37 cases of myogenic torticollis treated by scalp and body acupuncture

OBJECTIVE: The Manchester procedure (MP) was compared to vaginal hysterectomy (VH). Surgical and postoperative complications were evaluated. MATERIAL AND METHODS: A retrospective review of women undergoing VH and MP for uterine prolapse was performed. All the operations were performed between 1974-1994. MP was performed in 190 patients and VH (Heaney technique) in 231 women. RESULTS: MP patients, when compared to VH patients, were more likely to be older and postmenopausal at the time of surgery. Statistically significant differences were found for operative time and blood loss. This difference was not dependent on the performance of anterior or posterior repair. CONCLUSIONS: We suggest the use of MP as an alternative to VH in the absence of uterine pathology in appropriate candidates with uterine prolapse.     

206 cases of spinogenic dizziness treated by contralateral acupuncture

The case of an 18-year-old pregnant woman with cryptococcal meningitis treated with amphotericin B and flucytosine since the third trimester of pregnancy is reported. She delivered a normal baby. The maternal outcome was favorable. There is no evidence of congenital infection in the newborn.     

Pyogenic liver abscesses in patients with malignant disease: a report of 52 cases treated at a single institution

OBJECTIVE: To generate baseline data about the experiences of researchers applying to five or more local research ethics committees (LRECs) for ethical review. The new multi-centre review system will be compared with these data. DESIGN: Ninety-seven researchers, whose status as multicentre researchers was unclear, were identified from various sources in the South Thames Region. They were each sent a questionnaire asking for their views on the substance of ethical review and their experiences of the process of ethical review. RESULTS: Of the completed questionnaires, 24 fitted the multicentre criteria of applying to five or more LRECs. Responses showed dissatisfaction with LRECs' treatment of the scientific aspects of research, but satisfaction with aspects relating to consent and protection of patients' welfare. Respondents experienced great difficulty in the administration of the process of ethical review. CONCLUSIONS: The need for a new system of ethical review for multi-centre research is beyond doubt. It remains to be seen whether it will be an improvement.     

体针、电针配合足底穴位注射治疗顽固性失眠856例临床观察

目的观察体针、电针配合足底穴位注射治疗顽固性失眠的疗效.方法对856例顽固性失眠患者采用体针、电针配合足底穴位注射治疗.体针主要取神门、太冲、足三里、阴陵泉、三阴交、太渊、少府、太溪等穴.电针主要取安眠1、安眠2、安眠3、翳风穴.穴位注射取足跟中点部位敏感点.结果856例中治愈722例(84.3%),显效123例(14.4%),好转58例(6.8%),总有效率为100.0%.结论体针、电针配合足底穴位注射治疗顽固性失眠具有较好疗效.     

探索音乐疗法治疗大学生心理焦虑97例效果观察

自1998年高校大规模扩大招生以来,全国各级各类高校在校学生人数不断增加,且学生结构日趋复杂,促使了各种心理问题凸现,而大学生心理危机则严重影响其成长成才、影响高校稳定和发展.因此,大学的心理教育的重要性也显得日益突出,其中当代大学生的心理困惑主要体现在心理焦虑问题上.     

Feasibility of retroperitoneal pelvic lymph node exploration in cancers of the cervix treated by radiosurgery association or radiotherapy alone. Apropos of a series of 52 cases

From June 1980 to May 1993, 52 patients with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopic procedure for cervix carcinoma classified as stage IA (14), IB (12), IIA (6), IIB (14), IIIB (3), IVA (3). Two techniques were used: a retroperitoneoscopy in 16 cases and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. The aim was to define, with a better accuracy, the pelvic lymph node status, to adapt the target volume, and to estimate the morbidity. More nodes were biopsied with PRPP than with retroperitoneoscopy (p < 0.05). There was a disagreement between the conventional radiologic assessment and the histological results in 28.6%. Specificity is 100%. Intra-operative and post-surgical morbidity was equivalent in the two procedures. One grade 3 urinary late morbidity (3%) was observed among the 33 patients who underwent a pelvic external irradiation. There was no morbidity of the gastro-intestinal tract. Discussion deals with the support offered by the two laparoscopic procedures to define the pelvic lymph node status, to choose the planning target volume, and to precise the lymph node boost.     

