应用现代口腔粘结技术治疗儿童下颌骨骨折

目的:探讨口腔粘结技术对儿童下颌骨骨折的治疗效果。方法:对37例儿童下颌骨骨折应用复合树脂粘结固定夹板,其中 4例应用复合树脂直接固定;13例实施尼龙丝结扎-复合树脂固定夹板;12例实施贴钩-尼克丝-复合树脂固定;3例应用金属丝弓一复合树脂单颌固定;5例实施牙列贴钩 带钩丝弓-复合树脂颌间弹性牵引。结果:37例儿童下颌骨骨折中有35例咬合关系恢复正常,2例 有轻度错(牙合),经调(牙合)后咬合关系正常。结论:儿童混合牙列时期乳、恒牙交替及牙齿形态特殊,又儿童下颌骨中含有牙胚不易手术治疗,而常规牙弓夹板固定困难,因此,应用复合树脂粘结固定夹板治疗儿童下颌骨骨折是一项简易、高效的技术。     

238例复治肺结核病人耐药状况分析

目的 了解复治肺结核病人形成原因和耐药状况，分析结核病控制策略的效果。方法 分析1999年湖北省耐药监测入选238例复治涂阳培阳病例既往病史和耐药状况；药敏试验采用比例法，培养基中药物浓度分别为S 4μg/ml、H 0．2μg/ml、R 40μg/ml和E 2μg/ml；结果 总耐药率为44．5％，耐多药率为21．8％，在综合医院、乡镇卫生院和结防专业机构治疗造成的耐药率和耐多药率(含H和R)分别为56．4％、31．3％、46．3％和30．8％、15．0％、20．8％。结论 治疗不规范是导致耐药率和耐多药率升高的原因，建议加强结核病人归口、化疗和全程督导管理，进一步完善结核病控制策略，减少复治病例和耐药的产生。     

第一、二鳃弓综合征颜面不对称的整形外科矫治

目的探讨第一、二鳃弓综合征面部不对称畸形的整形外科矫治方法。方法根据第一、二鳃弓综合征患者临床及X线所示面部双侧不对称情况,采用健侧下颌骨外板去除、颧骨截骨降低;患侧下颌体、颧骨应用健侧下颌骨外板贴附植骨或高密度多孔聚乙烯(Medpor)假体置入等术式,配合颏部水平截骨颏成形术,以缩小面部双侧宽度的差异,矫治颜面不对称畸形。结果共矫治23例,经6个月至3年的术后随访观察,双侧面部宽度差异明显缩小,正面观面部不对称明显改善。结论第一、二鳃弓综合征面部骨骼发育畸形是三维方向的,双侧面骨宽度的差异,是造成正面观面部不对称的重要因素,根据受术者的具体情况,采用以上术式的组合,扩充患侧或同时缩窄健侧骨骼,进行面部骨性支架重建,可以取得良好的矫治效果。     

心肌显像联合冠状动脉造影及组织学检查在评价Ad-HGF治疗猪心肌梗死疗效中的价值

目的探讨心肌静息显像联合冠状动脉造影及组织学检查在评价重组腺病毒-肝细胞生长因子（Ad—HGF）治疗猪实验性心肌梗死中的价值。方法低、中、高剂量Ad—HGF治疗组[Ad-HGF剂量依次为10^8，4×10^8，5×10^9空斑形成单位（PFU）／点；均分10点注射]，生理盐水对照组及空白对照组小型猪各5头，分别于治疗前后行静息心肌显像及冠状动脉造影，并于治疗后行组织学检查。结果空白对照组及生理盐水对照组治疗前后心肌灌注及Rentrop评分无明显变化。各Ad-HGF治疗组治疗后心肌灌注及Rentrop评分较治疗前改善，低、中、高剂量组治疗前后冠状动脉左回旋支（LCX）供血节段得分分别为7．8±1．3和16．4±1．1（低），8．2±1．6和17．6±0．9（中），8．4±1．5和19．0±0．7（高）；各组治疗前后LCX供血区域Rentrop评分分别为0．80±0．16和1．66±0．15（低），0．94±0．11和2．16±0．11]（中），0．90±0．22和2．22±0．19（高）。3组治疗前后数据比较差异均有统计学意义（P〈0．01）。各Ad-HGF治疗组及空白对照组治疗后血管数量明显多于生理盐水对照组。结论用心肌静息显像联合冠状动脉造影及组织学检查评价Ad-HGF治疗猪心肌梗死的疗效有价值。     

