MicroscanAS—4自动微生物分析仪在细菌室间质控中的评价

应用 Microscan AS- 4(以下简称为 AS- 4)自动微生物鉴定 /药敏测试系统 ,对细菌室间质评中的 39株不同质控菌株进行鉴定 ,并作了 110对次平行药敏试验。AS- 4对质控菌株鉴定的总正确率为 89.7%。对肠杆菌科、非发酵菌、苛养菌、弧菌科以及葡萄球菌、链球菌属鉴定具有较稳定的良好效果 ;对真菌 (酵母菌 )、李斯特菌属鉴定较局限 ;对马红球菌、棒状杆菌属不能鉴定。对沙门菌属、志贺菌属仍须借助血清学分型鉴定。 AS- 4检测的 MIC与质控测定菌株药敏靶值的完全符合率达 98.2 % ,比药敏纸片的 K- B法测定符合率略高。     

颈外静脉与四肢静脉留置套管针的对比分析

目的 观察颈外静脉留套管针与四肢置套管针的差别。方法 对２００例住院输液病人同分为颈外静脉留置套管针组１０４例与四肢静脉留置套管针组９６例,分别观察统计两组病例的留置时间,静脉发生情况。结果 两组通过前瞻性临床观察分析对比证实（留管时间比较Ｘ＾２＝６３．１２,Ｐ〈０．００１,静脉炎发生率比较Ｘ＾２＝３７．９４,Ｐ〈０．００１）差异有显著意义。结论 颈外静脉留置套管针具有留置时间长、静脉炎发生率低、     

The scientific history of hydrocephalus and its treatment

Summary  Hydrocephalus cases were regularly described by Hippocrates, Galen, and early and medieval Arabian physicians, who believed that this disease was caused by an extracerebral accumulation of water. Operative procedures used in ancient times are neither proven by skull findings today nor clearly reported in the literature. Evacuation of superficial intracranial fluid in hydrocephalic children was first described in detail in the tenth century by Abulkassim Al Zahrawi. In 1744, LeCat published findings on a ventricular puncture. Effective therapy required aseptic surgery as well as pathophysiological knowledge – both unavailable before the late nineteenth century. In 1881, a few years after the landmark study of Key and Retzius, Wernicke inaugurated sterile ventricular puncture and external CSF drainage. These were followed in 1891 by serial lumbar punctures (Quincke) and, in 1893, by the first permanent ventriculo-subarachnoid-subgaleal shunt (Mikulicz), which was simultaneously a ventriculostomy and a drainage into an extrathecal low pressure compartment. Between 1898 and 1925, lumboperitoneal, and ventriculoperitoneal, -venous, -pleural, and -ureteral shunts were invented, but these had a high failure rate due to insufficient implant materials in most cases. Ventriculostomy without implants (Anton 1908), with implants, and plexus coagulation initially had a very high operative mortality and were seldom successful in the long term, but gradually improved over the next decades. In 1949, Nulsen and Spitz implanted a shunt successfully into the caval vein with a ball valve. Between 1955 and 1960, four independent groups invented distal slit, proximal slit, and diaphragm valves almost simultaneously. Around 1960, the combined invention of artificial valves and silicone led to a worldwide therapeutic breakthrough. After the first generation of simple differential pressure valves, which are unable to drain physiologically in all body positions, a second generation of adjustable, autoregulating, antisiphon, and gravitational valves was developed, but their use is limited due to economical restrictions and still unsolved technical problems. At the moment, at least 127 different designs are available, with historical models and prototypes bringing the number to 190 valves, but most of these are only clones. In the 1990s, there has been a renaissance of endoscopic ventriculostomy, which is widely accepted as the method of first choice in adult patients with aquired or late-onset, occlusive hydrocephalus; in other cases the preference remains controversial. Both new methods, the second generation of valves as well as ventriculostomy, show massive deficits in evaluation. There is only one randomized study and no long-term evaluation. Received: 4 August 1999 / Accepted: 12 August 1999     

矩形外固定器治疗桡骨远端粉碎性骨折

本文报告一种新的矩形外固定器,１９９２年以来,治疗５例桡骨远端粉碎性骨折,经临床观察和随访,治疗结果较满意。外固定针固定在２～３掌骨和桡骨干上。根据需要,闭合复位后,可利用外固定器行加压或撑开固定,该固定器具有操作简单和固定牢固等优点,很适宜治疗桡骨远端粉碎性骨折     

Selection criteria for treatment of rectal cancer with combined external and endocavitary radiation

