小体积前列腺增生引起膀胱出口梗阻三种术式疗效的比较

目的探讨小体积前列腺增生引起膀胱颈出口梗阻的较理想治疗方法。方法自1996-01~2005-01共收治小体积前列腺增生69例,其中耻骨上经膀胱前列腺摘除27例,单纯经尿道前列腺电切除术(TURP)22例,TURP加膀胱颈内切开术(TUIBN)20例。三组患者年龄、病程、术前前列腺重量及手术切除重量均无明显差异。从国际前列腺症状评分(IPSS)、最大尿流率(Qm ax)及膀胱残余尿量(PVR)三个参数来比较三组治疗的疗效。结果术后各项指标均有改善,分别为开放手术组IPSS由(24.6±3.8)降至(15.1±3.8),Qm ax由(8.2±3.1)m l/s升至(10.5±4.2)m l/s,PVR由(96.0±36.0)m l降至(54.0±27.0)m l。单纯TURP组IPSS由(22.3±5.6)降至(11.7±2.7),Qm ax由(8.5±3.6)m l/s升至(11.4±4.2)m l/s,PVR由(105.0±39.0)m l降至(32.0±14.0)m l。TURP加TUIBN组IPSS由(23.6±5.7)降至(6.4±2.3),Qm ax由(9.1±3.8)m l/s升至(19.5±6.2)m l/s,PVR由(98.0±37.0)m l降至(8.0±5.0)m l。TURP加TUIBN组与另两组比较,术后IPSS、Qm ax及PVR均有极显著性差异(P<0.001)。结论TURP加TUIBN是目前治疗小体积前列腺增生引起膀胱颈出口梗阻较为理想的方法。     

经尿道等离子双极电切术与前列腺电切术的疗效比较

目的比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效。方法回顾2005年7月至2008年8月我院BPH患者根据手术方式不同分成PKRP组(144例)和TURP组(152例),比较两组术后最大尿流率(Qm ax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标。结果PKRP组与TURP组各组手术前后IPSS、QOL、PVR、QM ax差异有统计学意义(P<0.01),手术后两组IPSS、QO l、PVR、QM ax差异无统计学意义(P>0.05)。两组平均手术时间差异无统计学意义(P<0.05)。PKRP组术中出血量、围手术期及术后并发症较TURP组减少,差异有统计学意义(P<0.05)。结论PKRP与TURP治疗BPH疗效相近,平均手术时间相近,但PKRP术中出血量、围手术期及术后并发症较TURP明显减少,手术安全性高。     

TURP结合TUVP治疗高危前列腺增生42例分析

目的探讨经尿道前列腺电汽化术(transurethral electrovaporization of the prostate,TUVP)联合经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗高危重度良性前列腺增生症(bengnprostatichyperplasia,BPH)的效果。方法TUVP联合TURP治疗42例BPH。根据sohlege手术危险分类:Ⅰ级25例,Ⅱ级17例。所有患者术前国际前列腺症状评分(IPSS)为24±2,最大尿流率为(3.0±2.2)ml/s。残余尿量120～360 ml。结果手术时间40～80 min,平均60.0min。4例术后输血300 ml,1例先兆前列腺电切综合征发生,平均留置尿管5.0 d。42例随访6～36个月,平均11.0个月,IPSS由术前平均(24±2)下降至术后平均(8±3),最大尿流率(Qmax)由术前平均(3.0±2.2)ml/s升至术后平均(13.0±2.6)ml/s。术后暂时性尿失禁2例。结论联合应用TUVP及TURP治疗高危重度BPH疗效满意。     

经尿道前列腺钬激光剜除术治疗大体积前列腺增生的临床观察

目的探讨经尿道前列腺钬激光剜除术(HoLEP)治疗大体积前列腺增生(BPH)的临床效果。方法将2017年1月至2020年2月我院收治的100例大体积BPH患者随机分为两组各50例。治疗组行HoLEP,对照组行经尿道前列腺电切术(TURP)。比较两组的手术相关指标、IPSS、PVR、Qmax、并发症。结果治疗组术中出血量少于对照组,膀胱持续冲洗时间、手术时间、住院时间、导尿管留置时间短于对照组(P<0.05)。术后,治疗组IPSS、PVR低于对照组,Qmax高于对照组(P<0.05)。治疗组术后并发症发生率为4.00%,低于对照组的20.00%(P<0.05)。结论与TURP相比,HoLEP治疗大体积BPH具有失血量少、手术时间短、并发症少、IPSS及PVR低、Qmax高、恢复快等优点,值得临床推广。     

PKRP与TURP治疗良性前列腺增生的临床观察

目的比较经尿道前列腺等离子双极电切术（PKRP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的临床疗效及安全性。方法将130例BPH患者随机均分成PKRP组和TURP组,比较两组术中出血量、并发症发生率及术后最大尿流率（Qmax）、剩余尿量（PVR）、国际前列腺症状评分（IPSS）、生活质量评分（QOL）。结果所有病例均获随访3个月,PKRP组同TURP组在手术时间、术中出血量、留置导尿时间、住院时间、术后并发症的比较差异有统计学意义（P〈0．05）;2组术后IPSS、QOL、Qmax、PVR均较术前明显改善（P〈0．01）,但2组间差异无统计学意义（P〉0．05）。结论PKRP与TURP治疗BPH疗效相近,但PKRP比TURP并发症更少,恢复更快,更安全,是经尿道治疗BPH的理想方法之一。     

