自膨式带膜支架治疗食管恶性狭窄与食管气管瘘的临床观察

目的:评价自膨式带膜支架治疗晚期食管癌并发食管恶性狭窄或食管气管瘘临床应用价值。方法:对29例晚期食管癌患者在X线电视监视下置入自膨式带膜支架,其中食管恶性狭窄24例,食管气管(支气管)瘘5例。结果:均一次置放成功,全部病例术后吞咽功能立即得到改善,并发食管气管瘘呛咳消失。患者术后能进软食或普食,提高了生活质量。结论:自膨式带膜支架治疗食管恶性狭窄安全有效,并发症少,有效提高生存期。     

食管癌术后吻合口恶性狭窄支架植入术的临床应用

目的探讨食管支架置入治疗食管癌术后吻合口恶性狭窄临床效果。方法采用食管金属支架置入术及内镜下球囊扩张术对26例食管癌术后吻合口恶性狭窄患者进行治疗。经治疗,患者梗阻情况迅速改善,全组未出现穿孔、大出血等严重并发症。结论采用内镜下球囊扩张及食管支架置入术对食管癌术后吻合口恶性狭窄进行治疗,具有安全、有效的优点,值得推广运用。     

自膨式带放射性粒子食管支架治疗食管恶性狭窄20例临床观察

食管恶性狭窄是食管癌手术后复发和晚期食管癌的常见症状,患者往往需要多次进行食管狭窄球囊扩张,且狭窄扩开后短时间内易复发.置入支架虽然效果较好,但肿瘤组织往往会自支架缝隙中长入[1-2].2008年我院开始采用自膨式带放射性粒子带膜支架对食管恶性狭窄进行扩张、支撑和近距离放疗.为了探讨自膨式带放射性粒子带膜支架对食管恶性狭窄的治疗效果,我们选择应用自膨式带放射性粒子食管支架治疗的20例患者和传统食管支架治疗的20例患者进行对比分析,现将结果报告如下.     

早、晚期食管癌的内镜下微创治疗

食管癌是一种常见的恶性消化道肿瘤,我国食管癌的发病和死亡平均水平居恶性肿瘤前列。随着内镜技术的迅速进步,早期食管癌可通过内镜下粘膜切除术（EMR）、内镜粘膜下剥离术（ESD）、隧道技术、多环套扎黏膜切除（MBM）、氩离子血浆凝固术（APC）等微创技术治疗,其效果好,创伤小,费用相对少。对于晚期或无法手术的进展期食管癌患者,食管狭窄是影响生活质量的关键因素,单纯扩张、支架置入技术、化疗药物局部注射、射频治疗等,以及联合上述治疗措施的综合疗法可缓解食管狭窄,解决进食问题,增加营养摄入,提高患者生活治疗,延长生存期。本文就目前早、晚期食管癌的内镜下微创治疗作一回顾性综述。     

食管支架置入术治疗晚期食管癌贲门癌疗效及并发症分析

目的探讨食管支架置入术在晚期食管癌贲门癌姑息治疗中的疗效,术后并发症及相关因素。方法27例晚期食管癌贲门癌患者,采用食管支架置入术治疗食管贲门恶性梗阻。结果食管支架置入术治疗吞咽困难、饮水呛咳的疗效100％,改善了患者生存质量。并发症主要为胸骨后疼痛和异物感、出血、胃食管反流、支架堵塞、支架移位和食管再狭窄。严重并发症为大出血。结论食管支架置入术可以有效治疗晚期食管癌贲门癌恶性狭窄和食管瘘,缓解吞咽困难,提高生活质量。预防术后大出血需要深入研究。     

食管内^125I粒子带膜支架与普通支架治疗中晚期食管癌临床治疗效果对比

目的 对比食管内125I粒子带膜支架与普通支架治疗中晚期食管癌的临床应用效果.方法 36例中晚期食管癌患者分为两组,18例放置自膨式携带125I粒子带膜食管支架(A组),18例放置传统自膨式带膜食管支架(B组).术中、术后观察随访支架置入成功率、术后体质恢复、术后3个月再狭窄率、生存期及并发症的发生率.结果 A、B两组支架置入成功率均为100.00%,吞咽困难程度均从Stooler分级2～4级改善至0级,A组支架置入后体质恢复(卡氏评分≥60分者100.00%)、平均生存期(8.5±3.2个月)明显高于B组(55.56%,4.5±1.4个月,P＜0.05),术后3个月再狭窄率A组(5.56%)明显低于B组(44.44%,P＜0.05),并发症发生率两组比较差异无统计学意义(P＞0.05).A组未发现与放疗有关的并发症.结论 食管内125I粒子食管支架治疗中晚期食管癌的疗效优于普通支架,可明显延长患者的生存期.     

内镜下微波凝固联合金属支架置入治疗晚期食管癌

食管贲门恶性狭窄经置入金属支架后能有效解除患者的吞咽困难,改善生活质量,延长生存期,但单纯支架置入后再狭窄并发症的发生率较高,约束了其广泛应用.我院自2003-2008年,对30例中晚期食管癌梗阻采用内镜下微波凝固联合金属支架置入等多种措施,获得较好的疗效.现报道如下.     

晚期食管癌性狭窄内镜下食管支架置入治疗方法体会

目的探索食管癌晚期食管狭窄的有效治疗方法。方法在内镜下置入网状记忆合会支架。结果18例食管癌晚期食管狭窄病人置入支架后，均立即消除了因吞咽梗阻所致的进食困难。结论本方法是治疗食管癌晚期食管狭窄最有效方法．疗效显著，且操作简单安全，所需设备要求不高，易推广应用。     

食道癌放疗后狭窄及食管气管瘘食管内支架治疗方法的探讨

目的:评价食管内支架治疗食管癌放疗后狭窄及食管气管瘘的临床效果及方法探讨.方法:本组8例食管癌放疗后狭窄的患者,其中并发食管气管瘘3例,8枚食管内支架置入均在X线电视监视下进行,术后给予抗生素、止血药及镇静止痛药.结果:8例患者均成功置入,其中一例中段食管气管瘘置入支架后一周支架滑脱进入胃腔被取出,另两例中上段食管气管瘘完全被封闭,其进水呛咳症状消失.5例单纯狭窄伴梗阻患者术后吞咽困难完全消除.但其中一例患者食道下段狭窄长于10cm,使用了长14cm宽2.0cm支架术后反应较大,两个月后仍感觉胸骨后疼痛和撑胀感.结论:食管内支架治疗食道癌放疗后狭窄,选用1.8cm以下支架及中上段食道狭窄的患者更为安全有效.     

金属覆膜支架在食管癌术后食管-气管瘘的临床应用

目的总结金属覆膜支架在食管癌术后食管-气管瘘的临床应用经验。方法 2012年1月—2013年12月收治的8例食管癌术后食管-气管瘘患者,在DSA引导下行金属覆膜支架置入治疗。结果 8例置入金属覆膜支架均成功,术后患者进食困难均有所改善,肺部感染症状得到明显控制。术后1周、1个月复查上消化道造影或胸部CT,均提示瘘口已愈合,支架在位,通畅,其中有一例支架压迫左侧气管,术后6个月食管气管瘘复发,再次行食管支架置入术。所有患者术后除了有食管异物感、支架植入处不适、胃食管反流外,均未发生如食管穿孔、大出血等严重并发症。结论金属覆膜支架治疗食管癌术后食管-气管瘘是一种简便、安全、有效的方法,能有效改善症状,提高患者的生存质量,延长生存时间。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.