Y HOC VIET NAM THANG 2 - SO 1/2014 bao du'dc hoat hoa se phdng thich nhieu
interleukin-2 hdn, den lu'dt chat nay lai tac dung len te bao ban dau va tren cac te bao T nhay cam khac, nen cd hien tu'dng t i / kich - autocrin- lam khuech dai phan irng [ 1 ] , Nhu' vay phai chang do tinh chat nay ma sau cat lach plian i/ng nay van cdn, gdp phan lam cho so lu'dng te bao lympho tang nhu'ng khdng ro ret. hoac su" tang lympho nay cd the do phan i/ng cua tuy xu'dng sau cat lach.
So lu'dng lympho B (te bao cd CD19) giam nhu'ng khdng dang ke, theo chiing tdi cd le cat lach lam mat di ndi pha huy tieu cau chii yeu, tire la mat di ndi giang hoa va trinh dien cac peptit ciia cac glycoprotein. Nen mac du so lu'dng te bao lympho TCD4 tang, nhu'ng khong ed cac peptit de nhan dien. Va nhu' vay lympho B cung khong nhan dien du'dc lympho t mang peptit eua cac glycoprotein, dan den khdng kich thich du'dc lympho B. Mat khac eat lach lam mat di mot trong nhu'ng ndi chii yeu tang sinh va biet hoa cua lympho B trong benh XHGTCCRCN. Day la gia thiet, chiing tdi chu'a khang dinh du'dc trong pham vi nghien ciru nay.
V. KET LU/iN
Qua nghien ciru 27 benh nhan XHGTCCRCN sau cat lach chiing tdi riit ra mot so ket luan sau:
- Sau cat lach cd hien tu'dng giam mien dich dich the keo dal. Trong dd chii yeu la giam ham lu'dng IgG, IgM.
- 0 nhdm khong dap irng va dap irng khdng hoan toan ham lu'dng IgG, IgM, IgA cao hdn nhdm dap irng hoan toan.
- Tang so lu'dng te bao lympho TCD3, TCD4, TCD8 va giam so lu'dng te bao CD19, nhuYig khong khac biet so vdi binh thu'dng, tuy nhien ti leTCD4ArCD8<l.
TAI LIEU T H A M K H A O
1. Vu Trieu An, Jean Claude Homberg (1998),
"Cac co" quan mien dich, nhiTng te bao tJiam gia vao dap img mien dich", i^/en dich hoc, Nha xuat ban Y hoc, tr.50-52, i:r.60-81.
2. N g u v f n Hu'u Toan, J r i / d n g Cong Duan, Nguyen Trieu Van, Do Trung Phan va CS (1997), ''Ket gua khao sat chi so ^'bao mau va tuy xu'Ong. Ky thuat simitest mien djch huynh quang trWc tiep cua cac CD va &ng dung trong nghien cuU cac quan the iymphd', Y hoc Viet Nam, tr.39-51,
3. Bo Y Te (2003), "Cac gia tn sinh hoc ve hu^jet hoc", Cac gia tn smh hoc ngu'di Viet Nam binh thddng thap ky 90 the ky XX, Nha' xuat ban Y hpc, tr.73-78.
4. Cines Douglas B., Blanchette Victor S.
(2002), "Immune thrombocytopenic purpura", N EnglJmed, 346 (13), pp,995-1006.
n. George James N., Rizvi Mujahid A. (2001),
"Thrombocytopenia", William Hematology, Sixth Eidition, chapter 117, pp,1513-1520.
6. Gibson. M, Sehon J.K (2000),"Splenectomy for idiopathic thrombocytopenic purpura: a five-year retrospective review" Am-Surg, 66(10), 952-4.
7. Rintelen C.Z., Vl/eltermann A., et al (2002),
"Efficacy and safety of splenectomy in adult chronic immune thrombocytopenia", Hematol, vol 82, 290-294.
