颈腰椎旋转手法拇指最大推扳力比较及量效关系的研究

目的比较颈、腰椎定点旋转手法作用时,拇指对棘突的最大推扳力的差异,为推拿手法的量化提供定量化依据。方法应用压力传感器检测系统,检测并记录旋转手法作用时出现咔哒声响时术者拇指推扳颈、腰椎棘突的最大推扳力。结果以出现咔哒声响作为颈、腰椎旋转手法成功的标志,此刻在腰椎左、右手拇指的最大平均推扳力分别为5.08±1.289kg和6.636±1.484kg。颈椎此刻术者左右手拇指的最大平均推扳力分别为4.75±1.04和6.44±1.34kg。结论颈、腰椎同侧的最大推扳力差异无显著性(P>0.05),颈、腰椎咔哒声响的发生与拇指推扳力的大小无直接关系。     

仰卧整复法治疗颈椎不稳所致颈性眩晕的经颅多普勒超声和X线观察

目的　观察仰卧整复手法治疗颈椎不稳所致颈性眩晕患者的经颅椎动脉多普勒超声和颈椎侧位X线摄片的变化 ,探讨其治疗颈性眩晕的可能机制。方法　回顾分析仰卧整复手法治疗颈椎不稳所致颈性眩晕患者 16例 ,观察手法治疗的效果及手法治疗前后患者经颅椎动脉多普勒超声和颈椎侧位X线摄片椎体间的位移变化 ,并和正常人群进行比较。结果　 16例患者治疗前椎动脉平均血流速度为 (48.6± 3.1)cm/s ,显著高于同龄正常人群 (P <0 .0 5 ) ;仰卧整复手法治疗后椎动脉平均血流速度为 (39.2± 3.5 )cm/s ,较治疗前有显著下降 (P <0 .0 5 )。治疗前颈椎侧位X线摄片示C3 ,4间的位移为 (3.18±0 .4 2 )mm ,C4,5间的位移为 (3.4 6± 0 .2 6 )mm ;治疗后分别为 (2 .2 5± 0 .35 )mm和 (3.2 8± 0 .35 )mm ,C3 ,4间的位移明显减少 (P<0 .0 5 )。手法治疗效果评价 :10例痊愈 ;4例显效 ;2例有效。结论　仰卧整复手法是治疗颈椎不稳所致颈性眩晕的有效手法 ,其治疗机制与改善椎动脉血流和恢复脊柱稳定性有关     

手法复位夹板固定治疗Ⅱ度以上踝关节骨折脱位

目的：总结踝关节骨折脱位中医正骨治疗方法的治疗效果。方法：自1999年1月-2002年7月，以手法复位改良夹板固定治疗Ⅱ度以上踝关节骨折脱位96例并进行随访。男74例，女22例。按Lauge-Hansen分型：Ⅱ度55例，Ⅲ度30例，Ⅳ度11例。根据Baird和Jackson的主观和X线踝关节评分系统对其疗效进行评定和分析。结果：随访5～12个月，平均8个月。96例总优良率为88．6％，除3例患者长时间行走疼痛外，其余均无疼痛。结论：手法复位夹板固定治疗踝关节骨折脱位可取得良好的效果。熟练的复位技巧、可靠的夹板固定和注意保持治疗过程中的骨折的稳定对提高远期疗效非常重要。     

老年人椎动脉的解剖学观测及意义

目的:为颈部推拿手法治疗提供老年人椎动脉的解剖学资料。方法:对20具老年人尸体标本椎动脉的行程、弯曲和管径等情况进行解剖学观察,并与10具年轻人尸体标本做比较。结果:老年人标本椎动脉的弯曲明显多于年轻人。多者达10余处,C2～G6段弯曲多为增生的Luscka关节向外推挤所致;左右侧椎动脉管径相差悬殊者并不少见。结论:老年人椎动脉变异较多,易受损伤。     

Adaptation of an instrument to measure the informational needs of men with prostate cancer

AIM OF THE STUDY: The aim of this study is to adapt an instrument suitable for assessment of the informational needs of men with prostate cancer. BACKGROUND: In recent years prostate cancer has become an important public health problem world-wide with considerable social and economic consequences. It is reported that it is the most common cancer affecting British men, with an average lifetime risk of occurrence of one in twelve. DESIGN/METHODS: Methodological research was conducted to develop an instrument to assess the informational needs of men with prostate cancer on hormonal manipulation therapy (HMT) regarding their disease and treatment. The Toronto Informational Needs Questionnaire (TINQ-BC) (Galloway et al. 1997) was modified for use with this client group and was applied to a sample of 90 men generated from three urology centres in Northern Ireland. RESULTS/FINDINGS: Construct and content validity of the instrument was established. Internal consistency reliability using Cronbach's alpha was calculated and found to be satisfactory (0.92). Using confirmatory factor analysis, factor loadings ranging from 0.37 to 0.90 were obtained and considered satisfactory. The subsections of the TINQ-BC categorized as Disease, Investigative tests, Treatment, Psychosocial and Physical needs were confirmed as individual factors. These results indicate that this instrument can be validly applied to this client group. As the instrument was initially developed in Canada and successfully used in the United Kingdom (UK), it is suggested that this instrument also has the potential for cross-cultural application. It has the potential to be used as a clinical reference instrument to assess the informational needs of this patient group. Health care professionals must be aware of the domains of information that these men perceive important so that educational interventions can be accurately and appropriately planned.     

Does hormonal manipulation in conjunction with permanent interstitial brachytherapy,with or without supplemental external beam irradiation,improve the biochemical outcome for men with intermediate or high‐risk prostate cancer?

