米非司酮治疗异位妊娠68例疗效观察

目的评价米非司酮用于保守治疗异位妊娠的疗效。方法所选病例均住院治疗，予口服米非司酮50mg，每天两次，连服6天，定期复查B超和测定血p—HCG水平以观察疗效。结果68例异位妊娠患者的治疗，治愈46例，治愈率67．7％。结论米非司酮保守治疗异位妊娠疗效确切，副作用小。     

Calcium entry blocker: Treatment in acute pain in cluster headache patients

15 chronic cluster headache patients in whom pain was induced by nitroglycerin received acute intravenous treatment with a calcium entry blocker. At the time of peak pain we noted a sudden decrease after the Verapamil injection. The mechanism by which the calcium entry blocker afforded relief is unlikely to have been vasodilatation in patients whose blood vessels had just been dilated by nitroglycerin. A more probable mechanism is blockade of the release of the pain-inducing neurotransmitters. The vasodilatation phase is not a primary factor in the onset of pain.

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Sommario Sono stati studiati 15 soggetti affetti da Cluster cronica inducendo loro la crisi dolorosa con Trinitrina, trattandoli poi con calcio antagonista (Verapamil) per via endovenosa. Al momento dell'apice del dolore, valutato dal paziente con un analogo visivo, la somministrazione di Verapamil endovena, determina una rapida estinzione del dolore. L'azione efficace del Ca-antagonista non può sicuramente essere rapportata alla vasodilatazione poiché la crisi dolorosa insorge già in una fase di vasodilatazione per l'azione della Trinitina. Il meccanismo d'azione più probabile è il blocco del release di neurotrasmettitori inducenti l'attacco doloroso. Si sottolinea che la vasodilatazione non è il fattore primario dell'induzione del dolore.

     

Choices in oncology: factors that influence patients' treatment preference

Medical treatment of cancer often entails a trade-off between outcomes of two different attributes: quality of life (QOL) and length of life (LL). This process of weighing advantages and disadvantages seems to be influenced by different factors. The main purposes of this study were (a) to investigate the relative importance of different factors on the trade-off and (b) to explore the relationship between these importance ratings and personal characteristics. We asked 199 patients with cancer to indicate to what degree they consider a number of factors to be of importance if they had to choose between two treatment modallties that differ in their expected outcomes concerning QOL and LL. The seven factors were their age at the time of decision, having a partner, having children, inability to work due to side-effects of the treatment, the nature of the side-effects, disease-related life expectancy and baseline QOL. The results indicate that six of the seven factors were of considerable to great importance when a treatment choice had to be made. The negative effects of treatment on the ability to work did not seem to be a very important consideration. Patient age and education were positively associated with importance ratings.Supported by the Dutch Cancer Society (Project IKW 90-13).     

骨盆骨折槽型固定器的研制及临床应用——附62例临床分析

为解决骨盆不稳定性骨折固定难，易产生并发症的难题，结合骨盆的特征进行研究，设计出一种新型骨盆骨折固定器，经62例骨盆不稳定性骨折的治疗观察，随访6个月～2年零6个月，治疗前后X线检查及临床疗效评定：治愈50例，好转12例，认为该固定器设计合理，操作简便，固定牢靠，有加压、撑开、纠正旋转等多项功能结合干一体，仅通过四枚4mm螺纹针，穿入髂骨的髂前上棘处，是一种治疗骨盆不稳定性骨折比较新颖和理想的外固定器。     

医源性小儿气管及支气管破裂外科治疗方法的选择

目的探讨医源性小儿气管、支气管破裂的外科治疗方法．方法根据气管、支气管破损程度，分别采用颈部深筋膜切开１４例，胸膜腔闭式引流１０例，气管膜部修补５例，病肺切除术２例．结果本组３１例患儿全部治愈．结论严密观察，及时处理，恰当选择外科手术方法是提高疗效的关键．     