Aesthetic rhinoplasty with maximum preservation of alar cartilages: experience with 52 consecutive cases

Historically, rhinoplasty has been conceptualized mainly as an excisional and reductional operation of the nasal framework; however, there is growing evidence showing that conservatism in terms of preserving as much skeleton as possible makes the final results more predictable and more physiologic. On the basis of this point of view and using modifications of Tebbetts' technique, a prospective study of 52 patients presenting for primary open rhinoplasty was made. In all the cases, the cephalic portion of the lateral crus was preserved, and the procedure was designed basically to create a better anatomy from an aesthetic point of view. The results were evaluated aesthetically and by cephalometry, and patients showed improvement; native crura preservation was maximized. This report suggests more prospective studies need to be conducted to demonstrate the efficacy of these surgical variations on the average patient.     

Eight cases of pyelo-ureteral junction syndrome treated by laparoscopic surgery

From may 1994 to may 1995, eight consecutive patients with symptomatic congenital ureteropelvic junction syndrome (UPJS) were treated by pyeloplasty as described by Anderson, Hynes and Küss by laparoscopic surgery. Three patients had a lower pole artery crossing the anterior surface of the junction and two had a giant renal pelvis. The mean operating time was 120 minutes (min: 90 min; max: 147 min) and the mean hospital stay in the absence of complications (one case) was 3.5 days (min: 1.5 day; max: 8 days). This one complication was due to a postoperative fistula resulting from a technical error requiring an additional fortnight in hospital. All the patients are evaluable at three months. All are asymptomatic and the radiological results showed frank improvement in seven out of eight cases, while the dynamic appearance was improved in the other case. UPJS can be treated by laparoscopic surgery according to proven surgical principles, provided it is performed in a perfectly equipped operating room, by a surgeon and operating team experienced in this type of surgery.     

Two cases of cancer with bone metastases treated with local therapy

Two cases with osteolytic bone metastases from cervical cancer and esophageal cancer treated by local therapy were reported. The first case is a 53-year-old female with bone metastases of left ischium developed 1 year after hysterectomy. She was treated by intratumor injection of sizofiran (SPG) 20 mg/w and radiation therapy. After 4 weeks, ischias pain decreased and bone lesion showed remarkable calcification (PR) 8th months later. The second case is a 58-year-old male with bone metastases of the left tibia and fibula developed 1 year after surgery. He was treated by intratumor injection of SPG 20 mg/w x 4 and OK-432 1.0 KE/w x 8 after radiation therapy. After 4 weeks, pain and swelling of left leg decreased and bone lesions showed remarkable calcification (PR) three months later. We suggest that intratumor injection of SPG and OK-432 with radiation therapy was effective for osteolytic bone metastases.     

Erosive pustular dermatosis of the scalp in skin grafts: report of three cases

The objective of the present prospective, noncomparative, multicenter study was assess the safety and efficacy of gentamicin and doxycycline therapy for human brucellosis. In the first part of the study, a cohort of 17 patients received 100 mg of doxycycline (or 50 mg/kg of body weight per day if the body weight was < 40 kg) orally every 12 h for 45 days (cohort 1). In the second part of the study a subsequent cohort of 35 patients was treated with doxycycline at the same dosage for 30 days (cohort 2). All patients were treated intramuscularly with gentamicin at 240 mg (or 5 mg/kg per day if the body weight was < 50 kg) once daily for the first 7 days. Both cohorts showed a favorable response during therapy, and there were no therapeutic failures. Relapse was noted in 1 (5.9%; 95% confidence interval [95% CI], 0.15 to 28.7%) of the 17 patients in cohort 1 and in 8 (22.9%; 95% CI, 10.4 to 40.1%) of the 35 patients in cohort 2. Nineteen patients (36.5%; 95% CI, 23.6 to 51.0%) had adverse effects, with no differences between cohorts, and no patients had a treatment-limiting adverse effect. The study indicates that the combination of doxycycline for 45 days and gentamicin for 7 days is an effective and well-tolerated therapy for human brucellosis. The relapse rates obtained with doxycycline treatment for 30 days appear to be higher than those obtained with doxycycline treatment for 45 days.     

