上颌第一磨牙近中颊根第二根管的治疗体会

目的 探讨在临床上上颌第一磨牙近中颊根第二根管（MB2）的发现及扩通。方法 在25例需要进行根管治疗的上颌第一磨牙上寻找MB2，若无法找到，使用超声根管异物清除工作尖10P清理髓底及慢速圆钻去除预计位置部分牙本质，再次寻找。找到后通畅根管，若无法扩通，使用慢速圆钻在MB2根管口处向根方去除少量牙本质。结合使用EDTA再次通畅根管。结果 25颗治疗齿中有13颗找到MB2（52％），其中2颗是在超声根管锉清理髓室底后发现的，4颗在进一步去除MB2根管口位置的牙本质后发现。8颗治疗齿的MB2通畅（32％），其中3颗自然扩通，5颗在去除MB2根管口处部分矛本质并使用EDTA后通畅。结论 临床上上颌第一磨牙MB2发现率为52％。扩通率为32％。掌握MB2的解剖位置，使用超声方法以及EDTA可提高MB2的发现率和扩通率。     

交锁髓内钉治疗下肢长管状骨骨折的效果

①目的 探讨交锁髓内钉治疗下肢长管状骨骨折的效果。②方法 应用交锁髓内钉治疗下肢长管状骨骨折56例，随访8～26个月，观察治疗结果。③结果 56例病人术后对位、对线均满意，股骨骨折平均愈合时间为19．9周，胫骨骨折平均愈合时间为17．7周，2例延迟愈合。无主钉或锁钉断裂．无肢体短缩、功能障碍发生。④结论 交锁髓内钉是治疗下肢长管状骨骨折的一种理想、可靠的内固定方法，其疗效满意，值得临床推广应用。     

改进微波幅射器探头治疗宫颈糜烂疗效观察

目的：探讨改进的微波辐射器探头治疗宫颈糜烂的疗效。方法：将微波辐射器探头由双直线形、双针形、单针形等点线状改进成为“单舌形”和“双舌形”两种弧形平面探头，用于治疗宫颈糜烂。分析1999-2002年450例宫颈糜烂治疗资料，其中300例经微波治疗(A组)，150例经C02—激光治疗(B组)，随访1—3个月。结果：两组治疗后3个月内A组治愈率明显高于B组(P＜0．005)，总有效率A组明显高于B组(P＜0．025)。两组术中、术后不良反应比较：术中宫颈创面出血A组明显低于B组(P＜0．005)，术中腹痛、脱痂期出血量、术后局部感染率方面两组相似。结论：所改进的微波辐射器探头治疗宫颈糜烂治愈率高，操作安全，术后并发症少，医患乐于接受。     

Boerhaave’s syndrome: Primary repair vs. esophageal resection—Case reports and meta-analysis of the literature

Boerhaave’s syndrome is a life-threatening disease with a high mortality. With regard to the heterogeneity of treatment strategies, no comparative studies exist and recommendations remain controversial. Seventeen cases of Boerhaave’s syndrome operated on between 1989 and 2000 at our hospital were reviewed retrospectively to compare the time period between perforation and diagnosis, and the morbidity and mortality among the different treatment options. In addition, we conducted a meta-analysis of the literature including all series containing five or more patients and compared the findings with our own data. Our patients with a perforation history of less than 12 hours showed significantly fewer signs of sepsis compared to patients with a history of more than 12 hours. In a comparison of patients with primary repair vs. patients treated with esophageal resection or an exclusion operation, no differences were found. In the literature, patients with a long period of perforation (more than 24 hours) were treated more often with an esophageal resection than patients with primary repair. In cases of Boerhaave’s syndrome, primary suturing of the esophageal perforation should be reserved only for those patients presenting within 12 hours after perforation. In all other cases, depending on the extent of the tissue damage, a two-stage esophageal resection with cervical esophagostomy and gastrostomy is recommended as the safest treatment.     

胸腰椎骨折术后内固定松动、断裂的原因及预防

目的 探讨椎弓根螺钉系统用于胸腰椎骨折术后出现松动、断裂的原因，并提出相应的预防对策。方法 12例胸腰椎骨折术后内固定失效病例，采用RF系统3例，AF系统9例。均未行植骨融合，AF系统中未按要求安装横连结3例，术后伤椎前缘高度平均恢复至正常的85．2％。结果 术后8—21个月出现棒断裂4例，螺钉断裂3例，钉帽松动5例。结论 内固定物的自身问题、术者的经验欠缺及操作不规范是胸腰椎骨折术后椎弓根螺钉系统松动、断裂的原因，但伤椎骨结构未能得到良好重建及术后椎间盘退变可能是其更重要的因素。因此重视内固定物的选择、加强规范操作，强调对损伤椎体及椎间盘的全面处理是预防内固定失效的有效措施。     