PURPOSE: The aim of this study was to identify factors predictive of recurrence of rectal tumors treated with combined external and endocavitary radiation. METHODS: Seventy-two patients with rectal cancer were evaluated clinically and with transrectal ultrasound before combined external and endocavitary radiation. Ideal lesions were moderately differentiated, mobile, not ulcerated, <3 cm in diameter, and <12 cm from the anal verge. External radiation (4,500 cGy) was given during five weeks followed by endocavitary radiation (3,000 cGy × 2). Median follow-up was 31 (range, 7–93) months. RESULTS: Pretreatment transrectal ultrasound stages were uT1 (6 patients), uT2(27 patients), and uT3 (39 patients). Clinical evaluation identified 26 ideal and 46 nonideal tumors. Overall recurrence was 36 percent; mean time to recurrence was 12 months. Ideal lesions recurred less than nonideal (15vs. 48 percent;P=0.01). Mobile lesions recurred less than tethered lesions (26vs. 52 percent;P=0.048). Transrectal ultrasound stage was predictive of recurrence (0 percent uT1, 22 percent uT2, and 51 percent uT3;P=0.015). Surgery was possible in 14 of 17 patients with pelvic recurrence only; 11 patients (65 percent) had curative surgery. Distant metastases occurred in nine patients; all had pelvic recurrences, and six died of disease. CONCLUSION: Patients with uT3 or nonideal rectal cancers should not be offered combined external and endocavitary radiation for cure. Transrectal ultrasound stage is the only independent predictor of recurrence.Presented at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

Treatment with Steroids and Double Filtration Plasmapheresis for a Case of Anti-GQ1b Antibody-Positive Bickerstaff's Encephalitis

The treatment of Bickerstaff's brainstem encephalitis (BBE) is still controversial. We report a case of BBE with positive anti-GQ1b antibody. The patient was successfully treated with steroids and double filtration plasmapheresis.     

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with External Snapping Hip: A Comparison Study of Matched Case Series

ObjectiveTo determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH).MethodsRetrospectively review the preoperative and minimum of 2‐year follow‐up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age‐ and gender‐matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient‐reported outcomes (PROs) including international Hip Outcome Tool (iHOT‐33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS‐pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS‐satisfaction score of two groups at 2 years postoperatively were also analyzed.ResultsThe prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22–48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty‐three age‐ and sex‐matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT‐33, mHHS, and VAS‐pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3‐month and 24‐month follow‐up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS‐satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2‐year follow‐up.ConclusionAlthough abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.     

Effect of high-frequency oscillatory ventilation on the upper airways of kittens

BACKGROUND: High-frequency oscillatory ventilation (HFOV) has become the preferred method of ventilation for the fragile lungs of neonates and infants because its beneficial effects on lungs are well known; however, its benefits on upper airways are not yet known. We investigated the effects of HFOV and conventional mechanical ventilation (CMV) on the airways of kittens with normal lungs. METHODS: Ten healthy cross-bred kittens, 2-3-months-old, with a mean bodyweight of 0.98 kg, were randomly divided into two groups: HFOV and CMV. Kittens were intubated and ventilated for 24 h. A semiquantitative scoring system was used to grade histopathological tissue changes in the cricoid, mid-trachea, carina and left bonchus. The injury scores of the two groups were ranked and compared using a two-tailed Mann-Whitney rank test. RESULTS: Histopathologic changes were similar and mild in both groups under light microscopic examination. There was no significant difference in airway injury between the two groups. CONCLUSIONS: We conclude that, in this animal model, HFOV results in minimal airway damage when properly managed and causes no greater tracheobronchial injury than CMV.     

痔科外洗方加快肛门病术后康复的疗效观察

目的 观察痔科外洗方对肛门病术后康复的疗效。方法 治疗组１０８例应用痔科外洗方与对照组３１例应用高锰酸钾坐浴进行对照观察。结果 治疗组病人术后肿胀、疼痛、出血等均较对照组轻,２组相比有显著性差异（Ｐ〈０．０５）。结论 痔科外洗方确有消肿、止痛的作用,对加快肛门病术后康复疗效确切。     

胫腓骨骨折石膏固定与外固定架固定疗效比较

目的：探讨直视下复位加石膏外固定与外固定架固定治疗胫腓骨骨折的疗效。方法：７６例胫腓骨骨折均行直视下复位,简单内固定,以后分２组,１组３９例行石膏外固定,另１组３７例行外固定架固定,从骨折愈合时间,并发症２个方面进行比较分析。结果：石膏外固定组仅有２例术后存有膝关节功能障碍和１例骨不愈合,它的骨折愈合时间短。结论;直视下复位石膏外固定治疗胫腓骨骨折个有简单可靠,骨折愈合快,并发症少等优点。