感染性糖尿病足多学科联合治疗

感染性糖尿病足是在糖尿病周围神经病变、血管病变的基础上发生的,或由清洁性溃疡继发感染而成.如果治疗不当,可以导致截肢等事件的发生,因此,需要多学科联合治疗,以期最大限度地保护患者肢体功能、降低截肢率.     

35例感染性糖尿病足的治疗与护理

总结了本院内分泌科2008年1月～2010年5月共收治的35例感染性糖尿病足的治疗与处理.包括:整体治疗:控制血糖、控制感染、改善微循环、营养神经治疗.局部创面处理.采取的护理措施:体位护理、患足局部护理、心理护理、饮食调理.认为以上的治疗和护理措施,可以使感染性糖尿病足患者致死致残率大大降低.     

中医外治法治疗类风湿性关节炎探讨

中医外治法治疗类风湿性关节炎的方法多种多样,各有利弊,与传统的药物治疗相比,在缓解症状,促进功能恢复方面有其独到之处.临床可根据具体情况,选用一二,配合药物治疗,取长补短,以达到最佳的治疗效果.     

糖尿病足的预防与护理要点

糖尿病足是一类在糖尿病周围神经病变和外周血管病变基础上,由于足应力、外伤、感染等因素引起的严重下肢病变的总称.近年来,随着人口不断老化、生活方式的不断改变和生活水平不断的提高,糖尿病患病率明显上升,糖尿病足发病率也越来越高,严重威胁着人们的身体健康,有时甚至无法愈合而截肢,因此预防和护理糖尿病足非常重要.     

糖尿病足的临床分析及综合性治疗

目的:探讨糖尿病足的临床特点及有效的综合性治疗方法.方法:对21例糖尿病足患者的临床资料进行回顾性总结;有效控制高血糖、高血脂、高血压;根据细菌培养和药敏使用抗生素;改善局部血供、抗凝、扩张血管,药物湿敷等综合治疗.结果:0～3级糖尿病足总有效率为87%,4～5级无一例治愈.结论:糖尿病足应早期发现、早期全面综合治疗.     

糖尿病足的临床观察与护理

糖尿病足是指患者踝关节以下部位的溃疡坏疽或感染,是糖尿病的严重并发症.我院自2006年-2010年共收治糖尿病足36例,经胰岛素控制血糖、抗生素控制感染、抗凝改善微循环及局部换药清除坏死组织等治疗,取得了满意效果,全部病人均治愈出院.现将护理体会报告如下.     

浅谈糖尿病足患者护理与健康宣教

目的:探讨糖尿病足的护理措施及健康宣教.方法:采用讲座、发放小册子、看录像等方法,让患者及家属了解糖尿病的基础知识,明确糖尿病足是可防可治的.结果:通过健康宣教,提高了患者的自我保健能力,从而有效地降低了糖尿病足的发生率.结论:糖尿病足的预防是关键,感染后合理的创面护理、局部皮肤护理、综合治疗相结合,有效地缩短了溃疡愈合的时间,减少了截肢的发生,提高了患者的生活质量.     

肤痔清软膏换药治疗30例糖尿病足的护理体会

糖尿病足(糖尿病合并肢端坏疽)是由于局部周围神经病变和下肢远端外周血管病变导致的足部感染、溃疡或深层组织破坏,是一种慢性、进行性以肢端缺血、溃烂、坏死为临床表现的疾病,主要原因是大血管、微血管及周围神经病变.糖尿病足作为糖尿病血管并发症之一,具有病程长,不易愈合且易复发的特点,是糖尿病患者致死致残的重要原因.本院从2004年起采用苗药肤痔清软膏换药治疗糖尿病足30例,取得了满意效果.现报告如下.     

