VIETNAM MEDICAL JOURNAL N°2 - APRIL - 2017
TAI UEU THAM KHAO
1. Jones, G., et al. (2010), Companson of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AI^BITION study. Ann Rheum Dis, 69(1): p. 88-96.
2. Kremer 3 M, Blanco R, Brzosko M et al.
(2011), Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with inadequate responses to methotrexate: results from the double-blind treatment phase of a randomized placebo-controlled trial of tocilizumab safety and prevention of structural joint damage at one year. Arthritis Rheum, 63(3), p. 609-21.
^. Smolen, J.S., et al. (2008), Effect of interleukin- 6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial.
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5. L.K. Dung, T.T. Thuy, T. V. Sung, P. T. Ninh (2004). Phenol glycosides from Vieljiamese Artocarpus tonkinensis. Tap dif dude liiu'i (1), 2-5.
6. Hoang Thj Que (2011), Ngfiien ahi tac dung cua bai thudc "Tam Ty thang gia giam" dieu tri benh viem khdp dang thap, Luan an tien sT y hocj Tru'dng dai hgc Y Ha Ndi.
7. Lu'u Thj H^nh (2012), Danh gia tae dung bai thude Khddng hoat nhu hddng thang tnjng dieu tn ho trd viem khdp dang thap glai doan I- II, the nhiet ty, Luan van tdt nghiep bac sT noi tru, trUcJng dai hoc Y Ha Npi.
NGHIEN CU'U DAC DIEM LAM S A N G AO GIAC, HOANG TUd^NG 6" BtNH NHAN LOAN THAN DO RU-gU
Nguyin Hfru Thang*, Bui Quang Huy**, Nguyin Sinh Phuc**, Cao Tiin Dire**
T O M TAT
Muc tieu: Ao giac va hoang tudng ia pho bien d benh nhan loan than do rUOu. Cac tneu chifng nay co the gay nguy hiem cho nhffng ngUdi xung quanh va cho benh nhan. Muc tieu nghien ciru ciia cliung toi:
1). D|c di^m ao giac do rUdu. 2). Dac diem hoang tu'dng do rU^u. Doi tu'dng va phu'dng phap nghien cifu: Gdm 79 benh nhan di/dc chan doan la loan than do rUdu. Sif dung tieu chuan chan doan ciia ICD-10 (1992). Diing phu'dng phap nghien cifu mo ta cat ngang. Cac so lieu dUdc xif ly va phan tfch tren chu'dng trinh Standa 12.0. Ket qua: 45,67% so benh nhan ci5 ao giac ket hdp vdi hoang tUdng, chi co ao giac chiem 27,85% va so benh nhan chi co hoang tudng chiem 26,58%. Ao thi giac chiem 58,23%. Ao giac xuat hien thudng xuyen chiem 96,55%, ao giac chi phdi hanh vi ciia benh nhan chiem 60,34%. Benh nhan chi ed 1 loai ao giac chiem 70,69%. Hoang tudng bj trijy hai chiem 59,49%. Sd benh nhan cd hoang tudng xuat hien thudng xuyen chiem 82,46% va tat ca eac hoang tudng deu chi phdi hanh vi cua benh nhan. Sd benh nhan chi cd 1 lo?i hoang tUdng chiem 70,17%.
T&khda:ko giac, hoang tUdng do rUdu
*Benh vien Tam than TU'2 Bien Hoa
*Benh vien 103, Hgc vien Quan y Chiu trach nhiem chfnh: Biji Quang Huy Email: [email protected] Ngay nhan bai: 11/1/2017 Ngay phan bien khoa hoc: 10/2/2017 Ngay duyet bai: 25/2/2017
SUMMARY
RESEARCH CUNICAL CHARACTERISnCS HALLUCINATIONS, DELUSIONS I N PAHENTS
WITH ALCOHOL-INDUCED PSYCHOSIS Objective: Hallucinations and delusions are common in patients with alcohol-induced psychosis.
These symptoms ean be dangerous for people and the patient. The goal of our research: 1). Features hallucinations caused by alcohol. 2). Features delusions caused by alcohol. Subjects and methods: 79 patients diagnosed as alcoholic psychosis. Using the diagnostic criteria of ICD-10 (1992). Cross-sectional and prospective method, describe every individual of 79 inpatients. The data is processed and analyzed on programs Standa 12.0.
Results! 45.67% of patients have hallucinations associated with delusions, hallucinations only account for 27.85% and delusions only account for 26.58%.
Visual hallucinations account fbr 58.23%.
Hallucinations occur frequently occupies 96.55%, hallucinations dominate the behavior of patients accounted for 60.34%. Patients have only one kind of hallucinaBon accounted for 70.69%. Harmful delusion accounted 59.49%. Delusions occur frequently occupies 82.46%, and alt delusions dominate behavior of patients.
70.17% of patients liave only one kind of delusion.
Keywords: Hallucinations, alcoholic delusions.
I.
DAT VAN DELoan than do ru'du rat pho bien trong lam sang Tam than. Hoang tu'dng va ao giac do ru'^u la eac trieu chu'ng loan than nang, co the gay nguy hiem cho nhifng ngu'cfi xung quanh va cho
I R
ehinh benh nhan. 6 Viet Nam, chu^ co nghien CLfu sau ve eae hoang tu'cfng va ao giac d benh nhan roi loan tam than do ru'du. Chiing toi thife hien de tai ^'Nghien c&u dae die'm lam sang ao giae, hoang tddng d be,nh nhan loan than do r&du"\id\ mue tieu sau: Dae die'm ao giac do r&du. Dac die'm hoang t&dng do rudu.
