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Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis最新文献

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[Laparoscopic surgery: possibilities and limitations]. [腹腔镜手术:可能性和局限性]。
U Herzog
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引用次数: 0
Chronic neurogenic pain and the medial thalamotomy. 慢性神经性疼痛和内侧丘脑切开术。
D Jeanmonod, M Magnin, A Morel

69 patients suffering from chronic therapy-resistant neurogenic pain of peripheral and/or central origin underwent a stereotactic medial thalamotomy. Medial thalamic unit recordings were performed peroperatively, allowing the physiological confirmation of the electrode location and the recognition of a specific physiopathology. Thanks to these recordings, a concept was developed, based on the presence of an imbalance between medial (nucleus centralis lateralis mainly) and lateral (nucleus ventroposterior) thalamic nuclei, resulting in an over-inhibition of both by the reticular thalamic nucleus, and then in a paradoxical activation of pain-related cortical areas. The medial thalamotomy, re-actualized by new technical, anatomical and physiological data, offers a 50-100% relief to 67% of all patients with peripheral as well as central neurogenic pain, on all body localizations, without producing neurological deficits and without risk for the development of iatrogenic pain.

69例外周和/或中枢源性慢性治疗难治性神经性疼痛患者行立体定向内侧丘脑切开术。术中进行内侧丘脑单元记录,允许对电极位置的生理确认和对特定生理病理的识别。由于这些记录,一个概念被提出,基于内侧(主要是外侧中央核)和外侧(腹后核)丘脑核之间存在不平衡,导致丘脑网状核对两者的过度抑制,然后在与疼痛相关的皮层区域产生矛盾的激活。内侧丘脑切开术,通过新的技术、解剖和生理数据重新实现,为67%的周围和中枢神经性疼痛患者提供了50-100%的缓解,在所有身体部位,不会产生神经功能障碍,也没有发生医源性疼痛的风险。
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引用次数: 0
[Current diagnosis in pathology]. [当前病理诊断]。
J Briner

The introduction of modern methods into research and daily diagnostic practice of pathology has brought about major advances. In the middle of our century electron microscopy gave new insights into the ultrastructure by increasing the resolution one thousand times as compared to classical light microscopy. Immunofluorescence and histochemistry allowed assessment of functional and morphologic changes. Important new information was gained by the introduction of immunohistochemistry. The ability of antibodies to bind to epitopes even in formalin-fixed and paraffin-embedded tissues allows the precise diagnosis in many poorly differentiated tumors. The combination of different techniques (as for example immunohistochemistry and electron microscopy in the case of immuno-electronmicroscopy) lead to important new findings. The application of molecular biologic methods was a major step forward. They allow to precisely detect genomic sequences. Complementary strands are synthesized (so called probes), labelled and allowed to hybridize to the nucleic acid sequence looked for. Several examples are shown. The detection of viral nucleic acids (many of which can not reliably be identified on routine histological sections) can be achieved by in situ hybridization. The demonstration of bacteria which are slowly growing (as mycobacteria) or cannot be successfully cultivated can be easily achieved after amplification of specific nucleic acid sequences by the polymerase chain reaction. Molecular biological techniques are indispensable in cancer research (as shown here by the demonstration of IGF2 in nephroblastomas) but are also important in the diagnosis of tumors (as shown by the presence of T-cell-receptor-rearrangement in the case of suspected T-cell-lymphoma).(ABSTRACT TRUNCATED AT 250 WORDS)

