全球精选文摘 - 宫颈移行带大范围环形电刀切除术后阴道抗菌治疗的应用：一项前瞻性随机化试验

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宫颈移行带大范围环形电刀切除术后阴道抗菌治疗的应用：一项前瞻性随机化试验

The use of vaginal antimicrobial after large loop excision of transformation zone: a prospective randomised trial

Chan KKL, Tam KF, Tse KY 2009/5/27 10:50:39

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BJOG, 2007,

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Abstract

Objective:

To investigate whether the use of an antibacterial vaginal pessary containing tetracycline and amphotericin B would reduce complications from large loop excision of the transformation zone (LLETZ).

Design:

Prospective randomised controlled trial.

Setting:

Department of Obstetrics and Gynaecology, University of Hong Kong.

Population:

A total of 321 women who underwent LLETZ.

Methods:

Women were randomised to either receiving an antimicrobial vaginal pessary twice a day for 14 days after LLETZ or no medication. Before LLETZ, endocervical and high vaginal swabs were taken for the detection of Chlamydia and other pathogens. All women were given a diary to record the degree of symptoms, such as vaginal discharge, bleeding and pain for 3 weeks. These were then compared between the two groups.

Main Outcome Measures:

Bleeding, vaginal discharge and pain after LLETZ.

Results:

There was no significant difference in the total bleeding, vaginal discharge and pain scores between the two groups. However, for women who had positive endocervical or high vaginal swabs, the treatment group had significantly less bleeding in the second week (Z=−2.083, P=0.037) and less overall vaginal discharge (Z=−2.024, P=0.043).

Conclusions:

An antimicrobial vaginal pessary containing tetracycline and amphotericin B did not provide any significant benefit after LLETZ, except for a subgroup of women with positive vaginal or endocervical swabs. Given that this group of women cannot be identified before the procedure since swabs are not routinely taken, the use of routine prophylactic topical antibiotics cannot be recommended for the general population.

liu201011 说：		2010-5-26
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呼吸急促伴精神状态改变——《西氏内科学》病例

摘自：《西氏内科学》，第23版

患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。

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