鼻腔结构矫正结合射频治疗常年性变应性鼻炎

目的：观察鼻内镜手术结合射频治疗伴有鼻腔结构异常的常年性变应性鼻炎的疗效。方法：46例伴有鼻中隔偏曲或下鼻甲肥大的常年性变应性鼻炎患者，在鼻内镜下行鼻中隔黏膜下矫正术或下鼻甲黏膜下部分切除术，同时结合射频热凝下鼻甲、鼻丘、与鼻丘对应的鼻中隔等副交感神经密集部位。结果：术后随访1年以上，术后1个月和术后1年的总有效率分别为97．8％、82．6％。7例复发，其中6例发生在手术6个月以后。结论：对伴有鼻中隔偏曲或下鼻甲肥大的常年性变应性鼻炎患者，鼻内镜手术结合射频治疗是理想的治疗方法，术后复发多在6个月以后。     

鼻内接触性头痛134例治疗分析

目的探讨鼻内接触性头痛的治疗方法。方法对134例鼻内接触性头痛患者,根据其具体病情,采用鼻中隔矫正术和（或）下鼻甲部分切除术或黏骨膜下切除术或骨折外移术或下鼻甲微波治疗。结果术后随访2~36个月,鼻中隔偏曲术后头痛治愈率为88.9%,鼻中隔偏曲伴慢性肥厚性鼻炎术后治愈率为85.5%,单纯为双下鼻甲微波治疗后治愈率86.1%。结论通过经鼻内镜下行鼻中隔矫正术和/或下鼻甲手术或下鼻甲微波治疗,对于解除鼻内接触性头痛可获良好效果。     

综合治疗变应性鼻炎伴鼻中隔偏曲103例临床分析

变应性鼻炎（AR）是耳鼻咽喉科临床的常见病、多发病,其发病机理复杂,治疗方法多样。对有变应性鼻炎伴有鼻中隔偏曲的患者,通过矫正鼻隔偏曲、切除部分下鼻甲后改善了变应性鼻炎症状。自2005年5月～2011年2月,作者选择性地对变应性鼻炎合并鼻中隔偏曲和下鼻甲肥大患者采用综合治疗措施,即系统脱敏治疗、鼻中隔矫正术和下鼻甲部分切除术,现报告如下。     

变应性鼻炎临床治疗分析

目的观察对128例变应性鼻炎的临床治疗。方法回顾分析我科自2001～2006年对128例变应性鼻炎治疗，陆床疗效，采取鼻中隔偏曲矫正术及双下鼻甲射频热凝治疗，术后结合下鼻甲封闭治疗。结果治愈110例，好转12例，无效6例，总有效率95.3％，治愈率86％。结论使用手术加下鼻甲封闭术，治疗变应性鼻炎疗效显著，值得临床应用。     

鼻中隔矫正术治疗变应性鼻炎的临床观察

目的探讨鼻中隔粘骨膜下矫正术治疗鼻中隔偏曲伴变应性鼻炎的临床疗效。方法8例鼻中隔偏曲伴变应性鼻炎全部在常规下行鼻中隔粘骨膜下矫正术。结果全部病例术后短期内症状均停止发作，术后4周总有效率100％；术后一年总有效率87．5％。结论鼻中隔矫正术可以通过去鼻黏膜的部分副交感神经支配及改善鼻腔通气等，以治疗鼻中隔偏曲伴变应性鼻炎，达到缓解临床症状的目的。     

变应性鼻炎合并鼻中隔偏曲的综合治疗

目的：探讨变应性鼻炎合并鼻中隔偏曲的综合治疗效果。方法：对128例变应性鼻炎合并鼻中隔偏曲患者采用鼻中隔矫正、局部微波热凝和下鼻甲切除术的局部综合治疗措施。根据治疗前后临床症状和体征的变化，评价近期和远期效果。结果：术后4周，全部病例显效。1年后有105例获随访，其中显效77例，有效17例，无效11例，总有效率89．52％。无并发症发生。结论：变应性鼻炎合并鼻中隔偏曲患者实施综合治疗的疗效满意，安全简便。     

鼻内镜鼻腔框架结构重塑治疗常年性变应性鼻炎98例

目的:探讨鼻内镜下鼻腔框架结构重塑治疗变应性鼻炎的疗效.方法:对98例变应性鼻炎并鼻腔结构异常的患者施行鼻内镜下鼻中隔矫正术、下鼻甲部分切除术、纠正异常中鼻甲.所有患者随访1年以上,评价其临床效果.结果:术后3个月总有效率95.9%,术后半年总有效率81.6%,术后1年总有效率65.3%,术后2年总有效率60.2%.结论:该手术安全有效,有助于变应性鼻炎的治疗.     

鼻内筛前神经合并双侧下鼻甲行微波凝固治疗变应性鼻炎的临床观察

目的探讨变应性鼻炎的临床治疗方法。方法根据近年来国内外治疗变应性鼻炎的经验，采用筛前神经合并双侧下鼻甲行微波凝固治疗变应性鼻炎，病例37例，男23例，女14例，平均年龄31岁(18～52岁)。结果所有病例术后症状和体征明显改善。根据病情分级评定疗效，1个月全部症状消失，显效率100％；半年显效率94％(35／37)，有效率5．7％(2／37)；1年显效率78％(29／37)，有效率22％(8／37)；1．5～4年显效率65％(24／37)，有效率35％(13／37)。无一例出现鼻中隔穿孔、嗅觉减退、萎缩性鼻炎、眼干、头痛等并发症。结论鼻内筛前神经合并双侧下鼻甲行微波凝固治疗变应性鼻炎可作为临床治疗变应性鼻炎的一种有效的新方法。     

鼻中隔骨折移位术治疗变应性鼻炎的临床分析

目的：探讨合并鼻中隔偏曲的变应性鼻炎的治疗方法。方法：采用鼻中隔矫正加双下甲黏膜下骨折移位术治疗合并鼻中隔偏曲的变应性鼻炎32例，随访1年。结果：显效28例，有效4例。结论：鼻中隔矫正术加双下甲黏膜下骨折移位术治疗合并鼻中隔偏曲的变应性鼻炎，是一种较为理想的方法。     

鼻内镜微波凝固切断筛前神经治疗变应性鼻炎疗效观察

目的观察微波凝固筛前神经治疗常年变应性鼻炎的疗效。方法26例确诊为变应性鼻炎的患者在鼻内镜引导和局麻下开放前组筛房，暴露筛前血管神经骨管，微波探针接触凝固。结果术后随访1年，其中显效16例，占61．5％，有效6例，占23％，无效4例占，15．5％，总有效率84．5％。结论鼻内镜微波凝固筛前神经治疗变应性鼻炎定位准确、创伤小、术后疗效好。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.