OBJECTIVE

To determine whether hormonal manipulation improves the biochemical outcome for men with intermediate or high‐risk prostate cancer and undergoing permanent brachytherapy with or without supplemental external beam radiation therapy.

PATIENTS AND METHODS

From April 1995 to August 2000, 350 patients with intermediate‐risk (225 men; a Gleason score of ≥ 7 or a prostate specific antigen, PSA, level of ≥ 10 ng/mL or clinical stage ≥ T2b) or high‐risk features (125 men; two or three of a Gleason score of ≥ 7 or PSA ≥ 10 ng/mL or clinical stage ≥ T2b) underwent transperineal ultrasonography‐guided permanent brachytherapy. No patient underwent pathological lymph node staging. Of these patients, 293 received supplemental external beam radiation therapy (EBRT), 141 received hormonal manipulation, with 82 having hormonal therapy for ≤ 4 months (median 4) for cytoreduction, while 59 had neoadjuvant and adjuvant hormonal manipulation (median 8 and 12 months for intermediate‐ and high‐risk, respectively). The median patient age was 68.5 years. No patient was lost to follow‐up. The mean (sd ) and median follow‐up was 50 (18) and 49 months (calculated from the day of implantation). Biochemical disease‐free (BDF) survival was defined using a consensus definition. The clinical variables evaluated for BDF survival included risk group, Gleason score, patient age, clinical T‐stage and pretreatment PSA. Treatment variables included use of hormonal manipulation stratified into cytoreductive (≤ 4 months) vs adjuvant (> 4 months) regimens, supplemental EBRT, isotope and dosimetric variables.

RESULTS

For intermediate‐risk patients, the 6‐year actuarial BDF survival rates were 98%, 96% and 100% for hormone naïve, cytoreductive and adjuvant treatment, respectively (P = 0.693); for high‐risk patients the respective values were 79%, 94% and 92% (P = 0.046). When stratified by pretreatment PSA, hormonal manipulation improved the outcome for patients with a PSA of ≥ 10 ng/mL (P = 0.019), but not for those with < 10 ng/mL (P = 0.661). Hormonal status was not statistically significant in predicting biochemical outcome when stratified by Gleason score. The follow‐up in hormone‐naïve patients was significantly longer than that in hormonally manipulated patients, at 55 (20) vs 43 (15) months (P < 0.001). In a multivariate analysis only the Gleason score predicted failure in intermediate‐risk patients, while pretreatment PSA, the use of hormonal manipulation and Gleason score predicted the outcome in high‐risk patients (P = 0.035). For both hormone‐naïve and hormonally manipulated BDF patients, the median PSA level after implantation was < 0.1 ng/mL.

CONCLUSION

In patients treated by permanent prostate brachytherapy, hormonal manipulation improved the biochemical outcome for those at high‐risk and those with an initial PSA of ≥ 10 ng/mL, but not for those with intermediate‐risk features. The use of hormonal therapy for> 4 months conferred no additional biochemical advantage over short‐course regimens. Because the follow‐up in hormone‐naïve patients was longer than that for those receiving hormonal manipulation, additional follow‐up will be mandatory to confirm the durability of these findings.

     

Manipulation: description,identification and ambiguity

The word manipulation is frequently applied to some of the difficult-to-manage behaviours of the personality-disordered patient. However, the term is rarely defined, and a review of both the clinical and research literature shows that little has been written about its definition and identification, let alone its clinical management in both in- and outpatient settings. Recent empirical work conducted with nurses in forensic settings has demonstrated the range of behaviours that professionals refer to as 'manipulative', thus clarifying the use of the term and allowing the provision of a more precise definition. The scope of manipulation in everyday life, management practice and politics is perhaps relatively small, although manipulation can occur in all areas of human activity. Social behaviour is doubly ambiguous with respect to judgements of manipulation, as such judgements involve a moral evaluation combined with the identification of deception on the basis of little or partial evidence. The implications of this social ambiguity for clinical psychiatric practice are that professionals need to guard themselves from two polar faults: seeing manipulation everywhere; or being blind to its presence. In order to achieve a cautious moderation, staff need to hold both alternatives in mind at all times.     

从针灸、推拿的起源谈中医外治法的发展

目的:追寻针灸、推拿疗法的起源,探求中医外治法的机理,使人们真正认识和了解中医外治法的本质,从而为中医外治法的发展开阔思路.方法:通过对人类社会发展历史的推理分析,揭示外治法治疗疾病的基本原理.结论:人类最早的外治法工具就是自己的双手;只要给穴位或疾病的反应点一个刺激,通过经络、腧穴的良性调节作用,就能治疗疾病.这一结论为今后发明新的外治疗法奠定了基础.     

中西医结合法治疗肩周炎

[目的]比较两种方法治疗重度肩周炎的疗效.[方法]将200例重度肩周炎随机分为2组,每组100例.单纯治疗组:神经阻滞加痛点注射.治疗加松解组:神经阻滞加痛点注射加肩关节阻滞及肌间沟阻滞下手法松解粘连.疗程治疗1次/周,3-4次为1个疗程,比较两组疗效的差别.[结果]两组治疗结果比较差异显著(P＜0.05).[结论]治疗加松解组在疼痛评分和功能障碍评分都明显优于单纯治疗组.     

针灸推拿配合体疗治疗腰椎间盘突出症临床观察

目的:观察针灸推拿结合体疗治疗腰椎间盘突出症的临床疗效。方法:采用针灸推拿结合体疗治疗腰椎间盘症30例,设电针结合牵引作为对照组,观察两者的临床疗效。结果:治疗组有效率为100%,对照组84%,经统计学处理,P<0.01,两组间差异有显著性。结论:治疗组优于对照组。