三种根管内用药治疗难治性牙髓尖周病的临床疗效

在临床治疗中有些根尖周炎病例病程长,复诊次数多,常规根管预备后,反复多次封药,仍有叩痛、咬合痛,根管内分泌物、窦道未闭合等症状。在三组这类患牙根管内分别封入氢氧化钙、替硝唑、碘仿后,绝大部分病例临床症状消失,可明显缩短疗程,现将结果报道如下。1　材料和方法1.1　病例选择封药6次以上仍有叩痛、咬合痛,根管内有分泌物者。1.2　临床资料1998—2001年共治疗此类根尖周炎患者132例,男78例,女54例,年龄22～74岁。牙髓炎失活后去髓39例,急性尖周炎76例,有窦道者17例。其中前牙51例,前磨牙42例,磨牙39例。X线片显示根尖阴影39例,根尖骨…     

乳管内视镜对伴乳头溢液乳腺癌患者的临床价值

目的探讨乳管内视镜对伴乳头溢液乳腺癌的临床诊断价值。方法对70例伴乳头溢液乳腺癌患者,分别应用乳管内视镜以及乳腺X射线进行检查,并与病理检查结果进行对照。结果乳管内视镜诊断的符合率为94.3%,乳腺X射线检查的符合率为61.4%,两者比较差异显著(P<0.01)。结论乳管内视镜对伴乳头溢液乳腺癌的诊断,与组织病理学检查的诊断具有较高的符合率,能够为其临床早期诊断提供可靠信息,值得推广应用。     

Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation:a scanning electron microscopy study

The time domain entombment of bacteria by intratubular mineralization following orthograde canal obturation with mineral trioxide aggregate（MTA） was studied by scanning electron microscopy（SEM）. Single-rooted human premolars（n560） were instrumented to an apical size #50/0.06 using ProF ile and treated as follows： Group 1（n510） was filled with phosphate buffered saline（PBS）; Group 2（n510） was incubated with Enterococcus faecalis for 3 weeks, and then filled with PBS; Group 3（n520） was obturated orthograde with a paste of OrthoM TA（BioM TA, Seoul, Korea） and PBS; and Group 4（n520） was incubated with E. faecalis for 3 weeks and then obturated with OrthoM TA–PBS paste. Following their treatments, the coronal openings were sealed with PBS-soaked cotton and intermediate restorative material（IRM）, and the roots were then stored in PBS for 1, 2, 4, 8 or 16 weeks. After each incubation period, the roots were split and their dentin/MTA interfaces examined in both longitudinal and horizontal directions by SEM. There appeared to be an increase in intratubular mineralization over time in the OrthoM TA-filled roots（Groups 3 and 4）. Furthermore, there was a gradual entombment of bacteria within the dentinal tubules in the E. faecalis inoculated MTA-filled roots（Group 4）. Therefore, the orthograde obturation of root canals with OrthoM TA mixed with PBS may create a favorable environment for bacterial entombment by intratubular mineralization.     

乳管镜图像特征在伴乳头溢液乳腺癌中的诊断价值

目的探讨乳管镜图像特征多元参数在伴乳头溢液乳腺癌中的诊断价值。方法回顾性分析1159例病理资料完整的伴乳头溢液乳腺病患者的乳管镜资料,通过）（2检验筛选出乳管镜下诊断乳腺癌的相关图像特征,用Logistic回归分析评价它们在伴乳头溢液乳腺癌中的诊断价值。结果乳管镜诊断相关的图像特征包括病变的位置、管腔改变、管壁弹性、管壁表面形态、乳管末稍出血、病变在乳管内的位置、病变形状、病变颜色、病变表面形状、病变数量及病变表面出血等（P〈0．05）,行Logistic回归分析筛选出各乳管镜图像特征的DR值分别为：DR管壁表面形态=3．05,OR乳管末梢出血=2．22,OR病变数量=2．09,0R病变颜色=1．53,OR病变表面形状=1．53,DR病变形状=1．41,OR管壁弹性=0．43。根据OR值对各孚L管镜图像特征在伴乳头溢液乳腺癌中的诊断价值进行排序：管壁表面形态〉乳管末梢出血〉病变数量〉病变颜色=病变表面形状〉病变形状〉管壁弹性。结论乳管镜图像特征对伴乳头溢液乳腺癌的诊断有重要价值。     

Endovascular embolization for gastrointestinal bleeding caused by splenic arteriovenous fistula