NHAN XET KET QUA PHAU THUAT DIEU TR| GAY XU'QNG DON TAI BENH VIEN DAI HOC Y H A NOI
T b M TAT
Muc tieu nghien cu'u: 1) Mo ta dac diem ton thu'dng'gay xu'dng don du'dc phau thuat tai benh vien Dai Hpc Y Ha Npi; 2) Danh gia ket qua dieu tn phau thuat ket hdp xu'dng don. Doi tu'dng va phu'dng phap nghien cCru; Nghien ciru hoi ciru 38 benh nhan gay xu'dng don du'dc dieu tri phau thuat ket hdp xu'dng tai benh vien Dai Hpc Y Ha Noi tir 2008 den
Tran Trung Dung*
thang 6 nam 2013. Ket qua nghien cirti: Ty l§
nam/nD' la 1,5:1. Tuoi trung binh la 42, Gay ddn gian la chii yeu chiem 65,4%, gay 1/3 gii/a chiem 92,1%.
Ket qua dieu tr; lien xu'dng dat 100%, ket qua chung theo thang diem Constant la 94,7% tot va 5,3% kha, khong co ket qua trung binh va kem. Ket luan: Phau thuat ket hdp xUdng don cho ket qua tot va 100% cic benh nhan hai long vdi ket qua dieu tri
Tif khoa: gay xu'Ong don, ket hdp xu'dng
* Tru'dng Dai Hpc Y Ha Npi
Phan bi$n khoa hgc: PGS. TS Dao Xuan Tich
V HOC VIET NAM THANG 2 - SO 1/2014
S U M M A R Y
OSTEOSYNTHESIS FOR CLAVICLE FRACTURE I N H A N O I MEDICAL
U N I V E R S I T Y HOSPITAL Objectives: 1) Discribe the character of clavicle fracture; 2) Evaluate the result of surgical treatment for clavicle fracture. Patients and method:
Retrospective study 38 clavicle fracture patients who were treated surgically in Hanoi Medical University Hospital from 2008 to June 2013. Results: Male/female ratio IS 1,5/1. Average age is 42. Simple fracture is 65,4%, 1/3 middle fracture is 92,1%. Bone union is 100%. Overall result is 94,7% excellent and 5,3%
good according to Constant score. 100% patients satisfied with the result.
/ifejwo«fe; clavicle fracture, osteosynthesis 1. O^T VAN OE
Gay xu'dng ddn la ton thu'dng gay xu'dng kha thu'dng gap tren lam sang, chiem b/ le khoang 5% cac loai gay xu'dng d ngu'di Idn, khoang 44 - 66% cac gay xu'dng viing quanh vai va chiem khoang 29 den 64 benh nhan tren 100000 ngu'di[l]. Gay xu'dng ddn it gay nhiTng anh hirdng Idn den toan than, xu'dng ddn it lien quan den cac chirc nang tru'c tiep trong sinh hoat do do, trong qua khir, xu tfie dieu tri bao ton cao[l,2,3]. Hien nay, nhu cau dieu tri ciia benh nhan cao hdn, mong muon hoan hao ve tham my, tra lai sdm ve mat chirc nang ciia khdp de cd the hoat dpng xa hoi sdm hdn nen xu the md' ket hdp xu'dng ddn cao hdn. Ket hdp xu'dng trong
gay xu'dng don khdng khd ve mat ky thuat nhu'ng neu can thiep khong dung thi cac nguy cd khong mong mudn tu'dng ddi cao nhu' nhiem triing, khdp gia. Tai benh vien Dai Hpc Y Ha Ndl, trong thdi gian tir 2008 den thang 6 nam 2013, chiing tdi da phau thuat ket hdp xu'dng don cho 38 benh nhan. Nghien ciTu nay nham muc tieu:
l.f^oja dac diem ton thu'dng gay xWdng don du'dc phau thuat tai benh vien Dai Hoc Y Ha Noi
