Transarterial embolisation of complex cavernous sinus dural arteriovenous fistulae with low-concentration cyanoacrylate

We report the effectiveness of low-concentration n-butyl-2-cyanoacrylate (NBCA)-Lipiodol-tungsten mixture (10–15 %) in the management of patients with aggressive or recurrent complex cavernous dural arteriovenous fistulae (CSDAVF). We treated five patients with complex CSDAVF with a low concentration of an NBCA-Lipiodol-tungsten mixture after catheterisation of the feeding arteries arising from the external carotid artery. Three had a recurrent CSDAVF after transarterial particulate embolisation. Three refused transvenous treatment or could not be treated in this way; two patients had also feeding dural branches of the internal carotid artery. All patients had complete resolution of symptoms and signs within a month of the procedure. No definite neurological complication was found during follow-up ranging from 12 to 36 months. Transarterial embolisation with low-concentration cyanoacrylate appears to be an effective alternative management of aggressive or recurrent CSDAVF. Received: 8 November 1999/Accepted: 2 March 2000     

针灸按摩治疗慢性疲劳综合征研究进展

目的：通过综述近15年来针灸按摩治疗慢性疲劳综合征的文献，为临床治疗该病提供相应的参考资料。方法：共综合了盟篇相关文献的内容，从辨证分型、治疗方法、疗程、疗效4个方面进行了归纳总结。结论：针灸按摩治疗慢性疲劳综合征具有疗效肯定、无副作用、经济安全的特点。     

中西医结合治疗宫颈糜烂50例观察

目的：观察恒和坤净栓联合波姆红外光治疗宫项糜烂的疗效。方法：中西医结合组50例用恒和坤净检与波姆红外光治力仪联合治疗；对照组50例，单用波姆红外光治疗仪治疗。结果：中西医结合组痊愈率82％，对照组痊愈率40％。结论：中西医结合疗效较好，优于单用西医治疗。     

地肤子及其混淆品的扫描电镜与紫外法鉴别研究

分别采用扫描电镜和紫外光谱法对地肤子、藜、小藜和扫帚菜四种药材进行了比较鉴别。结果表明：扫描电镜下四种药材的胞果、毛茸、气孔和种子形态特征有较为明显的区别；紫外光谱扫描结果表明地肤子和扫帚菜无明显区别，但与藜和小藜之间有显著区别。     

益肾通脑宁治疗偏头痛的神经化学机理研究

目的：研究益肾通脑宁对大鼠脑内神经递质水平的影响。方法：皮下注射氢化可的松诱发大鼠肾阴虚，并同时灌服益肾通脑宁，测定大鼠下丘脑中DA和5-HT含量。结果：益肾通脑宁可明显增加氢化可的松肾阴虚模型大鼠下丘脑中5-HT的含量，时DA含量无明显影响。结论：益肾通脑宁可能是通过升高脑内5-HT水平而发挥治疗作用。     

卫生体制改革的目标与政策选择--国际卫生体制改革的经验与教训

引入市场机制,采取分权、分级与分类管理等政策与措施是当今国际卫生体制改革中的主流特点,由于各个国家的社会经济体制与卫生保健制度不同,这些改革政策与措施所产生的影响与效果也各具特色.因此,在深化我国卫生体制改革的进程中,借鉴国际卫生体制改革的经验与教训具有一定的现实意义.     

Pneumatization of perpendicular plate of the ethmoid bone and mucocele]

OBJECTIVE: To find out the prevalence of pneumatization of perpendicular plate of the ethmoid bone, and to discuss the diagnosis and management of perpendicular plate mucocele (nasal septal mucocele). METHODS: The CT data from 32 patients with septal deviation were reviewed, and an unusual case of perpendicular plate mucocele was reported. RESULTS: Six cases (6/32, 18%) were found to have pneumatization of perpendicular plate of the ethmoid bone, with 2 located in the anterior portion (frontal-septal pneumatization), and 4 located in the posterior portion (spheno-septal pneumatization). A patient with perpendicular plate mucocele was treated by the technique of marsupialization under nasal endoscope. This patient was followed-up for 10 months without recurrence. CONCLUSION: As a kind of variation of nasal septum, the clinical significance of pneumatization of perpendicular plate should be emphasized. We reported the first case of perpendicular plate mucocele, originated possibly from the pneumatization of perpendicular plate of the ethmoid bone. Marsupialization under endoscope was considered to be the initial management for this unusual disease.     

Acute fulminant invasive fungal sinusitis]

OBJECTIVE: To discuss the clinical presentation, diagnostic criterion and treatment principle of acute fulminant invasive fungal rhinosinusitis (AFFS). METHODS: Six patients were diagnosed as AFFS based on history, nose, especially eye symptoms with or without fever, sinus CT and MRI, endoscopic and cytological findings in the nasal cavity. Surgical debridement was performed on 5 of 6 biopsy proven AFFS patients, one of them being amputated of the orbital content. With the original disease controlled simultaneously, 4 of 5 patients were prescribed with systemic amphotericin B or liposomal amphotericin B (1 case) and one with Itraconazole orally. One patient had not been involved with any of the anti-fungi measures. RESULT: Mucor (Zygomycetes) was identified on culture in 1 patient, Rhizopus species in 2, Aspergillus in 1, Alternaria in 1 and mixed Mucor and Rhizopus in 1. All patients were proved of tissue invasion histopathologically through biopsy. One patient died without any anti-fungi therapy on the 7th admission day, 3 patients survived for 88 days, 32 and 6 months respectively and died of original diseases (diabetes 1, leukaemia 2). One patient survived 9 months and lost for follow-up, 1 patient survived 11 months after treatment. CONCLUSION: A high index of suspicion and early endoscopic investigation through nasal cavity with fungal investigation should highly be strengthened for recognition of this disease. MRI findings should be considered as, or even more, important as that of CT scan on the early diagnoses. Extensive and aggressive surgical debridement, prompt and enough dosage of antifungal therapy intravenously, together with serious controlling of the underlying disease, all take important roles in the complete control of the disease.     

前庭水管扩大综合征患者的人工耳蜗植入术

目的 评价前庭水管扩大综合征患者人工耳蜗植入术的安全性和可行性。方法 1995年5月1日～2002年6月1日因双耳重-极重度感音神经性聋在北京协和医院接受人工耳蜗植入术的患者312例中诊断为双耳前庭水管扩大者10例(3．2％)，其中语前聋7例，语后聋3例。回顾性分析这10例患者的临床资料。结果 10例患者人工耳蜗电极植入顺利，8例耳蜗底回开窗时发生轻度井喷，迅速用颞肌筋膜牢固封闭圆窗制止井喷。全部患者术后未出现脑脊液漏、颅内感染、面瘫、中耳炎等并发症。开机6个月时8例患者具有开放性言语识别力，已进入普通学校(幼儿园、小学、大学)就读。另2例语前聋的幼儿视觉强化测听听阈达40dB HL，与其他无内耳畸形的全聋儿童术后效果差异无显著性。全聋前语言能力较好的5例患者术后语言能力明显好于语前聋的患者，语言交流基本听不出聋人特有的语音特征。另5例患者语言均有不同程度的进步。结论 尽管前庭水管扩大患者在人工耳蜗植入术中可能出现井喷，但术后未出现并发症且听力-言语康复效果好，因此重-极重度聋的前庭水管扩大综合征患者行人工耳蜗植入术是安全可行的。     

女性睡眠呼吸暂停低通气综合征临床特点

OBJECTIVE: To realize the characteristics of symptoms and polysomnography in women with sleep apnea-hypopnea syndrome (SAHS) compared with that of male patients. METHODS: The symptoms and polysomnography were compared between men and women with SAHS and among mild (5 to 19 events/h), moderate (20 to 39 events/h), severe (> or = 40 events/h) of female patients. RESULTS: Female patients were older than that of male(51.1 +/- 11.2 yr versus 43.9 +/- 10.1 yr). The mean body mass index(BMI) for women was (27.8 +/- 3.9) kg/m2 and (28.1 +/- 3.8) kg/m2 for men. Women with higher AHI snored more severely, and female had a lower apnea hypopnea index (AHI) and apnea index (AI) but higher hypopnea index (HI) than did male. In addition, the respiratory events during non-rapid eye movement for men were significantly higher than that for women. CONCLUSION: Female patients are older than male but not more adipose. SAHS and respiratory events during NREM sleep are less severe in women.