Search

开放性气管、食管横断伤一例

膝关节镜下松解术治疗膝关节功能障碍

【摘 要】 目的 总结膝关节功能障碍行关节镜下松解，以及术后康复方法及疗效。 方法 2002 年10 月－2006 年2 月，采用膝关节镜下松解术治疗膝关节功能障碍15 例，男11 例，女4 例；年龄25 ～ 56 岁。左侧9 例，右侧6 例。髌骨骨折7 例，胫骨平台骨折4 例，前交叉韧带断裂3 例，化脓性关节炎1 例。病程6 个月～ 3 年，平均1.5 年。膝关节功能障碍程度：伸膝0 ～ 10º，屈膝30 ～ 60 º；膝关节活动范围30 ～ 50 º。术后行关节腔冲洗，早期CPM 机功能锻炼，手法屈膝按摩。 结果 患者术后切口Ⅰ期愈合，无并发症。获随访1 ～ 3 年半，平均2 年。膝关节活动度: 屈110° ～伸0°者4 例，屈100° ～伸0° 者7 例，屈90° ～伸0° 者3 例，屈70° ～伸0° 者1 例。按KSS 评分标准，优11 例，良3 例，可1 例，优良率为93.3％。 结论 关节镜下行膝关节内松解，术后关节腔冲洗，为早期行膝关节功能锻炼创造了条件，有利于膝关节功能康复。

Experience of Diagnosis and Treatment of Duodenal Injuries (Report of 16Cases ）

目的 探讨十二指肠损伤的诊断、手术治疗及手术方式的选择。方法 对我院2000年3月至2007年5月收治的16例十二指肠损伤患者的临床资料进行回顾性分析。结果 16例均进行手术治疗，仅3例术前明确诊断，术中确诊13例； 术后并发症4例； 16例均治愈出院。结论 十二指肠损伤的病情复杂，治疗成败的关键是掌握好早期手术探查指征和选择合适的术式。对于较重的Ⅲ、Ⅳ级十二指肠损伤者，改良十二指肠憩室化手术为一种较理想的手术方法。

The Effects of Apoptosis and Proliferation on Choledochal Cyst

ObjectiveTo observe apoptosis and proliferation of choledochus wall epithelial cell and fibrocyte, to understand the effects of apoptosis and proliferation on choledochal cyst development.MethodsThirty two cases of cystic dilatation,35 cases of cylindrical dilatation，and 25 cases of cholangiectasis caused by choledocholith were collected. All specimens were offered by department of hepatobiliarypediatric surgery. The apoptosis related index (bcl2 and bax) and cell proliferation index (PCNA) were detected by the immunohistochemical technique; Apoptosis was detected by TUNEL method. ResultsThere was serious mucosal epithelial cell damage in cystic dilatation group. In cylindrical dilatation group there was a damage similar to that of the cystis dilatation group, but the damage was not serious. In control group there was little damage in the duct wall, but there was a low positive rate of apoptosis of 〔epithelium cell (2.74±1.00)% and fibroblast (2.95±0.87）%〕, and a low bcl2 and bax’s expression rate, and a high PCNA’s expression rate 〔epithelium cell (3.74±1.00)%, fibroblast (3.71±1.77)%〕. There was no obvious difference between cylindrical dilatation group and cystic dilatation group (Pgt;0.05): the PCNA’s expression rate was low 〔(0.99±0.51)% and (0.90±0.38)% respectively〕, the bax expression rate was high in remaining epithelial cell, and the positive rate of bax was apparently higher than that of bcl2 (P＜0.05), the positive rate of the apoptosis cell was high 〔(13.94±4.77)%, (7.51±3.46)%〕; the expression rate PCNA were high 〔(9.91±2.91)%,(9.70±3.18)%〕, and expression rate of bax’s was low in the fibre tissue, the positive rate of bcl2 was markedly higher than that of bax, and the positive rate of the apoptosis cell was low 〔(3.74±2.12)%,(4.46±2.41)%〕. There were no marked difference between the two groups (Pgt;0.05). The expression of bcl2 and bax had marked difference both in cylindrical dilatation group and cystic dilatation group and as compared to control group (P＜0.05). ConclusionApoptosis has certain promoting effect in the course of choledochal cyst formation.

