Objective To provide evidence-based therapeutic schedule for an adult patient with Lumber Isthmic Spondylolisthesis grading II. Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to April 2011), DARE (April 2011), CENTRAL (April 2011), MEDLINE (April 2011), EMbase and CBM were searched to collect high quality clinical evidence, and then we told a patient information about treatment plans. The plan was chosen by the patient for she knew her conditions and the plans. Results We included 1 meta-analysis, 3 randomized controlled trials, 5 systematic reviews and 1 prospective study on the natural course of isthmic spondylolisthesis were included. Literature evidence indicated that the prognosis of isthmic spondylolisthesis was good. Surgery should be selected when there was neither no remission of symptom, nor progression of lumber olisthy with conservative treatment. The long-term effect of surgery may be good, but it cannot change the natural course of the disease. Based on literature evidence, the patient chose the conservative treatment. After one year’s treatment the patient recovered, her sciatica relieved, and CT showed no progression of lumber olisthy. Conclusion Patient with low grand isthmic spondylolisthesis chose conservative treatment may achieves good effects, whereas on the process of the treatment, regular follow-up to monitor the progression of lumber olisthy should be conducted.
Behccedil;et's disease,a stubborn malady,has extremely bad visual prognosis due to the recurrence of uveitis. The combination of chlorambucil with traditional Chinese medicine herbs was designed to treat 16 patients with Behccedil;ets disease,resulting in total remission of uveitis in 11 patients and partial remission in 5 patients. Visual improvement was seen in 63.33% of the eye involved in Bebcet's disease. The extraoeular manifestations such as oral aphthae,multiform skin lesions,genital ulcer and muscular pain were disappeared in 10 patients and dramatically improved in 6 patients. The treatment was well tolerated by the patients with few side effects. The indications,side etfeets and relevant problems of the treatment were discussed based on the results presented here. （Chin J Ocul Fundus Dis,1994,10:142-148）
Objective To investigate whether there is an off-hours effect on the endovascular treatment (EVT) process for patients with acute ischemic stroke (AIS) after emergency admission to the hospital. Methods We retrospectively analyzed AIS patients who were admitted to the West China Hospital of Sichuan University on the stroke green channel between September 2019 and August 2023 and planned to perform emergency EVT. The patients were divided into working-hour and off-hour groups according to their admission time. The clinical information, door-to-puncture time (DPT), door-to-head/neck imaging time (DIT) and door-to-blood test time (DBT) of the two groups patients were compared, and subgroup analysis was conducted according to whether they arrived at the hospital at night, before and after the guideline update, and whether they were in the coronavirus disease 2019 epidemic period. Results A total of 586 AIS patients with large vessel occlusion were included, including 220 patients admitted during working hours and 336 patients admitted during off-working hours. There was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Subgroup analysis showed that in patients admitted during off-working hours, there was no statistically significant difference in the basic information and EVT process time between patients arrived at the hospital at night and patients did not arrive at the hospital at night (P>0.05). Before and after the guideline updated, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). No matter whether it is in the coronavirus disease 2019 epidemic period, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Conclusions There is no off-hours effect on the EVT process time after AIS patients arrive at the hospital. In the future, more stroke centers of different levels are needed to further explore the impact of off-hours effect on emergency diagnosis and treatment of AIS patients.
Objective To explore the concept, contents and existing problems of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The fast-track programmes enhance recovery of the patients who underwent the colorectal resection with the combination of multimodal techniques and approaches. Conclusion The fast-track programmes in colorectal surgery is the typical modality of the multi-disciplinary treatment, this modality can decrease the complications and reduce the hospital stay with preserve the well physiological fundament of the patients.
From March 1979 to February 1987, 500 cases of firearm wounds of blood vessels were treated. Of them, 465 cases were recovered, 15 cases were disabled, 13 cases had amputation, and 7 cases died. The article presented the clinic materials. The following problems were discussed: (1) The characteristics of firearm wounds of blood vessels. (2) Emergency treatment of injuries of major blood vessels of limbs. (3) Indications of repair of blood vessels. (4) The methods of repair of defect in blood vessel. (5)Factors influencing the survival of extremities, and (6) Active prevention and treatment of complication.
Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
目的 探討胰性腦病的可能的發病機制、發病情況及防治措施.方法 計算機檢索中文科技期刊全文數據庫(1989～2004),收集有關胰性腦病的臨床研究,并進行統計分析.結果 共納入43篇文獻,435例患者.胰性腦病在重癥急性胰腺炎中的發病率遠高于輕癥急性胰腺炎;發病年齡趨向中、老年;病死率為43.67%;病因仍以膽系疾病為主;伴發低氧的幾率不高于未并發胰性腦病患者.結論 胰性腦病的發生可能是多因素共同作用的結果,仍需進一步探討其發病機制.血清髓鞘堿性蛋白有望成為有價值的診斷指標.防治以治療原發病急性胰腺炎為主,重在預防.胰酶抑制劑和早期營養支持有一定預防作用.
摘要:目的:總結汶川地震26例多器官功能衰竭患者的臨床資料,就其發病特點,治療經過及預后進行探討,為防治提供依據。方法:對汶川地震26例多器官功能衰竭患者的臨床資料進行回顧性分析。結果:19例患者死亡,死亡率為73.1%。死亡率隨著功能衰竭的器官數量增多而增高,4個及以上器官功能衰竭者死亡率為100%。結論:多器官功能衰竭預后差,死亡率高。強調對 MOF的早期識別、早期診斷、早期治療以及治療上的統籌兼顧,防治結合。Abstract: Objective: To investigate the clinical characteristic and treatable methods of the multiple organ failure (MOF) in Wenchuan earthquake. Methods: The clinical records of the 26 patients with MOF were studied retrospectively. Results: Nineteen patients died and the mortality was 73.1%.The mortality increased along with the quantity of the organ failure, and the death rate of the patients with equal or more than 4 organs failure was 100%. Conclusion:The prognosis of the patients with MOF was bad and the death rate was high in Wenchuan earthquake. We emphasize the early recognition, early diagnose and early treatment and the treatment of overall planning and allround consideration and prevention in combination with treatment.
Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．