产后子宫内翻临床分析

目的 提高对产后子宫内翻诊治及预防的认识。方法 回顾性分析我院收治的3例子宫内翻患的临床资料。结果 3例年龄分别为26、28、29岁，均有多次生育史，临床表现为出血、休克、疼痛、阴道口见脱出的红色球状肿物，多伴有排尿困难。第三产程的非适当处理为其主要原因。结论 提倡新法接生，提高助产技术，正确处理第三产程是预防子宫内翻的关键。而提高对子宫内翻的认识，早期发现，及时正确的处理，又是治疗子宫内翻的关键。     

A 5-year retrospective analysis of employer-provided dental care for Finnish male industrial workers

Abstract The treatment-mix, treatment time, and dental status of 268 male industrial workers entitled to employer-provided dental care were studied. The data were collected from treatment records of the covered workers over the 5-year period 1989-93. Treatment time was based on clinical treatment time recorded per patient visit, and the treatment procedure codes were reclassified into a treatment-mix according to American Dental Association categories, with a modification combining endodontics and restorative treatment. The mean number of check-ups followed by prescribed treatment (treatment courses) during the 5 years was 3.7 among those who had entered the in-house dental care program prior to the monitored period (old attenders). Their treatment time was stable, 57–63 min per year, while the first-year mean treatment time (170 min) of those who had entered the program during the study period (new attenders) was significantly higher (P<0.01) than the 5-year mean of the old attenders (61 min). Over the first 2 years, the treatment-mix of the new attenders showed a rise in diagnostic and preventive procedures from one-third to about one-half of all procedures, as it was for the old attenders. The new attenders' mean number of carious teeth (2.7), registered at the initial check-up visit, paralleled the mean recently demonstrated in the similar non-covered population. It was significantly higher than the 5-year mean of the old attenders (0.5) (P<0.001), but declined to the same level after the first year of treatment. It was concluded that the studied program seemed to contribute to a stabilization of treatment-mix, and to the establishment of a shorter annual treatment time within the first 2 years of treatment.     

Down-regulation of rat β-adrenoceptors by clenbuterol or desipramine does not require chronic treatment: [H]CGP-12177 binding reveals rapid (24 hour) modulation

Desipramine (DMI, 15 mg/kg, s.c.) decreased [³H]CGP-12177-labelled cortical β-adrenoceptor density (B_max) by 30% upon chronic (14 day) treatment. However, even a single dose (in mg/kg) of DMI (15) or the β-adrenoceptor agonist, clenbuterol (20), induced a rapid (24 hour) and significant reduction of β-adrenoceptor B_max (−15%; p<0.01). Acute treatment with amitryptiline (10), clorgyline (1), fluoxetine (10), nomifensine (10) or maprotiline (20) had no significant effect on [³H]CGP-12177-labelled β-adrenoceptors, suggesting that rapid down-regulation may not be a general property of antidepressant drugs. None of the antidepressants altered the B_max of [³H]ketanserin-labelled 5-HT_2A receptors on acute treatment. These results show that β-adrenoceptor down-regulation by clenbuterol and DMI is not dependent on chronic treatment and may, therefore, be a poor correlate of the gradual onset of therapeutic efficacy seen clinically with antidepressant drugs.     

Health-related quality of life under six months' treatment of migraine—an open clinic-based longitudinal study

Health-related quality of life (HQL) assessment in the clinical setting have distinguished subjective perceptions (e.g. well-being), signssymptoms of the disease, and functional capacity as three major components. The impact of short-term treatment for migraine attacks on these variables was evaluated in an open prospective 6-month study at the Gothenburg Migraine Clinic. Socio-economic factors, subjective symptoms, and general well-beingquality of life were evaluated by self-administered questionnaires in 99 patients with migraine with or without aura in accordance with the classification of the International Headache Society. Short-term treatment comprising conventional therapy or subcutaneous sumatriptan reduced number of days per month with migraine and absenteeism from work, migraine-associated symptoms, but did not significantly improve general well-being between attacks. Future assessment of the patients' HQL in accordance with this approach would enable us to consider all the advantages and disadvantages of current therapies of particular interest in the field of migraine.