毒品注射致假性股动脉瘤的手术并发症和愈合不良的分析

探讨毒品注射导致假性股动脉瘤(femoral false aneurysm,FFA)的术后合并症或愈合不良的原因.分析10年来46例毒品导致FFA的围手术期并发症和愈合不良情况.结果46例患者中,髂股动脉缝扎后4例患肢缺血,1例人工血管感染,4例切口淋巴瘘,1例惠肢肿胀,2例深静脉血栓,2例患肢麻痹,均经相应处理后好转.因此,综合评估毒品导致的FFA患肢的血供和假瘤,个体化选择手术方案.可减少术后并发症以及愈合不良.     

不同时期颅骨修补术对重型颅脑外伤患者的临床价值分析

探讨和分析不同时期颅骨修补术对重型颅脑外伤去大骨瓣减压术患者的临床效果。选取我院2015年7月～2017年7月收治的重型颅脑外伤去大骨瓣减压术后患者98例,随机分为早期组52例和晚期组46例,早期组在去大骨瓣减压术后1个月～3个月行颅骨修补术,晚期组在术后6个月后行颅骨修补术,比较两组术后神经功能、脑组织血流变化和并发症发生情况。早期组患者Karnofsky (KPS)评分和功能独立性测量(FIM)评分明显优于对照组(P0.05或P0.01),患者患侧大脑中动脉(MCA)和颈内动脉(ICA)的血流速度明显高于晚期组(P0.05),早期组颅骨修补术后颅内血肿、颅内感染、皮下积液和切口愈合障碍等并发症发生率明显低于晚期组(χ2=6.56,P0.05)。重型颅脑外伤去大骨瓣减压术后早期完成颅骨修补术能明显改善神经功能和增加脑血液循环,减少并发症的发生,提高患者生命质量。     

直光束绿激光膀胱肿瘤剜除术治疗表浅性膀胱癌的疗效分析

探讨经尿道160W直光束绿激光膀胱肿瘤剜除术治疗表浅性膀胱癌(NMIBT)的疗效及安全性.使用经尿道160W直光束绿激光膀胱肿瘤剜除术治疗46例NMIBT.并统计术中出血量,手术时间,术中术后并发症发生率,平均住院时间及术后肿瘤复发率.所有46例手术均顺利完成,平均术中出血量14.0ml±3.4ml,平均手术时间23.4min士9.7min,术中及术后均未发生严重并发症.平均住院时间5.3d士2.1d,术后随访12个月～24个月,肿瘤复发率为15.2％.经尿道160W直光束绿激光膀胱肿瘤剜除术治疗NMIBT具有操作简便、手术时间短、术中出血量少、手术并发症少及肿瘤复发率不高等优点,可作为一种治疗NMIBT的手术方法.     

感觉寻求对工读生毒品使用的影响：有中介的调节效应

以523名工读生为调查对象,考察工读生毒品使用特点,并在控制相关人口学变量后,探讨感觉寻求、压力性生活事件、结交不良同伴与工读生毒品使用的关系。结果显示：（1）工读生的毒品使用行为严重,34.2%的工读生曾使用过毒品,毒品使用呈现低龄化、以吸食新型毒品为主的趋势。（2）工读生的感觉寻求是毒品使用的风险因素。（3）压力性生活事件对感觉寻求与毒品使用之间的关系具有风险增强的调节效应。（4）这种调节效应以结交不良同伴为中介变量。因此,感觉寻求对工读生毒品使用的影响是有中介的调节效应。研究结果对青少年毒品使用的预防和干预有重要的理论价值和参考价值。     

FOCUS超声刀与电刀在甲状腺手术中的比较研究

探讨FOCUS超声刀在甲状腺手术中的应用价值。选取2012年12月～2013年12月在我院乳甲外科住院手术甲状腺病例180例作为研究对象,其中FOCUS超声刀组90例,电刀组90例。比较两组手术时间、术中出血量、术后伤口引流量、术中气管前及腺体周围线结数量、手术并发症发生率。结果超声刀组在甲状腺手术平均时间（58．4±7．7）min ,术中平均出血量（24．8±8．1）ml,术后伤口引流量（41．5±6．7）ml,气管前及腺体周围线结数量（1．8±1．2）个,与电刀组比较,差异均有统计学意义（P＜0．05）。术后并发症发生率超声刀组与电刀组均较低。FOCUS超声刀在甲状腺手术中比传统电刀具有明显优势,安全、有效且不增加并发症发生率,值得在临床工作中推广。     