留置皮下通道多术式联合治疗肝内胆管结石

目的:探讨留置皮下通道多术式联合治疗肝内胆管结石和狭窄的疗效及长期效果评价.方法:回顾性分析北京大学第三医院普通外科从1993年4月至2010年3月收治的肝内胆管结石符合做留置皮下通道的病例共156例,手术采用保留Oddi括约肌功能、肝门部胆管切开成形、狭窄纠正、病变肝组织切除和留置皮下通道的方式.结石位于左半肝占23.7%(37/156)、右半肝占14.1%(22/156)、左右半肝均有结石占62.2%(97/156),另外,结石合并狭窄占63.5%(99/156).结果:所有患者均成功手术,无围手术期死亡,手术并发症发生率为35.9%(56/156).146例获得随访,随访率94.8%,中位随访时间为7年,随访发现胆管炎发作者占13.0%(19/146),再发结石者占21.9%(32/146),新发现胆管狭窄者占8.2%(12/146),另外,利用皮下通道切开胆道置管引流、取石或狭窄支撑35例,占24.0%(34/146).结论:留置皮下通道、保留Oddi括约肌功能、多术式联合治疗肝内胆管结石和狭窄的方法安全、有效,对再发结石和狭窄的处理符合微创.     

针刺内迎香治疗嗅觉下降

嗅觉是一种比较原始的感觉,有影响食欲、情绪及警示危险信号等作用.嗅觉障碍会严重影响人的生活质量.对于该病的治疗,临床上鲜有报道.20余年来,我们应用针刺内迎香治疗嗅觉障碍取得了满意的疗效,现介绍如下.     

Resection of the metatarsal head for diabetic foot ulcers

Dobutamine-induced hypotension has been disregarded as a marker of more severe functional abnormalities in patients with suspected coronary artery disease. However, its functional significance in patients with myocardial infarction has not been studied. The aim of this study was to define the predictors of systolic blood pressure (SBP) response to dobutamine in patients with previous myocardial infarction. Dobutamine stress (up to 40 microg/kg per minute) echocardiography was performed in 326 patients with prior myocardial infarction referred for evaluation of myocardial ischemia. A 16-segment, four-grade score model was used to assess left ventricular function. Wall motion score index was derived by summation of wall motion score divided by 16. SBP and heart rate increased from rest to peak dobutamine stress (127 +/- 22 vs 134 +/- 27 mm Hg and 72 +/- 14 vs 122 +/- 24 bpm, p < 0.00001 in both). An increase of SBP > or = 30 mm Hg occurred in 50 patients (15%). By multivariate analysis, independent predictors of failure of SBP increase were higher peak wall motion score index (p < 0.001), higher resting SBP (p < 0.01), and medication with calcium channel blockers (p < 0.05). SBP drop > or = 20 mm Hg occurred in 54 patients (17%). Independent predictors of SBP drop were higher resting wall motion score index (p < 0.001), higher resting SBP (p < 0.0001), and older age (p < 0.05). In patients with myocardial infarction, left ventricular function and baseline systolic blood pressure are powerful predictors of SBP response to dobutamine stress testing.     

Factors contributing to the presentation of diabetic foot ulcers

We have undertaken a prospective study of the presentation of all 669 ulcers seen in a specialist multidisciplinary foot clinic between 1 January 1993 and 1 August 1996, with particular reference to the factors which precipitated ulceration as well as to any delays in referral. Nearly two-thirds (61.3%) of all lesions were first detected by the patient or a relative, and the remainder by a healthcare professional. The median (range) time which elapsed between ulcer onset and first professional review was 4 (0-247) days, and the median time between first review and first referral to the specialist clinic was 15 (0-608) days. Significant delays were judged to have occurred in 39 instances. The most common precipitant of ulceration was rubbing from footwear, which was responsible for 138 (20.6%). Fifty-eight (8.7%) were the result of immobilization from other illness, and a further 24 were the consequence of surgery. Overall, professional factors contributed to the development or deterioration of 106 lesions (15.8% total). These results should form the basis of strategies designed to minimize the onset of ulceration in those known to be at risk: educational strategies need to be directed at professionals as much as at patients.     

A metabolically active human dermal replacement for the treatment of diabetic foot ulcers

OBJECTIVE: To determine the extent to which esophagoscopy and bronchoscopy are being used in various regions of the United States in the initial examination of patients with head and neck cancer. DESIGN: Population-based study derived from Medicare claims data and information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. SETTING: Five SEER areas (San Francisco, Calif; Connecticut; Seattle, Wash; Iowa; and Detroit, Mich). PARTICIPANTS: The cohort included 1410 Medicare patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx diagnosed between March 1, 1991, and December 31, 1993, in the 5 SEER areas. MAIN OUTCOME MEASURE: Rates of esophagoscopy and bronchoscopy according to SEER area. RESULTS: The proportion of patients who underwent esophagoscopy ranged from 12.9% (San Francisco) to 39.8% (Detroit) for patients with local cancer and from 22.2% (San Francisco) to 59.7% (Detroit) for patients with regional cancer. The proportion of patients who underwent bronchoscopy ranged from 6.9% (San Francisco) to 32.6% (Detroit) for patients with local cancer and from 12.8% (San Francisco) to 50.7% (Detroit) for patients with regional cancer. After controlling for differences in age, sex, race, tumor site, tumor grade, comorbidity, and socioeconomic status, SEER area remained independently associated with esophagoscopy and bronchoscopy (both P < .001). CONCLUSIONS: There is substantial geographic variation in the use of esophagoscopy and bronchoscopy as part of the initial examination of patients diagnosed as having head and neck cancer that cannot be explained by differences in patient or tumor characteristics. This variation likely underscores uncertainty and disagreement about the value of endoscopic screening for synchronous tumors. Additional research is required to determine whether routine endoscopic screening increases survival rates or improves quality of life.     

The total contact cast: a method for treating neuropathic diabetic ulcers

Plantar ulcers that do not heal in patients with diabetes and peripheral sensory neuropathy have been shown to be precursors of lower extremity amputation. The total contact cast is considered by many authorities to be the most effective technique for healing of wounds in the neuropathic extremity, yet it still is not widely used in clinical practice. Use of the total contact cast allows mobilization and results in diminished edema and decreased pressure over the ulcerated area. Complete healing usually occurs in eight weeks or less. Total contact casting with careful follow-up should be considered as a useful modality for healing plantar ulcers in diabetic patients with neuropathy of the extremities.     

Reactions of internal and external test-anxious students to counseling and behavior therapies.

Studied the responses of 36 test-anxious students, who differed on Rotter's Internal-External Control Scale, to 3 forms of therapy (counseling, systematic desensitization, and automated desensitization). Support was obtained for the prediction that internal Ss would show greater resistance to the control implied in the 2 behavior therapies than external Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Three-dimensional fibroblast culture implant for the treatment of diabetic foot ulcers: metabolic activity and therapeutic range

Dialysis techniques are discussed as a means for effective removal of low-molecular-mass components from fermentation broth to reach high cell density. Reactor systems and process strategies, the relevant properties of membranes and examples for high-density fermentation with dialysis, and problems related to scale-up are addressed. The dialysis technique has turned out to be very efficient and reliable for obtaining high cell densities. As in dialysis processes the membranes are not perfused, membrane clogging is not a problem as it is for micro- and ultrafiltration. By applying a "nutrient-split" feeding strategy, the loss of nutrients can be avoided and the medium is used very efficiently. The potential of dialysis cultures is demonstrated on the laboratory scale in a membrane dialysis reactor with an integrated membrane and in reactor systems with an external dialysis loop. In dialysis cultures with different microorganisms (Staphylococci, Escherichia coli, extremophilic microorganisms, Lactobacilli) the cell densities achieved were up to 30 times higher than those of other fermentation methods. The technique enables high cell densities to be attained without time-consuming medium optimization. For animal cell cultures the concept of a fixed bed coupled with dialysis proved to be very effective.