的介绍并探讨一种切除颅咽管瘤的手术入路。方法经胼胝体-穹窿间入路切除颅咽管瘤10例。结果在显微镜下全切肿瘤9例,大部分切除1例,无死亡病例。结论利用显微外科技术经该手术入路切除第三脑室内颅咽管瘤,术野显示清楚,对周围结构损伤小,肿瘤全切率高,术后并发症少。     

鼻内镜下经蝶窦入路切除颅咽管瘤二例

颅咽管瘤是胚胎期颅咽管的残余组织发生的良性肿瘤,是鞍区第二常见的良性肿瘤,该区肿瘤一般位置深在,毗邻重要的解剖结构,手术难度较大,术后较容易出现各种并发症。所以,良好的外科手术技术在肿瘤治疗中具有重要地位。随着影像设备,显微与内镜切瘤技术的广泛应用,微创手术理念的深入,使经蝶入路已成为中颅窝肿瘤切除的理想术式。本文报道2例鼻内镜下经蝶窦入路切除颅咽管瘤的成功经验,并附相关的文献复习。     

侵犯下丘脑的颅咽管瘤手术全切除和下丘脑保护探讨

目的 探讨侵犯下丘脑的颅咽管瘤显微外科手术入路的选择和术中下丘脑保护问题。方法回顾性分析12例颅咽管瘤显微手术的临床资料。结果12例中肿瘤全切除8例，次全切除2例；部分切除2例。全切除率为66．7％。因下丘脑的损伤致患者死亡2例(16．7％)。结论术中根据肿瘤性质、部位和大小，选择恰当的手术入路，保护好供应下丘脑的动脉可以提高颅咽管瘤的全切除率，降低下丘脑损伤的发生率。     

经眉弓锁孔切除颅咽管瘤患者的护理

颅咽管瘤为鞍区常见的先天性良性肿瘤,采用经眉弓入路到鞍区的锁孔微创显微手术使得手术路径更便捷,显微操作更方便;且手术创伤小,能减少患者的住院天数和医疗负担,并减少手术对患者外观的影响。我科于2004—2009年对22例颅咽管瘤患者经眉弓锁孔入路进行肿瘤切除,取得良好的效果,现将护理体会报道如下。     

内镜下扩大经鼻蝶入路切除鞍上三脑室内颅咽管瘤

目的：探讨完全内镜下扩大经鼻蝶入路切除位于鞍上三脑室内的颅咽管瘤的可行性和有效性。方法：采用完全内镜下扩大经鼻蝶入路切除位于鞍上三脑室内的颅咽管瘤1例。结果：肿瘤被全部切除,术后随访6个月,患者在内分泌替代治下生活正常。结论：完全内镜下扩大经鼻蝶入路可以安全有效地切除位于鞍上三脑室内的颅咽管瘤。对于选择性的颅咽管瘤病例,该手术入路是一种切除肿瘤的更新、更微创的手术入路。     

经翼点入路鞍区肿瘤显微手术25例临床分析

目的介绍25例鞍区肿瘤(脑膜瘤5例,颅咽管瘤8例,垂体瘤12例)经翼点入路显微手术的治疗经验。方法经翼点入路开颅,骨窗扩大至颞底、咬除蝶骨嵴外侧部分,显微镜下充分解剖、显露侧裂池、颈动脉池、视交叉池、鞍上池。对脑膜瘤行分块全切、根部电灼。对颅咽管瘤及垂体瘤则充分利用鞍区四个间隙,先囊内后囊壁分块切除。术后均常规放疗。结果脑膜瘤5例均全切,颅咽管瘤8例全切6例、占75％,垂体瘤12例全切10例、占83.3％,无手术死亡,随访3月～5年未见复发。结论鞍区肿瘤经翼点入路显微手术是最佳入路选择。     

颅咽管瘤显微外科治疗40例临床分析

目的 探讨颅咽管瘤切除的显微手术入路和手术技巧.方法 回顾性分析我院2006年3月至2008年3月收治的40例颅咽管瘤患者临床表现、影像学特点、手术入路、肿瘤切除程度以及随访资料.结果 采用翼点入路24例,额下入路15例,经右侧侧脑室入路1例.肿瘤全切除26例(65.0%),次全切除10例(25.0%),大部切除3例(7.5%),部分切除1例(2.5%).经终板入路是翼点和额下入路对某些瘤体暴露不足和切除困难时最好的补充,特别是对于有钙化瘤体者.结论 翼点和额下入路仍是目前切除颅咽管瘤的主要入路.充分打开脑底各池、合理应用组织间隙、重要结构组织保护是手术成功、减少术后并发症的关键.     