2. Danh gia kit qua dieu tri phau thuat kit hdp xu'dng don
II. 0 0 1 Tt/pWG VA PHircrNG PHAP NGHIEN CLTU
• Odi tu'dng nghien ciru: 38 benh nhan du'dc phau thuat ket hdp xu'dng ddn, du'dc theo doi toi thieu 3 thang tai benh vien Dai Hgc Y Ha Ndi - Phu'dng phap nghien ciru: hoi ciru md ta - Cac chi tieu nghien ciru:
+ Oac diem chung ve tuoi, gidi
+ Phan loai thu'dng td'n gay xu'dng don theo vi tri (phan loai Allman[2]) (1/3 trong, 1/3 giij^ va 1/3 ngoai), theo thu'dng td'n ddn gian (khdng cd manh rdi) va phirc tap (cd 1 hay nhieu manh rdi)
+ Ky thuat phau thuat: ket hdp xu'dng nep vit hay dinh npi tuy
+ Ket qua sdm sau phau thuat; nhiem triing hay khdng, ,,,
^ Ket qua xa: danh gia si/ lien xu'dng, danh gia chirc nang van dong khdp vai theo thang diem Constant[4]
. K £ T QUA NGHIEN CU'U
Bang J / N o t so dac diem chung ciia nhom benh nhan P a c diem nghien cu'u
Gidi
Tuoi trung binh 42 ( 1 8 - 5 6 tudi)
Thdi ^ian theo doi trung binh 12,2 (3 - 24 thang)
IVh$n xet: Juo\ trung binh la 42, nam chiem ty e Idn hdn vdi 60,5%. Thdi gian theo ddi trung binh la 12,2 thang
BAng 2: Dac diem ton thu'dng Dac diem nqhien cu'u
Vi tn gay
Loai gay
1/3 nqoai 1/3 qiiJa 1/3 trong Don qian Co 1 manil rdi Co 2 manh rdi
N 2 35
1 25 10 3
»/o
5,3%
92,1%
2,6%
65,8%
26,3%
7,9%
Nh$n xet: Ton thu'dng chii yeu la gay ddn gian, khong manh rdi chiem 65,8% va ton thu'dng vj tri chu yeu la 1/3 giiJa chiem ty le 9 2 , 1 %
Y HOC VIET NAM THANG 2 • SO 1/2014
ga/7g J ; Phu'dng phap dieu tri Phu'tfng phap dfeu trj
Ket hdp xu'dng Nep vit Sir dyng chi thep
phoi hdp
Dinh ndi tuy Khdng
52,6%
Nhan xet: jy le sir dung nep vit va dinh ndi tuy la tu'dng du'dng nhau, cd 65,7% cac tru'dng hdp phai dung chi thep phdi hdp do gay co manh rdi
Bang 4: Ket qua dieu tri
f)ac diem nqhien cu'uLien xu'Ong
Niiiem trung nong Ket qua ttieo diem
Constant
Co lien xu'Ong Kiidnq iien xu'dng
Cd Khionq
Tot Ktia TB va i^em
N 38 0 1 37 36 2 0
100% %
0%
2,6%
97,4%
94,7%
5,3%
0%
Nhan xet: Ket qua lien xu'dng dat 100%, cd 1 tru'dng hdp nhiem trung ndng chiem 2,6%, 100% cac tru'dng hdp dat ket qua tot va kha, khdng cd tru'dng hdp nao trung binh va kem
IV. BAN LUAN
Qua bang 1 ta thay b/ le nam/nij' la 1,5:1, tu'dng du'dng nhau va khong cd sir khac biet.
Tud'i trung binh ciia cac benh nhan la 42, khdng thay cd sir khac biet ro ret giUa cac nhdm tuoi khac nhau. Da so cac tac gia khac cung thdng bao ket qua tu'dng ti/ ve tuoi va gidi la khdng cd SLT khac biet 1 each r5 ret[l,2,3,5,6]. Thu'dng ton gay xu'dng ddn ddn thuan thu'dng gap trong cac tai nan sinh hoat, lao dpng hoac giao thdng vdi cd che chan thu'dng khdng qua manh nhu'ng thu'dng benh nhan bj nga dap vai xuong dat va lu'c truyen theo true gay gay xu'dng [3] nen co the gap d moi lira tud'i va moi gidi.
