显微内窥镜下治疗腰椎间盘突出症和腰椎管狭窄症

目的探讨显微内窥镜(MED)治疗腰椎间盘突出症和腰椎管狭窄症的临床效果。方法MED下切除增生内聚的关节突、肥厚的黄韧带及突出的椎间盘，彻底解除对硬膜、神经根的压迫。结果随访324例，按中华骨科学脊柱学组腰背痛手术评定标准，优297例，良14例，差13例，疗效优良率达96．0％，结论MED损伤小、恢复快、疗效好。     

Finding a place for needle exchange programs

Using the concepts of stigma, NIMBY and place, this paper examines the difficulties of finding a place for needle exchange programs (NEPs). Data were drawn from semi-structured interviews with NEP staff (Ontario, Canada) that focused on operational policies and routines. An iterative, inductive analytic process was used. NEPs, their staff and clients are not always welcome additions to organizations or communities because of concerns about the ‘dangerousness’ of clients and the potential contamination of communities and workplaces by stigmatized individuals and their artefacts (e.g. contaminated injection equipment). Public parks where a lot of drug ‘action’ takes place are good destinations for outreach workers but these places are contentious sites for NEP activities, particularly when residents do not perceive a need for the program and/or want to redefine their neighbourhoods. Issues of ‘place’ are further complicated when service delivery is mobile. Finding a place within organizations is difficult for NEPs because of concerns about the diversion of limited financial and spatial resources to ‘non-core’ activities and ‘undesirable’ clients. Workers respond to these challenges by contesting the social and spatial boundaries of who is an acceptable client or neighbour and refuting the perceived ‘differentness’ of injection drug users. Implementation of an unpopular service involves a delicate balancing act of interests, understanding of the dynamics of particular communities and a willingness to reinvent and redefine programs. The sociospatial stigmatization of injection drug use has had a negative impact on NEPs, and perhaps limits HIV prevention efforts.     

新生儿颅内出血的临床分析

目的 为探讨各种类型新生儿颅内出血的早期诊断方法，明确其临床特点与CT的关系。方法 对176例经CT证实有颅内出血新生儿的临床资料进行回顾性分析。结果 176例患儿中缺氧所致123例(72．6％)，产伤21例(11．9％)，新生儿出血症22例(12．5％)，早产儿10例。患儿有意识障碍者156例(88．6％)，惊厥98例(55．68％)，肌张力改变113例(64．2％)，原始反射减弱或消失104例(59％)，贫血16例。CT示：SAH121例。占68．75％，为NICH最常见类型；SDH17例，IPH13例，IVH5例，混合性出血20例。结论 根据临床表现考虑NICH者应做头颅CT或头颅B超检查。Cr是确诊的最佳手段，能正确显示出血部位、范围、程度及区分各种类型，头颅B超对早产儿、低出生体重儿的IVH、IPH检出率高。