锁定加压钢板联合自体骨治疗非感染性股骨骨不连的疗效观察

观察锁定加压钢板联合植骨对非感染性股骨骨不连的临床疗效.回顾性分析2010年~2012年收治的31例非感染性股骨骨不连患者的临床资料.结果29例愈合,2例未完全愈合,本组愈合时间6个月~14个月,平均愈合时间6.9个月;术后均无感染、下肢成角、缩短畸形等并发症,手术前后髋、膝关节功能评分差异具有统计学意义（P＜0.05）.锁定加压钢板联合自体骨治疗非感染性股骨骨不连可获得牢固连接,并发症少,是临床治疗股骨骨不连的有效方法之一.     

缝合复位治疗髌骨粉碎骨折效果分析

探讨缝合复位技术治疗髌骨粉碎骨折的临床疗效。自2005年3月至2011年7月应用髌骨骨折片缝合复位的方法配合内固定器械固定治疗髌骨粉碎骨折患者共24例。男13例,女11例;年龄23岁～62岁,平均42．2岁。1例为开放性髌骨粉碎骨折,其余为闭合性髌骨粉碎骨折。1例开放骨折采用横切口,其余采用纵直切口。暴露髌骨骨折后,用可吸收缝线紧密缝合骨折片,缝合的同时骨折得到复位及固定,后加用其他内固定器械加强固定。术后早期开始屈伸膝关节功能锻炼。结果24例患者术后均获得随访,随访时间8个月～24个月,平均13．4个月。8周随访均达到临床愈合,2个月～3个月（平均2．8个月）骨性愈合,无并发症发生。采用Bostman评分方法评定疗效：优21例,良3例,优良率100%。因此采用缝合复住技术治疗髌骨粉碎骨折,具有操作简便、手术时间短及关节面复位固定好等优点;配合内固定器械固定,使粉碎骨折复住后固定更稳定,术后可以早期功能锻炼,疗效确切。     

父母控制、不良同伴和感觉寻求对工读生毒品使用的影响机制

在社会学习理论和生态系统理论基础上提出一个有调节的中介模型,探讨父母心理控制、行为控制与工读生毒品使用的关系,以及结交不良同伴的中介效应和感觉寻求的调节效应。514名工读生完成了父母控制问卷、不良同伴问卷、感觉寻求量表和毒品使用问卷。结果显示:(1)父母心理控制能正向预测工读生的毒品使用,父母行为控制能负向预测工读生的毒品使用。(2)结交不良同伴在心理控制、行为控制与工读生毒品使用的关系中起中介作用。(3)结交不良同伴的中介作用受到感觉寻求的调节。     

胰十二指肠切除术后C级胰瘘防治

随着现代医学的发展以及手术技术的进步,胰十二指肠切除手术(PD)的围手术期死亡率不断下降,大部分胰腺中心甚至已经达到小于2%,但术后并发症,比如胰瘘、术后出血、腹腔感染、胃排空障碍等居高不下。其中术后出血和腹腔感染会导致病情危重,有时需要紧急处理,否则危及生命;术后胰瘘是最常见并发症。胰腺术后胰瘘(POPF)发生率3%~45%,可能导致术后出血和腹腔感染,也是导致术后死亡的主要原因。如何防治胰瘘,尤其是防治C级胰瘘,是所有胰腺外科医生共同面临的难题。本文结合临床实践与文献,对胰瘘发生危险因素,以及预防和治疗胰瘘进行探讨。     

原发性肝癌术后肝内复发:再手术还是射频消融

观察射频消融治疗原发性肝癌术后肝内复发的临床疗效.选取我院确诊为原发性肝癌行根治性手术治疗后肝内复发且没有肝外转移的患者168例,其中99例患者行射频消融术治疗,69例行再手术治疗.观察两组患者的临床疗效、术后并发症、生存率.结果射频消融及再次手术治疗均能明显消除肝内复发病灶,射频消融治疗组未出现严重并发症,而再手术组1例患者因术后肝功能衰竭死亡.射频消融组和再手术组的1年、2年生存情况差异无统计学意义(P>0.05).应用射频消融治疗原发性肝癌术后肝内复发的临床疗效及预后与再手术治疗类似,但射频消融治疗方法的适应证更宽、术后并发症更少、更易于被患者和家属接受,可推广临床应用.     

