两种麻醉方案用于经皮肾镜取石术的利弊分析和临床抉择

本文概括地比较了经皮肾镜取石术与传统取石术的优劣,指出了经皮肾镜取石术时理想麻醉方案的重要性,详细地分析了全身麻醉和椎管内麻醉用于经皮肾镜取石术的利弊,最后作者针对如何优化经皮肾镜取石术的麻醉方案进行了深入的思考。     

小儿肾结石微创治疗研究进展

近年来小儿肾结石的发病率逐渐升高,体外冲击波碎石(ESWL)、经皮肾镜碎石取石术(PCNL)、输尿管软镜碎石取石术(FUL)等微创治疗技术已逐步取代开放性手术成为小儿肾结石的主要治疗手段。ESWL操作方便、创伤小及花费相对较少,但治疗体积较大和复杂性肾结石的清石率明显降低;PCNL治疗复杂性肾结石有较大的优势,但其并发症(如大出血、肾及周围脏器损伤等)的发生却不容小觑;FUL有更加微创、并发症少、可反复治疗等优点,但由于设备昂贵、易损耗、治疗成本高等原因限制了其在临床的推广应用。本文主要对微创治疗在小儿肾结石中的应用做一综述。     

经皮肾镜取石术前测定血清降钙素原和尿细菌学培养的临床价值

探讨在经皮肾镜取石术前测定降钙素原和尿细菌学培养在临床中的应用价值。根据全身炎症反应综合征诊断标准将患者分为全身炎症反应组36例和非全身炎症反应组49例,用统计学方法分析各因素对经皮肾镜取石术术后发生全身炎症反应综合征的影响。单因素分析结果显示第一时间血清PCT水平高、术前尿培养阳性与尿源性全身炎症反应综合征的发生有关(P均0.05)。多因素分析结果显示第一时间血清PCT值阳性、术前尿培养阳性与全身炎症反应综合征的发生相关(P均0.05)。经皮肾镜取石术术后出现全身炎症反应综合征受诸多因素影响,术前测定降钙素原和尿细菌学培养对术前病情评估及预防全身炎症反应综合征方面具有较高的临床应用价值。     

后腹腔镜肾盂输尿管切开取石术34例临床体会

探讨后腹腔镜下肾盂、输尿管切开取石的技术要点和临床应用价值.回顾性分析34例后腹腔镜肾盂、输尿管切开取石术的临床质料.男22例,女12例,肾盂结石10例,输尿管结石24例.结果34例成功完成腹腔镜取石术,手术时间40min～90min,平均58min,术中出血10 ml～30ml,术后1例漏尿3d,术后3d～5d拔除后腹腔引流管,术后住院7d～9d,34例随访12个月～26个月,患者肾输尿管积水均明显好转,无结石复发及输尿管狭窄.后腹腔肾盂输尿管切开取石术可部分取代肾盂结石的开放手术,可作为输尿管上段结石ESWL或(和)URL治疗失败的首选治疗方案.     

部分尿路腔镜手术麻醉的选择

就某些情况部分尿路腔镜手术麻醉问题进行探讨,从国内外现状以及个人工作经历等方面对该问题进行解析,提出如何按照循证医学理念,结合临床实际与决策者手术技能来解决实际工作中的问题,对部分尿路腔镜手术麻醉要求进行革新。     

部分尿路腔镜手术麻醉的选择

就某些情况部分尿路腔镜手术麻醉问题进行探讨,从国内外现状以及个人工作经历等方面对该问题进行解析,提出如何按照循证医学理念,结合临床实际与决策者手术技能来解决实际工作中的问题,对部分尿路腔镜手术麻醉要求进行革新.     

后腹腔镜肾盂输尿管切开取石术34例临床体会

探讨后腹腔镜下肾孟、输尿管切开取石的技术要点和临床应用价值。回顾性分析34例后腹腔镜肾盂、输尿管切开取石术的临床质料。男22例,女12例,肾盂结石10例,输尿管结石24例。结果34例成功完成腹腔镜取石术,手术时间40min～90min,平均58min,术中出血10ml～30ml,术后1例漏尿3d,术后3d～5d拔除后腹...     

伴心脑血管疾病老年患者行半髋关节置换术时麻醉选择的循证依据

本文针对1例伴心脑血管疾病的老年患者行半髋关节置换术的麻醉方案进行循证分析.首先,笔者评估该患者术前的生理情况,对围术期可能出现的棘手问题进行预测.然后,针对如何科学地看待上述问题,进行证据检索和评价.最后,根据循证依据为该患者选择理想的麻醉方式.     

