小儿重肾31例分析

目的　探讨小儿重肾的诊断及治疗。方法　对我院 1989～ 2 0 0 1年收治的 3 1例小儿重肾进行回顾性分析。结果　 3 1例中有 2 3例患儿接受 2 6次手术 ,有 16例行上半重肾及输尿管切除 ,其中有 2例须处理输尿管残端及盲袋所致的梗阻。 2 2例手术后恢复较好 ,仅 1例伴有轻度的尿失禁。结论　对于重肾伴肾积水或发育不良所致的各种临床表现应首先考虑做上半肾及输尿管大部切除术。B超、CT及静脉肾盂造影术 (IVP)对诊断分型有意义。     

胰腺囊性肿瘤15例分析

作者报告了该院３０年来经手术及病理证实的１５例胰腺囊性肿瘤，男５例，女１０例，其中囊腺瘤３例，囊腺瘤恶变３例，囊朱癌９例，肿瘤位于胰尾部８例，体尾部６例，胰头部１例。２例有肝转移，１例肿瘤浸润胃后壁，根治生切除１０例，单纯肿瘤切除、肿瘤切除加肝转移瘤局部切除、囊腺癌内外引流、肿瘤活检各１例。术后死亡１例。随访１２例，１０例效果满意，２例囊腺癌行内外引流者术后６、９个月死亡。文中讨论了胰腺囊性肿瘤的     

李辅仁治疗老年脑部疾患的经验

治疗脑出血,急症抢救期先以安宫牛黄丸之类芳香开窍醒脑,并予以止血,待神志清醒,血压稳定后,再施以补气活血、化瘀通络、平肝潜阳之法,脑血栓亦先开窍醒脑,后用自拟安脑化瘀汤以安脑通络、活血化瘀治之;老年性痴呆则以滋补肝肾、填精健脑为主,佐平肝活血、醒脑开窍为辅,药用自拟醒脑复聪汤;蛛网膜下腔出血以清脑醒神、镇痉熄风为治,药用自拟清脑熄风汤。     

原发性骨质疏松骨折治疗探讨

目的　探讨原发性骨质疏松骨折的治疗方法。方法　对 138例原发性骨质疏松骨折 ,在治疗骨折的同时采用联合用药 ,中西医结合用药及脉冲电磁场进行病因学治疗。结果　 138例中 134例获得 8～ 36个月 ,平均 13.5个月的随访 ,按优、良、可、差疗效评定标准 ,优 4 8例 ,良 6 2例 ,可 14例 ,差 6例 ,优良率 85.1% ,另 4例半年后死于其它疾病。结论　原性骨质疏松性骨折必须在进行骨折治疗的同时 ,进行骨质疏松病因学的治疗 ,二者结合才能收到较好的疗效     

Initial lithium augmentation improves the antidepressant effects of standard TCA treatment in non-resistant depressed patients

The hypothesis was tested that an initial lithium-tricyclic antidepressant (TCA) combination has a better antidepressant effect than standard TCA treatment in non-refractory depression at the beginning of an episode. Twenty bipolar melancholic type depressed inpatients under lithium-TCA treatment were compared with 20 patients with the same diagnosis and TCA-placebo treatment for 5 weeks under double-blind conditions. All patients were male. Initial lithium-TCA treatment reduced depressive symptoms significantly more than antidepressant treatment with TCA and placebo after 5 weeks, but not in weeks 1 or 2. It can be concluded that lithium augmentation of TCA treatment should be started even at the beginning of antidepressant TCA treatment to provide a better treatment response in those patients who will profit from long-term lithium prophylaxis, e.g. bipolar patients with melancholic type depression.     

The role of different imaging modalities: is MRI a conditio sine qua non for ETV?

Objective To describe the different imaging modalities used for the diagnosis and classification of hydrocephalus, their role in defining the optimal treatment of hydrocephalus and to define the optimal preoperative diagnostics for endoscopic third ventriculocisternostomy (ETV). Methods An overview on available imaging modalities for hydrocephalus will be given and their pros and cons discussed. In addition, different aspects of the treatment of hydrocephalus by shunts and by ETV will be highlighted. Discussion The role of the technical aspects of performing an ETV, the role of the surgeon’s philosophy, the role of the urgency of the procedure, and the role of informed consent on the requirements for the imaging of the hydrocephalus will be discussed. Conclusion The authors conclude that MRI is a conditio sine qua non for ETV in elective surgical cases.     