将现代方法引入到病理学的研究和日常诊断实践中带来了重大进步。本世纪中叶,电子显微镜比传统光学显微镜的分辨率提高了一千倍,从而使人们对超微结构有了新的认识。免疫荧光和组织化学可以评估功能和形态变化。通过引入免疫组织化学获得了重要的新信息。即使在福尔马林固定和石蜡包埋的组织中,抗体与表位结合的能力也允许对许多低分化肿瘤进行精确诊断。不同技术的结合(例如免疫组织化学和电子显微镜在免疫电镜的情况下)导致重要的新发现。分子生物学方法的应用是一个重大的进步。它们可以精确地检测基因组序列。互补链被合成(所谓的探针),标记并允许与寻找的核酸序列杂交。下面给出了几个例子。病毒核酸的检测(其中许多不能在常规组织学切片上可靠地鉴定)可以通过原位杂交来实现。对生长缓慢的细菌(如分枝杆菌)或不能成功培养的细菌,通过聚合酶链反应扩增特定的核酸序列,可以很容易地实现演示。分子生物学技术在癌症研究中是不可或缺的(如图所示,肾母细胞瘤中显示了IGF2),但在肿瘤的诊断中也很重要(如在疑似t细胞淋巴瘤的病例中出现t细胞受体重排)。(摘要删节250字)
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引用次数: 0
[Erythropoietin: from gene to therapeutic agent]. [促红细胞生成素:从基因到治疗剂]。
C Bauer

Erythropoietin is a hormone whose production is stimulated by all forms of oxygen deficiency. The main production takes place in specialized fibroblasts in the kidney of adults and in liver cells during the fetal and neonatal period. The most important function of the hormone can be derived from its name: It stimulates erythropoiesis in the bone marrow and thus controls O2-capacity of blood. A thoroughly controlled feedback-mechanism between oxygen-supply erythropoietin release and renewal of erythrocytes provides for a constant level of erythrocytes in blood. This feedback mechanism is disturbed by chronic renal diseases, chronic inflammations and also in premature infants. Recombinant human erythropoietin is used as hormonal substitute in order to correct diverse types of anemia and may also be used in the context of re-transfusions.

促红细胞生成素是一种激素,它的产生受到各种形式的缺氧的刺激。主要的生产发生在成人肾脏的特化成纤维细胞和胎儿和新生儿时期的肝细胞。这种激素最重要的功能可以从它的名字中得出:它刺激骨髓中的红细胞生成,从而控制血液中的o2容量。供氧促红细胞生成素释放和红细胞更新之间的完全控制反馈机制提供了血液中红细胞的恒定水平。慢性肾脏疾病、慢性炎症和早产儿也会干扰这种反馈机制。重组人促红细胞生成素被用作激素替代品,以纠正各种类型的贫血,也可用于再输血。
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引用次数: 0
[Risk assessment and patient information before anesthesia]. [麻醉前风险评估及患者信息]。
A Zollinger, T Pasch

In order to determine the risk of anesthesia the anesthesiologist has to assess both the physical and the psychological status of the patient. The essential basis of any preoperative medical evaluation are the history and complete physical examination of the patient. Few laboratory screening tests and, in case of pathological findings, specific diagnostic procedures will ensue. If possible, preoperative therapies must be considered in order to reduce the risk resulting from concomitant diseases. However, apart from the patients diseases, both the risks of the anesthetic and surgical procedures contribute to the overall perioperative risk. On the basis of the preoperative evaluation, the anesthesiologist determines the methods of anesthesia to be applied. He also informs the patient about the planned anesthesia, the sequence of further measures, the risk of anesthesia, and accompanying risks. The family doctor can help to facilitate the preoperative assessment by performing certain examinations himself and by providing the anesthesiologist with relevant informations. By giving a piece of advice to the patient he can help to prepare him for anesthesia and to reduce fear and apprehensiveness.

为了确定麻醉的风险,麻醉师必须评估病人的生理和心理状态。术前医学评估的基本基础是病人的病史和完整的体格检查。很少实验室筛选试验,在病理发现的情况下,将进行具体的诊断程序。如果可能,术前治疗必须考虑,以减少风险造成的伴随疾病。然而,除了患者自身的疾病外,麻醉和手术的风险都是围手术期总体风险的因素。在术前评估的基础上,麻醉师确定麻醉的方法。他还告知病人麻醉计划、进一步措施的顺序、麻醉的风险和伴随的风险。家庭医生可以通过自己进行某些检查并向麻醉师提供相关信息来帮助促进术前评估。通过给病人一条建议,他可以帮助他为麻醉做准备,减少恐惧和忧虑。
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引用次数: 0
[Do's and don'ts in travel medicine advice]. 【旅行用药建议的注意事项】。
R Steffen, I Klopfstein

