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81.
82.
胸腰段椎间盘突出症诊断的临床研究 总被引:4,自引:0,他引:4
目的探讨胸腰段椎间盘突出症临床表现的特点与规律,提高胸腰段椎间盘突出症的诊断水平。方法回顾性分析1995年9月~2004年1月我院经X线、CT、MRI及手术证实的胸腰段椎间盘突出症65例的临床资料,并将其分为低位胸椎组(T10-T12L1)43例,高位腰椎组(L1-2-L2-3)16例,多节段突出组6例。结果躯体感觉障碍89.2%(58/65)和下肢无力83.1%(54/65)是最多见的症状。9.2%(6/65)表现为上运动神经元损害,47.7%(31/65)表现为下运动神经元损害,43.1%(28/65)表现为上、下运动神经元混合性损害。仅3例为单根神经根损害,其余表现为多根神经或马尾神经的损害。腰背痛44.6%(29/65)和下肢无力40.0%(26/65)是最常见的首发症状。低位胸椎间盘突出以混合性运动神经元损害为主,占58.1%(25/43),易导致行走障碍、足下垂、下肢肌张力升高和病理征阳性;而高位腰椎间盘突出则以下运动神经元损害为主,占93.8%(15/16),易造成腰背、下肢疼痛及马尾神经损害。结论胸腰段椎间盘突出症的症状广泛、体征多样,当临床上存在以下情况时应高度怀疑胸腰段椎间盘突出症:①大腿前方、外侧或腹股沟部位出现感觉障碍者;②下肢无力,股四头肌,胫前肌肌力减退者(如足下垂);③下肢运动或感觉障碍范围广泛、不规则,缺乏根性分布特征者;④上、下运动神经元损害同时存在,或虽表现为下运动神经元损害,但难以用低位腰椎间盘突出症解释者。 相似文献
83.
John P. Forman Julie Lin Manuel Pascual Mark D. Denton Nina Tolkoff-Rubin 《American journal of transplantation》2004,4(11):1786-1791
The significance of anticardiolipin antibodies (ACAs) prior to renal transplantation is unclear. We studied a cohort of 337 patients who underwent renal transplantation from 1996 to 2001. Follow-up continued until allograft loss, patient death or 31 December 2002. The primary outcome was a composite endpoint of death-censored allograft loss or a 25% reduction in estimated glomerular filtration rate (GFR) from 1-month post-transplant. Secondary outcomes were allograft loss, a 25% reduction in GFR, acute rejection and creatinine at 1 year. IgG and IgM ACA titers were positive (> or =15) in 18.1% of recipients. There were no significant differences at baseline between recipients, except coumadin therapy in those with positive ACA titers (20% vs. 7.4%). Post-transplant, there was no increase in the primary outcome in ACA-positive patients, even after adjustment for anticoagulation with coumadin (HR = 1.42 [0.68, 2.96]). There was no difference in secondary outcomes between those with or without positive titers. Two of five patients with very high titers (>50) who were not anticoagulated had early graft loss. A positive ACA titer prior to kidney transplantation was not associated with inferior renal outcomes after transplantation, although more research is required to address the prognostic significance of very high ACA titers. 相似文献
84.
Objective: The scientific quality of research is an important ethical issue. To clarify the quality of research projects in pharmacotherapy/pharmacology,
40 randomly selected research projects in pharmacotherapy/pharmacology submitted to a research ethics committee were reviewed.
Results: Eight of the projects would not have contributed new knowledge nor were they necessary as controls for the results of previous
research. Fifteen of the research protocols were of good quality, 15 could be used after revisions, and 10 were unfit for
use. Eleven of the research projects were not finished 5 years after they were started. A written report was produced from
26 of the projects. Nine were of good quality and could be accepted for publication in a medical journal, 10 of the reports
were in need of revision before publication, and 7 should not be accepted for publication.
Conclusion: Research in this field ought to be improved, and ways to improve the standard of clinical trials in pharmacotherapy are
dicussed.
Received: 1 April 1996 / Accepted in revised form: 28 June 1996 相似文献
85.
86.
