深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

The purpose of this study was to identify those factors that influence the outcome after conservative treatment of undisplaced fractures of the fifth metatarsal. This was done with univariate analyses and, for the first time, with regression analyses of day-to-day clinical practice. Thirty-eight patients were treated with plaster and periods of no weight bearing (NWB). Their mean age was 48 years. They were evaluated using the Olerud ankle score, with analogue scales for pain and comfort, and with questions about cosmesis and wearing of shoes. Six patients sustained a Jones fracture and 32 a tuberosity avulsion fracture. The mean period of NWB was 17 days and of casting was 38 days. Three Jones fractures and all the avulsion fractures were healed at the end of treatment. After a mean of 490 days, the global ankle score was 82/100. Ten patients reported problems with shoes and nine reported cosmetic problems. The linear analogue scale for pain was 2.11/10 and for comfort 8.42/10. Gender, age, and fracture type did not affect outcome. The most significant predictor of poor functional outcome was longer NWB, which was strongly associated with worse global outcome, discomfort, and reported stiffness. NWB should be kept to a minimum for acute avulsions of the tuberosity of the fifth metatarsal.     

Evaluation of outcome of treatment of congenital clubfoot

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible.Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems.The feet were also evaluated using a new scoring system that has 3 domains of evaluation, viz, morphological, functional, and radiological. Comparison of the scores in each of these domains showed that there was a correlation between morphology, function, and radiological measurements of tarsal alignment. Several of the criteria used in this new scoring system were reproducible.     

肌少症的定量测量现状及研究进展

肌少症是一种以骨骼肌质量减少及其功能减退为主要临床表现的复杂的老年综合征。在全球其发病率逐年增高,目前已成为威胁老年人健康,影响老年人生活质量的重要危险因素。其诊断标准主要由欧洲老年人肌少症工作组、亚洲肌少症工作组、国际肌少症会议工作组提出的,通过骨骼肌质量、肌肉力量和身体活动能力进行诊断。肌少症前期仅有肌肉质量减少,肌少症期包括肌肉质量减少伴随肌肉力量下降或身体活动能力降低,重度肌少症期肌肉质量以及身体活动能力均会降低。早期对骨骼肌进行定量测量成为诊断肌少症的重要手段之一。骨骼肌定量测量方法主要有计算机X线体层摄影、磁共振成像、双能X线吸收法、生物电阻抗测量、超声等方法。计算机体X线层摄影在骨骼肌质量的研究中主要应用是作为金标准来校准其他方法;磁共振成像在肌肉定量测量中发挥着越来越重要的作用;双能X线吸收测定法和生物电阻抗方法是目前公认筛查肌少症的手段,并且有诊断的阈值,然而精确性欠佳;超声有经济、易携带、高效等优点,但其对体成分的检测价值有限。本文探讨了骨骼肌定量测量研究的现状及其进展。     

人工关节松动病因的研究

目的：探讨人工关节松动的病因。方法：选择７例松动人工髋关节，翻修手术时取松动关节周围的界膜组织；同时选择１０例骨折内固定患者，拆除内固定物时取内固定物周围瘢痕组织。标本做组织学检查和肿瘤坏死因子（ＴＮＦ）测定。选择１０只成年兔，将２０只模拟假体分别置入双侧股骨远端。分别于术后第６、８、１０、１２、１４周向右侧膝关节腔注射聚乙烯微粒悬液，作为实验侧；左侧膝关节腔注射生理盐水，作为对照侧。第１６周取股骨远端标本，做组织学检查。结果：松动人工髋关节周围的界膜组织主要含大量的组织细胞和聚乙烯微粒，而骨折内固定物周围的瘢痕组织主要为纤维成分，无聚乙烯微粒。松动关节周围界膜组织中的ＴＮＦ浓度明显高于骨折内固定物周围的瘢痕组织（Ｐ＜０．０１）。动物实验发现，实验侧模拟假体周围有一层充满组织细胞的纤维结缔组织界膜，并有明显骨吸收和骨溶解现象，而对照侧无明显纤维结缔组织界膜，也无骨破坏现象。结论：人工关节磨损后，产生大量的磨损微粒，微粒刺激组织细胞分泌ＴＮＦ等溶骨性因子，这些溶骨性因子直接或间接地激活破骨细胞，从而引起假体周围骨吸收、骨溶解，最终导致假体松动。假体松动后又可加重磨损，产生更多的微粒，形成恶性循环     

