郑氏热补手法临床应用体会

郑氏热补手法临床应用体会张宁霞甘肃中医学院热补法是郑氏对复式补法烧山火的简化，该手法在郑氏传统针法中占有重要地位。郑魁山教授对传统手法不仅在理论研究方面有较高的造诣，而且有很丰富的实践经验，随导师临床两年来，受益颇深。郑老临床应用热补法首先押手关闭，...

桡骨远端骨折90例临床手法复位治疗加中医药结合治疗疗效分析尝试

目的该次实验将针对桡骨远端骨折的临床手法复位与中医药结合治疗的临床效果进行探究。方法该实验选取了2015年5月—2016年6月在该院就诊的90例桡骨远端骨折的患者,随机分为对照组和观察组。对照组采用手法复位治疗,观察组在此基础上结合中医药早晚分服。结果观察组在治疗后骨密度值、骨代谢指标上均优于对照组,两组差异有统计学意义(P<0.05)。结论在桡骨远端骨折的治疗上结合临床手法复位与中医药剂有助于提高治疗有效性,值得在临床过程中推广使用。

推拿手法要求之我见

用手或肢体其他部分,按各种特定的技巧动作,在体表操作的方法,称为推拿手法。手法是推拿治病的主要手段,其熟练程度及如何适当运用手法,对治疗效果有直接的影响。

不同取穴方式及针刺手法在原发性骨质疏松症治疗中的运用现状

通过综述不同取穴方式和针刺手法对原发性骨质疏松症的临床、及实验研究,分析总结不同取穴方式及针刺手法治疗原发性骨质疏松症的临床特点、运用机理及各自的独特之处,为针刺运用于治疗骨质疏松症的临床方案优化提供理论依据。

Ampullary carcinoma:Effect of preoperative biliary drainage on surgical outcome

AIM： To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma.METHODS： We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage （PBD group）, and 47 were not drained （non-PBD group）. The mode of biliary drainage was endoscopic retrograde cholanoiopancreatography （n = 33） or percutaneous biliary drainage （n = 2）. The following parameters were analyzed： wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d （hospital mortality） and also longterm. The statistical endpoint of this study was patient survival after surgery.RESULTS： The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non- PBD group （10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group）.Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 （2.9%） vs 12 （25.5%）]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 （28.6%） vs 14 （29.8%）], intra-abdominal bleeding [1 （2.9%） vs 5 （10.6%）], intra-abdominal abscess [1 （2.9%） vs 8 （17%）], gastrointestinal bleeding [3 （8.6%） vs 5 （10.6%）], pancreatic leakage [2 （5.7%） vs 3 （6.4%）], biliary leakage [2 （5.7%） vs 3 （6.4%）], pancreatitis [2 （5.7%） vs 2 （4.3%）], gastroparesis [6 （17.1%） vs 10 （21.3%）], need for blood transfusion [10 （28.6%） vs 17 （36.2%）] and re-operation rate [1 （2.9%） vs 5 （10.6%）]. There was no early mortality in either group. Median survival was 44 mo （95% CI： 34.2-53.8） in the PBD group and 41 mo （95% CI： 27.7-54.3; P = 0.86） in the non-PBD group.CONCLUSION： Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage.

Factors that influence outcome in non-invasive and invasive treatment in polycystic liver disease patients

