甲氨喋呤配伍米非司酮治疗异位妊娠的疗效观察

目的探讨甲氨喋呤配伍米非司酮保守治疗异位妊娠的临床疗效。方法对138例异位妊娠患者分两组进行甲氨喋呤50mg与甲氨喋呤配伍米非司酮150mg日2次口服，共服3d。结果对照组68例，单药甲氨喋呤治愈率73．5％。观察组70例，甲氨喋呤配伍米非司酮治愈率87，1％。结论两药配伍治疗异位妊娠有协同作用，对于能早期就诊、早期诊断异位妊娠的患者可提高治愈率。     

甲氨喋呤配伍治疗异位妊娠的疗效观察

目的探讨甲氨喋呤配伍米非司酮保守治疗异位妊娠的临床疗效。方法138例对异位妊娠患者分成对照组和观察组，对照组68例，采用甲氨喋呤治疗；观察组70例，采用甲氨喋呤配伍米非司酮治疗。结果对照组治愈50例，治愈率73．5％；观察组治愈61例，治愈率87．1％。结论两药配伍治疗异位妊娠有协同作用，对于早期诊断异兰妊娠的患者能提高治愈率。     

米非司酮联合甲氨喋呤治疗异位妊娠25例

目的 探讨米非司酮联合甲氨喋呤治疗异位妊娠的疗效及不良反应。方法 将50例异位妊娠患者随机分为米非司酮联合甲氨喋呤组（治疗组）和单用甲氨蝶呤组（对照组），对两组疗效及不良反应进行比较。结果 治疗组成功率92％，对照组成功率76％，两组比较有显著性差异（P〈0．05）。治疗组血β人绒毛膜促性腺激素（β-HCG）值在用药后5d即开始下降，对照组于10d开始明显下降，两组比较有显著性差异（P〈0．05）。治疗组不良反应发生率明显低于对照组（P〈0．05）。结论 米非司酮联合甲氨喋呤治疗异位妊娠安全有效。     

甲氨喋呤治疗24例切口妊娠的临床诊治分析

目的探讨甲氨喋呤(MTX)在治疗剖宫产后切口妊娠中的作用,为临床医师早期诊断、早期处理本病提供依据。方法回顾性分析甲氨喋呤在治疗24例剖宫产后切口妊娠过程中局部用药和全身用药的作用。结果24例均用甲氨喋呤杀胚治疗,16例局部用药,8例全身用药,均治愈。结论甲氨喋呤能快速抑制滋养细胞的分裂增殖,破坏胚胎组织的活性,杀胚后清宫副作用小,能避免因盲目清宫引起的大出血和子宫全切。     

85例异位妊娠保守性治疗的临床分析

目的:探讨异位妊娠保守性治疗的临床应用价值。方法: 回顾性分析1997年1月~2003年12月住院确诊为异位妊娠并适合保守治疗的患者85例, 随机采用甲氨喋呤化疗44例, 米非司酮治疗41例。比较各组疗效、住院时间、住院费用、血清β-HCG下降情况及副反应。结果: 甲氨喋呤组治愈率为72. 73%, 米非司酮组治愈率为73. 17%; 甲氨喋呤组和米非司酮组的平均住院时间分别17 .86±3 .21d和5 .34±2 .68d, 住院费用分别为815±62 .35元和786±68. 54元; 甲氨喋呤组和米非司酮组血β-HCG下降的时间分别为HCG下降的时间为15 .98±7. 16d和14. 77±6. 89d; 甲氨喋呤及米非司酮的副反应发生率分别为50 .00%及24. 39%, 二者间有统计学差异, (P<0 .05 )。结论: 米非司酮治疗异位妊娠是一种有效、安全、方便的药物,且便于门诊应用; 在异位妊娠能够得到早期诊断的前提下, 其应用前景广阔, 有可能作为异位妊娠保守治疗的首选药物。     

异位妊娠的药物保守治疗临床观察

近年来，异位妊娠发病率呈不断上升趋势，但由于早期诊断水平的提高，使许多未破裂型异位妊娠得以早期诊断，为药物保守治疗的应用提供了可能性。本文对未破裂型异位妊娠患者采用米非司酮联合甲氨喋呤治疗，并与单用甲氨喋呤治疗者进行比较，对其临床效果分析报告如下。     

甲氨喋呤配伍米非司酮治疗异位妊娠疗效观察

目的观察甲氨喋呤配伍米非司酮治疗异位妊娠的临床效果.方法69例异位妊娠患者分两组,进行甲氨喋呤50mg单次肌注与甲氨喋呤配伍米非司酮150 mg/d×3,治疗前后行血β-HCG、B超包块、蜕膜管形、尿HCG监测.结果对照组34例单药甲氨喋呤治愈率61.7%,观察组35例甲氨喋呤配伍米非司酮治愈率85.7%.结论观察组两药配伍治疗异位妊娠有协同作用,可以提高异位妊娠保守治疗的治愈率.     