Aspergillus osteomyelitis of the thumb in a 5-year-old child

Aspergillus osteomyelitis is a rare condition and is a recognized infection of the immunosuppressed. The pediatric cases that were documented suggest that in children, chronic granulomatous disease is the major underlying disease [Tack et al.1982 73(2):295–300, Baez-Escudero et al. 2000 Case report—primary sternal Aspergillus osteomyelitis. Infect Med 17(7):505–516]. We report an interesting case of Aspergillus osteomyelitis of the thumb in a 5-year-old boy with aplastic anemia. The infection progressed despite a combination of antifungal therapy with Voriconazole and surgical debridement. The thumb was amputated and the child recovered. This case highlights the difficulty in diagnosing Aspergillus osteomyelitis and also the failure of conventional management in this child, which resulted in the amputation of the thumb as a life-saving measure. We believe this to be the first case report of Aspergillus osteomyelitis in the thumb.     

Congenital toxoplasmosis—prenatal aspects of Toxoplasma gondii infection

Toxoplasma gondii (T. gondii) is the cause of toxoplasmosis. Primary infection in an immunocompetent person is usually asymptomatic. Serological surveys demonstrate that world-wide exposure to T. gondii is high (30% in US and 50–80% in Europe). Vertical transmission from a recently infected pregnant woman to her fetus may lead to congenital toxoplasmosis. The risk of such transmission increases as primary maternal infection occurs later in pregnancy. However, consequences for the fetus are more severe with transmission closer to conception. The timing of maternal primary infection is, therefore, critically linked to the clinical manifestations of the infection. Fetal infection may result in natural abortion. Often, no apparent symptoms are observed at birth and complications develop only later in life. The laboratory methods of assessing fetal risk of T. gondii infection are serology and direct tests.Screening programs for women at childbearing age or of the newborn, as well as education of the public regarding infection prevention, proved to be cost-effective and reduce the rate of infection.The impact of antiparasytic therapy on vertical transmission from mother to fetus is still controversial. However, specific therapy is recommended to be initiated as soon as infection is diagnosed.     

颌面部髓外浆细胞瘤

髓外浆细胞瘤为少见疾病,发生在颌面部软组织者更少见。本文结合一典型病例的临床诊治过程,分析研究其发病原因,临床及病理分型和诊断方面存在的问题。提出颌面部髓外浆细胞瘤良性及恶性其主要临床特征和有关的诊断依据。治疗仍多采用综合方法。恶性者放疗总剂量多在5000Gy以上,化疗以COP,COAP、COAAP方案为主,散在病损可行激光治疗效果良好。     

Erfahrungen zur PFFB von isolierten radiusköpfchenfrakturen

Zusammenfassung Den Vorteilen einer osteosynthetischen Versorgung einer Fraktur mit sofortiger Aufnahme seiner Funktion, stehen die aus der Literatur bekannten Komplikationen gegenüber. Diese und unsere eigenen unbefriedigenden Ergebnisse nach der operativen Versorgung von Radiusköpfchenfrakturen ließen uns zu einer prospektiven randomisierten Studie einer primär funktionellen Behandlung unter Verzicht auf eine äußere oder innere Stabilisierung greifen. Seit Dezember 1991 haben wir im UKH-Graz bis einschließlich Dezember 1992 insgesamt 70 Patienten nach einem strikten Behandlungskonzept, unter Zuhilfenahme der Computertomographie zur Verlaufsbeobachtung versorgt. Die in 91% der Fälle als sehr gut and gut einzustufenden Frühergebnisse sowie das fehlende Auftreten einer, wie bei operativer Versorgung möglichen Komplikation, ebenso die zusätzlich deutlich frühere Arbeitsfähigkeit bzw. deutlich kürzere, wenn auch aufwendigere Behandlungszeit, lassen uns diese Verfahren nicht nur in unserem Hans weiterführen, sondern können wir auch weiter empfehlen.

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Experience with internal fixation of fractures of the head of the radius

The advantages of internal fixation of fractures, with the possibility of immediate resumption of the function of the fractured bone, are in contrast to the well-known complications described in the literature. These complications and our own unsatisfactory results after surgical treatment of fractures of the head of the radius induced us to carry out a randomized prospective study of primary functional treatment of such fractures without external or internal stabilization. From December 1991 through December 1992, a total of 70 patients were treated according to a strict treatment protocol at the Graz Hospital for Accident Surgery, and CT was used for observation of the healing process. The positive early results, which in 91% of all cases were classified as very good or good, the lack of complications that sometimes follow surgical treatment, the markedly earlier recovery of the patient's working capacity, and the clearly shorter — albeit somewhat more expensive — treatment period required have led us to continue using this method at our hospital and also to recommend its use elsewhere.