开放手术观察腰椎间盘突出症溶核失败45例分析

目的 通过开放手术观察分析椎间盘髓核化学溶解术治疗腰椎间盘突出症失败原因。方法 收集溶核失败的腰椎间盘突出症45例行开放手术治疗。结果 术中见45例硬膜外脂肪完全消失，43例髓核未见溶解，2例髓核溶解呈糊状但未被吸收，21例伴有侧隐窝狭窄，15例突出物与神经根粘连，20例黄韧带增厚，2例椎管骨性狭窄，14例突出物钙化。结论 腰椎间盘突出症病变间隙合并有侧隐窝狭窄、神经根粘连、椎管狭窄、突出物钙化等，不是溶核治疗的适应证。     

动态监测胃黏膜内pH值对胆源性胰腺炎外科治疗的价值

目的探讨胃黏膜内pH值对胆源性胰腺炎病情预后评估及在决定手术冶疗中应用的价值。方法对确诊的146例胆源性胰腺炎患者经鼻插入胃黏膜二氧化碳张力计（TRIP-NGS导管）测定胃黏膜内pH值，每隔12小时测定一次，并进行APACHEⅡ评分，将2组数据与外科治疗进行相关分析。结果①pH值变化反映胆源性胰腺炎病情发展变化，与器官衰竭数呈负相关；②外科干预治疗与内科治疗比较差异有统计学意义（P〈0．05）；③pHI〉7．25与pH〈7．25患者开腹手术病死率和细菌培养阳性率比较差异有统计学意义（P〈0．05）。结论pH值对胆源性胰腺炎外科治疗有指导意义。外科处理原则是：①胆道无梗阻，以内科保守治疗为主；②伴胆道梗阻，先行经内镜十二指肠乳头括约肌切开术、经内镜鼻胆管引流术、B超导引引流、腹腔灌洗等，如胆道引流不畅或pH值持续下降，则开腹手术。     

Predicting the experience of dentinal caries or restorative dental treatment in adolescents using D1 and D3 visual caries assessments

Standardised epidemiological caries assessments used in oral health surveys have been shown to be poor at predicting whether a tooth surface will be treated restoratively when a patient visits a dentist. However, it has been argued that oral health surveys may be more relevant in determining needs at the level of an individual or groups of individuals. The objective of this study was to determine the discriminatory power of visual caries assessments at two thresholds (D₁ & D₃) in adolescents of average age 12.1 years to predict experience of dentinal caries 3 years later or the experience of restorative treatment (not re‐treatment) during the 3‐year period. The data was derived from a prospective 3‐year longitudinal study in which the dental care provided by 41 dentists for 403 adolescents was monitored. Dental caries experience was monitored by annual standardised assessments of caries undertaken by a single trained examiner. ROC analysis showed that caries assessed visually at the D₁ threshold in 12‐year‐olds was a better predictor (P < 0.001) of experiencing some dentinal caries after 3 years (Az = 0.781) than was caries assessed visually at D₃ threshold in 12‐year‐olds (Az = 0.670). Assessing caries visually at either the D₁ or the D₃ threshold had no discriminatory power for predicting whether an individual would experience some restorative treatment during the ensuing 3‐year period (Az for D₁ = 0.507; Az for D₃ = 0.518).     

Pressure stability of nasal CPAP and bilevel devices

Summary Question of the study   Nasal continuous positive airway pressure (CPAP) prevents collapse of the upper airway during sleep in patients with obstructive sleep apnea provided that a positive transmural pressure can be maintained during inspiration. We examined pressure-flow characteristics in seven CPAP and bilevel devices during spontaneous breathing.
Methods   The CPAP devices were set to a pressure level of 9.8  hPa (10  cm H₂O) and adapted to a pneumotachograph using a standard CPAP hose and an outlet valve. We continuously measured flow, volume and pressure during resting ventilation and increasing voluntary hyperventilation and analysed the dependence of the variables on a breath-to-breath basis.
Results   Mean CPAP pressures differed between the devices (9.9 – 10.6  hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8  hPa and increased during expiration to 11.1 – 11.7  hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19  hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16  hPa. Inspiratory pressures dropped to 8.5 – 4.5  hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions   Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated.     