Well-being (quality of life) in connection with hypertensive treatment

Quality of life is often considered to equate how the medical treatment is subjectively perceived by the patient, but ought to include the total impact of the disease/treatment on the patient's emotional, physical, and social well-being. Recently, a proposal for a generally applicable definition of quality of life in health care was put forward. This definition includes general well-being, health, and welfare (external factors), as three fundamental components, and the definition is based on both objective and subjective judgments. General well-being is exclusively and expression of the individual's subjective experience and is based on his or her own qualitative evaluation of well-being in relation to condition, treatments, and experiences. Health is according to the proposed definition, judged both objectively (signs) and subjectively (symptoms). Apart from health and well-being, there is also reason to include objectively registrable factors at the welfare level (external factors) such as the consumption of medicines, number of days in hospital, length of sick leave, need of in-home care, etc. This review is an attempt to elucidate the effects of antihypertensive pharmacotherapy on the patient's general well-being. The topic will be discussed from several points of views (e.g., aims of antihypertensive treatment, occurrence of symptoms in the population, compliance with prescribed treatment, symptom inventories, the concept of quality of life.     

Evaluation of Class I ART restorations in Brazilian schoolchildren: three-year results

Atraumetic Restorative Treatment (ART) has been adopted around the world to avoid unnecessary extractions, especially in non-industrialized countries The development of specific glass ionomer cements marketed for the ART technique has contributed to the technical success rate. In this study. Ketac-Molar^a (3M ESPE. Dental Medzn Germany) was used to restore 150 Class I cavities in 118 Brazilian public school children, aged from 7–12 years. At baseline and at subsequent recalls. CPI probes with a ball-end of 0.5 millimeters (mm) were used to assess loss of restorative material, and photographic color transparencies of restorations were made. After six months. 83 patients returned for follow-up examinations, with 71.8% of their restorations designated as acceptable. After three years. 49 patients with 57 ART-restorations were evaluated, with 21.0% of these restorations graded as acceptable Another 29.8% of their restorations had been replaced by more permanent materials. The main objective of the ART technique is tooth retention; this was achieved for 94.7% of the restored teeth in a high caries risk population who returned for recalls.     

彩超引导介入治疗腘窝囊肿23例

目的探讨彩超引导下腘窝囊肿介入治疗的价值。方法在彩超引导下穿刺囊肿并抽尽囊液，生理盐水反复冲洗囊腔后注入无水乙醇，5min后抽出，反复2～3次。结果23例中22例穿刺一次治愈，1例穿刺2次治愈。23例随访6个月，无复发。结论彩超引导下介入治疗腘窝囊肿操作简便，创伤轻微，安全可靠，效果显著，可重复操作。     

Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy

Background Sympathectomy is the treatment of choice for primary hyperhidrosis. One curious occurrence that is difficult to explain from an anatomophysiological point of view in cases of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH) is the observed improvement in plantar hyperhidrosis (PLH). Nevertheless, current reports on VATS rarely describe the effect on PLH or just give superficial data. The aim of this study was to prospectively investigate, how surgery affects PLH in patients with PH and PLH over one-year period. Methods From May 2003 to January 2004, 70 consecutive patients with combined PH and PLH underwent VATS at the T2, T3, or T4 ganglion level (47 women and 23 men, with mean age of 23 years). Results Immediately after the operation, all the patients said they were free from PH episodes, except for two patients (2.8%) who suffered from continued PH. Compensatory hyperhidrosis (CH) of various degrees was observed in 58 (90.6%) patients after one year. Only 13 (20.3%) suffered from severe CH. There was a great initial improvement in PLH in 50% of the cases, followed by progressive regression, such that only 23.4% still presented that improvement after one year. The number of cases without overall improvement increased progressively (from 17.1% to 37.5%) and the numbers with slight improvement remained stable (32.9–39.1%). Of the 24 patients with no improvement after one year, 6 patients graded plantar sweating worse. Conclusion Patients with PH and PLH who undergo VATS to treat their PH present a good initial improvement in PLH that reduces to a lower level of improvement after the one-year period.     

创伤性睾丸脱位5例报告

目的 探讨创伤性睾丸脱位的诊断和治疗。方法 对所收治的5例患的诊治情况进行分析研究，并结合复习有关献。结果 1例手法复位成功，4例行手术复位．1例发生睾丸萎缩后切除患睾。结论 创伤性睾丸脱位临床少见，漏误诊率较高。对骨盆部、会阴部、阴囊部外伤患应警惕本病；详细检查阴囊及睾丸．确诊后尽早行手法或手术复位固定．定期随访。