甲氨喋呤配伍米非司酮治疗异位妊娠疗效观察

目的:观察甲氨喋呤配伍米非司酮治疗异位妊娠的临床效果。方法:69例异位妊娠患者分两组,进行甲氨喋呤50 mg单次肌注与甲氨喋呤配伍米非司酮150 mg／d×3,治疗前后行血β-HCG、B超包块、蜕膜管形、HCG监测。结果:对照组34 例单药甲氨喋呤治愈率61.7％,观察组35例甲氨喋呤配伍米非司酮治愈率85.7％。结论:观察组两药配伍治疗异位妊娠有协同作 用,可以提高异位妊娠保守治疗的治愈率。     

妇产科术后宫腔出血的介入治疗

目的介绍妇产科术后子宫出血的介入治疗方法及临床价值。方法对12例术后子宫出血患者，经子宫动脉造影确诊为子宫动脉出血后，以明胶海绵及弹簧圈行双侧子宫动脉栓塞，并观察其治疗效果。结果12例出血患者立即获得成功止血，2例合并有宫颈妊娠者经灌注甲氨喋呤（MAX）后，血中绒毛促性腺激素（β—HCG）水平3d后恢复正常。结论经子宫动脉栓塞治疗宫腔出血是简单、可靠的方法。     

米非司酮配伍甲氨喋呤治疗异位妊娠疗效观察

目的:评价米非司酮配伍甲氨喋呤(MTX)治疗异位妊娠的疗效。方法:符合保守治疗宫外孕者86例,随机分为治疗组46例、对照组40例。治疗组:肌肉注射甲氨喋呤50 mg,同时服用米非司酮50 mg/次,2次/d,总量550 mg。对照组:甲氨喋呤肌肉注射50 mg/m2,1周后血β-HCG无下降趋势者,再注射1次。结果:治疗组血β-HCG转阴、包块缩小及阴道出血停止的时间明显早于对照组(P<0.05)。结论:米非司酮配伍甲氨喋呤治疗异位妊娠可提高疗效,为异位妊娠保守治疗的有效方法之一。     

骶管与硬膜外阻滞治疗腰椎间盘突出症疗效对比研究

目的研究骶管阻滞与硬膜外阻滞治疗腰椎间盘突出症临床应用价值，并对骶管阻滞的技术操作及适应证和禁忌证进行探讨。方法腰椎间盘突出症患者120例采用骶管阻滞（骶管组），于骶管腔注入（曲安奈德40mg、维生素B1 100mg、维生素B12 1mg、2％利多卡因100mg，用0．9％氯化钠稀释为20～30m1），2周1次，3次为1个疗程。并与硬膜外阻滞治疗腰椎间盘突出症患者120例（硬膜外组）的疗效进行对比观察。结果一次性穿刺成功率骶管组为93．3％（112／120），硬膜外组为82．5％（99／120），两组比较差异有统计学意义（P〈0．05）。治疗后骶管组、硬膜外组优良率分别为85．0％（102／120）、933％（112／120），差异无统计学意义（P〉0．05）；可差率分别为15．0％（18／120）、6．7％（8／120），差异有统计学意义（P〈0．05）。结论骶管阻滞和硬膜外阻滞均为治疗腰椎间盘突出症的有效疗法，能较快解除神经根压迫症状和强迫体位。而骶管阻滞较硬膜外阻滞操作简单、安全性较高。     

复发性多软骨炎的胸部CT表现

目的：分析复发性多软骨炎的胸部CT表现,以提高对该病的诊断准确性。方法：分析5例经病理证实复发性多软骨炎的胸部CT表现。结果：CT证实该病特征性CT表现为喉、气管、支气管管腔狭窄。软骨部管壁增厚,膜壁无增厚。结论：CT密度分辨率高,能够清楚地显示病变的部位及特点,对临床选择治疗方案有指导价值,是复发性多软骨炎的有效诊断方法。     

Diagnostic image (171). A man with a painful red ear. Relapsing polychondritis

A 50-year-old man presented with a painful and red swollen right ear, fever, iridocyclitis and a peripheral facial nerve palsy, due to relapsing polychondritis. Immunosuppressive therapy was successful.     

CT findings of the benign tracheobronchial lesions with calcification

In the benign tracheobronchial lesions with calcification, tracheobronchopathia osteochondroplastica, relapsing polychondritis and tracheobronchial amyloidosis were considered. CT demonstrated small nodules with calcifications at the trachea with or without deformity of tracheal wall in the case of tracheobronchopathia osteochondroplastica, swelling of tracheal cartilage with diffuse and multiple calcifications in the case of relapsing polychondritis and calcifications in the deep parts of tracheobronchial amyloid nodules. CT findings were able to differentiate those benign lesions. High-resolution CT is more useful in the distribution of abnormal calcification of these diseases.     

