痰菌阴转后复阳的几点思考及防治对策

现代结核病控制策略是当前控制结核病的重要措施,其核心是提高新发涂阳肺结核的发现率和保证高的治愈率,彻底治愈涂阳肺结核病、减少传染源,肺结核病的疫情才能得到控制.临床工作中也会遇到痰菌阴转后再次复阳的病人.现将临床常见的情况作一分析.     

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??Open abdomen technique in the management of gastrointestinal fistula complicated with severe intra-abdominal infection REN Jian-an Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, China Abstract Objective To investigate the result of open abdomen technique in the treatment of gastrointestinal fistula complicated with severe intra-abdominal infection. Methods The clinical data of 73 gastrointestinal fistula patients complicated with severe intra-abdominal infection received open abdomen therapy from January 1999 to December 2008 at Nanjing General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. Results Fifty-six of 73 patients (76.7%) survived to discharge. Ten patients (13.7%) died and 7 patients ( 9.6%) gave up the treatment. The main causes of death were hemorrhage of abdominal cavity (5 cases), infection and organ nonfunction (5 cases). The average APACHEII score for survivors was 13.5±4.3 before open abdomen and dropped to 9.2±4.5 and 8.1±6.2 after 5 and 15 days of open abdomen. The average APACHEII score for dead patients was 16.0±5.8 before open abdomen and dropped to 12.9±5.5 and increased to 16.3±11.8 after 5 and 15 days of open abdomen. The score of organ function changed similarly .Conclusion The open abdomen therapy is an effective treatment for gastrointestinal fistula complicated with severe intra-abdominal infection. Open abdomen could improve the severity score of severe intra-abdominal infection patients. The therapy can be divided into three stages including temporary closure of the open abdomen, skin graft of open wound and permanent closure of abdomen and resection of enteric fistula. The reconstruction operation of digestive tract and abdominal wall can be performed simultaneously.     

巧揭患儿头皮留置针敷贴方法

患儿头皮皮肤娇嫩，毛发细软，且揭敷贴时不配合，备皮不严格；而敷贴黏合度高，固定牢固，致使揭敷贴比较困难，近半年来，我科在临床中采用无菌液状石蜡湿润皮肤后揭敷贴，取得明显效果。现介绍如下。     

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??The postoperative recurrence of liver cancer??diagnosis and standardized treatment FAN Jia??WANG Zheng. Liver Cancer Institute and Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??FAN Jia??E-mail??jiafan99@yahoo.com
Abstract The recurrence and metastasis (as high as 70%) after surgical treatments of liver cancer are of the main obstacle to achieve better results. Early detection, diagnosis and standardized treatment should be performed for the improvement of surgical effects. Combination therapies to utilize the advantages of individual method according to the stage and liver functional reserve of different patients are of paramount importance. The randomized controlled clinical trials are the basis to evaluate the therapeutic strategies.     

部分睑板全层切除联合提上睑肌缩短术矫正中重度上睑下垂

目的:探讨部分睑板全层切除联合提上睑肌缩短术矫正中重度上睑下垂的方法和疗效。方法:对15例(2007年～2011年)(19只眼)中重度上睑下垂患者行部分睑板全层切除联合提上睑肌缩短术。结果:术后随访6个月～3年,本组15例(19只眼)中重度上睑下垂均矫正满意(外观满意,弧度自然)。早期均有不同程度的眼睑闭合不全的情况,一般术后1～3个月内完全恢复,无并发症发生。结论:部分睑板全层切除联合提上睑肌缩短术,此手术操作简单,并发症少,而且疗效确切。     

广东南海九江镇中小学教师生存质量影响因素分析

生存质量作为一个健康与生活水平的综合指标,正在成为医学或社会发展的目标[1].生存质量在国内被广泛应用于普通人群的生存质量测定、临床试验效果评价以及卫生政策评估等领域[2],随着社会的发展,中小学教师的生存质量问题成为国内外职业压力研究领域的核心课题之一.本研究采用简明健康调查问卷SF-36(中文版)[3-4]对广州市九江镇中小学教师的生存质量进行评定,探讨其影响因素,为制定针对性的干预措施提供依据.     

心理护理对老年股骨粗隆间骨折术后的影响

目的探讨围手术期心理护理对老年股骨粗隆间骨折手术后的影响。方法选择在我院手术治疗的老年股骨粗隆间骨折患者62例,随机分为观察组和对照组,每组31例。观察组在实施骨科常规护理措施的基础上,配合有针对性的心理护理措施．对照组则仅实施骨科常规护理措施。比较两组患者手术后的疼痛视觉模拟评分情况及对患者护理的满意程度。结果观察组手术后的疼痛程度明显低于对照组,护理满意度则明显高于对照组,两组差异均有统计学意义（P〈0．05）。结论心理护理能明显减轻老年股骨粗隆间骨折患者手术后的疼痛程度,促进患者的身心康复,改善护患关系,提高护理满意度。     

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??Medical emergencies that are life-threatening can occur in dental practice. Anxiety??tension??pain and discomfort during dental treatment are thought to be causative factors.Other causes may be related to allergic and toxic reactions to local anesthetics. Complications may arise because of an underlying disease-specific pathology such as epilepsy??cardiovascular diseases and hyperthyroidism etc. Consequently??it is important to decide whether the dental treatment concerned could be safely performed in order to prevent medical emergencies.     

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??Objective    To explore the application of digital technology to the treatment of dento-maxillofacial deformities. Methods    Twelve patients with dento-maxillofacial deformities were enrolled and DICOM data were reconstructed with 3D-CT of maxillary and mandible. The DICOM data were input into the software of Proplan CMF. We built digital skull model and 3D-printed skull model to perform surgical planning?? postoperative prediction and simulate operation. Clinical examinations of facial symmetry were performed 3 months later. Results    All the surgical plannings?? postoperative predictions and simulate operations of the twelve patients with dento-maxillofacial deformities were performed. And the orthognathic surgery was successfully. The patients were satisfied with the facial symmetry 3 months after operations?? with a satisfaction rate of 91.67%?? Conclusion    When using digital technology to perform surgical planning and simulate operation??the accuracy of surgeries is improved with satisfactory effect. So the digital technology has practical value in the treatment of dento-maxillofacial deformities.