Selective impairment of the graphemic buffer in acquired dysgraphia: a case study

The case of an Italian dysgraphic patient (S.E.), who showed a deficit of both written and oral spelling capacities, without significant differences between words and nonwords, is reported. The pattern of the patient's performance was identical on writing to dictation, delayed copying, and written naming. The most common category of errors was single-letter deletions, and errors were predominantly made in medial positions. Stimulus length appeared to be the single factor that most affected performance. This pattern is consistent with the hypothesis that S.E.'s spelling disorder results from selective damage of the Graphemic Buffer. The case is discussed in relation to current functional models of writing and is compared with similar cases reported previously.     

吸毒者心理社会生活质量分析

本研究旨在考察吸毒者的心理社会生活质量。云南地区194名吸毒者和198名正常被试参与了此项研究。结果表明：1)吸毒者和正常人在幸福感、自尊感、社会交往焦虑感、无力感、无意义感等方面都有显著差异,吸毒者的心理社会生活健康质量较差;2)不同性别、从事不同工作、兄弟姐妹数目和父母教育水平不同的吸毒者的心理社会生活质量不同;3)首次吸毒和复吸的大多数原因是心理因素。本研究对有关结果对吸毒者戒毒及教育的指导意义进行了讨论。     

Recent research on the relationship between illicit drug use and crime

This article reviews research on the relationship between illicit drug use and crime conducted since 1980. Significant advances are noted in studies of the crime of known drug abusers and in studies of the drug use of individuals processed by the criminal justice system. Major conclusions supported by the results of studies of the criminal activity of narcotic abusers are that both a higher prevalence and higher rates of crime are associated with more frequent use of heroin and/or cocaine, although addicts vary with regard to the type, amount, and severity of crime they commit. Rates of lifetime and recent illicit drug use, particularly the use of cocaine, among prisoners, parolees, probationers, and arrestees are high compared to the general population. Issues discussed include the etiology of drug abuse, the effects of treatment and criminal justice interventions on drug use and crime, and drug-related violence.     

Male alcoholics,secondary psychopathy and Eysenck's theory of personality

The scores of several samples of male alcoholics and others on the MAC Scale (an MMPI-derived scale for the differentiation of male alcohol abusers from non-substance-abusing male psychiatric outpatients) are summarized, and the responses of the false negatives and false positives from the scale's standardization samples are analyzed. The following 7conclusions were reached: (1) There are two broad classes of male alcoholics—those who fall into the E + N + quadrant of secondary psychopathy and those who fall into the E - N + quadrant of neurotic introversion; (2) Unselected runs of male alcoholics populate these two quadrants in a quite stable ratio of 17 to 3, respectively; (3) Pari passu, Eysenck's placement of alcoholics in the E + N + quadrant will be upheld in approximately 85% of the cases while those who hold that alcoholics are ‘dysthymics who also drink too much’ will find themselves in error in approximately similar degree.     

Perception of nonverbal facial cues in chronic phencyclidine abusers.

The ability to interpret nonverbal facial cues was tested in 10 young white male chronic phencyclidine (PCP) abusers. When their responses were compared with those of age-matched controls, abusers were significantly more accurate in interpreting the facial cues of videotaped medical interns. Phencyclidine abusers tend to form a socially maladroit and downwardly mobile group. However, previous studies of similar maladroit populations such as heroin addicts have indicated that they are less accurate in interpretation of nonverbal facial cues. The complex action of multiple affected neurotransmitters in PCP abusers was examined. Dopamine and serotonin were thought to be the relevant transmitters.     

Discounting of monetary and directly consumable rewards

We compared temporal and probability discounting of a nonconsumable reward (money) and three directly consumable rewards (candy, soda, and beer). When rewards were delayed, monetary rewards were discounted less steeply than directly consumable rewards, all three of which were discounted at equivalent rates. When rewards were probabilistic, however, there was no difference between the discounting of monetary and directly consumable rewards. It has been reported that substance abusers discount delayed drug rewards more steeply than delayed money, but this difference may reflect special characteristics of drugs or drug abusers, or it may reflect a general property of consumable rewards. The present findings suggest that abused substances (like beer) share the properties of other directly consumable rewards, whereas delayed monetary rewards are special because they are fungible, generalized (conditioned) reinforcers.     