Gastrointestinal bleeding is a common acute clinical emergency, with a mortality rate of 5%-12%.Most gastrointestinal bleeding is self-limited, but a small number of cases are difficult to treat due to an untraceable site and cause of bleeding, massive bleeding, serious illness, or other complications. Conservative treatment usually cannot achieve effective hemostasis.2 Blind exploratory laparotomy is risky and often leads to delayed postoperative recovery. In some cases,     

Retrospective study on the endovascular embolization for traumatic carotid cavernous fistula

Objective： To retrospectively analyze 95 cases of traumatic carotid cavernous fistula treated by endovascular embolization. Methods： From January 1994 to December 2008, 95 patients with traumatic carotid cavernous fistula were treated in our hospital. All patients received selective cerebral angiography through femoral artery catheterization. Accordingly, 89 cases were treated by detachable balloon embolization, 5 by platinum microcoils and 1 by coveredstem, respectively. Results： In the study, 61 cases achieved successful balloon embolization at the first time. Fifty-six cases had multiple balloons due to the big fistula. Nine cases received balloon embolization twice. But among the 5 patients treated with platinum microcoils, one developed slight brainstem ischemia. After operation the patient had herniparesis and swallow difficulty, but gradually recovered 3 months later. No neurological deficits were observed in other cases. All the cases recovered. Eighty-five cases were followed up for 1-15 years and no recurrence was found. Conclusions： The endovascular embolization for traumatic carotid cavernous fistula is minimally invasive, safe, effective and reliable. The detachable balloon embolization is the first choice in the treatment of TCCF.     

咪达唑仑在小儿氯胺酮联合骶管麻醉中的应用

目的观察咪达唑仑在小于3岁患儿腹部以下部位手术氯胺酮联合骶管麻醉时小儿体动抑制的临床效果。方法60例小于3岁进行腹部以下部位择期手术的患儿按麻醉及手术操作中肢体活动次数、运动幅度及活动与麻醉手术操作的关系来判定其麻醉效果。结果咪达唑仑、氯胺酮联合骶管麻醉60例病人,效果达优者58例,占96.67%,良好者2例,占3.33%一般及差者均为0例。结论咪达唑仑可有效解除氯胺酮联合骶管麻醉时患儿的不自主运动和突然抽动,总有效率达96%以上,大大提高了骶管麻醉操作时的安全性,同时保证了手术的顺利进行。     

Endovascular treatment of Budd-Chiari syndrome

Background  Budd-Chiari syndrome (BCS) is a posthepatic portal hypertension caused by the obstruction of the lumen of the hepatic veins or the proximal inferior vena cava (IVC). This study aimed to evaluate the clinical experience of interventional therapy for Budd-Chiari syndrome.

Methods  IVC venography was carried out first, the obliteration or stenosis in the IVC was opened or dilated with the hard guided wire or Rups100 puncture needle and balloon, then a stent was routinely implanted for the type of obliteration or stenosis.

Results  The procedure was successful in 821 out of 903 cases including IVC intervention in 760 cases, and hepatic vein intervention in 61 cases. An IVC stent was used in 517 cases and hepatic vein stent in 19 cases. There were no pulmonary embolisms, but acute renal failure occurred in eight cases, hepatic coma in two cases and acute heart failure in 43 cases. Two patients died in this group and five cases were complicated with acute IVC thrombosis. Follow up of 7 to 124 months was made in 679 cases with recurrence found in 59 cases.

Conclusions 　Interventional therapy is safe and effective with a fast recovery for most types of BCS. It is gradually becoming the first therapeutic choice.

     

阿瓦斯汀联合多西他赛治疗乳腺癌不良反应的观察与护理

阿瓦斯汀是近年来用于治疗肿瘤的新型靶向药,是重组的人源化单克隆抗体,其作用机制可结合人血管内皮生长因子(VEGF)并防止其与内皮细胞表面的受体(Flt-1和KDR)结合[1],切断肿瘤组织的血液供应,从而抑制肿瘤的生长.阿瓦斯汀为无色透明,浅乳白色或灰棕色,pH值为6.2的无菌液体,有100 mg和400 mg 2种规格,对应的体积为4 mL和16 mL(25 mg/mL),不含防腐剂,以一次性小瓶包装,用于静脉输注.     

一种防气管切开管内套管脱出的新方法

气管切开置管是在紧急危重情况下建立人工气道的一种急救方法,由于它具有能有效地解除呼吸道梗阻、便于吸痰、使患者舒适以及可以长时间留置等优点,因此临床应用广泛。但由于各种因素影响致使气管切开套管较易脱出气管外,如未及时发现或处理不当,可发生严重的后果,甚至危及生命。我们经临床实践找到了一种防此种气管切开管内套管脱出的方法,并取得了良好的效果,现报告如下。