医源性胆管损伤的诊治体会

目的探讨手术中胆管损伤后即时手术和再次手术处理的方法。方法回顾性分析1984年5月-2003年11月经作者手术或参与手术21例的临床资料。结果术中即时发现并处理6例。其中，成功4例，术后狭窄再次手术治愈1例，处理结果不满意1例。术后处理15例，均择期行胆肠吻合治愈。结论术中处理结果与损伤程度和胆管横径大小密切相关。术后因各种原因导致胆管狭窄者应行胆管空肠吻合术。     

空心钉经皮微创内固定技术治疗骨盆环损伤的疗效评价

目的：评价经皮微创空心钉固定骨盆环损伤的安全性及可靠性。方法：对48例不稳定骨盆环损伤患者，分别行闭合复位、经皮微创空心钉内固定术。按Tile分型：B1型4例，B2．1型8例，B2．2型10例，B3型4例，C1型11例，C2型7例，C3型4例。39例前后环损伤均固定，4例仅固定前环损伤，5例仅固定后环损伤。以术前骨盆的三位x线片（前后位、入口位及出口位）及CT片判断骨盆的稳定性及移位情况，术后以x线片及CT片评估复位情况及螺钉位置准确性。结果：手术时间15～95min，平均55min。术中出血量15～150ml，平均60ml，术中及术后无输血。48例患者共植入空心钉157枚，每人2～8枚，平均3．3枚。术后行骨盆CT检查42例（共植入135枚空心钉），发现123枚空心钉位置准确，占91．11％；7枚空心钉因偏向或超长而侵入盆腔或髋臼（但均〈0．5em）；5枚位置偏差干扰骶管或骶孔，但均未引起任何症状。随访8～49个月，平均13个月，45例患者骨盆环移位复位满意，所有骨折均Ⅰ期愈合。40例恢复原工作，4例末次随访时尚处康复期，其余4例因坐骨神经损伤或下肢截肢而不再工作。参照Lindahl改良的骨盆损伤后功能评定标准，优35例，良10例，可3例，平均得分78.7分。结论：在对骨盆环及其毗邻血管神经的解剖结构熟练掌握的基础上，结合良好的透视引导，闭合复位经皮微创空心钉内固定治疗不稳定骨盆环损伤安全可行，疗效满意。     

宁夏高校新生乙型肝炎知识和正向态度的调查

目的：调查宁夏地区大学生新生有关乙型肝炎防治知识的认知情况，为开展健康教育提供基线资料。方法：采取分层整群抽样方法，对宁夏1000名大学新生进行问卷调查。结果：对乙型肝炎一般知识、传播途径的正确回答率宁夏医学院新生高于宁夏大学和宁夏农学院新生，传播途径得分女生高于男生；正向态度得分宁夏大学新生高于其它2校，汉民高于回民；乙肝的一般知识、传播途径及正向态度得分城市学生均高于农村，差异均有显著性。结论：大学生对乙肝的防治知识有一定了解，但不全面，不系统，不均衡，开展健康教育非常重要。     

双环法旋转圆锥状腺体蒂乳房缩吊术

目的改进传统的双环法在乳房缩小术、乳房悬吊术术后外形扁平，凸度不足，上极瘪陷，提升不够等缺点。方法采用双环切口。“扇”形分离、切除皮下部分脂肪，“楔”形切除适量的外上象限腺体，螺旋状旋转剩余腺体成圆锥状，将其固定在第2肋软骨膜上，矫正轻中度乳房肥大和下垂。结果术后随访20例患者1～3个月，乳房上极较丰满，形态好，乳头乳晕功能正常，切口瘢痕轻，乳房肥大和下垂的矫正获得了满意的效果。结论双环切口，螺旋状旋转剩余腺体成圆锥状，并固定于第2肋软骨膜上，可较好地塑形并悬吊乳房，其切口相对隐蔽，术后乳房高凸，上极略饱满，乳头微上翘，乳晕形态合适，是矫正轻中度乳房肥大下垂的一种较理想的术式。     

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。     

颌骨陈旧性骨折与发育畸形同期联合治疗

目的探讨陈旧性骨折与颌骨畸形同期联合手术治疗的可行性。方法伴有颌骨发育畸形的陈旧性骨折患者，在骨折手术复位的同时行上颌LeFort-I截骨术下颌矢状劈开术（SSRO），治疗发育畸形。结果6例患者术后均I期愈合。术前术后投影测量指标显示，患者正侧貌、审美平面及鼻唇角等指标有明显改善。结论在修复颌骨创伤畸形的同时，解决了颌骨发育畸形所带来的形态及功能障碍，陈旧性骨折与颌骨畸形同期联合治疗是可行的。     

'Jumping through hoops': parents' experiences with seeking respite care for children with special needs

Background   Respite care may act as a means to reduce stress and fatigue in people caring for a dependent who has a disability. Despite this, a variety of barriers may exist to obtaining such services. This study explored caregivers' experiences seeking respite care for their children with special needs within a province in Canada.
Methods   Caregivers were recruited from two agencies providing respite care for children with fetal alcohol spectrum disorders and other mental health and developmental difficulties. In total, 10 caregivers participated in in-depth individual interviews. A constructivist grounded theory approach was employed in the design and analysis of the data.
Results   Caregivers discussed their frustrations with the process of finding and obtaining respite care, a course of action described as 'jumping through hoops'. This construct was composed of subcategories emphasizing the complexity of 'navigating the system', the bidirectional process of 'meeting the requirements' and the challenges of 'getting help'.
Conclusions   The collective experiences of these caregivers point to the need for more flexibility and co-ordination of respite care services for children with special needs.     

The chronic fatigue syndrome – an update

Background –  In this article, current scientific knowledge on the chronic fatigue syndrome (CFS) is reviewed. The US case definition of CFS (the CDC-definition) is most widespread in research and clinical practice. Estimates of prevalence vary from 0.2% to above 2%. The female–male ratio is approximately 3:1.
Clinical Features –  Severe fatigue is the dominating complaint; it is worsened from exertions and not substantially relieved by rest. In addition, the patients might have a varying combination of accompanying symptoms. Clinical evaluation should be based upon standardized guidelines, including an assessment of functional impairments.
Pathophysiology –  The pathophysiology should be interpreted within a biopsychosocial framework. Present knowledge suggests that certain genetic polymorphisms and personality traits might be regarded as predisposing factors, some infections and severe psychosocial stress constitute precipitating factors, whereas disturbances of immunity, skeletal muscle, cognitive abilities, endocrine control and cardiovascular homeostasis are possible perpetuating factors.
Treatment –  Cognitive behavioural therapy and graded exercise therapy are of proven value in randomized controlled trials. Several pharmaceutical measures have been explored and found to have no beneficial effect. Most patients might expect long-term improvement, but full recovery is rare; however, the prognosis is better among adolescents.     

浙江省温州市2004年结核病监测结果分析

目的 通过分析温州市2004年结核病监测资料评价现行的防治措施效果.方法 收集并分析温州市2004年结核病监测报表.结果监测点涂阳新登记率为27.45/10万,其中流动人口为26.84/10万,流动人口病例涂阳比例（68.3%）明显高于总人口病例涂阳比例（45.9%）,新登涂阳病例1年转归队列分析治愈率为86.6%.结论 提高涂阳病人的发现率依然是本地区结核病控制工作的重点,流动人口结核病问题不容忽视.