食管穿孔83例分析

８３例不同原因引起的食管穿孔，保守治疗５７例；手术２６例，行单纯食管修补术２０例、开胸行纵隔和／或胸腔引流２例、切除贲门肿物行胃食管吻合１例、颈部食管外置２例（其中１例并行二期结肠代食管手术）、１例开胸取异物形成食管瘘后，行二期修补瘘术。全组死亡８例，其中死于纵隔胸腔感染和主动脉破裂出血各４例。总治愈率８５％。并指出异物假牙造成食管穿孔的重要性，对严重的腐蚀性食管灼伤应早期行食管镜检，并针对食管穿孔部位、种类、间隔期、纵隔与胸腔的感染程度及病人具体情况采取相应的治疗措施。     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。     

Pharmacological effects of essential oils of plants of the northeast of Brazil.

The authors have reviewed the pharmacological studies done with essential oils obtained in the state of Ceará, in Northeast of Brazil, from 15 species of aromatic plants, some of which are native to the phytogeographic semiarid region characteristic of the Northeast, the "caatingas". These studies have dealt with the effect of these oils on muscle contraction and with their antispasmodic, analgesic, antiinflammatory, anticonvulsant and antibacterial activity. The essential oils of the medicinal species have shown activity coherent with the use of these plants in folk medicine. The review is aimed primarily at summarizing the information relevant for a critical evaluation of the perspectives and potential of these oils as pharmacological and therapeutic agents.     

Predictors of severity of attacks of acute pancreatitis

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH and PO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Repair of avulsion of insertion of biceps brachii tendon

An end-result study was made of 16 cases of avulsion of the insertion of the biceps brachii tendon. The follow-up period spanned one to 25 years post-treatment (average, eight years). Fourteen of the 16 cases included in the study were acute cases with primary repair and reinsertion of the biceps tendon into the area of the radial tuberosity. One case, with the loss of function of the biceps muscle secondary to temporary paralysis of the musculocutaneous nerve, was explored. The tendon was found intact and did not require repair. The sixteenth case was included for comparison of a patient who chose to forgo surgical treatment. One surgical procedure, a modification of Bunnell's technique, was used in treating all patients from 1954 to 1977. The surgically repaired biceps showed various amounts of residual impairment, ranging from negligible to limited restriction of preinjury activities. The treatment successfully returned 14 patients to their previous occupations and activities. The one case not surgically treated of the ten work-related injuries resulted in continuing disability compensation based on no greater than 20% of the entire extremity. This end-result study substantiates the positive results of this surgical technique, presents modifications of the surgical repair procedures, and allows for a similar long-range study of other treatment techniques. The evaluation of treatment methods is easily attainable by low technological clinical methods.     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Diagnosis of degree of serosal invasion of carcinoma of the colon by angiography

Angiography (AG) using Prostaglandin E1 was performed on 35 cases of carcinoma of the colon in order to diagnose the degree of serosal invasion. The findings of AG were classified into 4 groups: AG-S3, abnormal change (like irregularity and/or encasement) up to marginal vessels; AG-S2, abnormality up to vasa recta; AG-S1, abnormality of penetrating branches of vasa recta; AG-S0, no distinct findings of above mentioned vessels. 1) Diagnosis of AG is in accord with the visible postoperative findings in 82.9%. 2) Diagnosis of AG is in accord with the histopathological findings in 32.4%. 3) Postoperative examinations confirmed the AG diagnosis precisely but the conflict with histopathological findings should not be overlooked. This may be the results of inflammatory change, adhesion and fibrosis around the carcinoma of the colon.     

食管胃结合部腺癌的手术原则

食管胃结合部腺癌（AEG）在欧美地区急剧增加,引起世界范围的高度关注。我国虽有散见的相关研究报道,但对AEG治疗现状的把握是困难的。目前对AEG的规范化治疗正在逐渐形成共识。早期AEG的治疗是以内镜下黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）、腹腔镜下手术、缩小手术为主。进展期AEG的治疗,SiewertⅠ型患者作为食管癌处理,开胸手术、纵隔淋巴结清扫可获得良好的预后效果;SiewertⅡ、Ⅲ型患者行开胸手术获益少,作为胃癌手术清扫更为妥当,经腹食管裂孔扩大、下段食管切除、全胃切除、下纵隔腹腔淋巴结（D：）清扫。     

踝关节塔门型骨折22例临床分析

踝关节塔门型骨折是一种少见且治疗困难的关节内骨折。本文介绍２２例该类骨折，分别采用单纯手法复位石膏外固定、撬拨复位钢针内固定、切开复位钢针内固定和踝关节融合术等方法。其结果以撬拨复位、切开复位钢针内固定的效果较好，而单纯手法复位石膏外固定和关节融合术的疗效较差，文中着重讨论了该病的发病机理，诊断及治疗等问题。     

Principles of treatment of nonparasitic cysts of the liver

A comparative investigation of different methods of treatment of nonparasitic cysts of the liver was carried out in 104 patients aged from 21 through 74 years with sizes of the cysts from 6 to 21 cm in diameter, divided into three groups. The first group included 50 patients who were subjected to open operations (segmentectomy, bisegmentectomy, fenestration of the cysts with treatment of the residual inner lining with ethanol, diathermocoagulation or cryodestruction). Laparoscopic fenestration and chemical or thermal treatment of the cysts were used in the second group of 29 patients, in the third group consisting of 25 patients a puncture-aspiration method was used under sonographic control. An analysis of the results showed advantages of laparoscopic and puncture methods that gave good immediate and long-term results, less number of postoperative complications and shorter periods of rehabilitation of the patients.     

Characteristics of the surgical treatment of nodular forms of dyshormonal hyperplasia of the breast

Analysis of the case histories of 116 patients who were hospitalized for a second time after sectoral resection of the mammary gland conducted earlier for dyshormonal hyperplasia showed that the possible causes of the discovered changes could be, on the one hand, incomplete removal or failure of removal of the pathological focus, and, on the other, advancement of changes in the remaining part of the gland, particularly in the presence of epithelial proliferation. This requires careful techniques of sectoral resection and continuous postoperative control.     

Results of operative treatment of fractures of the posterior wall of the acetabulum

BACKGROUND: The purpose of this study was to determine the clinical outcome in patients in whom a displaced fracture of the posterior wall of the acetabulum had been treated by open reduction and internal fixation. METHODS: One hundred patients who had had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum were studied. Ninety-four patients were assessed at a mean of five years (range, two to fourteen years) after the injury. Six patients with a poor result were followed for less than two years. The functional outcome was evaluated with use of the clinical grading system adopted by Letournel and Judet with incorporation of modifications by Matta. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional outcome. RESULTS: The reduction of the fracture, as determined with plain radiography, was graded as anatomic in ninety-seven patients and as imperfect in three. The clinical outcome at the time of final follow-up was graded as excellent in fifty-five patients, very good in twenty-five, good in nine, fair in one, and poor in ten. The radiographic result was excellent in eighty-one patients, good in five, fair in four, and poor in ten. There was a strong association between the clinical outcome and the final radiographic grade. Variables identified as risk factors for an unsatisfactory clinical result included a delay of greater than twelve hours before reduction of an associated hip dislocation, an age of fifty-five years or older at the time of injury, intra-articular comminution, and osteonecrosis. CONCLUSIONS: The uncomplicated radiographic appearance and relatively simple operative approach for fractures of the posterior acetabular wall belie the risk of poor results. Prompt reduction of an associated hip dislocation is imperative. Fractures in elderly patients and those with extensive comminution are more likely to have a poor clinical result. However, a high likelihood of a long-term good-to-excellent result can be expected following anatomic reduction and internal fixation of these fractures.