The cornerstones of a travel health consultation are: information, advice on anti-mosquito measures, vaccinations, malaria chemoprophylaxis and guidelines for presumptive treatment. The art of travel medicine is the ability to focus on the realistic health needs of the traveller whilst leaving aside superfluous information. In this way, unnecessary adverse events, expenses and patient anxiety can be avoided.

旅行卫生咨询的基础是:信息、灭蚊措施咨询、疫苗接种、疟疾化学预防和推定治疗指南。旅行医学的艺术在于能够关注旅行者的实际健康需求,同时将多余的信息放在一边。这样可以避免不必要的不良事件、费用和患者焦虑。
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引用次数: 0
[Current eczema therapy]. [目前的湿疹治疗方法]。
W Spirig, P Elsner

The diagnostic term eczema refers to a group of skin diseases defined by the morphological criteria of erythema, papules, papulovesicles and, in the chronic stage, lichenification and desquamation. While the diagnostic workup should lead to a more specific diagnosis (irritant or allergic contact dermatitis, atopic, seborrheic or nummular dermatitis), the therapeutic approach is similar for most forms of eczema. In the present review, traditional and innovative therapeutic options are presented and discussed.

诊断术语湿疹是指一组皮肤疾病,其形态学标准为红斑、丘疹、丘疹小囊,慢性期为地衣变和脱屑。虽然诊断检查应该导致更具体的诊断(刺激性或过敏性接触性皮炎,特应性皮炎,脂溢性皮炎或numular皮炎),但大多数湿疹的治疗方法是相似的。在目前的审查,传统和创新的治疗方案提出和讨论。
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引用次数: 0
[Hip pain from a rheumatologic viewpoint]. [从风湿病学角度看髋关节疼痛]。
P Brühlmann, B A Michel

The differential diagnosis of hip pain does not only include disorders limited to the hip joint itself but those of adjacent bones and periarticular soft tissues. In addition spine disorders, intraabdominal pathologies, peripheral vascular diseases and nerve entrapment syndromes should be considered. A careful clinical history and examination of the patient are essential for precise diagnosis. Some typical manifestations of disorders frequently seen in clinical practice are outlined.

髋关节疼痛的鉴别诊断不仅包括髋关节本身的疾病,还包括邻近骨骼和关节周围软组织的疾病。此外,还应考虑脊柱疾病、腹内病变、周围血管疾病和神经卡压综合征。仔细的临床病史和对病人的检查是精确诊断所必需的。概述了临床实践中常见的疾病的一些典型表现。
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引用次数: 0
[Therapy of nephrolithiasis]. 【肾结石的治疗】。
D Hauri

Urolithiasis has always been a well known phenomenon to mankind. Whereas up to the beginning of the 19th century, open surgery for bladder stones was known to be a high risk operation due to its frequent complications, nowadays we are able to disintegrate renal and vesical calculi into spontaneously excretable fragments by means of shock waves generated extracorporeally (ESWL). The physical principles of shock waves and their impact on the stone are explained. By means of ESWL the time of hospitalisation as well as of recovery can be massively reduced saving billions to our economy.

尿石症一直是人类所熟知的现象。然而,直到19世纪初,膀胱结石的开腹手术因其常见的并发症而被认为是一种高风险的手术,如今我们能够通过体外冲击波(ESWL)将肾结石和膀胱结石分解成可自行排泄的碎片。阐述了冲击波的物理原理及其对石材的影响。透过体外健康护理,可大大缩短住院及康复时间,为本港经济节省数十亿元。
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引用次数: 0
[What is your diagnosis? Primary malignant bone tumor]. 你的诊断是什么?原发性骨恶性肿瘤]。
H Marty
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引用次数: 0
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Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis
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