因症就诊检出早期大肠癌的临床及病理学特征 总被引:1,自引:0,他引:1
目的探讨在就诊的肛肠病人中如何提高早期大肠癌的检出率。方法在11家医院推广对肛肠病人的四项检查程序——直肠指检,乙结镜检查,大便隐血试验,和X线气钡灌肠造影。结果在4821例有肛肠症状的病人中,检出大肠癌188例,检出率为3.9%,其中180例有术后病理诊断。47/180例(26.1%)属早期癌(DukesstageA)。41/47例由上述四项检查作出初步诊断。初发症状为:(1)便血(26例,持续15.2±9.4周后就诊,肿瘤平均直径2.58cm);(2)大便习惯改变(9例,33.4±19.7周,3.39cm);(3)腹痛腹块(10例,19.2±11.2周,5.0cm);(4)贫血(2例,17.2±9.9周,4.75cm)。8/12例的A0和A1期病例属便血组,并多位于直肠。41/47例以高、中分化腺癌为主,其中15例伴有腺瘤癌变。术前曾作活检的27例中,12例未检出癌变细胞。结论四项检查对检出早期大肠癌是有效的,便血是提示早期癌最有价值的症状,加强大肠癌防治宣教,采用瘤灶多点或全瘤活检技术,高度重视大肠腺瘤和不典型增生等癌前病变,将有助于提高早期大肠癌的检出率 相似文献
87.
What should nurse teachers be doing? A preliminary study 总被引:1,自引:0,他引:1
Heather A. Cahill BSc RGN RMN RCNT RNT Cert Ed 《Journal of advanced nursing》1997,26(1):146-153
There is little doubt that the role of the nurse teacher is complex and multifaceted in nature. The apparently conflicting demands of NHS trusts and education in the United Kingdom, at the time of integration of nurse education into the higher education sector, further complicates the role. This recognition underlines the need to capture and measure key aspects of nurse teacher function in order to maximize educational gain. Using a comprehensive literature review, focus group discussions and a small number of individual semi-structured interviews, this preliminary study explored the issue of teacher workload, from the perspective of the principal stakeholders in nurse and higher education. Competing research and clinical practice objectives for nurse teachers are identified against a background of changing health care provision, reduced availability of placements and an increased need for evidence-based practice. 相似文献
88.
不断强化医务人员的服务意识是消除医患纠纷的首要条件,认真培养敬业精神是避免医患纠纷的根本途径;提高道德境界是避免医患纠纷的决定因素. 相似文献
89.
P. Bertram K. -H. Treutner G. Winkeltau H. -J. Booß G. Staatz Prof. Dr. V. Schumpelick 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1993,378(4):249-254
Zusammenfassung Die Pneumatosis cystoides intestinii (PCI), das Auftreten submuköser oder subseröser, gasgefüllter Zysten in der Wand des Gastrointestinaltrakts, tritt als seltene Erkrankung ohne eindeutige Geschlechtspräferenz vorwiegend in der 3. bis 5. Lebensdekade auf. Atiopathogenetisch werden unterschiedliche Faktoren diskutiert, am wahrscheinlichsten ist eine bakterielle Ursache (Clostridium perfringens) in Verbindung mit einer minimalen Unterbrechung der Mukosaintegrität. Eine pathognomonische Symptomatik gibt es nicht, das klinische Bild reicht von asymptomatischen Zufallsbefunden bis zur Hämatochezie. Die Diagnose wird durch den Nachweis der Gaseinschlüsse mittels Abdomenübersichtsaufnahme und Kolonkontrasteinlauf gestellt. Als Behandlungsmethoden für symptomatische Patienten stehen Sauerstofftherapie, Antibiotikagabe (Metronidazol) und in schweren Fällen die Resektion des betroffenen Darmabschnitts zur Verfügung.
Pneumatosis cystoides intestinalis (PCI), a condition involving submucosal or subserosal gas-containing cysts of the wall of the gastrointestinal tract, is a rare entity. It is mostly diagnosed between the third and fifth decades of life without a clear sexual predominance. Different aetiopathogenetic factors are under discussion, the most probable being a bacteriologic cause (Clostridium perfringens) in combination with minimal leaks in mucosal barrier. There are no pathognomonic symptoms; the clinical picture ranges from incidental findings to haematochezia. Diagnosis is based on plain abdominal film and X-ray following barium enema. Methods of treatment in symptomatic cases are oxygen and antibiotic (metronidazole) therapies and, in severe cases, resection of the diseased part of the intestine.相似文献
90.
In the last few years, survival of patients infected with human immunodeficiency virus (HIV) has been improved because of a decreased incidence of some opportunistic complications attributable to prophylactic treatments and antiretroviral drugs. The impact of these agents should also be reflected in the quality of life (QoL) of patients. We have reviewed this topic with an emphasis on different types of measurements such as Q-TWIST, MOS and the Spitzer score which seem to be most appropriate for this patient population. We do not think that a special type of assessment should be designed for HIV-infected persons. It would be less time-consuming to improve already existing validated scores focusing on HIV infection. QoL in intravenous drug users with HIV should be evaluated more often. 相似文献