Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

持续正压通气辅助治疗高血压并发睡眠呼吸暂停综合征的临床研究

目的探讨持续正压通气辅助治疗高血压并发睡眠呼吸暂停综合征（SAS）对血压的影响。方法41例高血压并发睡眠呼吸暂停综合征病人,随机分为常规组（21例）和持续正压通气治疗组（20例）均给予常规降压药物治疗4周,治疗在常规治疗基础上加用气道持续正压通气治疗,观察两组治疗前后24 h血压变化。结果治疗组治疗后24 h平均收缩压、舒张压进一步降低,夜间收缩压及舒张压则显著降低（P〈0.01）。结论高血压并发睡眠呼吸暂停综合征病人,在常规应用降压药物同时应用持续正压通气辅助治疗血压下降更理想。     

压膜式间隙保持器的临床应用

目的:观察正压压膜式间隙保持器的临床应用特点和效果.方法:选择60例5.9～10岁的乳牙过早缺失的患儿,随机分为实验组和对照组,实验组用正压压膜式间隙保持器,对照组用带环式丝圈间隙保持器.分别从患者对保持器的接受程度、保持器的制作、椅旁操作时间、固位效果及其保持疗效和因保持器本身问题导致的复诊率进行对比研究,并对测量数据进行统计学处理.结果:两组患者在对保持器的接受程度、保持器的制作、椅旁操作时间、美观、防止对合牙过度伸长方面具有显著的差异,在固位效果及其保持疗效和因保持器本身问题的复诊率上有差异,但是差异没有显著性.结论:正压压膜式间隙保持器是一种美观舒适,制作简单,戴用便捷、固位好,疗效佳,便于观察恒牙萌出程度的间隙保持器,它为口腔医师进行保持缺隙治疗时提供了一种新的选择.     

丹参注射液椎管内局部灌注对急性脊髓损伤的保护作用

目的 探讨丹参对急性脊髓损伤的防治作用。方法 以改良Allen's法造成兔不完全性脊髓损伤的模型,硬膜下插管。随机分成丹参治疗组和对照组。术后按每天0.3ml/kg体重的总量分4次从硬膜下导管推入丹参注射液,对照组推入生理盐水。损伤后8、72h对脊髓损伤区进行过氧化物歧化酶(SOD)、丙二醛(MDA)、组织形态学观察、神经元凋亡、bcl-2等进行评价。结果 丹参组SOD含量高于对照组(P<0.01),MDA含量低于对照组(P<0.01)。细胞凋亡数目TUNEL法丹参组低于对照组(P<0.01),流式细胞术检测凋亡丹参组低于对照组(P<0.05)。bcl-2的表达丹参组高于对照组(P<0.05)。神经元及神经纤维变性、坏死轻于对照组。结论 丹参能改善损伤脊髓微循环,抑制和减轻脊髓损伤后的两种死亡方式坏死和凋亡。     

上胸椎骨折手术治疗方法的探讨

目的 探讨上胸椎骨折的特点及治疗。方法 15例病人按AO分型，A型2例、B型10例、C型3例。均经后路切开复位、脊髓减压、长节段内固定、取髂骨植骨融合术治疗。结果 随访18-24个月，后路长节段固定随访时无一例失败，完全瘫的患者9例中有1例神经功能改善I级．不完全瘫的5例均有Ⅲ级改善，1例无神经损伤。结论 上胸椎骨折损伤严重，后路长节段固定技术是一种合理的有效治疗方法。     

连续埋线法重睑术的临床评价

目的 探讨连续埋线法重睑术的适应证和手术要点.方法 手术在局部麻醉下施行,从外眦向内眦沿睑板上缘作连续缝合,然后折返,外眦缝合口打结.结果 本组132例患者术后随访形成良好重睑者为121例,占92%;两侧重睑皱襞高低不一的7例,占5%;重睑消失的4例,占3%,后两者均补充埋线法或者切开法重睑术修复.结论 连续埋线法重睑术除适用于上睑皮肤较薄的年轻患者,也可扩大到中等以下程度的上睑皮肤松弛患者,以及以外侧为主的上睑臃肿者.     

颅脑损伤患者上消化道出血的预防和治疗(附625例报告)

目的探讨颅脑损伤后上消化道出血的预防措施及其治疗方法。方法回顾性分析625例颅脑损伤后上消化道出血的病例,在治疗原发伤病基础上,采用止血、制酸、保护胃黏膜等对症处理,同时应用阿托品治疗22例;胃镜下治疗8例;胃次全切除术5例。结果本组病例中,治愈572例,缓解36例,无效5例,死亡12例,其中阿托品治愈20例;胃镜下治愈6例;胃次全切除术治愈4例。结论预防和治疗的重点是消除颅脑损伤病灶和保护胃黏膜,常规处理方案效果满意,简单、经济且安全有效,但必要时应及时使用特殊治疗手段,以迅速控制出血病情。     

Invasion of the intracranial space by a malignant odontogenic mixed tumor: Report of a case

A case of an odontogenic tumor which invaded the intracranial space from the mandible is reported. Judging from the radiographic images it was similar to a malignant tumor. The patient died 17 years after the first visit. According to the final pathological diagnosis, it was malignant odontogenic mixed tumor of low grade which did not belong to any of the WHO classification.     

应用无死腔气管插管提高正常和急性肺损伤兔的机械通气效率

目的：观察无死腔气管插管能否提高急性呼吸衰竭常规机械通气的效果。方法：应用一种新型无死腔气管插管和普通聚氯乙烯气管插管对正常和急性肺损伤兔进行常规通气，对两种气管插管的肺气体交换和气道内气体动力学及血流动力学变化进行比较。无死腔气管插管用２根Ｐｏｔｅｘ气管插管远端３ｃｍ处纵切后对粘而成。５只新西兰成年兔，麻醉下气管切开，在持续应用潘龙阻断自主呼吸条件下，随机用新型气管插管和普通气管插管Ｓｅｒｖｏ９００Ｃ进行机械通气，每次持续３０分钟，测定并记录动脉血压、气道压力、血流动力学参数和呼气末ＣＯ２浓度。结果：在正常肺和急性肺损伤条件下，新型气管插管可使所有动物的ＰａＣＯ２和生理死腔／潮气量（ＶＤ／ＶＴ）下降，ＰａＣＯ２分别下降１．４０±０．２０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）和１．６０±０．３０ｋＰａ（Ｐ＜０．０１），ＶＤ／ＶＴ分别下降０．１３±０．０２和０．１５±０．０４（Ｐ＜０．０１）；ＰａＯ２、气道压力和血流动力学无显著变化。结论：无死腔气管插管可明显提高常规机械通气效率。