Two cases of severe cytomegalovirus pneumonitis treated with permissive hypercapnia

Two patients with severe cytomegalovirus (CMV) pneumonitis were treated with permissive hypercapnia. Case 1 was a 66-year-old male who suffered ventricular septal perforation caused by acute myocardial infarction. Case 2 was a 54-year-old male who sustained a blunt chest injury. In both cases, hypoxia with reduction of lung compliance developed after their operations. They were mechanically ventilated and we limited their peak inspiratory pressure, disregarding hypercapnia (i.e. permissive hypercapnia). During permissive hypercapnia, the maximum arterial partial pressure of carbon dioxide (PaCO2) was 96 mmHg in case 1 and 141 mmHg in case 2. Duration of hypercapnia (PaCO2 > 50mmHg) was 22 days in case 1 and 29 days in case 2. The patients were weaned from the respirator after two months of mechanical ventilation. In conclusion, the permissive hypercapnia was a useful method in the treatment of severe CMV pneumonitis.     

Hemispherectomy: a hemidecortication approach and review of 52 cases

Between 1975 and 1994, 52 hemispherectomies, of which two were anatomical and 50 hemidecortications, were performed at Johns Hopkins Medical Institutions. Eighteen patients were 2 years old or less. There were three perioperative mortalities and one patient died 9 months later from causes not related to surgery. One patient developed hydrocephalus 6 years postsurgery and has been treated effectively. Seizure control and the functional status of each patient were measured as outcome variables. Forty-six (96%) of the surviving patients were seizure free or had reduced seizures as of their last follow-up examination. Twenty-one individuals (44%) were participating in age-appropriate classes or working independently, 18 were classified as semiindependent, and nine children will likely depend on a lifetime of assisted living. The relationships between the outcome variables and the patient's age at surgery, the interval to surgery, and the etiology of the disease were compared. The authors' clinical experiences strongly suggest the importance of a multidisciplinary approach to patient selection and follow-up care. Moreover, anesthetic management of infant surgery is a major component of success.     

A case of Rathke''s cleft cyst with apoplexy

OBJECTIVE: To develop and evaluate a model of integrated primary dental and medical care. DESIGN: 3-year prospective study. SETTING: A general dental practice and a general medical practice occupying the same building in Glasgow. INTERVENTION: Regular staff meetings, joint use of patient records systems and information derived from patient questionnaires. Dentistry was included in established screening programmes such as child health surveillance and care of elderly. Staff were encouraged to participate in joint work practices and joint consultations were carried out. MAIN OUTCOME MEASURES: Patient registration, avoidance of discrepancies in information, reduction of secondary referrals, joint work practices. RESULTS: The number of registered joint patients attending both medical and dental practices increased by 90%. The joint use of patient record systems avoided discrepancies in patient information which would have affected the quality of patient care. Including dentistry in child health surveillance and care of elderly screening programmes resulted in an increase in 0-5 year olds registering with dentists from 36% to 68% (P < 0.001) and with > 75 year olds from 47% to 71% (P < 0.001). Joint consultations reduced the need for secondary referrals. CONCLUSIONS: This model of health care demonstrated the potential for coordination and integration of functions between the dental team and the primary care team. Integrated primary dental and medical care requires attitudinal change in health care professionals and requires greater emphasis in education and training of health care professionals in the future.