螺旋CT三维重建成像在先天性高肩胛症手术方式选择中的作用

[目的]探讨螺旋CT三维重建技术在先天性高肩胛症分度和手术方式选择中的作用。[方法]22例先天性高肩胛症术前应用螺旋CT对病变部位进行扫描并三维重建，测量以肩胛骨肩胛冈内侧缘为参照点，两侧肩胛骨高度差。根据测量结果依据Cavendish分度将其分类，并根据三维重建成像选择不同的矫形手术术式。[结果]本组22例病人，随访2—4年，外观及功能均有不同程度的改善，未出现神经、血管和椎体等的损伤。[结论]根据螺旋CT扫描和三维重建检查结果，术前即可直观的明确先天性高肩胛症的病变程度，相互关系，伴发畸形，患侧肩胛骨与正常对侧肩胛骨的外观差异等，便于手术操作方案的制定，避免了手术操作的盲目性，减少医源性并发症的发生。     

Socio-economic burden of permanent incisor replantation on children and parents

Abstract – This study describes the socio‐economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6–17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first‐year post‐trauma management was $1465 CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post‐trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty‐one patient–parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over $2000 CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio‐economic burden and responsibilities of patient/parent and dentist and their role in informed consent.     

不同临床和病理分型对肝门部胆管癌切除术预后的影响

目的 研究临床和病理分型与肝门部胆管癌切除术疗效的关系。方法总结1993年至2004年在解放军总医院肝胆外科手术切除的肝门部胆管癌198例病例资料。结果临床分型Ⅰ型34例，Ⅱ型60例，Ⅲa型27例，Ⅲb型33例，Ⅳ型19例，Ⅴa型6例。Ⅴb型19例。病理高分化腺癌35例，中分化腺癌52例，低分化腺癌54例，三者的中位生存期分别为29．5、11、5．5个月；病理切缘阴性者与切缘阳性者生存率有显著性差异（P 〈0．05）。手术并发症出现率41．4％，围手术期死亡1例。结论肝门部胆管癌根据临床分型进行相应的手术治疗；病理切缘阴性是影响预后的主要因素之一；围手术期正确处理，是减少手术并发症，提高患者生活质量和延长生存期的关键。     

前臂预成皮瓣腭部缺损1例整复术护理

目的:提高前臂预成皮瓣整复术的护理水平.方法:通过术前心理护理,供区的皮肤保护,口腔装备,术后环境准备和卧位,皮瓣观察,切口护理,饮食和口腔护理进行评价.结果:预成皮瓣正常成活,色泽红润如期修复腭部缺损.结论:良好的护理可以提高前臂预成瓣移植的成功率.     

男性病人冠状动脉病变与吸烟关系的研究

[目的]探讨吸烟对病人冠状动脉病变的影响。[方法]对吸烟组(5 0例)与不吸烟组(3 0例)进行冠状动脉造影,观察记录冠状动脉病变情况并进行统计学分析。[结果]两组冠状动脉病变记分、每日不同吸烟量与冠状动脉病变记分、不同的吸烟年限与冠状动脉病变记分比较均有统计学意义(P <0 .0 1)。[结论]长期吸烟可使冠状动脉病变程度加重,应加强对长期吸烟及冠状动脉介入术后病人的健康教育,有效预防和控制冠心病,提高人群的健康水平。     

TEN YEARS' EXPERIENCE IN LOW VISION PRACTICE

The Low Vision Clinic at the Palmerston North Hospital has now been oerating for 70 years. Over the course of these ten years a number of factors have emerged which can be as readily applied to general ophthalmological practice as to low vision practice. The philosophy of low vision care is one of which all ophthalmologists should be aware and includes factors to be taken into account when dealing with children, people in the workplace, and everyday factors involved in daily living activities, all of which are equally relevant in routine ophthalmological practice. This paper endeavours to share some thoughts on these factors and also discusses means by which the visually handicapped can be helped in areas where specialist low vision services are not readily available.     