Treatment time analysis for extensive amalgam restorations

The treatment times for the fabrication of Extensive Amalgam Restorations (EAR) as recorded in a longitudinal clinical trial at the Dental School in Nijmegen were analyzed. 269 EAR's with different retention methods were made on molars by three operators. A mean total treatment time of 60 min was found. The factor operator had a significant influence on all treatment phases resulting in a 26% difference in total treatment time between operators. Also significant influences were found in some treatment phases for the factor retention, side location of the tooth and extension of the restoration. The results of this study with regard to treatment times must be considered from the perspective of the quality of the care provided.     

锁骨中段骨折--手术与非手术治疗比较

有些证据表明,锁骨中段骨折采用手术或非手术治疗都可以获得成功,但非手术治疗的并发症更少。数据多数来自病例组研究,因此还需要对比研究来证明这些原始数据的真实性。     

出血性脑室铸型的疗效分析

目的 探讨出血性脑室铸型的治疗方法与疗效。方法 分析脑室外引流、尿激酶脑室内注入、气管切开、控制血压以及脑积水的处理等多种治疗手段在治疗脑室铸型过程中的作用及其效果。结果 经过综合治疗完全恢复日常生活者10例(28．6％)，部分恢复日常工作或独立进行家庭生活者13例(37．1％)，生活需要照顾或护理者7例(20％)，死亡5例(14．2％)。结论 对于出血性脑室铸型这类重症病人早期及时的脑室外引流是快速而有效的抢救措施，尿激酶脑室内注入对溶解血凝块，疏通脑室系统行之有效。气管切开对降低死亡率至关重要，控制血压是防止再出血的关键。脑积水的处理是康复过程中需要高度重视的环节。     

原发性输尿管癌31例临床分析

目的：提高原发性输尿管癌的术前诊断水平。方法：对南京医科大学第一附属医院1989-2002年间收治的31例原发性输尿管癌的临床资料进行回顾性分析。结果：31例中，肉眼血尿22例(71．0％)，腰痛11例(35，5％)。B超、静脉肾盂造影(IVU)、CT和逆行造影检查的阳性率分别为输尿管腔内占位4例(13．0％)、输尿管腔内占位3例(11．5％)、膀胱或合并膀胱占位8例(36．4％)，输尿管充盈缺损6例(40．0％)。29例患者经手术治疗，其中13例行患侧肾、输尿管、膀胱袖状切除。结论：老年患者反复发作的腰痛及血尿应考虑原发性输尿管癌的可能，造影诊断对本病有较高价值，应作CT及MRU无创检查。     

Benign osteoblastoma of the occipital bone: Case report and literature review

We present a case of benign osteoblastoma of the occipital bone. Benign osteoblastoma is an uncommon primary bone tumor, which usually involves the vertebrae and the long bones. This tumor rarely develops in the calvaria, showing a preference for the temporal and frontal bones when it does. To the best of our knowledge, this case is only the eighth reported case of benign osteoblastoma confined to the occipital bone. A 20‐year‐old male presented with a mild tender mass lesion of the occipital area, just below the lambda. Plain X‐ray films and CT scans demonstrated an osteolytic mass surrounded by the sclerotic rim within the diploic space. MRI proved to be effective for the evaluation of the intracranial and intraosseous extensions of the tumor. However, it was very difficult to formulate a differential diagnosis against other osteoblastic tumors, or osteoid osteoma, in view of its radiological appearance. The final diagnosis was obtained by careful consideration of the histopathological characteristics of the tumor combined with its clinical and radiological features. Although generally regarded as benign, a complete resection is preferred over conventional curettage as this can guard against possible recurrence and malignant transformation.