MIXED TUMOURS OF THE UTERUS
MIXED TUMOURS OF THE UTERUS
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子宫混合瘤
DOI：
10.5694/j.1326-5377.1939.tb98854.x
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发表时间：
1939
影响因子：
11.4
通讯作者：
A. Duggan
中科院分区：
文献类型：
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作者：
A. Duggan
在所有情况下，无论后续采用何种治疗方法，都应立即开始使用混合制剂进行治疗。应立即向双眼滴入一滴1%的蓖麻油溶液，如果病人还没有卧床，则应将其放在床上。医院一直是治疗急性青光眼的最佳场所。病人到达医院后，应给予0.1克甘汞(两粒)和0.01克(六分之一粒)硫酸吗啡皮下注射。甘汞，以及后来的盐水溶液，可以缓解充血，吗啡可以消除疼痛，诱导站立可以平息焦虑。这些措施，除了它们的普遍价值外，还可以预防另一只眼睛的急性青光眼。我‘他把艾司林的油性溶液滴入患眼，每半小时滴一滴，持续两小时，然后每小时滴一滴，持续四个小时。如果眼睛继续好转，我会每隔四到六个小时滴一滴。用0.3%硫酸艾斯林水溶液滴入未受影响的夜间。在危机期间和早上，并在很长一段时间里每天一次，以保持瞳孔小。Eserine的油性溶液是用以下方法制成的。1‘hirty立方厘米(1盎司)的蓖麻油在一个手表玻璃杯中加热，然后将先前溶解在少量氯仿中的0.3克(4粒)芥子生物碱轻轻搅拌进去。油性溶液确保了茶碱更持久、更持久的作用。少量的这种溶液，如7.5立方厘米(2德拉克米)，在手术中或袋子里总是放在手边的小东西；它可以无限期保存，可以在滴注过程中立即使用。因此，避免了恼人的和破坏性的延误。皮下注射硫酸吗啡可根据需要重复两到三次。在最初的六个小时里，眼睛应该每小时洗十分钟，然后每四个小时洗一次，水要像婆罗洲闭上眼睛一样热。这些洗澡最好以“勺子洗澡”的方式进行。碗里塞满了绒毛，里面塞着一把木制的厨匙。获得了一盆热水。将勺子浸入热水中，病人坐在床上，笔直地坐在床上，将勺子的衬垫碗抬到剂量眼旁，尽可能热地敷在上面，一旦热量消失，就重复这个过程。这是一项最令人欣慰的措施。患者总是能欣赏到它的存在。护士们也很欣赏它，因为它不需要监督，不需要敷料或绷带。在同一时期，它更可靠地按照外科医生的要求进行。如果有的话，短波透热效果最好。在离外眼角半英寸的寺庙里，放上一两条健康的水蛭，现在很少买到了。在潮湿的垫子下，是一种古老但无懈可击的治疗方法。这些措施总能使患者感觉更舒适，但也可能不能充分缓解青光眼。必须保持警惕；如果没有瞳孔周围均匀收缩的迹象，如果这种治疗在12小时内没有检测到紧张的缓解，那么再等下去是不明智的，必须进行手术。油滴不能无限期地持续下去，因为它们会对眼睛造成刺激，通常是恶心，然后是脂肪性·酸性结膜炎。过于保守的治疗往往会增加下睑痉挛的内翻，并使已经受到严重影响的眼睛出现倒立，这可能会导致延迟，因为在进行虹膜切除术之前需要手术缓解。当病人必须被运送到遥远的城市或基地医院时，可以进行巩膜穿刺术。这项手术可以在没有一般设备或特殊仪器的情况下进行。它应该在任何习惯于普通外科手术的人的技能范围内。除非情况严重，如果没有手术干预，在这种不可避免的延误之前，所有有用的视力肯定都会丧失，否则不建议这样做。
In all casestreatmentwith miotics should commence at once, whatever the subsequenttreatment adopted. One drop of a 1% solution of eserineinOleum Ricini should be instilled into both eyes immediately, and the patient should be put to bed, if he is not already there. Hospital is the best place always for the treatmentof acute glaucoma. The patient should be given 0·1 gramme (two grains) of calomel and a hypodermic injection of 0·01 gramme (one-sixth of a grain) of morphine sulphateon arrival at hospital. The calomel, and later a draughtof salinesolution, relieve congestion, and the morphinerelievesthe pain, inducesrestand quells anxiety. These measures,apart from their generalvalue, are prophylacticagainstthe onsetof acuteglaucomain the other eye. 'I'he oily solution of eserine is instilled into the affectedeye, one drop every half-hour for two hours, then one drop every hour for a further four hours. 'I'hereaf'ter one drop is instilled every four or six hours if the eye continuesto improve. One drop of 0·3% aqueoussolution of eserine sulphate should be instilled into the unaffected eye night. and morning during the crisis, and once daily for long after, to keep the pupil small. The oily solution of eserine is made in the following way. 'I'hirty cubic centimetres (one ounce) of castor oil are warmed in a watch glass and then 0·3 gramme (four grains) of eseriue alkaloid, previously dissolvedin a little chloroform, are gently stirred in. The oily solution ensures more constantand prolongedaction of the eserine. A small quantity of this solution, such as 7·5cubic centimetres(two drachms),is a small thing to keep always on hand in the surgery or in the bag; it keeps indefinitely and may be used immediately while the drops are being made. Thus irritating and damagingdelay is avoided. T'he hypodermic injection of morphine sulphate may be repeatedtwo or three times as required. The eye should be bathed for ten minutes every hour for the first six hours, then every four hours, with wateras hot as can be borneon the closedeye. These bathings are best carried out as "spoon bathings". A wooden kitchen spoon is padded in the bowl with lint. A basinof hot wateris obtained. The spoon is dipped into the hot water, and the patient, sitting upright in bed, lifts the padded bowl of the spoon to the dosedeye and applies it as hot as possible,repeatingthe processas soon [IS the heat is lost. This is a most comforting measure. and patients never fail to appreciateit. Nurses appreciateit too, as it requires no supervision,no messydressingsor bandages.For thesereasonsalso it is muchmorelikely to be carriedout as frequently as the surgeondesires. Short-wavediathermy is excellent if available. A healthy leech or two, now seldom available, applied to the temple, half an inch from the outer canthus. under a moist pad, is an ancient but unassailablygood treatment. These measuresnever fail to make the patient more comfortable, hut may fail to relieve the glaucoma sufficie-ntly. A watch must be kept '(1Il the eye; and if there is no sign of the' pupil contracting evenly all round, and if no nelief of tensionis detectablein twelve hourswith this treatment, it is unwiseto wait any further and operation must be performed. The oily drops .eannot be continued indefinitelyaas they cause irritation to the eye, often nausea and later fatty· acid conjunctivitis. Too much conservativetreatmentoften adds a spasmodicentropion of the lower lid, with trichiasis to the already acutely affected eye, and this may causedelay by requiring operation for its relief before iridectomy can be done. When patientshave to be transportedlong distancesto a city or a basehospital,a scleralpuncture may be performed. This operation can be carried out without general anresthesiaor special instruments. It should be within the skill of anyone accustomedto general surgery. It is not recommended unless the case is' so severe that without surgical interference before such an unavoidable delay all useful sight would assuredlybe lost.