术后镇痛10年后的质量控制探讨：1168例回顾性研究

目的 了解术后镇痛的现状，探讨术后镇痛的质量控制问题。方法 回顾近3个月1168例术后镇痛所采用的镇痛方法和预防术后恶心呕吐的方法，了解镇痛效果和副作用的发生情况，并分析影响镇痛效果和副作用发生率的有关因素，患者的满意度情况。结果 90％采用了连续硬膜外镇痛法，配方主要是小剂量吗啡复合低浓度布比卡因或罗比卡因，静脉镇痛主要采用吗啡复合氯诺昔康。预防术后恶心呕吐（PONV）的方法有5-HT3受体拮抗剂（昂丹司琼或阿扎司琼），氟哌啶，地塞米松等，单用或复合应用。连续硬膜外镇痛需要补救镇痛者约5％，静脉镇痛补救镇痛者约10％。PONV总体发生率低，妇科开腹手术低至20％，女性非妇科手术低至10％，剖宫产术低至1％，使用氟哌啶使妇科手术PONV降低约50％。1例高龄患者出现血氧饱和度下降至82％，经停药、吸氧等处理好转。硬膜外导管脱落0．5％。瘙痒、头晕等并发症小于5％。通过补救镇痛，及时处理并发症，患者满意度在90％以上。结论 硬膜外镇痛方法效果优于静脉镇痛方法，适度镇痛，减少镇痛药量，增加安全性，重视PONV的预防，及时处理镇痛不足和副作用，从而提高患者的满意度，是术后镇痛质量控制的可行的理念和方法。     

美国头颈癌患者生存资料分析

为使国内头颈癌生存分析的基本方法与国际一致，规范生存率分析的基本方法，以利于相互比较．本文以文字及表格方式，简述生存分析基本术语的概念、意义和应用，并介绍2002年第6版《美国头颈部肿瘤TNM分期》的1-5年观察生存率、相对生存率。     

Light exposure required for optimum conversion of light activated resin systems

OBJECTIVE: The aim of this study was to evaluate the relationship between the degree of conversion (DC) of composites and the light intensity using LED-curing units and also to determine the amount of exposure required to achieve optimal curing. METHOD: The light outputs of light-curing units and the depths of cure of composites exposed to these units were determined using the methods outlined in modified ISO standards, ISO/TS10650 and ISO 4049, respectively. The distributions of DC in composites were investigated by IR spectra of microareas obtained at various depths from the irradiated surface of thin specimens cut out from the cured composites. IR spectra were measured using a Fourier transform infrared spectrometer equipped with a microscopic unit. DC was calculated from the changes in the amount of C=C double bonds in the IR spectra. RESULTS: The light intensity at various depths through the cured composite was calculated from the attenuation coefficient of each material, obtained from the linear relationship between the depth of cure and the logarithm of the amount of exposure, which is defined as the product of the irradiance and irradiation time. There was a third or fourth order regression relationship between DC and the logarithm of total light energy at a particular depth. SIGNIFICANCE: The minimum light energy required to produce a saturated DC was about 1000 s mW/cm2.     

Association between cord blood IgE and genetic polymorphisms of interleukin-4, the β-subunit of the high-affinity receptor for IgE, lymphotoxin-α, and tumor Necrosis factor-α

High cord blood immunoglobulin E (cbIgE) is known to be associated with increased risks of atopic diseases in childhood. The relationship between genetic polymorphisms and high cbIgE has not been well documented. A cross-sectional study was conducted to assess the association between cbIgE and genetic polymorphisms of interleukin (IL)-4 -590C/T, the beta-subunit of the high-affinity receptor for IgE (FcepsilonRI-beta) E237G, lymphotoxin (LT)-alphaNcoI alleles, and tumor necrosis factor (TNF)-alpha -308G/A. A total of 320 mother-neonate pairs were recruited from four maternity hospitals from different locations of Taiwan. Cord blood was obtained and assayed for cbIgE. Polymerase chain reaction followed by restriction fragment length polymorphism was used to assess the genotypes. Three hundred pairs of mothers and neonates were included in the final analysis. Infants with IL-4 -590 C allele were found to have higher risk of elevated cbIgE (> or =0.35 IU/ml, 24.3%) (p = 0.004). After adjusting for gender, birth order, maternal age, and history of allergic disease in maternal and paternal families, odds ratios for CC and CT genotypes were 4.41 and 3.16 (95% confidence interval 0.78-22.67, and 1.66-6.13), respectively, using TT genotype as reference. The genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha were not associated with cbIgE before or after the adjustment. Our finding suggested a significant association of cbIgE with genetic polymorphism of IL-4 -590C/T, but not with the genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha.