小型节能头灯的制做与应用

医院(特别是儿童医院)在日常的诊断和治疗护理工作中,需要在小局部范围、短时间光源照明.目前市场上各种医用头灯存在着价格昂贵,使用不方便;我院医护人员在加05年10月至2007年3月使用我院自行研制的节能头灯,采用现代电子技术,在夜间给病人注射、换药和其他治疗以及查房巡视等小范围用光场合,取得了良好的效果.     

Cervicogenic exophthalmos: Possible etiology and pathogenesis

BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.     

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.     

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.     

世界疼痛日——中国镇痛周暨建立疼痛科新闻发布会隆重召开中华医学会疼痛学分会第七届年会胜利闭幕

世界疼痛日中国镇痛周暨建立疼痛科新闻发布会、中华医学会疼痛学分会第七届年会于2007年10月12～16日在北京九华山庄隆重举行.全国人大副委员长中科院韩启德院士、原全国人大副委员长中科院吴阶平院士、卫生部陈啸宏副部长、卫生部医政司王羽司长、卫生部科教司刘雁飞司长、中华医学会吴明江常务副会长、原卫生部副部长中国医师协会殷大奎会长及有关方面的领导、专家及参加大会的疼痛医学专家代表约五百人参加了新闻发布会.     

读片窗及答案

病例 男,62岁.以"发现尿黄5天"为主诉入院.无发热、恶心及厌食等伴随症状.查体:血压150/100mmHg,巩膜轻度黄染,腹软无压痛,肝区无叩击痛,肝肋下未触及.实验室检查:血WBC 13.1×109/L,EO 5.2×109/L,占39.7%.TBIL 36.6μmol/L,DBIL 21.5μmol/L,UDBIL 15.1μmol/L.ALT 88U/L,GGT 201U/L.AFP及CEA阴性.HBsAb阳性,其余4项均阴性.     

结合中医理论对上呼吸道感染的护理

上呼吸道感染一年四季均可发病,但以冬春季节为多.此类病人病程一般在10 d以上,易反复,有的甚至迁延不愈达1个月以上,造成门诊输液量增加、交叉感染机会增多,在医治过程中医护人员也易感染.此病虽然不像癌症使人恐惧,但它的发病率高,有的1年内可发病3次～5次,给身体和生活造成很大的不便.此类病人的症状为鼻塞、流涕、喷嚏、咳嗽、咽干、咽痛、头痛、发热、乏力、全身不适等,护理一般采取对症施护:休息、保持室内空气清新、多饮水、清淡饮食等,而应用中医理论施护则更具体、更有效,对于疾病的痊愈会有极大的促进作用.     

伸缩式垂直升降护理机的适用性探讨

昏迷病人、截瘫病人、慢性消耗性疾病及脑卒中后遗症病人常伴有肢体瘫痪而长期卧床,生活不能自理,大小便失禁,易发生压疮,给病人带来极大痛苦,给家属带来繁重的负担[1].为解决这一难题,人们研究了一些护理器械,如"升降护理装置",这种护理装置由铁床、软布带、支架杆、绑绳钢筋、软网布、定滑轮组件、动滑轮组件、万向节连接件和钢丝绳组成.     

Seroconversion of HBsAG coincides with hepatitis A superinfection: A case report

BACKGROUND Hepatitis B virus(HBV)is a hepatotropic virus that can cause acute and chronic liver damage.According to the world health organization 257 million people are infected with chronic HBV infection worldwide.Super-infection with other hepadnaviruses,including hepatitis A virus(HAV),hepatitis C virus,hepatitis D virus,and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.CASE SUMMARY Here,we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis,who presented with general fatigue,malaise and laboratory signs of acute hepatitis.Although the patient was regularly seen at a specialized university liver unit,the HAV vaccination status was unclear.Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis.Following acute HAV super-infection,spontaneous HBsAg elimination and development of an anti-HBs titer were observed.CONCLUSION This case illustrates the importance of carefully checking the vaccination status.In our patient,unspecific immunological responses to HAV led to functional cure of HBV.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

盆底康复锻炼对产妇盆底肌肉肌电活动及盆底功能的影响

目的:探讨产后盆底康复锻炼对盆底肌肉肌电活动、盆底功能的影响。方法:选取140例产妇,根据是否于产后6周接受盆底康复锻炼分为康复组83例(给予生物电刺激+生物反馈治疗)、对照组57例(患者不愿意接受产后盆底功能康复治疗),对比2组产妇产后6周及3个月时的盆底肌电生理指标、盆腔器官脱垂定量(POP-Q)分度。结果:产后6周时,康复组盆底Ⅰ类、Ⅱ类肌纤维的肌电位均值与对照组比较差异无统计学意义;产后3个月,康复组盆底Ⅰ类、Ⅱ类肌纤维的肌电位均值均显著高于对照组(均P0.05),康复组的盆底Ⅰ类、Ⅱ类肌纤维的疲劳值均显著小于对照组(均P0.05);产后3个月,康复组的C点距离、D点距离均显著大于对照组(均P0.05);产后3个月,康复组的PFIQ-7、PISQ-12评分均显著高于对照组(均P0.05)。结论:产后盆底康复锻炼对盆底肌肉肌电活动、盆底功能恢复具有积极作用。     

41例盆底功能障碍患者行盆底重建手术的疗效分析

目的 时有不同缺陷的盆底功能障碍患者行盆底重建手术,探讨其疗效.方法 采用聚丙烯网片经闭孔阴道前壁修复术、P-IVS术(经阴道后路悬吊带术)、腹腔镜下骶骨胛悬吊术,完成盆底3个平面的重建,合并有压力性或混合尿失禁的患者同时行TVT-O、TASS等.结果 手术时间平均为95.2 min,出血量平均为90mL,根据POP-Q分度法及问卷评价手术效果,41例患者的子宫脱垂、阴道前后壁膨出、尿失禁等症状全部得到纠正,无术后病率发生,未观察到其他与手术相关的并发症.术后随访平均11个月,相关症状消失或明显改善.未发现补片侵蚀、疼痛等.结论 以盆底功能障碍和治疗的整体理论为基础,行盆底修复是一种微创而又经济的盆底重建术,该手术术式中、短期疗效稳定,长期疗效有待进一步观察.在妇科泌尿学和女性盆底重建外科方面属于新的探索.     

经会阴盆底超声用于督导盆底功能障碍患者盆底肌训练并定量评估疗效

目的 观察经会阴盆底超声用于督导盆底功能障碍(PFD)患者盆底肌训练(PFMT)并定量评估其疗效的价值。方法 前瞻性纳入158例PFD患者,并将其随机分为研究组(n=69)和对照组(n=89),嘱患者完成12周PFMT,且对研究组额外增加超声督导、健康宣教及跟踪反馈;采用盆底超声评估患者PFMT前、后盆底功能,包括静息态及最大瓦尔萨尔瓦动作下膀胱颈位置及肛提肌裂孔面积,并分析其价值。结果 PFMT前、后,静息态及最大瓦尔萨尔瓦动作下2组膀胱颈位置及肛提肌裂孔面积差异均有统计学意义(P均＜0.05);且PFMT后,2组膀胱颈位置及肛提肌裂孔面积差异亦有统计学意义(P均＜0.05)。研究组患者PFMT依从性优于对照组(P＜0.05)。结论 经会阴盆底超声可用于督导PFD患者PFMT并定量评估其疗效。     

盆底悬吊术在盆底功能障碍中的应用及技术探讨

目的探讨盆底悬吊术在盆底功能障碍(PFD)中的应用效果和安全性。方法 49例女性盆底功能障碍患者根据治疗方式不同分为:观察组22例,行盆底悬吊术;对照组27例,行经阴道子宫切除联合阴道壁修补术。观察2组手术相关指标(手术时间、术中出血量、术后排气时间和导尿管留置时间)并术后随访,观察2组并发症,依据盆底功能障碍问卷(PFDI-20)评价术后恢复情况。结果观察组手术时间,术后排气时间和导尿管留置时间短于对照组(P0.01);2组均治愈出院,6个月时观察组复发1例,对照组复发2例;术后3和6月时观察组PFDI-20评分均优于对照组(P0.01)。结论与阴式子宫切除联合阴道壁修补术相比,盆底悬吊术治疗PFD疗效更确切,能显著改善患者术后生活质量。     

盆底康复训练对子宫切除妇女盆底功能障碍性疾病的疗效观察

目的:观察盆底康复训练对子宫切除术后盆底功能障碍的治疗效果。方法:子宫切除术后重度盆底肌力减退的患者156例,分为观察组102例和对照组54例,观察组采用生物反馈联合电刺激辅以阴道哑铃进行盆底肌肉锻炼;对照组在家中自行缩肛运动锻炼盆底肌肉。结果:治疗2个月后,观察组手测及电测肌力均较治疗前及对照组明显提高(P<0.01),观察组漏尿次数、漏尿量及对生活的影响程度均较治疗前及对照组明显减少(P<0.01),对照组各项评定治疗前后比较均差异无统计学意义。治疗后,观察组总有效率显著高于对照组(P<0.01)。结论:生物反馈联合电刺激辅以阴道哑铃治疗重度盆底肌力减退疗效显著,值得在临床推广应用。     

非侵入式盆底肌康复疗法对产后盆底康复效果研究

目的:观察非侵入式盆底肌康复疗法对产后盆底肌康复的治疗效果。方法:将128例产后盆底功能障碍患者随机分为治疗组和对照组各64例。对照组只接受家庭自主的盆底肌训练治疗,每天不少于40分钟的训练。对照组使用非侵入盆底肌康复疗法治疗40分钟,每周3次。两组患者治疗前,治疗后6周、12周时分别进行疗效评价。观察两组患者的盆底功能障碍评分、盆底肌力Glazer评分,对比两组患者疗效差异。结果:两组患者盆底功能障碍评分、盆底肌力Glazer评分治疗6周后、12周均显著改善(P<0.01),但治疗组治疗6周后及12周后疗效明显优于对照组,差异有显著统计学意义(P<0.01)。结论:与患者自行盆底肌锻炼相比,非侵入式盆底肌康复疗法能更够显著地改善患者的盆底功能状态,提高患者生活质量,增强盆底肌力。非侵入式盆底肌康复疗法是产后盆底肌松弛的有效治疗方案,同时该疗法非侵入,无创、无痛更容易被广大患者接受。有益于促进中国妇女盆底功能障碍防治项目的进一步发展推广。