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。     

Mirror foot: treatment of three cases and review of the literature

Purpose  To describe three cases of mirror foot and to develop a new classification of the mirror feet with an emphasis on their treatment. Methods  Surgical treatment was performed on three patients with mirror foot. Mirror feet in the English literature were surveyed and cases found in PubMed as well as our three cases were classified according to a new classification that was an analogy of the mirror hand classification proposed by Al-Qattan et al. (J Hand Surg Br 23:534–536, 1998). Results  All three cases obtained satisfactory outcome after the treatment. In addition to these cases, 28 mirror feet were well described in the English literature, among which only seven cases have been documented for their treatment. All of the cases could be assigned to one of the categories of the proposed classification. Conclusion  Mirror foot is a very rare congenital deformity of the foot. We successfully treated three novel cases of mirror feet. A classification of the mirror feet proposed in this article was useful in order to understand its nature and obtain a guideline for its treatment.     

直肠癌Miles术后并发内疝性肠梗阻的防治(附5例报告)

目的:探讨直肠癌Miles术后内疝性肠梗阻的原因、预防和诊治.方法:对1998年1月至2006年10月间收治的直肠癌Miles术后并发内疝性肠梗阻5例进行回顾性分析.结果:Miles术后并发内疝性肠梗阻的发生率为6%(5/82),表现术后不同程度的腹胀,阵发性腹痛,呕吐,胃管引流液每天超过500 mL者,结肠造瘘口无排气排便;腹部轻压痛,肠鸣音活跃或亢进.腹部立、卧位X线片检查,均发现肠腔扩张、多个液平或孤立性肠袢扩张.5例均行剖腹探查而证实,疝内容物为回肠,其中行单纯粘连松解复位2例,部分回肠切除、端端吻合术3例.再次手术后均痊愈出院.结论:Miles术后内疝性肠梗阻常缺乏典型的临床表现,早期诊断和及时剖腹探查是处理的关键,其重点在于预防.     

Febrile seizures - treatment and outcome

Assessment of treatment strategies in febrile seizures should be based on short- and long-term outcomes, with and without acute, intermittent, or chronic medical intervention, as well as short- and long-term side effects. Febrile seizures are a benign condition with a normal neurological, motor, intellectual, and cognitive long-term outcome and have a low risk of later epilepsy in most cases. Even many complex febrile seizures have a benign outcome. Prophylaxis may or may not reduce the recurrence rate, but does not appear to improve the long-term outcome as compared to acute treatment of seizures in progress. All agree that chronic prophylaxis with anti-epileptic agents is justified only in highly selected cases, if at all. Treatment with benzodiazepines during febrile episodes appears to effectively reduce the recurrence rate, provided adequate doses are given and compliance problems minimized. A selective approach to intermittent diazepam prophylaxis seems rational, as the recurrence risk and response to treatment are highly variable. An attractive alternative is acute treatment at seizure onset with rectal diazepam in solution given by the parents at home in order to prevent prolonged recurrent seizures. This regimen has the potential of moving the first line of anti-convulsant defence close to the child. It appears to be effective, inexpensive, feasible even for non-professionals, has few side effects and is well accepted by the parents. A reasonable policy would be to treat simple febrile seizures solely with acute rectal diazepam in solution and reserve intermittent diazepam prophylaxis for selected cases including those with multiple or prolonged recurrences, several risk factors for recurrent febrile seizures and other special situations.     

Voices of the Afflicted

Over the past 10 years, I have been privileged to conduct educational forums for audiences containing many recovering alcoholics or otherwise chemically dependent persons. In these forums about the addictive diseases and their treatment and research possibilities, significant interaction with the audience members occurs. During these interactions, certain anecdotal phenomena seem to predominate. The repetitive nature of these reports suggests the need for systematic investigation. As with editorial comments in major medical journals, observed phenomena and unanswered questions from those afflicted can be valuable in the generation of testable hypotheses. Perhaps the ideas presented herein will be useful in the development of future research on alcohol abuse and alcohol dependence.     

Brain stem tuberculoma in adult patients: Diagnosis and treatment

A consecutive series of six adult patients ranging in age from 29 to 53 years is presented. The clinical and radiological features in each patient are described. Attention is drawn to the features demonstrated on computed axial tomography. In only one patient, the first encountered, was surgical excision undertaken and histological verification obtained. One patient died before any form of treatment could be instituted. The remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography. The excellent response and good outcome in this conservatively treated group are documented.