Detection of Mycobacterium tuberculosis in nasopharyngeal aspirate samples in children
Detection of Mycobacterium tuberculosis in nasopharyngeal aspirate samples in children
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DOI：
10.1016/s0140-6736(05)61454-7
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发表时间：
1998-11-21
期刊：
影响因子：
168.9
通讯作者：
Sheen, P
中科院分区：
文献类型：
--
作者：
Franchi, LM;Cama, RI;Sheen, P
局部三硝酸甘油（GTN）已被证明是治疗慢性肛裂的有效方法，治疗8周后超过三分之二的患者愈合。据认为，愈合是通过手术或“化学”GTN括约肌切开术后裂隙部位的血供增加而介导的。2然而，与手术括约肌切开术不同，局部GTN治疗对内肛门括约肌没有永久性影响，并且在初始愈合后3个月显示括约肌恢复到预处理压力。一些研究者表示担心，恢复高括约肌压力意味着复发的可能性很高。目前还没有对局部GTN治疗的患者进行长期随访的报道。在先前报道的两项局部GTN试验中，慢性肛裂愈合的患者被确定并通过电话联系。从一份标准化问卷中询问患者，自试验结束以来，他们是否经历了进一步的排便疼痛和直肠出血症状。如果报告了这些症状，则询问患者复发的次数和持续时间。他们还被问及是否寻求过医疗照顾，以及如何治疗复发。从先前的研究中确定了44例患者；其中三人已经离开该地区，无法联系上。对41例患者进行问卷调查。随访时间中位数为28个月（24-38个月）。结果如图所示。在报告复发症状的患者中，5人只有一次发作，6人不止一次。5例症状复发时间短（1-3天），2例自行消退，另外3例经GTN治疗。在所有三个案例中，使用的GTN都是剩余的试验药物。在复发时间较长的患者中，1名患者选择在没有进一步治疗的情况下进行括约肌切开术，3名患者对进一步的GTN治疗有反应，2名患者在GTN治疗失败后需要进行括约肌切开术。
Topical glyceryl trinitrate (GTN) has been shown to be an effective treatment for chronic anal fissure, healing over two thirds of patients after 8 weeks of treatment. 1 It is thought that healing is mediated by increased blood supply to the site of the fissure after surgical or “chemical” sphincterotomy with GTN. 2 However, unlike surgical sphincterotomy, treatment with topical GTN has no permanent effect on the internal anal sphincter and return to pretreatment pressures of the sphincter has been shown by 3 months after initial healing. 3 Some investigators have expressed concern that return to high sphincter pressures means that the likelihood of relapse is high. No long term follow-up of patients treated with topical GTN has yet been reported. Patients whose chronic anal fissures had healed in two previously reported trials of topical GTN were identified and contacted by telephone. 1, 4 Patients were asked from a standardised questionnaire whether they had experienced further symptoms of pain on defaecation and rectal bleeding since the end of the trial. If such symptoms were reported, patients were asked about the number and duration of relapses. They were also asked whether they had sought medical attention and how their relapse had been treated. 44 patients were identified from the previous studies; three had moved from the area and could not be contacted. The questionnaire was administered to 41 patients. Follow-up interval was a median 28 (range 24–38) months. Outcome is shown in the figure. Of those reporting recurrent symptoms, five had only one episode and six had more than one. Five symptomatic relapses were of short duration (1–3 days), two settled spontaneously, and the other three were treated by a further course of GTN. In all three cases the GTN used was left over trial medication. Of the longer relapses, one patient opted to have a sphincterotomy without further treatment, three responded to further GTN treatment, and two required sphincterotomy after failure of GTN treatment.