Various clinical patterns of relapsing polychondritis in six cases

Relapsing polychondritis is a relatively rare disease characterized by episodic inflammation and progressive destruction of cartilage involving ears, nasal and laryngotracheal cartilage, cardiovascular system and the eyes. The increasing awareness of its clinically distinct has resulted in recognition of at least 550 reported cases. Six cases are reported to demonstrate the wide variety of clinical pattern. The most common features of the disease are auricular and nasal cartilage inflammation and nondeforming arthritis. Ocular symptoms and vasculitis is relatively rare. Two cases of relapsing polychondritis with laryngotracheobronchial manifestations illustrate the severe clinical features of the disease. Relapsing polychondritis may associate with diverse forms of connective tissue disease, such as rheumatoid arthritis. It seems interesting to note the onset in childhood. Treatment has been primarily symptomatic. In situations of mild symptoms, initial treatment is with nonsteroidal antiinflammatory drugs. For cases with serious manifestation, corticosteroids and immunosuppressants are indicated.     

Exposure of Oncologic Nurses to Methotrexate in the Treatment of Osteosarcoma

Methotrexate is a therapeutic agent used widely for osteosarcoma. We used an extremely sensitive high-performance liquid-chromatography assay to evaluate 112 urine samples obtained from 28 hospital employees during high-dose therapy with methotrexate and during routine care of patients. The highest cumulative urinary excretion was observed when methotrexate infusions were handled in a workbench from which a portion of filtered air was emitted into the room. Remarkable urine contaminations were identified for personnel, including 1 administrative employee who had “stood by” for 2 h in the room where infusions were prepared. Lower methotrexate concentrations were detected in the urine of nurses whose exclusive function was to care for patients. The urine burden in oncologic nurses decreased after a central pharmacy unit was installed. Methotrexate was excreted in the sweat of patients who were under high-dose therapy, and its elimination half-life was 11.1 h (mean maximal concentration = 1.7 μg/ml [n = 5]). The maximal burden in spontaneous vomit from these patients was 441.5 μg/ml, and it declined to 0.24 μg/ml 19.5 h after infusion was completed. No methotrexate was detected in personnel who prepared 20-g methotrexate infusions in the central pharmacy unit. We demonstrated that occupational safety depended not only on technical precautions, but on the skills of specifically trained personnel.     

A man with a red ear

A 80-year-old man had a red and painful ear with an repeating interval of 1 week. He had a history of COPD, an aortic valve and mitral valve replacement with a bioprosthesis and anterior uveitis. Histological examination of the ear showed relapsing polychondritis.     

Geschlechtsoder symptomspezifisches Verhalten m?nnlicher Assistenz?rzte?

We investigated the influence of the patient's gender for diagnostic and therapeutic approach of physicians at the outpatient clinic of the university hospital of Basle. In a prospective study 13 male residents in their second and third year of medical training were observed in their management of 25 female and 25 male patients presenting with the leading complaint of abdominal pain with regard to taking of the medical history, the physical examination and the performed diagnostic and therapeutic procedures, without informing the participating physicians. The time spent for the first consultation and the number of follow ups performed were registered. Following differences in the management of female and male patients were observed: The time spent at the first consultation was 59 +/- 5 minutes in female and 45 +/- 3.5 in male patients (p less than 0.03). Fundoscopic examination was three times more often performed in female patients. Endoscopic examinations were more often observed in male patients (p less than 0.01). Antacids and H2-antagonists were more frequently prescribed in male (p less than 0.01). Spasmolytics and laxatives more frequently in female (p less than 0.01). In summary in male patients the diagnosis of functional disease was predominantly made after exclusion of an organic disease what does explain the use of more diagnostic procedures and the induction of a more specific therapy.     

复发性多软骨炎17例临床分析

目的 提高对复发性多软骨炎诊断及治疗水平。方法 回顾性分析17例复发性多软骨炎患者的临床资料。结果 17例患者中，16例耳受累，10例鼻受累，9例喉、气管及支气管受累，8例眼受累，4例关节受累，1例心血管受累。1例死于呼吸道并发症，15例复发2次以上，最多复发达6次。结论复发性多软骨炎是少见的自身免疫系统疾病，早期临床表现不典型，容易误诊和漏诊。经糖皮质激素、免疫抑制剂、氨苯砜治疗或手术可控制症状。     

Tubal pregnancy in adolescence

Fourteen women under age 19 were evaluated and treated for ectopic pregnancy at the Regional Medical Center, Memphis. These women were screened according to a protocol involving use of quantitative beta-human chorionic gonadotropin (βhCG) and serum progesterone levels. All patients were in the first trimester of pregnancy, with a mean gestational age of 8.5 weeks based on menstrual dating. Ten patients denied knowing that they were pregnant prior to this evaluation. Because of the patients symptoms and clinical signs, nine patients underwent diagnostic laparoscopy at the time of initial evaluation. Of these, seven underwent either salpingectomy or salpingostomy for a raptured ectopic pregnancy or ectopic > 3 cm in greatest dimension. Two patients were successfully treated without surgery. Five patients were discharged after their initial evaluation and were identified only by abnormal values on serial determinations of βhCG and progesterone. One required salpingostomy, and the other four were successfully treated with methotrexate. Ectopic pregnancies identified at an early gestational age and prior to rupture are amenable to conservative treatment with methotrexate or laproscopic surgery. Patients who were identified by the protocol and not by clinical signs and symptoms were more likely to be candidates for conservative therapy.