超微经皮肾镜取石术治疗肾结石的体会

初探超微经皮肾镜取石术(SMP)治疗肾结石的安全性和临床疗效。选择2015年8月~2016年5月我院收治的肾结石患者26例,均有多次输尿管软镜和(或)体外冲击波碎石术(ESWL)治疗失败史,结石位于下盏、中盏、肾盂、肾盂合并下盏、肾盂合并输尿管上段分别为11例、1例、5例、5例、4例。结石直径平均为(1.2±0.6)cm。术后均不留置肾造瘘管及双"J"管。26例患者手术均成功完成,单通道24例,双通道2例,手术平均时间(47±19)min,术后第1天结石清除率为96.2%(25/26),1例为下盏残留结石直径约0.7cm,1例术后出现发热(体温38℃),术后住院时间(2.0±0.9)d。术后均未出现严重感染、尿外渗、肾周血肿等并发症。SMP治疗小于2cm的肾结石安全有效,尤其可作为ESWL及输尿管软镜术后残石的补救性治疗方法。     

孕妇非产科手术麻醉的评估和思考

临床上约有1%~2%的孕妇在孕期接受非产科手术麻醉;因孕期生理改变和手术麻醉对孕妇、胎儿的影响,加之妊娠合并心脏病、糖尿病等特殊病例以及现代腔镜手术、无痛人流特殊技术等复杂因素,为确保孕妇与胎儿安全,术前充分的评估、恰当的麻醉方法、药物选择与术中调控是我们必须重视与思考的课题。     

Seeing and hearing and space and space and time

A previous experiment had shown spatial location to be judged in terms of the framework provided by the modality in which stimuli were presented. In the present study, digits were either auditorally or visually presented, and in either form the three digits appeared successivly to the left, in the center, and to the right of the S. The digit which occurred temporally in the middle of the sequence was never central from the spatial viewpoint. The S was asked to indicate which digit was the middle one. Ss were blind, deaf, or normal. The deaf and two control groups saw visual displays, and the blind and their controls heard auditory displays. The former groups predominantly chose the spatially middle digit and the latter groups the temporally middle. It was concluded that modality of presentation was the trigger which switched in the coding dimension of time or space.     

Bob and Carol and Tess and Ali

Conflicting religious experiences in different traditions do not necessarily defeat the rationality of conflicting beliefs sustained by those experiences in those traditions. The circularity that protects religious beliefs from such mutual defeat is not vicious. Moreover, the lack of ‘epistemological humility’ exhibited by such believers poses no threat to world peace. In fact, a campaign for compulsory humility would itself constitute a much greater threat.     

Law and Gospel,and Youth and Family Ministry

Abstract : If “faith comes through hearing” the word of God comprised in law and gospel, how do the imperatives that characterize ‘Youth and Family Ministry’ make such hearing possible? Here, literature delineating ‘Youth and Family Ministry’ is analyzed in light of its biblical foundations. The primary lens implemented in this analysis is the law/gospel hermeneutic advocated by Martin Luther and other reformers.     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Dance and psychotherapy--possibilities and limits

From a starting point of therapeutic and prophylactic components identifiable in the dance, the authors regard the dance as deserving of greater attention than was hitherto the case in programs of physiotherapy, psychotherapy, and sociotherapy. From the existing essays at a therapy basing on body and motion, they infer basic common points, and to promote discussion, they state their attitudes in respect of the potential and rank of the dance in the concept of complex multimodal psychotherapy.     

Yin and Yang,and the Hot and the Cold

Yin and Yang are important concepts in ancient Chinese philosophy.Western scholars have become more familiar with these two concepts recently,but for a long time almost no one considered comparing them with their own tradition such as the ancient Greek philosophy,and especially with the ideas of the Hot and the Cold in Presocratic philosophy.In this paper,I make an attempt to do exactly that,and especially make a detailed comparison between the thoughts of two ancient thinkers:Laozi and Anaximander.I discuss the thought of Yin and Yang in Laozi-who was the earliest philosopher making use of the concepts Yin and Yang-to express his cosmological thought in ancient Chinese philosophy.Comparatively,I discuss the ideas of the Hot and the Cold in Anaximander,the earlier among Presocratic philosophers referring to the Hot and the Cold as fundamental concepts used to establish his cosmological system.Through this comparison,I indicate that the similarity between ancient Chinese and Western traditions is far more significant than what people are used to imagining.     