AIM: To evaluate the factors that influence outcome of both non-invasive and invasive treatment of polycystic liver disease. METHODS: Analysis of clinical files of patients with complete follow-up from July 1986 to June 2006. RESULTS: Forty-one patients (male, 7; female, 34), 47.8 ± 11.9 years age, and 5.7 ± 6.7 years follow-up, were studied. Alkaline phosphatase (AP) elevation (15% of patients) was associated with the requirement of invasive treatment (IT, P = 0.005). IT rate was higher in symptomatic than non-symptomatic patients (65.4% vs 14.3%, P = 0.002), and in women taking hormonal replacement therapy (HRT) (P = 0.001). Cysts complications (CC) were more frequent (22%) in the symptomatic patients group (P = 0.023). Patients with body mass index (BMI) > 25 (59%) had a trend to complications after IT (P = 0.075). Abdominal pain was the most common symptom (56%) and indication for IT (78%). Nineteen patients (46%) required a first IT: 12 open fenestration (OF), 4 laparoscopic fenestration (LF) and 3 fenestration with hepatic resection (FHR). Three required a second IT, and one required a third procedure. Complications due to first IT were found in 32% (OF 16.7%, LF 25%, FHR 66.7%), and in thesecond IT in 66.7% (OF 100%). Follow-up mortality rate was 0. CONCLUSION: Presence of symptoms, elevated AP, and CC are associated with IT requirement. HRT is associated with presence of symptoms and IT requirement. Patients with BMI > 25 have a trend be susceptible to IT complications. The proportions of complications are higher in FHR and second IT groups. RS is more frequent after OF.

Laparoscopic surgery in pregnancy

Each year, roughly 2% of pregnant women will undergo non-obstetrical abdominal surgery. Appendicitis, symptomatic cholelithiasis and adnexal masses are some of the common diagnoses encountered. Pregnancy poses challenges in the diagnosis and surgical management of these conditions for several reasons. Since the 1990's, laparoscopic surgery has gained popularity and in the past few years has become the standard of care for pregnant women with surgical pathologies. The advantages of laparoscopic surgery include shorter hospital stay, lower rates of wound infection, and decreased time to bowel function. This brief review discusses key points in laparoscopic surgery during pregnancy and highlights studies comparing laparoscopic and open approaches in common surgical conditions during pregnancy.

Mirizzi Syndrome: Our Experience with 27 Cases in PUMC Hospital

Objective To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome （MS）. Methods Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.

Piriformis Syndrome Treated by Triple Puncture with-the Bai Hu Yao Tou Maneuver

Piriformis syndrome is often seen in patients of middle and senior ages. It is manifested by pain in the hip with limited motion of the lower limbs.Prolonged course of the disease may lead to atrophy of muscles of the legs.

Congenital bronchoesophageal fistula in adults

AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively.The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

超声在6月龄以下婴儿发育性髋关节异常早期筛查中的应用价值

目的观察超声在6月龄以下婴儿(简称小婴儿)发育性髋关节异常(DDH)筛查中的应用价值。方法 983名小婴儿分别进行DDH手法检查,及在征得其家属同意后进行超声波检查。结果 983名小婴儿DDH手法检出阳性3 45例(3 5.1%)。8 79人进行了高频超声波髋关节检查,诊断DDH 3 4例(3.9%)。5 3 4名DDH手法检查阴性的婴儿,高频超声波髋关节检出DDH 17例(3.2%);手法检出阳性的345例婴儿高频超声波髋关节检出DDH 17例(4.9%)。结论基层儿保门诊开展超声波髋关节常规筛查能够准确地对小儿发育性髋关节异常进行早期诊断,降低晚期发育性髋关节异常的发生率。

Surgical Treatment of Intralobar Pulmonary Sequestration

Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

The standard treatment of endometrial cancer or atypical hyperplasia is surgical removal of the uterus and ovaries. In early stage disease this has an excellent chance of cure but results in infertility. Although the majority of patients are postmenopausal an increasing number of patients with atypical hyperplasia or endometrial cancer are presenting with a desire to retain their fertile potential. In the last 8 years a number of studies have been published involving 403 patients with endometrial cancer and 151 patients with Atypical hyperplasia treated with high dose progestagens. The response rate is 76.2% and 85.6% respectively with endometrial cancer having a recurrence rate of 40.6%. There is a 26% recurrence rate in atypical hyperplasia. Overall 26.3% of those wishing to conceive had a live baby. Although concerns exist about the risks of medical treatment, those that fail this treatment do not appear to have a significantly poorer prognosis although 20 patients(3.6%) had either ovarian cancer or metastatic disease discovered during treatment or follow up.

