全喉切除术后食管语康复实践

目的总结喉全切除术食管发声训练和效果。方法对我院自1998年6月～2003年6月的59例喉癌、下咽癌全喉切除术后患者,进行食管发声康复训练。结果53例(89.8%)获得不同程度的发声功能,46例无喉者的言语水平接近正常喉言语水平,他们的最大发音时程较长、听距较远,言语可懂度高,较流利;7例发音效果差,但言语可懂度仍高;不能发声者仅6例。结论与其它发声重建相比,食管发声能很快学会发基本音,并具有发声成功率高、发声质量良好等优点。     

Procedure for the quantitative evaluation of motor disturbances in cerebellar ataxic patients

Cerebellar ataxia is a complex motor disturbance that involves the planning and execution of movements and reduces movement accuracy and co-ordination. The quantification of ataxic signs is commonly realised through visual examination of motor tasks performed by the patient and assignment of scores to specific items composing the international co-operative ataxia rating scale (ICARS). The present work studied an experimental procedure to characterise specific aspects of motor disturbances in ataxia objectively. Four tests belonging to the ICARS were considered: walking, knee-tibia test, finger-to-nose and finger-to-finger test. Through a kinematic analysis performed during the above tests, specific indices were defined to quantify velocity, linearity, asymmetry, tremor, instability and smoothness of movement or posture. The procedure was applied to five patients with cerebellar ataxia and to ten healthy adult subjects. Results demonstrated that the patients moved significantly more slowly than the healthy subjects (0.67 against 0.97 m s⁻¹ and 0.81 against 1.02 m s⁻¹, respectively, for straight walk and finger-to-nose tests) and showed poorer linearity and smoothness behaviour. Velocity, linearity, tremor, smoothness and instability indices showed moderate to good correlation with the corresponding ICARS score. Some of these indices can separately evaluate aspects that are combined in single ICARS subscores. It is concluded that the combination of clinical assessments and instrumental evaluations allows a better insight into ataxic patients' motor disturbances and is a useful tool for the definition and follow-up of rehabilitation programmes.     

全膝关节置换术的康复治疗及护理

目的 探讨人工全膝关节置换术后的康复训练方法。方法 回顾分析2001年8月至2005年8月16例（17膝）人工全膝关节置换术后病人康复训练的过程及效果。结果 人工全膝关节置换术后经过系统康复训练，所有膝关节功能评分达到（70-86分）平均80分。结论 人工全膝关节置换手术效果与术后全面系统的康复训练密切相关。     

人行走时骨盆上下运动参数的模型分析

为了研究正常人行走过程中骨盆在垂直方向的运动特征,提出了一种以测量数据为基础建立骨盆运动参数数学模型的新思想。介绍了基于跑步机的骨盆运动轨迹测量系统,并对30名健康男性青年进行了获取骨盆运动参数的实验研究。实验结果得到了不同受试者分别以不同速度行走时的骨盆在垂直方向的多组运动轨迹,以及运动幅值、周期、初始相位等与行走速度和受试者身高的关系曲线。通过对曲线拟合,建立了各参数及骨盆运动轨迹的数学模型。通过对该模型进一步完善,可使其对康复评定、类人机器人等领域具有一定的应用价值。     

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

Assessed pain, anxiety, physical functioning, and cooperativenessin 32 childrenn with spastic cerebral palsy. This is the firststudy to assess children throughout rehabilitation followingselective posterior rhizotomy. Results of the ObservationalScale of Behavioral Distress and observer Likert ratings confirmedthe hypothesis that children's pain and anxiety decrease overtime. Children's physical functioning and cooperativeness improveover time. No significant correlation was found between painand changes in physical functioning. Cognitive impairment, parentalinvolvement, and children's pain behaviors explained 77% and56% of the variance in two forms of cooperativeness. Researchand clinical implications are discussed, and special considerationsregarding pain assessment and management in this populationare addressed     

脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

Importance of luxury flow for critically ill patients receiving a left ventricular assist system

The presence of a significant organ dysfunction does not immediately exclude patients from consideration for treatment with a left ventricular assist system (LVAS). However, in treating morbid circulatory shock patients with multiple organ failure, it is important to know the preoperative and postoperative factor or factors related to the recovery of the damaged organ function. In this study, we retrospectively analyzed patients receiving a LVAS at our institution and tried to determine the important factors related to the survival of patients with multisystem failure. Twenty-seven patients who underwent LVAS placement at Saitama Medical School Hospital between 1993 and 2003 were included in this study. The preoperative risk factors analyzed were renal dysfunction, respiratory dysfunction, hepatic dysfunction, the existence of active infection, and the combination of all four factors. As a postoperative factor, the pump flow index (mean LVAS pump flow during the first 2 weeks after LVAS surgery divided by the body surface area) was analyzed. None of the analyzed preoperative factors could predict survival after LVAS surgery, but a pump flow index of less than 2.5 l/min/m² had a significant relationship with death after LVAS surgery. Further analysis revealed that all the patients with a pump flow index of 3.0 l/min/m² or more could overcome preoperative organ dysfunction. Congestive heart failure patients with multisystem failure need luxury pump flow for successful LVAS surgery; this factor could be especially important in device selection and postoperative management.     

Eccentric visual acuity in patients with macular disease

A series of cards each containing a two dimensional array of identical Snellen "E's" was used to determine best eccentric visual acuity in patients with macular disease having Snellen visual acuity of 20/70 or worse. Each "full field E" card simultaneously presents the same letter to foveal and parafoveal areas. This test can therefore determine quickly if potentially useful vision is present in any area of the central visual field. In our study of 37 eyes, 70% demonstrated potential visual acuity at least two times better than visual acuity measured by conventional methods, and 20% demonstrated at least a fourfold improvement. This suggests that most patients with macular disease do not spontaneously employ their best remaining area of retina for fixation.     

Radiation therapy for pancreatic cancer: eleven year experience at the JCRT

Radiation therapy (XRT) for 41 patients with unresectable pancreatic cancer resulted in a median survival of 7.0 months. There was no difference in median survival for patients receiving external beam alone (3500 to 5600 cGy) (n = 28), intraoperative (IORT) boost plus external beam (5040 to 6750 cGy) (n = 9), or a gold-198 implant +/- external beam radiation (n = 4). A pilot study using orthovoltage IORT boost indicates no acute toxicity with doses of 1250 to 1750 cGy. Serious late damage has not been observed in any patients followed to 2 years. Local recurrence in patients treated post-operatively after "radical" surgery occurred in one of 10 (10%). This adjuvant treatment is safe and appears to improve local control rates compared to historical data, but survival is still poor. The median survival for the post-operative group is 10 months; three patients are alive without disease 8 months to 8.3 years after treatment.     

Postanesthetic malignant hyperthermia with convulsions

Journal of Anesthesia -