两种经尿道前列腺电切术的临床疗效比较

目的 比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的主要优缺点及临床疗效.方法 回顾性分析2004年1月至2007年6月收治并获得随访的186例BPH患者的临床资料.PKRP组90例,TURP组96例,比较两组手术时间、术中出血量、前列腺包膜穿孔、术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(PVR)及并发症的发生率等指标.结果 PKRP组手术时间、术中出血量、前列腺包膜穿孔发生率、术后1个月内继发性出血发生率、术后2个月内暂时性尿失禁发生率分别为(65.3±12.8)min、(213.6±78.2)ml、5.6%(5/90)、2.2%(2/90)和21.1%(19/90),TURP组分别为(83.6±17.5)min、(397.4±142.7)ml、17.7%(17/96)、11.5%(11/96)和36.5%(35/96),两组比较差异均有统计学意义(P<0.05).PKRP组术后IPSS、QOL、Qmax、PVR分别为(4.7±1.3)分、(1.1±0.4)分、(18.7±5.6)ml/s、(8.9±2.5)ml;TURP组分别为(5.3±1.0)分、(1.2±0.5)分、(20.4±4.3)ml/s、(11.2±3.2)ml;均较术前明显改善(P<0.05),但组间差异无统计学意义(P>0.05).结论 PKRP与TURP比较,治疗BPH疗效相近,但PKRP安全性更好,手术时间、术中出血量、围手术期及术后并发症等明显减少,是治疗BPH的理想方法.     

等离子前列腺剜除术与前列腺等离子切除术治疗单纯良性前列腺增生患者的疗效

目的探讨并比较经尿道等离子前列腺剜除术(TPKEP)与经尿道前列腺等离子切除术(TPKRP治疗单纯良性前列腺增生(BPH)患者的临床疗效。方法回顾性分析2014年8月至2018年6月收治的121例中老年单纯良性前列腺增生患者的临床资料,根据手术方式不同分为两组,其中TPKEP组67例,TPKRP组54例。比较两组手术时间、术中出血量、切除的前列腺组织重量、膀胱冲洗时间、导尿管留置时间及术后3个月的国际前列腺症状评分(IPSS)、残余尿量(PVR)、最大尿流率(Qmax)。结果 TPKEP组手术时间、术中出血量均优于TPKRP组,差异有统计学意义(P<0.05)。两组切除前列腺重量、术后膀胱冲洗时间、术后留置导尿管时间比较,差异无统计学意义(P>0.05)。术后3个月,两组的IPSS评分、PVR、Qmax均优于同组术前,但两组改善情况比较,差异无统计学意义(P>0.05)。两组均无严重并发症发生。结论 TPKEP和TPKRP都是治疗BPH患者的有效方法,但TPKEP是一种新型的微创手术,疗效和安全性均较高。     

经尿道等离子剜除术与电切术治疗前列腺增生症患者的疗效

目的比较经尿道等离子剜除术(TUEP)与电切术(TURP)治疗前列腺增生症(BPH)患者的疗效。方法选择2017年7月至2019年1月天津市津南医院接收的BPH患者72例,随机分为两组,各36例。对照组行TURP,试验组行TUEP,比较两组手术指标、国际前列腺症状评分表(IPSS)评分、残余尿量(PVR)、最大尿流率(Qmax)及并发症发生情况。结果试验组膀胱冲洗时间、手术时间、导尿管留置时间及住院时间均短于对照组,前列腺切除量大于对照组,术中出血量少于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。术后6个月,两组IPSS评分及PVR均低于术前,Qmax均高于术前,差异均有统计学意义(P<0.05);但术后6个月组间比较,差异无统计学意义(P>0.05)。结论BPH患者行TUEP与TURP均有较好的治疗效果,但TUEP的切除率高,患者术后恢复快,且并发症较少。     

改良式耻骨上前列腺切除术治疗前列腺增生256例分析

目的探讨改良式耻骨上前列腺切除术治疗良性前列腺增生(BPH)的安全性与有效性。方法采用改良式耻骨上前列腺切除术治疗前列腺增生患者256例。结果 237例术中出血少,术后恢复快,手术效果良好。术后随访1～6个月,最大尿流率(Qmax)由术前的(7.6±4.5)ml/s升高到术后的(22.6±4.7)ml/s;国际前列腺症状评分(IPSS)由(27.5±4.6)分降低至(7.4±2.8)分;生活质量评分由(4.5±0.5)分降低至(2.6±0.8)分;剩余尿量由(78.0±85.0)ml减少至(25.0±30.0)ml。6例发生膀胱颈挛缩症,5例发生前尿路狭窄,行尿扩或TURP后症状改善;8例发生轻微尿失禁,半年后缓解;本组无死亡病例。结论改良式耻骨上前列腺切除术治疗前列腺增生具有安全性、疗效确切、前列腺切除率高、并发症少,在基层医院及相对落后的地区仍有一定的应用价值。     

经尿道前列腺汽化电切术治疗前列腺增生症

目的探讨经尿道前列腺汽化电切术治疗良性前列腺增生（BPH）的疗效。方法回顾性分析TUVP联合TURP治疗前列腺增生症58例的临床资料。结果术后排尿功能恢复良好,术后5—26个月时随访,国际前列腺症状评分（IPSS）平均8．3分,最大尿流率（MFR）平均18．0ml／s,58例B超剩余尿量平均为13ml。术中发生电切综合征1例,输血1例。膀胱颈后尿道狭窄1例,术后假性尿失禁1例。结论联合应用TUVP和TURP治疗前列腺增生症具有效果好、安全性高及并发症少等优点,值得临床推广应用。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.