Endoscopic laser vs open approach for cricopharyngeal myotomy.

OBJECTIVE: To illustrate the safety and efficacy of the endoscopic laser approach for cricopharyngeal myotomy (CPM) compared to the traditional transcervical approach. STUDY DESIGN AND SETTING: Retrospective chart review of 22 patients undergoing CPM from 1996 to 2003 at the Mayo Clinic, Jacksonville. RESULTS: The laser CPM technique was used in 14 patients, and an open approach in 8. The mean hospital stay and operative times were shorter for the laser group. Functional outcome analyses showed improvement in both groups. There were no major complications in the laser group, while 1 patient in the transcervical group had a pharyngocutaneous fistula. CONCLUSIONS: The laser technique is at least as effective as the transcervical approach for CPM to improve dysphagia symptoms in the properly selected patient, with a low risk of major complications. SIGNIFICANCE: In this report, we provide the reader with data to support the safety and efficacy of laser CPM. EBM rating: B-3b.     

如何避免激光术后常见并发症

据一位经验丰富的激光外科医师说,通常所认为激光能够毫无损伤去除毛发、文身和胎记的观念是错误和有害的. C.B. Zachary医师是旧金山加利福尼亚大学皮肤外科和激光中心的临床教授和主任,他认为在医疗机构中,激光只能由经验丰富的护士和技师在皮肤科医师或其他经过相应训练的内科医师监督下实施.     

The genesis and development of creative activity

During the sixties many studies of creativity focussed upon the evaluation of outcomes or products and gave little serious attention to the study of the genesis and development of the cognitive abilities responsible for the products. As a result, creativity assessment was delayed until the child had developed the verbal and other expressive abilities necessary for product-orientated assessment and creativity was deprived of an adequate developmental theory.

This paper offers an explanation of creativity within a developmental constructivist framework. The focus is upon the nature of creative activity and not upon the evaluation of products. There is an attempt to demonstrate that creative activity may be observed from early infancy and that this early transformational activity increases in structural and contextual complexity as the individual develops.