AIDS and pediatric HIV infection: the problem of the infected mother and her newborn

The number or pediatric AIDS cases in the US was around 2000 in 1990, and children under 13 accounted for about 2% of reported cases. Pediatric cases are increasing as the number of infected women increases. Such cases are concentrated in poor urban populations, aggravating the lack of resources of already overtaxed health services. Ethnic minorities are overrepresented among AIDS cases. In the US, 52% of AIDS cases in adult women are in blacks, 27% in non-Hispanic whites, and 20% in women of Hispanic origin. Among children under 13, 53% are in blacks, 25% in Hispanics, and 22% in whites. The majority of children with AIDS were 5 and were probably infected by vertical transmission. Over 80% were born to mothers with AIDS or at risk of HIV infection, 11% received transfusions of contaminated blood, and 5% received contaminated blood products. Through December 1989, 53% of white, 91% of black, and 85% of Hispanic children with AIDS were infected vertically by their mothers. In the US, over 1/2 of cases of vertical AIDS transmission are due to maternal IV drug abuse and 1/5 to mothers who have sexual relations with IV drug abusers. The rate of infection in children born to seropositive mothers has not been established. Estimates of rates of transmission range from 20% to 50%. The factors causing HIV transmission in 1/3 of infants and protecting the other 2/3 have not been identified. Transmission to the infant may occur during pregnancy or delivery or through breast feeding. There is no evidence that cesarean delivery can protect against infection. The risk of intrauterine infection is probably much greater than that of infection during delivery. Diagnosis of HIV infection in young infants is difficult. There are no physical characteristics distinguishing infected newborns, and laboratory diagnosis is unhelpful because maternal HIV antibodies cross the placental barrier to the fetus. There is as yet no vaccine or curative treatment for HIV infection. Prevention of pediatric HIV infection requires prevention of the infection and the disease in pregnant women. Primary prevention in women depends on their being adequately informed about risks and able to change risk behaviors. Secondary prevention is achieved through use of AZT, which slows the progression of the disease, and prevention or treatment of complications. There is no conclusive evidence as yet that pregnancy hastens the progression of maternal HIV infection. Seropositive mothers should avoid breast feeding if adequate substitute foods are available. The average age at appearance of symptoms in infected children is 8 months. Mortality is higher among children manifesting the disease in the 1st year, with a median survival of 38 months. Full information about HIV infection and voluntary and confidential screening should be available to all women contemplating pregnancy.     

高龄股骨粗隆间骨折的治疗经验

探讨高龄患者粗隆间骨折的治疗,并观察比较股骨近端防旋髓内钉（proximal femoralnail anti—rotation,PFNA）和Gamma钉（Gamma Nail）在高龄患者粗隆间骨折治疗中的应用和疗效。经对81例高龄股骨粗隆间骨折行PFNA、Gamma内固定治疗,结果经术后1个月～24个月随访,PFNA...     

人工全髋关节置换术肢体长度调定方法的前瞻性研究

探讨人工全髋关节置换术预防双下肢不等长的方法。综合采用术前X线片模板测量股骨头运动中心指导选择假体颈长;术中根据股骨头运动中心是否与大粗隆尖端平齐、侧卧位测量双髌骨下缘是否在同一平面、牵拉患肢根据软组织张力调整患肢长度等方法来确定术中股骨颈假体的长度。本组44例患者分为2组：A组术前肢体等长（21例）;B组术前肢体不等...     

Twelve‐Step Groups,Attributions of Blame for Personal Sadness,Psychological Well‐Being,and the Moderating Role of Gender1

Two studies investigated links among 12‐step group participation, gender, attributions of blame for personal sadness, and psychological well‐being. Study I used a correlational design to examine these links cross‐sectionally among substance abusers who identified alcohol as their primary drug problem. Study 2 used an experimental design to examine prospective links among these variables for substance abusers who were also adult children of alcoholics. Females engaged in more blame than did males, and personal blame was negatively related to psychological well‐being in Studies 1 and 2. Most significantly, 12‐step group participation was associated with lower personal blame among females but not among males across both studies. These results indicate that 12‐step groups can reduce personal blame among females who have substance abuse problems.