Clinical analysis of 45 cases of surgical treatment for inner thigh primary soft tissue sarcoma

Objective: We aimed to study the relationship between clinical effect and surgical methods of inner thigh primary soft tissue sarcomas. Methods: Wide or radical resection were performed in 45 cases of soft tissue sarcomas, including 20 cases of postoperative recurrence after radiation therapy, 7 cases of first treatment. Thirty-six cases received 4–6 cycles of postoperative chemotherapy. Results: Thirty-eight of 45 cases were followed up for 1–5 years, with 5 case of recurrence and 6 cases of distant metastasis. Conclusion: The inner thigh primary soft tissue sarcoma can be effectively treated with wide or radical resection.

Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints

In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.

Centers of excellence in minimally invasive gynecology: Raising the bar for quality in women's health

The ＂Center of Excellence＂ concept has been employed in healthcare for several decades. This concept has been adopted in several disciplines; such as bariatric surgery, orthopedic surgery, diabetes and stroke. The most successful model in surgery thus far has been the bariatric program, with a very extensive network and a large prospective database. Recently, the American As-sociation of Gynecologic Laparoscopists has introduced this concept in gynecologic surgery. The ＂Center Of Excellence in Minimally Invasive Gynecology＂ （COEMIG） designation program has been introduced with the goals of increasing safety and efficiency, cutting cost and increasing patient awareness and access to mini-mally invasive surgical options for women. The program may harbor challenges as well, such as human and fnancial resources, and diffculties with implementation and maintenance of such designation. This commen-tary describes the COEMIG designation process, along with its potential benefits and possible challenges. Though no studies have been published to date on the value of this concept in the feld of gynecologic surgery, we envision this commentary to provoke such studies to examine the relative value of this new program.

西南联大诗人群对奥登诗风的接受与转化

英国现代诗人奥登曾于1938年访问中国,他的诗学观念和诗歌创作带给中国诗人新的启示。奥登受到弗洛伊德主义的影响,用一种“临床”的手法来剖析社会、介入现实,使诗作带有明显的现实取向。在形式上,奥登采用“轻松诗”的体式处理严峻的现实题材,使诗歌呈现出反讽性的结构张力。奥登介入现实的诗学思想和轻松反讽的诗歌风格都影响了西南联大诗人群的创作,西南联大诗人群在接受奥登的时候也结合了中国的现实语境,将其转化为本土化的诗歌实践。探究西南联大诗人群对奥登的接受与转化,对于理解1940年代现代主义诗潮的形成有着积极作用,也有利于探寻西方文学资源对中国新诗带来的有益影响。

ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients. Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4.5%. Fifteen patients ( 4.8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. Conclusion Although the difficulties and risk factors were increased, the results of redo CABG were still good.

Surgical repair of pelvic organ prolapse and follow-up: An institutional multi-center experience

AIM: To investigate the effects of the Elevate Anterior and Posterior transvaginal mesh procedure on 30 patients affected by pelvic organ prolapse(POP) at 12 mo follow-up.METHODS: Between September 2011 and September 2012, a prospective multicenter observational study enrolled 30 consecutive patients with POP-Q ≥ stage Ⅱ. After a preoperative evaluation, patients underwent prolapse repair utilizing the Elevate Anterior and Posterior Prolapse Repair System(American Medical Systems, Minnetonka, MN, United States). Operative technique was standardized and performed by the same surgical team under spinal or general anesthesia. Patients were evaluated postoperatively at 1, 3, 6 and 12 mo.RESULTS: All 30 patients completed the 12 mo followup. The mean age was 65.3 years(range 49-81 years) and average hospital stay was 4.5 d. The mean operative time was 65 min(range 40-120 min). Related adverse events reported were mesh extrusions(6.7%) and post void residual urine volume(13.3%). There were no visceral injuries, no infection of the mesh, and no symptoms of recurrent prolapse. All quality-of-life scores signifi cantly improved from baseline. CONCLUSION: One year's follow-up of our 30 patients confi rms the safety and the effi cacy of the Elevate Anterior and Posterior transvaginal mesh procedure for POP treatment. Our fi nal results are comforting but longer term follow-up is ongoing.