股骨远端锁定钢板治疗股骨远端复杂骨折

目的探讨股骨远端锁定钢板治疗股骨远端复杂骨折的可行性和疗效。方法 2007年9月～2010年2月期间应用股骨远端锁定钢板治疗股骨远端骨折26例,其中男18例,女8例,年龄25～66岁,平均(40.6±11.7)岁。AO分型:33A3型骨折12例,33C2型骨折5例,33C3型骨折9例。全部患者采用闭合或有限切开复位股骨远端锁定钢板内固定术。结果随访6～12个月,平均(10.5±2.3)个月,26例骨折,无一例感染及骨折不愈合发生;膝关节功能按Insall膝关节评分标准,均在85分以上(优)。结论股骨远端锁定钢板内固定是一种有效的适宜于股骨远端复杂骨折的治疗方法。     

股骨远端锁定钢板治疗中老年人股骨远端骨折

股骨髁上及髁间骨折一直是创伤骨科中较难治疗的关节部骨折之一。中老年人多有不同程度的骨质疏松,治疗起来就更加困难。处理方法有非手术治疗、手术复位内固定。近年来由于内固定材料及显露方法的改进,手术复位加内固定已被广泛接受,患者可早期进行功能锻炼,尽早恢复膝关节功能。     

超远端交锁髓内钉治疗胫骨远端骨折

髓内钉是传统治疗胫骨干稳定型骨折的标准方法。     

桡骨远端骨折

桡骨远端骨折通常是指Colles,Smith,Barton骨折,是按命名人获得的名称。亦包括橇骨茎突骨折、桡骨远端骨骺损伤、桡骨远端关节面广泛粉碎性骨折。 1 发病率 桡骨远端骨折约占急诊全部骨折的1/6,占前臂骨折的73％。上海地区一组800例发病分布调查:女性69％,男性31％;50～70岁的老年妇女发病率最高,占总数50％;男性0～30岁年龄段发病率较高。老年妇女发生桡骨远端骨折较多的原因     

肱骨远端解剖型锁定接骨板治疗肱骨远端骨折

目的评价新型肱骨远端解剖型锁定接骨板（DHP）的临床使用方法及治疗效果。方法选择2008年7月～2010年10月使用DHP治疗且获得随访的肱骨远端骨折患者11例,骨折AO分型：A型1例,B型3例,C型7例,均采用切开复位DHP固定,术后不附加外固定,第2天开始功能锻炼。采用Mayo肘关节评分标准（MEPS）及X线片评价临床疗效。结果所有患者均随访12～22个月,平均16个月。11例患者骨折均愈合,平均愈合时间为16周,无内固定失效或骨折再移位。10例均无肘关节疼痛,1例有轻微疼痛,前臂旋转功能同健侧一致,肘关节屈伸活动平均79°（10°～130°）,屈曲平均108°（60°～130°）,伸直平均25°（0°～80°）。MEPS评分平均91分（60～100分）,其中,优9例,良1例,中1例,优良率为90.9%。结论 DHP对于较高位的肱骨髁上部分粉碎骨折、低位的关节面的粉碎骨折,以及合并骨质疏松的肱骨远端骨折均能够达到满意的固定效果,允许早期功能锻炼。     

腹腔镜远端胰腺切除术与开腹远端胰腺切除术的效果观察

目的 探讨腹腔镜远端胰腺切除术与开腹远端胰腺切除术的效果.方法 选取在我院行远端胰腺切除术的208例患者,按照随机数字表法将患者分为对照组103例和观察组105例,对照组予以开腹远端胰腺切除术治疗,观察组予以腹腔镜远端胰腺切除术治疗,比较两组患者的疗效.结果 两组患者的手术时间[(225.68±91.80)min vs(216.21±84.95)min]、住院费用[(4.12±1.41)万元vs(3.75±2.2)万元]比较,差异无统计学意义(P＞0.05 l观察组患者的术中出血量[(113.67±10.68)ml vs(150.13±11.22)ml]、术后首次排气时间[(2.90±0.82)d vs.(4.03±1.92)d]、术后禁食时间[(4.93±1.33)d vs(6.54±3.83)d]、术后住院天数[(9.57±0.65)d vs(16.03±0.79)d]、手术切口长度[(3.19±1.07) cm vs.(20.15±3.33)cm]均明显优于对照组,差异有统计学意义(P＜0.05).结论 与传统开腹手术相比,腹腔镜胰腺远端切除术手术术中出血量减少、术后胃肠功能恢复快,且手术时间及住院费用均未增加.     

腓骨远端爪型支持钢板治疗腓骨远端骨折26例

目的介绍和总结腓骨远端爪型支持钢板治疗腓骨远端粉碎性或合并骨质疏松骨折的经验和疗效。方法对26例腓骨远端粉碎性或合并骨质疏松的骨折行切开复位，腓骨远端爪型支持钢板内固定，采用Baird—jackson评分系统进行疗效评定。结果随访时间平均13个月，临床观察获得满意结果，优20例、良4例、可1例、差1例，优良率达92．3％。结论腓骨远端爪型支持钢板治疗腓骨远端粉碎性或合并骨质疏松的骨折具有良好的疗效，为临床较佳选择。     

远端肾小管性酸中毒

患者,女性,42岁,3年前因泌尿系感染伴休克入院,后经检查确诊为右肾盂与输尿管结石并行右肾盂切开取石术。术中并见肾盂积水。术后20多天出现两下肢乏力,查血钾2.5mEq/L,补钾恢复至4.5mEq/L,症状缓解出院。此后先后发作5次,严重时四肢软瘫并神志恍惚,诊为“低血钾性麻痹”,每次均予补钾后好转。近年来经常关节酸痛,查类风湿因子阳性而诊为“类风湿性关节炎”。此次入院(1982年8月21日)前2天两下肢又不能站立,随后四肢软瘫,查血钾1.5mEq/L,BUN22mg%、CO_2CP39Vol%,EKG示ST、T异常,有U波及频发室早,即予静脉     

股骨远端骨折中西医治疗

目的探究股骨远端骨折中西医治疗的疗效。方法股骨远端骨折患者102例,行骨折内固定术、中药治疗和功能锻炼,观察中西医治疗股骨骨折的疗效。结果所有患者的术后恢复情况为：优95例（93.14%）,良6例（5.88%）,可1例（0.98%）,差0例。结论中西医治疗股骨远端骨折的疗效好,并发症少,适于在临床推广。     

桡骨远端骨折治疗新进展

桡骨远端骨折是骨科常见的骨折类型之一,但对其治疗方法的选用尚存在的一定的争议。本文对桡骨远端骨折的闭合复位外固定、经皮穿针复位固定、外固定器治疗、切开复位钢板内固定、腕关节镜指引下切开复位等治疗方法进行综述,结合桡骨远端骨折的各种治疗方法适用范围进行了探讨。     

手指末节断指再植82指报告

目的探讨末节断指再植的手术方法及临床疗效。方法从1998～2003年共有72例共82指末节采用显微血管吻合技术进行断指再植。结果82指中78指成活，成活率为95．1％(78/82)。术后随访再植手指功能良好，外形较满意，且动静脉均吻合成功的较其他病例好。结论末节断指只要有条件的，均应再植，且可取得良好的效果。高质量地吻合血管是成功的关键。     

Distal nephron function of the rat during acute aflatoxicosis

The effect of an acute intoxication with aflatoxin B1 (AFB1) on some parameters of distal nephron function was examined in rats 48 h after a single i.p. dose of 100 micrograms/kg body wt. The parameters tested were the capacity for the excretion of fixed acids and ammonium salts during metabolic acidosis and the concentration and dilution of urine applying conventional clearance techniques. The treated rats showed a glomerular filtration rate (GFR) approx. 50% lower than the controls, but they were able to reduce the urinary pH as were nonintoxicated animals. The ammonium excretion rate per ml of GFR was unimpaired in the treated rats, but the rate of excretion of fixed acids per ml of GFR was increased. The maximal urinary osmolality was significantly diminished in the intoxicated rats as was water reabsorption, when compared with data obtained in the controls. No differences between groups were seen in the free water formation although urinary excretion of electrolytes was significantly increased. The studies support the nephrotoxicity of AFB1 in the rat probably by interfering with transport function in the collecting tubule cells together with a diffuse impairment of proximal tubule function, as observed previously.     

Riboflavin-Enhanced Transport of Serum Albumin Across the Distal Pulmonary Epithelium

Purpose. Conjugation of bovine serum albumin (BSA) with riboflavin (BSA-riboflavin) increases its uptake into cultured epithelial cells. Our purpose was to determine whether transport of BSA-riboflavin across the intact distal pulmonary epithelium is also increased, and whether transcytosis plays a role. Methods. In anesthetized rats, we instilled ³H-BSA-riboflavin or ³H-BSA into the trachea and measured their appearance in blood. In isolated, perfused rat lungs we measured the distal pulmonary epithelium permeability-surface area product (PS) for FITC-BSA or FITC-BSA-riboflavin. Results. In intact rats we found 2.1 times more ³H-BSA-riboflavin than ³H-BSA appeared in blood 60 min after intratracheal instillation of the protein. In isolated, perfused rat lungs we found that BSA-riboflavin had double the PS of BSA (2.63 vs. 1.46 × 10^–5 cm³/sec). The addition of transcytosis inhibitors monensin or nocodazole (both 3 × 10^–5 M) reduced the BSA-riboflavin PS to that of BSA and had no effect on the PS of unconjugated BSA. Simultaneous measurements of ³H-sucrose PS showed no differences in paracellular transport among any of the experimental groups. Conclusions. Conjugation with riboflavin increases the flux of BSA across the distal pulmonary epithelium. The increased transport appears to be due to transcytosis, which apparently does not play a significant role in the movement of unconjugated BSA across the distal pulmonary epithelium.     