Thu'dng ton gay 1/3 giiJa xu'dng ddn la thu'dng gap nhat vdi 92,1%, cdn lai la gay 1/3 trong hoac 1/3 ngoai (bang 2). Cd che chan thu'dng thu'dng gap nhat la cd che gian tiep vdi liTc truyen tir vai vao nen thirdng gay d 1/3 giO'a xu'dng ddn, ben canh do, 1/3 ngoai va 1/3 trong xu'dng con du'dc giir bdi he thong day chang va cac khdp nen chac chan hdn so vdi 1/3 giUa. Ket qua ciia chiing tdi cung tu'dng ti/ vdi ket qua ciia 1 so tac gia khac nhu" Chalidis [6] nghien ciTu 171 benh nhan ca dieu tri bao ton va phau thuat vdi thdi gian theo doi trung binh 7,2 nam thay 65,4% gay 1/3 giiJ'a. Ty le gay ddn gian khdng cd manh rdi va cd 1 manh rdi chiem da sd vdi 92,1% (bang 2). Mpt so tac gia thong bao nhUng ket qua phau thuat vdi ty le nhdm benh nhan gay
phirc tap ddng hdn [5,7]. Van de chinh la do chi djnh dieu trj phau thuat. Vdi sir phat trien cua gay me hoi sire va phau thuat nhu' hien nay, dong thdi la nhu cau hoa nhap cupc song cao ciia cac benh nhan, chi djnh phau thuat tu'dng ddi du'dc md rpng hdn. Vdi nhiJng vj tri nhiT xu'dng ddn, cd the dieu trj bao ton hoac" phau thuat thi dieu tri phau thuat mang lai nhu'ng ldi diem ve mat xa hpi nen xu the benh nhan mong muon du'dc phau thuat nhieu hdn. Thu'c te dieu tri cho thay, mpt sd benh nhan ciia chung toi dang dieu trj bao ton da quyet djnh chuyen sang dieu trj phau thuat de rut ngan thdi gian bat ddng, trd lai sinh hoat va lam viec sdm hdn vi vay, ty le gay ddn gian ciia chiing tdi cao hdn bao cao ciia cac tac gia khac.
Phu'dng phap ket hdp xu'dng ciia chung toi cd the la nep vit hoac dinh npi tuy. Ddng dinh noi tuy xu'dng ddn, chimg tdi sir dung kim Kirchner cai tien de ddng vdi du'dng kinh tir 2,2 - 2,6 mm.
Viec lira chpn phu'dng phap nao di/a vao danh
gia trirc tiep trong phau thuat, tuy theo vj tri gay,
tinh chat gay ddn gian hay phirc tap ma li/a chgn
phu'dng phap ket hdp xu'dng. Co 20 benh nhan
du'dc ket hdp xu'dng nep vit va 18 benh nhan
du'dc ket hdp xu'dng dinh npi tuy. Ty le gan
tu'dng du'dng nhau. Mpt so tac gia khac bao cao
nhiTng ket qua ciia ket hdp xu'dng bang nep vit
ddn thuan hoac dinh npi tuy ddn thuan cho thay
nhu'ng ket qua tot tu'dng tiT nhau[3,5,7]. Cd 13
Y HOC VIET NAM THANG 2 - SO 1/2014 tnrdng hdp sir dung chi thep phoi hdp de cd dinh
cac manh rdi nho.
Ket qua dieu tri cho thay ty le lien xu'dng 100%, khong cd tru'dng hdp nao khdng lien. Ket qua tot nay cung cd the bdi vi 100% cac benh nhan la gay kin va ty le gay ddn gian cua chimg tdi cao. Chung tdi khong gap tru'dng hdp nao khong lien xu'dng. Cd 1 tru'dng hdp cd bieu hien nhiem triing ndng vdi vet mo tay ne nhe sau dd sir dung khang sinh da on djnh hoan toan. Danh gia ket qua chung vdi thang diem cho vai va khuyu Constant cho thay 100% cac tru'dng hdp dat ket qua tdt va kha, trong dd chi co 5,3% (2 benh nhan) dat ket qua kha la 2 benh nhan cd ton thu'dng 1/3 ngoai xu'dng ddn nen cd anh hirdng den van dpng cua khdp vai.
V. KET LUAN
Qua nghien cu'u tren 38 benh nhan gay xu'dng ddn du'dc phau thuat tai benh vien Dai Hpc Y Ha Npi chimg tdi thay rang;
Ty le nam/niJIa 1,5:1. Tuoi trung binh la 42.