Perversion and infancy and adolescence

Abstract

Studying the works of Freud and Lacan, the authors carried out research on perversion in childhood. Their work covered the perverse polymorphism of infantile sexuality and the perception of the anatomic difference between the sexes that leads the child to create sexual theories and fantasies. The phallic mother and the fetish are viewed as imaginary solutions directly related to the Oedipus and castration complexes. In perversion, a particular position is taken in relation to the Oedipus complex: a serious flaw occurs in the symbolization of the law, and the mechanisms of denial and disavowal take form. Sexuality requires a second “logical time,” separated from infancy by the latency period, in order to confirm (in action) that a fixed position of jouissance (enjoyment) has actually been established. This can only happen in a period after adolescent enhancement. The distinction between perverse traces and a perverse structure is made, taking into account the fact that, in the case of child analysis, the analyst should free the child from the family fantasy and help him/her to build his/her own fantasy.

Campos Santoro V. et al. Perversion und Kindheit und Adoleszenz.

Im Studium der Arbeiten von Freud und Lacan haben die Autoren Forschung über Perversion in der Kindheit gemacht. Die Studien behandeln den perversen Polymorphismus der infantilen Sexualität und die Wahrnehmung des anatomischen Unterschiedes zwischen den Geschlechtern, welche das Kind dazu führt, Sexual-Theorien und Phatasien zu schaffen.

Die phallische Mutter und der Fetisch werden als imaginäre Lösungen angesehen, die sich direkt auf den Ödipus- und Kastrations-Komplex beziehen. Bei der Perversion wird eine besondere Position in Bezug auf den Ödipus angenommen; ein ernsthafter Mangel tritt bei der Symbolisierung des Rechts auf; die Mechanismen der Verneinung und der Verleugnung bilden sich. Sexualität erfordert eine zweite “logische Zeit”, von der Kindheit durch die Latenz Periode getrennt, um (in der Handlung) zu bestätigen, daß eine fixierte Position der jouissance (Vergnügung) sich tatsächlich etabliert hat. Das kann sich nur in einer Periode nach der adoleszenten Verstärkung ereignen.

Es wird die Unterscheidung zwischen perversen Spuren und einer perversen Struktur gemacht, in Rechnung stellend, daß im Fall der Kinder-Analyse der Analytiker das Kind von der Familien-Phantasie befreien sollte und ihm/ihr helfen sollte, seine/ihre Phantasie auszubilden.

Campos Santoro V. Perversión e infancia y adolescencia.

Estudiando los trabajos de Freud y Lacan, los autores han investigado la perversión en la niñez. Los estudios cubren la sexualidad infantil perversa polimorfa y la percepción de la diferencia anatómica entre los sexos, que llevan al niño a crear teorías sexuales y fantasías.

La madre fálica y el fetiche son vistos como soluciones imaginarias relacionadas directamente con el complejo de Edipo y de castración. La perversión, toma una posición particular en relación al Edipo; un fallo importante tiene lugar en la simbolización de la ley; los mecanismos de negación y repudio toman forma. La sexualidad requiere un segundo “tiempo lógico” separado de la infancia por el periodo de latencia, para confirmar (en acto) que una posición fija de jouissance (goce) se ha establecido. Esto solo puede ocurrir en un periodo posterior a la intensificación adolescente.

La distinción entre las huellas perversas y la estructura perversa se ha hecho, teniendo en cuenta que, en el caso del análisis de niños, el analista debe librar al niño de la fantasía familiar y ayudar a el/ella a construir su propia fantasía.     

神圣、凡俗与净明、忠孝

本文结合有关宗教学理论,对宋元净明道所推崇的"净明"、"忠孝"概念进行了解析.作者以为:宋元净明道视世俗性的道德实践为"神圣"的宗教修炼,实与宗教学中的凡俗可以"转换"为神圣之理论相合;而净明道徒的这种"转换",则多与其个体的"宗教体验"有关.至于元代净明道借"无极"概念来释"净明",以"净明"为回复宇宙根源之境界,则合于宗教人经验到与万物的根源、终极的本体或神圣的世界契合之感.换言之,宋元净明道的"净明"、"忠孝"说,实与各种宗教的本质有着相通之处.