A comparative study of recommended drugs by guidelines or consensuses for cardiovascular and cerebrovascular diseases with the world health organization model list of essential medicines and the national essential medicines list

ObjectiveTo compare the recommended medicines of cardiovascular and cerebrovascular diseases guidelines, expert consensus, or diagnosis and treatment specifications with essential medicines from the 2023 World Health Organization Model List of Essential Medicines (WHO-EML) and the 2018 National Essential Medicine List (NEML) in differences and similarities. MethodsSix guideline websites and one association website including Guidelines International Network and National Guideline Clearinghouse, etc. were searched until July 2023. The latest cardiovascular and cerebrovascular diseases guidelines, expert consensus, diagnosis and treatment specifications involving medicine treatment were included, and we extracted the data (year, title, target disease, authors and recommended medicines), and the statistical analysis of recommended medicines included in the WHO-EML and NEML was performed by Excel 2016. ResultsA total of 83 guidelines, expert consensus, and diagnosis and treatment specifications were included, covering cerebrovascular diseases, ischemic heart diseases, hypertensive diseases, chronic rheumatic heart diseases, diseases of arteries, arterioles and capillaries and other unspecified circulatory system disorders. They were issued from 2002 to 2023. 55 (66.3%) were published in the past 5 years. For the 246 recommended medicines, they were divided into 14 categories according to the pharmacological effect. 27.2% (67/246) were included in WHO-EML and 32.9% (81/246) were included in NEML, among which 41 medicines were included both in WHO-EML and NEML, 40 in NEML only, 26 in WHO-EML only, and 139 in neither. The number of excluded medicines in antihypertensive medicines, lipid-regulating medicines and antiatherosclerotic medicines and anticoagulants exceeded 10. ConclusionThe number of cardiovascular and cerebrovascular disease guidelines, expert consensus, and diagnosis and treatment specifications recommended for WHO-EML and NEML is lower than 50%, and the coverage rate of NEML for cardiovascular and cerebrovascular disease guidelines recommended treatment medicines is higher than that of WHO-EML.

A comparative study of recommended drugs by guidelines or consensuses for malignant tumors with the World Health Organization model list of essential medicines and the national essential medicines list

ObjectiveTo compare the recommended medicines from malignancy guidelines/consensuses with essential medicines from the 2023 World Health Organization Model List of Essential Medicines (WHO-EML) and the 2018 National Essential Medicine List (NEML) in differences and similarities. MethodsTen guideline databases/association websites including Guidelines International Network, and the American Cancer Society, etc. were systematically searched until July 2023. The latest guidelines/consensuses for ten malignant tumors were screened, including lung cancer, liver cancer, stomach cancer, and other cancers. Recommended medicines were extracted from guidelines/consensuses and compared with WHO and Chinese essential medicines. ResultsA total of 163 guidelines/consensuses were included, extracting 244 recommended medicines, 12 categories, mainly antineoplastic and immunomodulating agents (190 medicines, 10 subcategories). For the 244 recommended medicines, 29.92% (73/244) were included in WHO-EML and 23.36% (57/244) were included in NEML, among which 45 medicines were included both in WHO-EML and NEML, 27 in WHO-EML only, 11 in NEML only, and 161 in neither. ConclusionThe number of recommended medicines in WHO-EML/NEML for ten malignancies is low, and the number in NEML is even much lower than that in WHO-EML. When adjusting medicines for malignant tumors in NEML, reference can be made to specific guidelines/consensuses and WHO-EML to ensure timely inclusion of applicable medicines and strengthen the role of essential medicines in meeting basic medical needs and rational use.