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目的 分析先天性血管畸形的治疗经验。方法 从1995年7月至2003年5月上海第二医科大学附属第九人民医院共治疗先天性血管畸形204例，其中先天性动静脉瘘58例，海绵状血管瘤72例，静脉畸形骨肥大综合征74例。先天性动静脉瘘采用手术、栓塞和手术联合栓塞等方法进行治疗；海绵状血管瘤采用手术和手术联合Nd：YAG激光治疗；静脉畸形骨肥大综合征采用保守治疗、外侧畸形静脉和曲张静脉切除、受压的深静脉段松解和胭动脉分支结扎等治疗。结果 经过治疗的先天性血管畸形大部分在临床均能取得一定的疗效，部分病人症状复发甚至加重。结论 先天性血管畸形的治疗仍是临床所面临的难题之一，积极的并根据病情所采用的个体化和联合的治疗方法是非常必要的，常可取得一定的临床效果。     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

案例分析法在医学伦理学课程中的运用

本文提出了案例选择与设计的原则,介绍了案例分析的基本方法.     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

医德教育改革应处理好几个关系

随着人文学科在医学教育中比重的增加,对医德教育提出了更高的要求.为适应这一变化,医德教育必须进行改革.就各类医学院校而言,要使医德教育的改革顺利进行,必须处理好几个关系.     

内镜下气囊扩张治疗食管贲门良恶性狭窄

我院近几年用气囊扩张治疗30例食管、贲门良恶性狭窄,共进行104次扩张治疗,取得满意效果。 1 临床资料 1.1 病例选择本组30例,男28例,女2例,年龄26～72岁,平均41.5岁。贲门失弛缓症4例,食管贲门癌术后狭窄20例,晚期食管癌2例,球部溃疡致幽门梗阻2例,食管烧伤致狭窄1例。     

Angiosome概念在重症肢体缺血中的应用进展

重症肢体缺血(critical limb ischemia,CLI)指周围动脉血管疾病(peripheral arterial disease,PAD)中最具严重症状者,出现静息痛、肢端溃疡、坏疽等,病程至少持续2~4周[1],主要病理变化是多节段、多平面大小腿动脉的粥样硬化闭塞,病变程度相当于Rutherford 4~6级或FontaineⅢ~Ⅳ期[2]。对于CLI,无论是行旁路转流术或是腔内血管成形     

高度近视白内障植入晶状体囊袋张力环52例分析

目的 探讨高度近视白内障超声乳化后囊袋内植入晶状体囊袋扩张环的临床疗效.方法 对高度近视白内障患者52例64眼行白内障超声乳化后植入囊袋张力环和人工晶体,观察其手术效果.结果 术后矫正视力>0.8者15例(21眼),0.6～0.8者29例(33眼),<0.5者8例(10眼).术后2 a内发生视网膜脱离的1例.后囊膜混浊的2例.结论 高度近视白内障患者植入晶体囊袋扩张环能较好的维持眼内组织稳定性,视力恢复明显,并有效地预防视网膜脱离及后发障的发生,使高度近视白内障的手术更加安全.     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

确立课堂教学设计原则的依据

确立课堂教学设计原则的依据解放军广州医学高等专科学校刘晓兵人们越来越重视课堂教学设计，并努力探索指导这一实践活动的客观规律。课堂教学设计原则，是人们研究的一个重要课题。笔者认为，要确立正确的课堂教学设计原则，必须认真探求这一原则确立的依据。由此，才能...