Les barotraumatismes dentaires à la plongée : du diagnostic au traitement

Barotrauma designates injury to a body cavity resulting from ineffective adaptation to a difference in pressure between the closed cavity and the surrounding pressure. This type of injury can occur in several situations (scuba diving, free diving, air travel, high altitude). Variations in outside pressure can induce under- or over-pressure within air-filled cavities associated with dental caries and/or other dental anomalies such as crown damage. Cracks may widen, breaking teeth. Intense pain is the main symptom resulting from nerve compression. For divers, there is significant risk of life-threatening pain-induced syncope. Clinicians providing oral-dental care for deep sea divers should be aware of the danger, taking appropriate measures to prevent barotraumas. The purpose of this work was to review prevention and management practices for dental barotrauma.     

瑞芬太尼联合硝酸甘油控制性降压在鼻内镜手术中的应用

目的比较瑞芬太尼和瑞芬太尼联合硝酸甘油在全麻下鼻内镜手术中控制性降压效果。方法鼻内镜下鼻息肉、鼻窦炎手术病人共40例,ASAⅠ或Ⅱ级,用随机数字表分为瑞芬组和瑞硝组,每组20例,咪达唑仑、丙泊酚、瑞芬太尼和维库溴铵静脉复合全麻气管插管,2组术中均以瑞芬太尼0.1～0.2μg·kg~(-1)·min~(-1)、丙泊酚2～5 mg·kg~(-1)·h~(-1)持续泵输,维库溴铵4 mg·h~(-1),静脉注射。瑞硝组加用硝酸甘油静脉滴注,开始剂量5μg·min~(-1),调节滴速使收缩压维持在12 kPa(90 mmHg)左右。观察降压前(T_0)、降压后5 min(T_1)、30 min(T_2)、60 min(T_3)和停止降压后5 min(T_4)的收缩压和心率,计算心肌氧耗指数,瑞芬太尼、丙泊酚用量,手术时间和病人苏醒时间。结果2组病人年龄、性别和体重间差别无统计学意义(P>0.05)。T_1时2组血压明显下降,与T_0比较,均P<0.01,且瑞硝组降压程度明显大于瑞芬组(P<0.01),降压后的T_1,T_2瑞硝组心率加快,与瑞芬组相比有非常显著意义(P<0.01);降压期的氧耗指数,瑞硝组低于瑞芬组(P<0.05,P<0.01);停止降压后,瑞芬组血压和心率变化与T_3比,无统计学意义(P>0.05),但瑞硝组血压和心率均明显增加(P<0.01);瑞芬组的瑞芬太尼、丙泊酚用量和手术时间明显大于瑞硝组(P<0.01),2组病人的苏醒时间差异无统计学意义(P>0.05)。结论鼻内镜手术瑞芬太尼在常用剂量范围内作控制性降压虽比较平稳,但难以达到目标血压,联合硝酸甘油后效果明显,并可减少麻醉药用量和手术时间,减少病人医疗费用。     

Postpartum cardiomyopathy revealed by acute lower limb ischemia

Peripartum cardiomyopathy is an uncommon disease defined as a dilated cardiomyopathy during puerperium, with left ventricular dysfunction (ejection fraction < 45%) without any other etiology. The etiology of this disease remains uncertain and it can be revealed in a variety of ways. Thrombo-embolic complications may be, although infrequently, the initial manifestation of peripartum cardiomyopathy, which is usually an intracardiac thrombosis. Lower extremity embolism is uncommon. The case reported is about a 39-year-old woman, multiparous, who presented, 40 days after delivery, a global heart failure with atrial fibrillation, revealed by left lower extremity thromboembolism. After echocardiographic and etiologic examinations, the diagnosis was established as peripartum cardiomyopathy. It evolved favourably after 2 months of medical treatment: the symptoms and cardiomegaly decreased, left ventricular systolic function was improved.     

运用语言艺术处理医疗纠纷问题的探讨

医学在本质上具有两重性,它既是一门科学,又是一门人学,医学需要人文精神的滋养.目前,因医务人员语言不当而引发的无过失医疗纠纷是医疗纠纷的高发原因.在处理医疗纠纷过程中,院方工作人员对患者的人文关怀是影响服务满意度的关键因素.许多医疗纠纷初并不以起向司法机关或卫生行政部门提出控告为条件,患方和院方从改善院患关系出发,主观上都愿意通过调解、和解来解决医疗纠纷,而不是诉讼、仲裁.良好的语言形象和适当的语言不但可避免发生非医疗过失纠纷,对快速、公正、低成本地解决医疗过失纠纷也具有十分重要的作用.     

杜桑《泉》--反艺术而艺术的创举

西方现代艺术，尤其是第二次世界大战之后的艺术主要是沿着杜桑的思想轨迹发展的。杜桑的代表画作《泉》反映了一种艺术观点，反映出一种把作品的形式与它所要表现的内容完全脱离开的艺术概念。无论是对杜桑的研究，还是从对他的行为进行的文化阐释，都是建立在更为广泛的传统和独一无二的创作基础上的，从而拓展了艺术的内涵和外延。杜桑《泉》在艺术发展史上有其独特的价值。     

Le sel : vigilance dans la première année de vie*

For infants, sodium recommended dietary allowances are low. The influence of sodium intake on young children's blood pressure has been shown contradictory. Sodium intake increases as children get older from 2 months, 5 months, 9 months, 12 months. This is especially influenced by complementary foods. Moreover, sodium intake can also vary by a factor of 2 at any time period, depending on food choice, i.e. milk formula, baby's food and even usual family's food. In addition no benefit is expected from a high level sodium intake; an excessive sodium intake is often linked in toddler's food to an excess intake of protein and saturated fatty acids. That's why it seems safer to limit sodium level consumption. Therefore nutritional information has to be organised for mothers and caregivers in maternity wards and in day care centers to promote healthy food habits in early childhood.     

医学院校人际关系与交往艺术选修课程教学的思考

目的 探讨医学院校人际关系与交往艺术选修课程的教学方法与教学效果.方法 采用教师讲授与演示相结合、案例分析法、模拟教学法、游戏教学法、实践训练教学法等多种教学方法,并对选修本门课程的学生进行问卷调查以了解教学效果.结果 学生对本门课程的教学感到满意,认为教学内容实用,扩展了他们人际交往方面的知识,提高了他们的人际交往能力.结论 医学院校开设人际关系与交往艺术课程非常必要,学生通过学习,可以奠定良好的人际交往认知基础,掌握人际交往的基本原则和方法,懂得人际交往的基本礼仪知识;而教师良好的教学艺术及行为,以及针对不同的教学内容采用适宜的教学方法是提高教学效果、实现教学目标的重要保证.