纸质病案保存期限的思考

本文作者比较了不同时期的纸质病案的使用率,讨论了旧病案的缺点,如难于保存,占用空间及实用价值不大.作者提出了改进保存病案的办法.     

钙拮抗药及烧伤血浆对大鼠PBMC内NF-κB活化和炎症介质产生的影响

目的 :探讨外周血单个核细胞 (PBMC)内上游信号分子及核因子 κB(NF κB)在烧伤后炎症级联反应中的作用。　方法 :体外检测在烧伤血浆作用下的PBMC内游离Ca2 及NF κB活化的变化 ,观察钙通道阻断药对NF κB活化及IL 6、NO表达水平的调控作用。　结果 :不同时相点的烧伤血浆可使体外PBMC内Ca2 明显增加 ,培养的PBMC核内NF κB的积聚明显增加 ,培养上清中NO和IL 6高表达。应用尼莫通 (Nimodipine)和丹曲林 (Dantrium)对NF κB的活化有调节作用 ,对IL 6和NO亦有下调作用。　结论 :烧伤血浆可使PBMC内信号分子浓度明显增高 ,NF κB过度活化 ,并易位进入细胞核内 ,NF κB介导的促炎性细胞因子和NO过度表达。两种钙通道阻断药有调控细胞内信号转导的作用 ,对烧伤后全身炎症反应综合征 (SIRS)可能有防治作用     

切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折

目的探讨切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折的疗效。方法1999年10月-2005年4月，对62例平均年龄7．5岁的患儿，应用切开复位克氏针固定治疗Gartland Ⅲ型肱骨髁上骨折。其中伸直尺偏型41例，伸直桡偏型18例，伸直中间型3例；无伴发血管、神经损伤和筋膜室间隔综合征。闭合性骨折47例，开放性骨折15例。结果术后56例获得随访，随访时间为6～15个月，平均11．5个月。所有骨折均获得愈合。根据Flynn标准进行疗效评价，其中优22例（占39．3％），良21例（37．5％），可9例（16．1％），差4例（7．1％）。伤后8h内手术的优良率为89．7％，伤后8h后手术的优良率为63．0％。直接手术治疗的优良率为90．1％，曾接受手法复位的优良率为67．7％。结论切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折可取得满意的疗效，是安全、有效的治疗方法。     

胸骨肿瘤CT诊断(附22例报告)

目的探讨胸骨肿瘤临床CT诊断和检查意义。方法搜集分析经临床病理证实的22例胸骨肿瘤CT资料,其中转移瘤17例(肺癌转移15例;乳腺癌转移2例)、骨髓瘤2例、软骨肉瘤1例、骨肉瘤1例、骨化性纤维瘤1例。结果局部骨质破坏(囊状膨胀性、溶骨性和混合性骨破坏3种),其中囊状膨胀性骨破坏1例(骨化性纤维瘤),溶骨性骨破坏16例(肺癌转移15例、骨肉瘤1例),混合性骨破坏5例(软骨肉瘤1例、骨髓瘤2例、乳腺癌转移2例)。胸骨处软组织肿块18例,胸骨前胸壁肌、皮下脂肪和胸骨后脂肪间隙浸润13例。结论胸骨肿瘤以转移瘤多见,CT检查对胸骨肿瘤有较高的诊断价值。     

分裂症患者的行为评定与护理对策

目的探讨分裂症患者行为能力与病程的关系,制定相应的护理对策.方法对238例住院精神分裂症病人按住院年限分15组,分别用护士用住院病人观察量表(NOSIE-30)进行评定并进行统计学处理.结果NOSIE总评分与病程呈负相关,相关系数为0.57,经显著性检验有高度显著性差异,各因子T分经方差分析有高度显著性差异.结论分裂症患者的行为能力随病程的延长逐渐衰退,积极因素逐渐下降,消极因素逐渐增加,合理的护理对减缓病人的衰退很有必要.     

Slow-wave photic stimulation relieves patient discomfort during esophagogastroduodenoscopy

Background and Aim: Although pretreatment with a sedative drug is effective in relieving pain during esophagogastroduodenoscopy (EGD), such drugs can cause significant side‐effects. The aim of this study was to examine the effect of slow‐wave photic stimulation on discomfort and/or pain felt during EGD. Methods: Forty consecutive patients (25 men and 15 women) who underwent diagnostic EGD in our hospital were included in the study. Twenty patients received photic stimulation for 25 min, and underwent electroencephalographic recording, in addition to the usual premedications. Twenty control patients received the same treatment but without photic stimulation. All patients evaluated the discomfort/pain felt during endoscopy against a five‐grade scale in comparison with what they had experienced in their previous examination. Results: Patients with an improved discomfort/pain score were 18/20 and 3/20 in the treated and control groups, respectively. Overall comparison of pain scores between both groups was significant (P < 0.0001). The proportion of slow‐wave activity recorded in patients’ electroencephalograms significantly increased in the treated group compared to control values (36.6 ± 6.8% vs 29.1 ± 3.4%, P < 0.001). There was a close correlation between the degree of discomfort/pain felt during endoscopy and the proportion of slow‐wave activity (P < 0.001). Conclusion: Slow‐wave photic stimulation shows promise as a treatment for relieving the discomfort and/or pain felt by patients undergoing EGD.     

Buccal mucosal graft for urethral reconstruction.

Urethral reconstruction with graft substances, such as skin and bladder mucosa, has been previously used when primary anastomosis cannot be achieved. However, stricture and meatal prolapse are associated with these grafts. We report the use of buccal mucosa for the reconstruction of urethral defects in 3 patients. One patient with failed operation for hypospadias received tube buccal mucosal graft for urethral replacement. Two patients with urethral necrosis and stricture received onlay buccal mucosal graft. All patients were disease-free during follow-up (range, 12 to 49 months; mean, 36 months). One patient had a pinhole fistula that was successfully managed with simple repair. This technique appears to be useful for urethral reconstruction when a local graft is not available, even in patients with complicated conditions.     

颅脑外伤后肢体痉挛状态的显微外科治疗

目的 探讨显微外科治疗颅脑外伤后肢体痉挛状态的疗效.方法 回顾分析2006年7月至2008年7月实施的21例显微外科治疗颅脑外伤后肢体痉挛状态,根据不同病例采用相应的选择性周围神经部分切断术,包括:胫神经、肌皮神经、正中神经、尺神经和腰骶段脊神经后根,共计50个肢体.结果 术后随访2～24个月,全部患者术后立即感相应肢体痉挛状态缓解,随访期间缓解率为98%(49/50).随访期间运动功能改善率为86%(18/21),生活质量提高率为95%(20/21).术后发生肢体麻木、疼痛等感觉异常26个(52%),肌力下降18个(36%),随访期间均见好转.术后痉挛状态复发1个(2%).结论 选择性周围神经部分切断术是治疗颅脑外伤后肢体痉挛状态安全有效的方法.选择适应证及手术时机和术后坚持康复训练是保证疗效的关键.