变应性鼻炎诊疗现状调查

目的 变应性鼻炎(allergic rhinitis,AR)是鼻科常见病之一,但患者的就诊率不高,部分患者对疗效不满意,表明临床诊疗过程中存在亟待改进的问题.本研究针对中国部分大中城市的耳鼻咽喉头颈外科医师进行AR诊疗现状调查,通过剖析存在的问题,为提高临床诊疗水平提供参考.方法 采用问卷调查方式在全国13个省或自治区(63个市)和4个直辖市,针对508名耳鼻咽喉头颈外科医师,调查AR患者门诊状况、诊断状况和治疗状况.结果 AR患者占全部耳鼻咽喉头颈外科门诊患者的比例平均为19%±14%,占全部鼻腔鼻窦疾病门诊患者的35%±17%.既往使用过鼻用糖皮质激素或H1受体拮抗剂等抗过敏药物的患者为42%±26%.可进行皮肤点刺试验和血清特异性IgE检查的医师比例分别为74%和20%.仅依据患者症状和体征诊断,不进行皮肤点刺试验和血清特异性IgE检查等临床检测的比例为6l%±29%,而综合病史和皮肤点刺试验或血清学检测的诊断比例为35%±28%.从医师治疗成人AR患者的药物处方比例来看,鼻用糖皮质激素平均为70%4-27%,口服和鼻用H1受体拮抗剂分别为49%±32%和36%±28%.过敏原特异性皮下免疫治疗占23%4±26%,口服白三烯受体拮抗剂和鼻用色甘酸钠分别为18%±22%和16%±22%.重视复诊随访患者所占比例平均为24%±17%,对复诊和随访重视程度一般的患者所占比例为35%4±19%,而几乎不复诊随访的患者所占比例为39%±24%.结论 AR已成为我国耳鼻咽喉头颈外科门诊患者求诊的主要疾病,但无论是患者对疾病的整体认识,还是专科医师的整体诊治水平,均需要在现有基础上尽快提高.     

腹腔镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄62例

目的总结腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的临床经验,探讨其手术技巧和相关并发症的防治。方法回顾性分析2010年3月至2014年7月本院经腹腔镜行幽门环肌切开治疗的62例先天性肥厚性幽门狭窄患儿临床资料。结果62例中,59例顺利完成手术,术中3例幽门黏膜损伤中转开腹手术,术后1例并发脐部戳孔疝,经修补治愈,1例术后仍有呕吐,行开放手术证实为肌层切开厚度不够所致。所有病例均无呕吐及肠粘连、肠梗阻等并发症发生。结论腹腔镜下行幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄疗效确切,术中损伤小,术后瘢痕小,但需要较高的腹腔镜操作技术。     

新生儿及婴儿发育性髋关节异常早期筛查及早期治疗的探讨

目的通过对新生儿及婴儿发育性髋关节异常的早期筛查,结合临床检查与超声检查诊断的评价,推动新生儿及婴儿发育性髋关节异常的早期诊治。方法对本院出生的1213例新生儿及866例年龄6个月以下婴儿进行临床及超声早期筛查（Graf方法）,以明确诊断,及时治疗。结果新生儿早期疑诊45例,最终确诊5例,婴儿确诊3例,经用Pavlik吊带治疗6例痊愈,1例6个月后行闭合复位石膏固定治疗。结论新生儿期超声检查髋关节不稳定率偏高（Graflla型髋）,发育性髋关节异常的早期筛查,特别是低于6个月的超声检查检出率高,各科医师合作有利于DDH的早期诊治。     

肠道病毒71型感染的药物治疗和疫苗预防

肠道病毒71型(EV71)是引起手足口病的重要病原,能引发严重的神经系统并发症甚至死亡,构成严重的危害,但目前对ET71尚无有效的抗病毒治疗策略.此文就抗EV71的药物、疫苗及RNA干扰技术的研究进展作了综述,为EV71的防治工作提供借鉴.     

基质金属蛋白酶-9与结直肠癌

基质金属蛋白酶（MMP）能够降解细胞外基质,对肿瘤生长、侵袭和扩散至关重要。作为MMP 家族中相对分子质量最大的,MMP-9参与结直肠癌的生成和进展。研究显示 MMP-9可用于结直肠癌患者的早期诊断,组织和血浆中 MMP-9表达水平与结直肠癌患者术后预后呈负相关。另外,针对MMP-9在结直肠癌组织中表达增加这一特点可设计相关的靶向治疗药物。     

Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects

Objective

Metronidazole is the drug of choice for the treatment of bacterial vaginosis (BV). However, so far the oral administration has not been clinically compared to the intravaginal application regarding efficacy, side effects and patient satisfaction in a scientific sound fashion.

Study design

Therefore, this randomized, double-blind, placebo-controlled clinical trial was designed to demonstrate non-inferiority of short-term intravaginal (i.vag.) application of metronidazole (2× 1000 mg pessaries 24 h apart) vs. a single oral dose (p.o.) of metronidazole (1 × 2000 mg tablets) in 263 patients with BV (double-dummy design). The follow-up period was 12 weeks. In addition, the number and the type of adverse events induced by the two regimens were compared, assuming better tolerability of the intravaginal application.

Results

Following the diagnosis of BV a total of 129 women (mean age 36.2 years) was orally treated with a single dose of 2 g metronidazole whereas a total of 134 patients (mean age 35.5 years) was treated intravaginally with 1 g metronidazole each day on two consecutive days and included in the per-protocol analysis. Non-inferiority of i.vag. application compared to p.o. administration was statistically significant regarding efficacy: Following intravaginal application the cure rate, assessed on day 8 after starting of the treatment, was 92.5% as compared to 89.9% after oral administration. Nausea was the most common adverse event reported in 10.2% i.vag. vs. 30.4% p.o. of all cases (p < 0.001), abdominal pain in 16.8% i.vag. vs. 31.9% p.o. (p < 0.01), a “metallic taste” in 8.8% i.vag. vs. 17.9% p.o. (p < 0.05). Women treated i.vag. were highly satisfied with the treatment and more content as compared to the women treated p.o. with metronidazole (p < 0.05, intent-to-treat analysis).

Conclusion

In this clinical trial the intravaginal application was as effective as the oral administration of metronidazole in treating BV. However, significantly less adverse events were reported after short-term intravaginal as compared to oral application (p = 0.023) and probably led to a better patient compliance.     

甲亢性心脏病的诊断和治疗

甲状腺功能亢进(甲亢)性心脏病是由于甲亢时过量的甲状腺激素对心脏的直接毒性作用或间接影响而引起的一系列心血管系统症状和体征的一种内分泌代谢紊乱性心脏病。它的发生与患者的年龄、病程、治疗是否正规,心脏扩大,心肌受损及低钾、感染有关,其临床表现为心律失常,心脏增大或心力衰竭、心绞痛或心肌梗死,并随甲亢控制而治愈。     

时毓民论治小儿慢性咽炎经验

小儿慢性咽炎根据临床表现属于中医"喉痹"的范畴,以虚火喉痹多见,多因急性喉痹反复发作,以致脏腑失调,虚火上炎所致,时毓民教授认为结合儿童本身的体质特点,小儿慢性喉痹以虚实夹杂最常见,本质是小儿肺、脾、肾先天虚弱和后天失于调养出现气血阴阳的失衡;治疗无论从脏腑虚实论治,还是从阴阳气血论治,都应标本兼顾,扶正祛邪为主要治则...