颅咽管瘤显微外科治疗40例临床分析

目的 探讨颅咽管瘤切除的显微手术入路和手术技巧.方法 回顾性分析我院2006年3月至2008年3月收治的40例颅咽管瘤患者临床表现、影像学特点、手术入路、肿瘤切除程度以及随访资料.结果 采用翼点入路24例,额下入路15例,经右侧侧脑室入路1例.肿瘤全切除26例(65.0%),次全切除10例(25.0%),大部切除3例(7.5%),部分切除1例(2.5%).经终板入路是翼点和额下入路对某些瘤体暴露不足和切除困难时最好的补充,特别是对于有钙化瘤体者.结论 翼点和额下入路仍是目前切除颅咽管瘤的主要入路.充分打开脑底各池、合理应用组织间隙、重要结构组织保护是手术成功、减少术后并发症的关键.     

两种手术入路方式治疗第三脑室颅咽管瘤的疗效比较

目的 比较经胼胝体、透明隔、穹窿间入路和皮质-侧脑室入路手术治疗第三脑室颅咽管瘤的临床疗效.方法 将山东省临朐县人民医院60例第三脑室颅咽管瘤患者随机分为两组(A、B组),每组30例,分别经胼胝体、透明隔、穹窿间入路和皮质-侧脑室入路行手术切除肿瘤,比较两组疗效及并发症发生情况.结果 两组肿瘤切除率和并发症发生情况间的差异无统计学意义(P>0.05).结论 两种手术入路方式治疗第三脑室颅咽管瘤均具有良好的疗效.     

脑性瘫痪高危儿的早期物理治疗

早期物理治疗对改善脑瘫高危儿的远期预后有着重要意义。将患儿父母作为治疗团队成员共同参与的早期物理治疗方案,对于患儿的运动发育有较大影响。脑瘫高危儿的早期治疗主要包括Vojta 法、Bobath 法及Doman-Delecato 法等,而其中Vojta法呈现出决定性优势。目前还缺少一种特定的治疗方案在脑瘫高危儿中应用疗效的研究。     

Permissive hypofiltration

ABSTRACT: Acute kidney injury (AKI) is a syndrome with a multitude of causes and is associated with high mortality and a permanent loss of renal function. Our current understanding of the most common causes of AKI is limited, and thus a silver bullet therapy remains elusive. A change in the approach to AKI that shifts away from the primary composite endpoint of death/dialysis, and instead focuses on improving survival and mitigating permanent renal damage, is likely to be more fruitful. We suggest that the current approach of augmenting renal function by increasing the renal blood flow or glomerular filtration rate during AKI may actually worsen outcomes. Analogous to the approach towards adult respiratory distress syndrome that limits ventilator-induced lung injury, we propose the concept of permissive hypofiltration. The primary goals of this approach are: resting the kidney by providing early renal replacement therapy, avoiding the potentially injurious adverse events that occur during AKI (for example, fluid overload, hypophosphatemia, hypothermia, and so forth), and initiating therapies focused on improving survival and mitigating permanent loss of kidney function.     

Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach

A physical therapy approach to lumbar spinal stenosis involves techniques directed at opening up the neurovascular spaces in the lumbar spine to reduce the stenosis. This entails manual therapy techniques for improving intervertebral motion, regaining neural mobility, and restoring muscle function, followed by an active exercise program that often involves flexion exercises. Techniques for unloading the spine and patient education are included in this physical therapy approach. A successful functional outcome requires a comprehensive and individualized approach to the patient with spinal stenosis.     

IV iron use in patients with higher serum ferritin: case study on anemia in kidney disease.

Anemia management practices in patients on hemodialysis that incorporate a balanced approach to erythropoiesis-stimulating agent (ESA) and intravenous (IV) iron therapy, use the lowest effective dose of ESA, and provide IV iron therapy in patients with higher serum ferritin levels have become important treatment considerations. This case study, followed by an indepth discussion, addresses these issues and helps to identify safe and effective treatment strategies to assist nurses in improving patient outcomes.     

Application of massage therapy in premature infant nursing care

Massage therapy has been used in the care of premature infants for many years in western countries, and a significant body of research has already shown the effectiveness of massage therapy in significantly increasing body weight, decreasing infant hospital durations, enhancing bone formation, and improving behavior. Key considerations when applying massage therapy on premature infants include gestational age, bodyweight, and physical condition. Nurses can teach parents to administer massage therapy on their premature infants to enhance parent-child attachment and interaction. This article introduces massage therapy principles and methods, the effectiveness of massage therapy in premature infant care, and an approach to teaching parents how to apply massage therapy on their premature infants. Massage therapy can be included in premature infant care programs in the future.     

Peritoneal mesothelioma presenting as an adnexal mass.

A case of primary peritoneal mesothelioma which presented clinically as an adnexal mass is reviewed. Difficulties in diagnosis and factors affecting prognosis are discussed. Operation to remove as much of the tumor as possible, followed by irradiation therapy, is suggested as a worthwhile approach to improving chances for cure or palliation.     

IV iron therapy and anemia management in patients on hemodialysis: benefits of a revised CQI strategy

Intravenous iron therapy is widely used in the management of anemia in patients on hemodialysis, and anemia management protocols provide a standardized approach to IV iron therapy. The author's hemodialysis center implemented an initial anemia management protocol in 2004 based on the principles of a continuous quality improvement (CQI) program, detailed by Bowe and Ammel in the Nephrology Nursing Journal in 2005. Successive revision using the CQI process has resulted in additional benefits regarding patient outcomes, which are reported here. This article illustrates the value of a CQI program for maintaining and improving clinical outcomes in patients who have anemia and are undergoing hemodialysis.     

30名学习困难儿童教育干预效果观察

目的探讨对学习困难儿童进行教育干预的方法及效果。方法选择玉林市某寄宿小学 2— 4年级 7— 10岁学习困难儿童 3 0名 ,采用个体化教育方式 ,内容包括感觉统合、精细运动、生活技能、认知能力训练和行为、游戏、音乐疗法 ,父母教育 ,为期1 5年。干预前后测定儿童的感觉统合评定量表和学习成绩 ,并与正常儿童比较。结果学习困难儿童在感觉统合和学习成绩方面基本达到正常儿童水平。结论对学习困难儿童进行教育干预 ,是激发学习障碍儿童生理和心理潜能的一种有效途径     

A contemporary neuroscience approach compared to biomedically focused education combined with symptom-contingent exercise therapy in people with chronic whiplash associated disorders: a randomized controlled trial protocol

BackgroundTo address the need for a better treatment of chronic whiplash associated disorders (WAD), a contemporary neuroscience approach can be proposed.ObjectiveTo examine the effectiveness of a contemporary neuroscience approach, comprising pain neuroscience education, stress management, and cognition-targeted exercise therapy versus conventional physical therapy for reducing disability (primary outcome measure) and improving quality of life and reducing pain, central sensitization, and psychological problems (secondary outcome measures) in people with chronic WAD.MethodsThe study is a multi-center, two-arm randomized, controlled trial with 1-year follow-up and will be performed in two university-based and one regional hospital. People with chronic WAD (n = 120) will be recruited. The experimental group will receive pain neuroscience education followed by cognition-targeted exercise therapy, and stress management. The control group will receive biomedically focused education followed by graded and active exercise therapy focusing on muscle endurance, strength, and flexibility, and ergonomic principles. The treatment will have a duration of 16 weeks. Functional status (Neck Disability Index) is the primary outcome measure. Secondary outcome measures include quality of life, pain, central sensitization, and psychological and socio-economic factors. In addition, electroencephalography will measure brain activity at rest and during a conditioned pain modulation paradigm. Assessments will take place at baseline, immediately post-treatment and at 6 and 12 months follow-up.ConclusionsThis study will examine whether a contemporary neuroscience approach is superior over conventional physical therapy for improving functioning, quality of life, and reducing pain, central sensitization, and psychological problems in people with chronic WAD.     

The role of cinacalcet in treating secondary hyperparathyroidism.

Compelling evidence exists to use cinacalcet as a primary therapy for the treatment of secondary HPT in patients requiring dialysis. The benefits of directly lowering PTH in combination with improving calcium-phosphorus homeostasis provide a means to better achieve the K/DOQI bone guidelines. Cinacalcet is usually well tolerated and safe to use, making it possible to treat a wide range of patients with varying levels of disease severity. The ideal course of action for this novel therapy is for nephrology nurses and renal dietitians to use a team approach in the management of secondary HPT.