1例海洛因白质脑病患者行血液净化治疗的护理

对1例巨大甲状腺肿瘤患者在体外膜肺氧合辅助下行肿瘤切除术，手术顺利，历时12．0h，切除肿瘤500g，住院23d患者康复出院。提出术前充分评估患者状况、做好心理护理和器械物品准备，术中熟悉体外膜肺氧合的操作方法、积极配合手术、密切观察病情等，是获得良好手术效果的重要环节。     

Vertex治疗齿状突骨折伴寰枢椎脱位的早期并发症分析

[目的]分析Vertex治疗齿状突骨折伴寰枢椎脱位的早期并发症发生的原因和预防措施.[方法]对18例齿状突骨折伴寰枢椎脱位中的5例6项术中和术后早期发生的椎动脉损伤、失语、失明、大出血、置钉错误等并发症的原因进行分析,避免并发症的发生.[结果]所有发生的早期并发症都得到相应治疗,未遗留后遗症.[结论]Vertex治疗齿状突骨折伴寰枢椎脱位的早期并发症均可以预防,一旦发生及时治疗效果满意.     

达芬霖与肾上腺素在鼻内窥镜手术中应用的比较

目的探讨达芬霖与肾上腺素在鼻内窥镜手术中的应用价值。方法观察达芬霖、肾上腺素分别在鼻内窥镜手术应用中对患者血压、心率的影响,观察出现反跳性鼻腔黏膜充血肿胀的时间和例数,并进行对比讨论。结果在达芬霖应用前后,30例患者的血压、心率变化差异无显著性,在肾上腺素应用前后,30例患者的血压、心率变化差异也无显著性,60例手术均在1￣3h内完成,达芬霖组无1例出现反跳性鼻腔黏膜充血肿胀,肾上腺素组有6例出现轻微的反跳性鼻腔黏膜充血肿胀,达芬霖组平均出血量248mL,肾上腺素组平均出血量120mL,P<0.05。结论达芬霖、肾上腺素作为鼻黏膜血管减充血剂和麻醉辅助药,常规用于鼻内窥镜手术是安全、有效的,用肾上腺素优于用达芬霖。     

亚低温用于缺血性脑卒中的神经保护研究进展

低温治疗一直是医学研究的热点,早在古罗马时代希波克拉底就知道将受伤的士兵包裹后放入雪中以减少出血量。上个世纪30～40年代,Fay[1]首次报道了低温用于脑外伤的治疗,第一次将低温应用于神经系统的     

余甘子功能食品的开发及其类SOD活力测定

余甘子是一种具有较高的食用和药用价值的野生植物资源，风味独特，含有丰富的类SOD活性物质和其他多种具有生物活性的物质，具有清除自由基、抗肿瘤、抗衰老等保健作用。作者提出了余甘予保健口服液的生产工艺流程及配方，并采用改良的Marklund方法测定了类SOD的活力，结果较为满意。     

Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.     

穴位综合疗法对先天愚型患者智商的影响

【目的】评价中医穴位疗法对先天愚型患者智商的影响。【方法】将80例先天愚型患者随机分为穴位综合疗法治疗组(简称综合治疗组)、脑复康对照组(简称脑复康组)、空白对照组,综合治疗组取四神针(百会穴前、后、左、右各旁开1.5寸)、智三针(神庭穴和左右本神穴)、颞三针(耳失直上2寸为第1针,左右旁开1寸为第2、3针)、脑三针(脑户穴及两侧脑空穴)为主穴,进行针刺和维生素B_(12)、维丁胶性钙、脑活素穴位注射,脑复康组口服脑复康,空白组不作任何特殊治疗;4个月为1个疗程,期间嘱家长在家对患儿进行相应的教育和训练;治疗前和疗程结束后采用 《中国修订韦氏儿童智力量表》测定患儿的智商(IQ),包括语言IQ(VIQ)、操作IQ(PIQ)和总IQ(FIQ)。【结果】4个月治疗后,综合治疗组总体智力水平均有提高(与空白组比较,均P<0.01),并较脑复康组为优;并且综合治疗组治疗后IQ的提高主要为PIO各项得分的提高所贡献,与操作有关的几个项目的得分与治疗前比,均有显著意义(P<0.05),而VIQ得分治疗后未见显著性提高(均P>0.05)。【结论】穴位综合疗法能提高先天愚型患者的智商。     

综合医院心理咨询门诊儿童咨客分析

目的；了解综合医院心理咨询门诊儿童咨客的特点。方法：总结中山大学附属三院心理咨询门诊近3年儿童咨客的资料。结果：咨客男女比例为1．96：1，咨客人数随着年龄的增长而增加，女童中13－16岁的比例男童大，5－8岁和9－12岁的比例较男童小。广州市内外的咨客比例为1．38：1，不同年龄儿童咨客的居住地构成是有差异的。最常见的病种是精神分裂症，神经症、精神发育迟滞，儿童多动症，单纯咨询和品行障碍，不同年龄，不同性别的儿童咨客的疾病构成是有差异的。结论：综合医院心理咨询门诊与儿童心理咨询门诊的儿童咨客是有差异的。     

宫腔镜电切术治疗宫颈肌瘤的临床应用

目的 :探讨应用宫腔镜电切术治疗宫颈肌瘤的临床应用价值。方法 :用宫腔镜电切术切除宫颈肌瘤3 7例 ,其中有蒂宫颈肌瘤 2 1例 ,无蒂内突型宫颈肌瘤 16例 ,术后随访 3～ 3 1个月。结果 :平均手术时间2 0 7min ,术中平均出血 2 0 5ml ,一次性治愈率达 10 0 % ,无 1例子宫穿孔、低钠血症、周围脏器损伤、感染及宫颈管粘连等并发症发生。结论 :治疗宫颈肌瘤首选宫腔镜电切术 ,它具有治愈率高、创伤小、恢复快、并发症少的特点。     

用于无创性充填治疗的传统玻璃离子水门汀对体外釉质脱矿的抑制效果评价

目的:评价传统的玻璃离子水门汀所产生的,特别是用于无创伤充填治疗技术时抑制体外釉质脱矿的能力.方法:二十四颗由于正畸治疗拔除的完整的恒前磨牙,在釉质颈部作洞型预备.这些牙齿分别用Fuji IX,Fuji IX GP,Ketac-Molar和复合玻璃充填材料充填,将它们放在5℃～55℃的温度下循环处理300次,后放在放在脱矿溶液(含有1g/l的溶解的羟磷灰石的0.1M的乳酸,pH为4.7)中四个星期.沿牙齿的长轴经充填体作平行于颊舌平面的切片,切片的厚度大约为100 μm.用偏振光显微镜检测这些切片,用图像分析软件分析病损大小,ANOVA和变异系数用于比较结果.结果:复合玻璃和Ketac-Molar比其它两种水门汀的表面腐蚀性小(P＜0.01).用玻璃离子水门汀瞬间接触充填体边缘抑制釉质脱矿的能力(20.5%～25.0%)较复合玻璃材料强(13.0%).但是,抑制带的宽度因材料和位置的不同而有变异.结论:充填材料释放的氟离子在某种程度上为邻近釉质抵抗体外脱矿提供保护.