两种复位内固定在胫骨远端骨折中的疗效比较

目的探讨切开复位锁定钢板内固定和间接复位经皮锁定钢板内固定在胫骨远端骨折中的应用,并且比较两种方法的治疗效果。方法根据复位方法将84例患者分为两组:观察组和对照组。其中观察组有39例患者,给予间接复位、经皮置入锁定钢板内固定;对照组为45例患者,给予直接复位、锁定钢板内固定。结果观察组39例患者有35例患者骨折愈合,3例患者为延迟愈合,1例患者未愈合;有2例患者的切口发生了感染。对照组45例患者有31例患者骨折愈合,12例患者为延迟愈合,2例患者未愈合;有3例患者的切口发生了感染,2例患者皮肤坏死。结论胫骨远端骨折采用间位复位治疗避免了骨折端的暴露,从而使得手术中的创伤得以减少,手术后疼痛以及切口并发症减少了,疗效较好。     

34例远端胃癌患者腹腔镜下BillrothⅡ式远端胃切除伴布朗式吻合术治疗的疗效及安全性分析

目的:探究分析腹腔镜下BillrothⅡ式远端胃切除伴布朗式吻合术治疗远端胃癌患者的临床疗效及安全性。方法:选取某院远端胃癌患者68例,按照手术方法分为两组各34例,对照组行BillrothⅡ式远端胃切除伴布朗式吻合术治疗,观察组行腹腔镜下BillrothⅡ式远端胃切除伴布朗式吻合术治疗,对比两组切口长度、术中出血量及并发症发生情况。结果:观察组切口长度较对照组短,术中出血量较对照组低(P0.05);观察组术后并发症发生率5.88%(2/34)较对照组26.47%(9/34)低(P0.05)。结论:与开腹手术相比,腹腔镜下BillrothⅡ式远端胃切除伴布朗式吻合术治疗远端胃癌患者,切口较短,术中出血量低,且术后并发症少。     

Effective Drug Treatment: Testing the Distal Needs Hypothesis

A long-standing view held by many drug abuse treatment providers, researchers, and policy makers is that maximally effective drug treatment needs to attend to the employment, health, housing, and other “distal needs” of the client. This paper tests the distal needs hypothesis by determining the effects of resolved, unresolved, and emergent family, housing, health, legal, emotional, and vocational needs on treatment engagement and treatment outcomes. Findings from a prospective, longitudinal study of 330 clients in 26 outpatient programs in the Los Angeles metropolitan area indicate little support for the distal needs hypothesis. Specifically, those with unresolved or emergent distal needs were not less likely to engage in treatment or use drugs during and after treatment. Treatment and research implications of these findings are addressed.     

锁定钢板在胫骨远端骨折中的应用

目的探讨应用L形锁定钢板在治疗胫骨远端骨折的疗效。方法自2008年8月—2009年12月,采用L形锁定钢板内固定治疗胫骨远端骨折患者25例。记录术后是否发生皮肤坏死,骨折愈合时间,术后是否存在感染,有无血管神经损害以及踝关节功能评分。结果所有病例均获随访,随访时间6～21个月(平均9.8个月)。术后所有患者均达到骨性愈合,无1例患者术后发生皮肤坏死,有1例患者术后创口发生浅表性感染,经积极抗炎及2～3周换药后愈合。其余患者切口均一期愈合,无血管神经损害并发症发生。根据Johner-Wruhs评价标准,优良率为92%。结论采用L形锁定钢板内固定治疗胫骨远端骨折具有固定可靠,血运破坏小,并发症发生率低等优点。     

Distal colon motility in schizophrenic patients

Although the dopaminergic blocking agents (DBA) haloperidol and sulpiride strongly inhibit distal colon motility in most nonpsychotic subjects (83 per cent), this effect was registered in only 10 per cent of the 30 schizophrenic patients investigated in the present study. In these cases, only sulpiride (an "atypical" DBA) displayed distal colon motility inhibition in schizophrenic subjects. When haloperidol (a "classical" DBA) produced any modification (in 23.3 per cent), this was rather in the nature of an increase in motility. All these cases showed low or absent distal colon motility during preinjection periods. the fact that three different types of antinoradrenergic drugs (dihydroergotamine, phentolamine, and clonidine), but not DBA, inhibited distal colon motility in 90 per cent of the schizophrenic subjects suggests the existence of an overactivity of the noradrenergic system at this peripheral level.     

锁定钢板用于青少年胫骨远端三平面骨折治疗中的效果观察

目的:探讨锁定钢板在青少年胫骨远端三平面骨折治疗中的效果。方法:选取2014年9~2015年10月于某院收治的108例青少年胫骨远端三平面骨折患者做为研究对象,随机分成两组,观察组62例患者使用锁定钢板治疗,对照组46例患者使用常规钢板治疗,观察对比两组的治疗效果以及恢复时间。结果:经过对患者1年的随访调查,观察组患者总恢复率为100%(62/62),平均治愈时间(17.3±2.6)周;对照组患者总恢复率69.6%(32/46),平均恢复时间(22.6±3.1)周。观察组在治疗效果和恢复时间上明显优于对照组,P0.05,具有统计学意义。结论:青少年胫骨远端三平面骨折治疗中采用锁定钢板具有恢复快、效果好的优点,适合在临床治疗中应用。     

Tamsulosin: Ureteral Stones (Distal)

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to ude.uk@larenegj.