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Dołączył: 13 Gru 2010
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 Wysłany: Nie 12:53, 20 Mar 2011 Temat postu: Intramedullary nail in treatment of the negative i |
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Intramedullary nail in treatment of the negative impact of lower limb bone fractures Research
Delaying treatment. Or unreasonable use often result in death or disability. This article hospitalized in our hospital between 2001-2006 were 31 cases of clinical analysis Results encephalopathy, experience is as follows. 1.1 1 clinical data youngest age and sex for 6 months, maximum 54 years, of which 8 cases of tuberculous meningitis of children to 3 to 4 years old as more than about 5O; adult tuberculous meningitis by 15 to 30 years': ~ to more than 76 {17 patients 7 were males and 24 female patients, male to female ratio was 1:3, r_ drug:: male female incidence was significantly higher than 1.2 on the slurry-type pathology and disease in 6 patients (19) cerebral meningitis in 5 cases (16oA),[link widoczny dla zalogowanych], spinal cord in 2 cases (6%), meningoencephalitis type 19 cases (58%). Early in 2 cases (6), medium in 16 cases (51%), late in 13 cases (33). 2 Treatment and outcome of anti-tuberculosis treatment: untreated patients in this group, 27 cases were using a large dose of isoniazid (INH)-based chemotherapy. Adult INH600900mg / d, rifampicin 450 ~ 600mg / d, ethambutol 0.75 ~ 1.0mg / d, Bi Qinxian ammonia 1.5mg / d. Children under kg body weight. The first 3 months after intensive treatment. Disable ethambutol, consolidation therapy 9 months, with a total course of treatment 1.5 years. Retreatment were added with streptomycin 0.75mg / d, 3 months intensive treatment,[link widoczny dla zalogowanych], disable, streptomycin and ethambutol, 12 months of consolidation therapy, with a total course of 1.5 --- 2 years. Application of corticosteroids: application of hormone therapy in this group, 26 cases, of which 3 died and 8% mortality rate, not with the hormone in 5 cases, 1 died, the mortality 2O. Hormone formulations and dosage: oral adult who can not use intensive dexamethasone 10 ~ 20mg / d of static points, to those with oral prednisone 30 - 40mg / d (JL children by kilogram body weight) of about 3 to 4 weeks reduced, 2 to 3 months by complete withdrawal. Intrathecal administration: the ill, poor efficacy of complex treatment of people in the systemic anti-tuberculosis treatment based on the use of intrathecal corticosteroid injection and the treatment with INH to obtain satisfactory results. The group of 18 patients were added later by intrathecal injection, INH50 ~ 100mg plus dexamethasone 2 ~ 5mg, 2 times per week, 14 times as a course of treatment, 18 patients who intrathecal injection up to 33 times, at least 7 times survival of 16 patients,[link widoczny dla zalogowanych], 2 died, the mortality 11. Many critically ill patients,[link widoczny dla zalogowanych], her condition improved after intrathecal administration. High intracranial pressure of the treatment: 31 cases of all applications dehydration, acute mannitol use 2O 125 ~ 250rnl, 6 ~ 8h a rapid static point, severe illness with glycerol and fructose were added static point, as the disease reduced, tapering to consolidate the maintenance of oral diuretics, oral diuretics individual patients for six months. Vesting: 3l patients with active tuberculosis, corticosteroids, dehydration, and other comprehensive treatment of intrathecal injection, survived in 27 cases, 4 deaths, 133 death rate before the advent of antituberculous drugs discussed, tuberculous meningitis mortality is high, almost 100. Reported in literature are still 15 or so. The author's experience are: (1) early diagnosis and timely treatment is to reduce mortality and improve the cure rate of the key, this group of patients early and mid 18 cases with no deaths after treatment, the survival rate of 100, but later 13 patients, 4 died fatality rate of 31, indicating the importance of early treatment. (2) full and reasonable anti-tuberculosis treatment is to reduce mortality,[link widoczny dla zalogowanych], reduce the after-effects of the important measures. Enhanced phase of rational drug use through treatment, although clinical symptoms of tuberculous meningitis can quickly disappear, but the symptoms does not mean cured. Even if the CSF examination was normal, such as the premature withdrawal is also easy to relapse. Therefore, the disease must be based on rational drug development program, in the whole course of treatment, regular use of anti-TB drugs, adhere to a reasonable period of consolidation therapy is to prevent persistent and recurrent disease an important measure. 4 patients died in this group of patients are persistent recurrence. (3) intrathecal injection of some critical condition, complicated, treatment, undesirable effects in patients with tuberculous meningitis drug in the body based on the use of intrathecal corticosteroid injection INH and receive better treatment. The group of advanced cases, the higher intracranial pressure, the higher protein, complex governance, poor efficacy prolonged course caught by intrathecal injection, the effect is good. (4) the earlier the better with hormone, the dose rate of decline should not be too large. The team found that prednisone reduced to lOmg, or dexamethasone reduced to 2mg later prone to rebound, this time reduction should be cautious, if necessary, assist the reduction of immunosuppressive agents was added. Hormone dose should not be too large, treatment should not be too long, 2 to 3 months withdrawal is completed. (5) Results of the rational use of the brain in acute dehydrating agent, with a period of consolidation with diuretics to control the hydrocephalus, to prevent herniation. The author argues that complete withdrawal of hormones after the stop dehydrating agent, after the first lot of a small amount of maintenance, in case of emergency. Received 2008-08-16 (Editor Akihito)
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