介入治疗并发症的发生与防治

介入治疗是融合了内科药物治疗、外科手术治疗及医学影像学的一种特殊的治疗体系 ,其疗效受到世人瞩目并成为目前发展最为迅速的学科之一。但是 ,再好的方法也会存在不足之处 ,介入治疗也不例外。随着介入治疗在各家医院的普遍应用 ,并发症的发生也会越来越多 ,迫使人们关注这个问题。所谓介入治疗并发症 ,是指因血管造影及 (或 )血管内治疗所引起、需要一定治疗、使病人的治疗复杂化或延长病人住院时间的不良反应 ,就其全身多系统而言 ,介入治疗引发并发症的原因大致可归纳为两个主要因素即介入器材操作和引入人体内的物质(包括介入治疗所…     

Recovery from depression after electroconvulsive therapy is accompanied by evidence of increased tetrahydrobiopterin-dependent hydroxylation

Serum phenylalanine and tyrosine levels were measured in 26 patients with severe depression before and after receiving electroconvulsive therapy. The phenylalanine:tyrosine [P:T] ratio declined significantly for those responding to treatment but not for nonresponders. These findings are discussed in relation to tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, dopamine and serotonin and the hydroxylation of phenylalanine to tyrosine.     

Near visual acuity: a simple measure of practical significance in insulin-treated diabetic patients.

The value of measuring near visual acuity as a predictor of loss of independence in administering insulin and monitoring blood or urine glucose has been assessed in 110 insulin-treated diabetic patients. Near visual acuity was simple to measure in the clinic setting, and correlated well with 6 m acuity. Fourteen patients depended on an assistant either to draw up the correct dose of insulin (n = 12), inject the insulin (n = 7) or to monitor blood or urine glucose (n = 12). Of these 14 patients only one, who was demented, had near visual acuity better than N.12. Two other patients had near visual acuity N.12 or worse and yet were independent of help. One had severe visual impairment and used a pen-injector and a meter with speech synthesizer, and the other had near visual acuity of N.12. Impairment of near visual acuity to N.12 or worse is associated with loss of independence in insulin-treated diabetes. Measurement of near visual acuity could be useful in predicting independence of insulin-treated patients.     

法莫替丁治疗消化性溃疡60例

60例(男50,女10,年龄43±8a)经内窥镜证实的活动性消化性溃疡患者,口服法莫替丁40mg,qn,疗程2-4wk或延至6-9wk。溃疡愈合率DU2,4,6 wk分别为50％,84％,92％,SU2,4,6,8 wk分别为40％,68％,73％,82％。服药后3,7,14 d上腹痛缓解率DU为50％,80％,100％,SU为40％,75％,95％。未见严重不良反应。故法莫替丁对溃疡病,尤其是DU是一有效和安全药物。     

Irritable bowel syndrome: The role of psychosocial factors

The irritable bowel syndrome (IBS) is a very common disorder of intestinal function characterized by variable symptoms of abdominal pain, diarrhea, constipation and bloating. The spectrum of severity ranges from mild symptoms, not worthy of clinical attention, to intense and continuous symptoms associated with impaired health-related quality of life and high health care use. Psychosocial disturbance is commonly found among patients with irritable bowel, but until recently, its precise role in the disorder was uncertain. The data now suggest that irritable bowel is not a psychiatric disorder per se, but psychosocial factors including life stress, psychiatric comorbidity and abnormal illness behavior, among others, influence how the illness is experienced and acted upon. Patients with mild symptoms usually respond to education, reassurance, dietary modification and, when needed, antimotility agents. However, patients with more severe symptoms, who usually have greater psychosocial disturbance, will also require behavioral interventions, and possibly psychopharmacological agents. In sum, a graduated, multicomponent plan of care that includes dietary, behavioral and pharmacological treatments is recommended.     

Consistent control of psoriasis by continuous long-term therapy: the promise of biological treatments

Psoriasis is a chronic, incurable disease that frequently requires long-term treatment. Although many patients benefit from effective traditional systemic therapies, namely methotrexate, cyclosporin, retinoids and fumaric acid esters, and some patients achieve long-term disease control, unrestricted long-term administration is not recommended due to the potential for cumulative toxicity. In order to diminish the risk of toxicity, physicians have adopted various treatment approaches (e.g. rotational, sequential, intermittent, and combination). However, these approaches may not provide continuous disease control or a stable treatment regimen. The recent advent of targeted biological therapeutics such as etanercept, infliximab, adalimumab, alefacept and efalizumab may offer physicians and their patients treatment options with improved safety profiles that may permit continuous disease control.     

自拟人参二苓解毒汤联合盐酸恩丹西酮注射液治疗顺铂引起恶心呕吐临床观察

[目的]探讨顺铂引起恶心呕吐的有效治疗途径。[方法]对肺癌患者64例,随机分2组。自拟人参二苓解毒汤联合盐酸恩丹西酮注射液(以下简称商品名欧贝)(B组)和单独使用欧贝(A组)对顺铂为主的静脉化疗后镇吐疗效。[结果]B组(78·13%,93·75%)较A组(59·38%,75·00%)在近期镇吐治疗(指化疗后24-48h出现恶心呕吐)有明显差异(P<0·05),并在副作用方面,如便秘,乏力症状和血三系下降有明显差异(P<0·05)。[结论]辅以自拟人参二苓解毒汤确有增效解毒功能。     

Fast Track—Different Implications in Pancreatic Surgery

Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools, normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients’ age, operation time, and early extubation proved to be independent factors of early discharge, shown through multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe and promotes earlier discharge without compromising patient outcomes.     

Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias

Background Cosmetic changes are to be expected after radiotherapy for skin tumours. Objectives This study aimed to answer the questions: How frequent are cosmetic changes after soft X‐ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field? Methods In total, 2474 examinations of 1149 irradiated fields were performed. Results Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X‐ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time–dose–fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews. Conclusions Cosmetic changes after soft X‐ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.