Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Medical-Social Aspects

The area of particular competence of the social worker in the habilitation of the congenitally malformed is in the social development of the child. It is an interest which continues throughout all stages of growth and development: (1) During the preschool and early life, the first consideration is to minimize or eliminate the disability. The social worker plays a supporting role to the doctor. (2) The middle years of growth are centred around the problems of education. The social worker plays an interpretative role with respect to family, school, and doctor. (3) For the adolescent and young adult the contact with the disabled person is more direct. The individual must face and solve his own problems and learn to become an independent adult. Throughout the entire development the doctor, social worker, and teacher are dependent each on the other.     

Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Pediatric Aspects

Since November 1961 it became apparent that the administration of thalidomide to pregnant women was associated with the occurrence of severe congenital anomalies. These deformities are frequently symmetrical, involving the limbs, particularly the proximal part, and associated with an absent external ear, mid-line facial hemangioma with saddle nose, atresia of the bowel and other congenital anomalies. Care of these children is a complicated problem requiring a team of specialists of many disciplines, particularly a pediatrician, an orthopedic surgeon, a prosthetic specialist and a social worker. Treatment by such a team ideally would commence immediately after delivery of the infant and continue until the child has been totally habilitated. Such care ideally should be provided within existing services in the country for the habilitation and rehabilitation of handicapped children.     

Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Psychiatric and Psychological Aspects

Nearly 100 cases of congenital malformations associated with thalidomide ingestion by the mother have been reported in Canada to the Department of National Health and Welfare. Depression and selfcastigation have been the specific psychiatric reactions noted, particularly in the mother. In most cases it is preferable psychologically for the parents and the child if the child is kept at home rather than placed in an institution. Parents should be fully informed concerning the child''s prognosis for future development. Most of the children followed up for about two years showed no intelligence defects. A prosthesis, if required, should be applied early (at three to six months) so that it may become a part of the child''s body-image, but it should not interfere with play activities. Assessment by a psychiatrist and a psychologist is indicated at about six months.     

手术治疗先天性心脏病患者活动期心内膜炎的相关因素

目的:确定先天性心脏病活动期感染性心内膜炎(active infective endocarditis,AIE)的手术指征。方法:于2003-2011年从71个机构数据库中调查并采集247例患有感染性心内膜炎的儿童及成人先天性心脏病(congenital heart disease,CHD)患者数据,其中74例(30%)进行了AIE手术治疗。回顾性分析患者的年龄、性别、感染心内膜炎前对CHD的诊断、致病微生物和感染部位等数据。结果:与AIE手术治疗必要性显著相关的指标是感染性心内膜炎(infective endocarditis,IE)病发前对心脏异常的诊断缺乏、主动脉瓣IE、瓣周脓肿、心力衰竭以及抗生素发生变化。逐步逻辑回归方程分析结果表明瓣周脓肿、心力衰竭以及抗生素改变是先天性心脏病患者进行AIE手术治疗必要性的独立决定因素。结论:对IE合并CHD的患者而言,当心力衰竭、瓣周脓肿或抗生素变化发生时,手术可作为治疗AIE的一种手段。     

Defects and Disabilities of Thalidomide Children

The range of defects and disabilities in thalidomide children is very much wider than is generally realized. The defects of 154 children are described and classified. Their disabilities range from incapacitating to negligible.     

右美托咪定对下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响

目的:探讨右美托咪定对下肢手术患者因止血带诱发肢体缺血-再灌注损伤的影响。方法:选取2015年1月-2016年5月我院行下肢手术治疗的患者90例,按照数字随机法分为观察组及对照组,每组各45例。两组均给予蛛网膜下腔阻滞联合硬膜外麻醉,观察组在穿刺成功15 min内静脉输注1μg/kg的右美托咪定,维持剂量0.5μg/kg·h直至手术结束,对照组患者则给予同等剂量的生理盐水。对比两组止血带前(T0)、止血带充气30 min(T1)、止血带充气1 h(T2)、止血带释放后30 min(T3)、止血带释放后1 h(T4)时的超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、平均动脉压(MAP)、心率(HR)水平以及不良反应发生情况。结果:T3、T4时点观察组SOD水平显著高于对照组,MDA水平显著低于对照组(P0.05)。T1、T2、T3、T4时点观察组TNF-α水平显著低于对照组,T4时点IL-6水平也显著低于对照组(P0.05)。T1、T2时点观察组MAP、HR水平均显著低于对照组(P0.05)。观察组术中止血带疼痛、高血压发生率均显著低于对照组(P0.05)。结论:右美托咪定可显著抑制下肢手术患者止血带诱发氧化应激反应以及炎症反应,进而降低肢体缺血-再灌注损伤,具有较好的安全性。