Gay ddn gian la chii yeu chiem 65,4%, gay 1/3 giij^ chiem 9 2 , 1 %
Ket qua dieu trj lien xu'dng dat 100%, ket qua Chung theo thang diem Constant la 94,7% tdt va 5,3% kha, khdng cd ket qua trung binh va kem.
T A i LIEU T H A M KHAO
1. ZIowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD (2005), "Treatment of acute midshaft clavicle fractures : systematic review of 2144 fractures : on behalf of the Evidence-Based Orthopaedic Trauma V/orking Group". ) Orthop Trauma 2005 ; 19 : 504-507.
2. Allman FL 3r. (1967), "Fractures and ligamentous injuries of the clavicle and its articulation". J Bone Joint Surg 1957 ; 49-A : 774-784.
J . Kotelnicki 31, Bote HO, Mitts KG (2006), "The management of clavicle fractures". Jaapa 2006 ; 19 : 50, 53-54, 56.
4. Constant CR, Murley AH, (1987), "A clinical method of function- al assessment of the shoulder". Clin Orthop 1987 ; 214 ; 160-164 3. Ngarmukos C, Parkpian V, Patradul A (1998),
"Fixabon of fractures of the midshaft of the clavicle with Kirschner wires. Results in 108 patients". J Bone Joint Surg 1998 ; 80-B : 106- 108.
6. Chalidis B, Sachinis N, Samladas E, Dinitriou C, Chnstodoulou A, Pournaras J (2008),
"Acute management of clavicle fractures: A long term functional outcome study". Acta Orthop Belg., ^74, 3 0 3 - 3 - 7
/ . Nguyen Thanh Chdn (2008), "Dieu trj phau thuat gay xiTdng don bang dinh Knowles", Ky yeu Hoi nghi thudng nien Hi3i CTCH TP Ho Chi Minh, 311 - 315
THirC TRANG NHIEM GIUN TRUYEN QUA DAT Of PHU Nir TUOI
SINH SAN TAI XA AN PHU, T H A N H PHO TUY HOA. T I N H PHU YENLe Huu Tho* , Thai van Cu'ffng*
T 6 M TAT
Mot dieu tra mo ta Ccit ngang du'dc thyc hien 6 405 phu nU trong dp tuoi smh san tir 15 den 45 tai xa dong bSng cd ca 2 viing nong thon va ven bien ciia Thanh pho Tuy Hoa, tinh Phii Yen nham xac dmh ty le v6 oiSng 6Q nhiem giun dua, giun toe va giun moc 6 phg nfftuoi sinh san tai diem nqhien ciTu tren. Ket qua nghien cuXi cho thay ty le nhiem giun chung d viing nong thon la 27,6%, giun dua la 9,4%, giun tdc la 2,6% va giun moc la 19,8%; ty fe nhiem giun chung.
' Sd Y ti Khanh Hda
**B$nh vi$n DDPHCN Phu Yen Phin bi^n khoa hpc: GS. TS 0$ng Du'c Anh
giun dua, giun toe, giun moc d viing ven bien fan lu'dt la 22,5%, 14,1%, 4,7% va 8,9%. Ket qua cho thay ty le nhiem giun moc d nong thon cao hSn d vimg ven bien (p<0,01). Ty le nhiem giun truyen qua dat 6 phu nCr CO chong (31,2%) cao hOn phu nO' chu'a chong (12,5%); phu niJ khong c6 thai (32,6%) eao hdn phu nir CO thai (22,6%). Dang luu y la ty le nhiem gmn mdc 6 phu nu* tuoi smh san chiem cao nhat trong cac nhom nhiem giun, cu the la ty le nhiem giun moc 6 phu ntr CO chong la 15,6%, phu nu" ch^a chong la 11,03%, phu nir co thai la 16,1% va phu ni? khong thai la 18,9%. Cu'dng do nhiem giun cao nhat tap trung vao nhom tuoi 35 - 45 (giun dua: 378,8 EPG;
giun tdc: 50,9 EPG; giun moc: 406,1 EPG).
Tu'khda: phu niJ'tuoi sinh san, nhiem giun tnjyen qua dat