II. €)6! TirpMG VA PHirONG PHAP NGHIEN COtI Gom 79 benh nhan du'dc chan doan la loan than do rUdu. Cae benh nlian nay du'dc dieu trj
not tru tai Benh vien Tam than Trung u'dng ; Bien hoa, tif thang 11 nam 2012 den thang / nam 2016.
- Tieu ehan ehan doan cac rot loan tam thar do ru'du theo ICD 10 (1992).
- Phu'dng phap nghien cifu mo ta cat ngang.
- Cac so lieu du'dc xif ly va phan tich trer ehUdng trinh Standa 12.0.
III. KET QUA NGHIEN CLTU 3 . 1 . Oac diem ao giac do ru'du Bang 1. Sit Icet hdp ao qiac vdi hoang twdnq
^ ^ ^ ^ ^ ^ Benh nhan
Trieu chu'nq ^ _ Chi CO hoanq tu'dng
Chi CO ao qiac Ao qiac va hoanq tl/dnq
Tong so
So lu'dng 21 22 36 79
Ty le »/o 26,58 27,85 45,57 100 Ket qua nghien cifu d bang 1 cho thiiy 45,67% so benh nhan co ao giae ket hdp vdi hoang tu'dng, so benh nhan ehi cd ao giae (27,85%) va sd benh nhan chi cd hoang tu'dng (26^58%) la gan tUdnc du'dng nhau.
Bang 2. tan suat cac loaiao giac
Ao thj giac that
Tan suat Ty le %
Ao thinh giac that
58,23 Ao xuc giac that
19 24,05
12
15,19
Ket qua bang 2 cho thay ao giae eua benh nhan rat da dang, phong phu, trong dd ao thi giac chiem den 58,23% sd benh nhan. Con ao ttiinh giac (24,05%) va ao xue giae (15,19%) thi ehi§m tj te it hdn.
ggffg 3. Tinh chat cua ao giac
• Benh nhan Dac diS'm ' ' '-—^^_
Xuat hien l<honq thu'dnq xuyen Xuat hien thu'dnq xuyen
Khonq chi phoi hanh vi Co chi piidi hanh vi
So lu'dng (n = 5 8 ) 56
2 23 35
Ty le «/o 96,55
3,45 39,66 60,34 Hau het ao giac cua benh nhan xuat hien thu'dng xuyen (96,55%) va
(60,34%) CO chi phdi hanh vt cua benh nhan.
Bang 4. Cac loai ao giac tren benh nhan
1 so cae ao giae nai
So lu'dng ( n = 5 8 ) 41 2 loai ao giac
3 loai ao qiac
Bang 4 cho thay dai da sd benh nhan (70,69%) chi co 1 loai ao giac. Khoang mdt phan t i (25,86%) so benh nhan cd 2 loai ao glae. Sd benh nhan ed 3 toai ao giae rat it gap (3,45%).
3.2. Dac diem hoang tu'dng do ru'du Bangs. Tyle cac ioai hoang t&dng Benh nhan Hoanq tu'dng ' ' — _ _
hioanq lu'dnq bi theo doi Hoanq lu'dnq bi truy hai Hoanq lu'dnq bi dau ddc Hoanq tu'dng ghen tudnq Hoanq tu'cinq tu' cao
So lUdng ( n = 5 7 ) 5 47 3 15 6
Ti le % 6,33 59,49
3,80 18,99 7,59
Ket qua bang 5 cho thay hoang tu'dng bi truy hai la hay gap nhat, chiem 59,49%. Tiep theo la hoang tu'dng ghen tudng vdi 18,99%. Cac hoang tu'dng khae ft gap.
Bang 6. Tinh chat hoang t&dng
Xuat hien khdng thUdng xuyen
So lu'dng ( n = 5 7 ) 47 Xuat hien thu'dng xuyen
Khdng chi phdi hanh vi
Cd chi phdi hanh vi 100
Bang 6 cho thay tuyet dai da sd benh nhan (82,46%) ed hoang tifdng xuat hien thu'dng xuyen va tat ea cac hoang tudng deu chi phdi hanh vi eua benh nhan.
Bang 7. Cac loai hoang tu'dng tren benh nlian
Ket qua bang 7 eho thay da sd benh nhan (70,17%) chi cd 1 loai hoang tu'dng. So benh nhan co hai loai hoang tudng chiem 26,32%, con sd benh nhan cd 3 loai hoang tu'dng chl cd 3,51%.
IV. BAN LUjCkN 4 . 1 . Dac diem ao giac - Sif ket hdp ao giac va hoang tu'dng Ngiiien cifu ciia ehung tdi cho thay sd benh nhan cd ao giae va hoang tu'dng gan tu'dng du'dng nhau. Cu the 45,67% sd benh nhan ed ao giac ket hdp vdi hoang tu'dng, chi cd ao giac ehiem 27,85% va sd laenh nhan chi ed hoang tudng chiem 26,58%. Ket qua nay phii hdp vdi y kien cua Bill Quang Huy (2010) khi cho rang tsn xuat eua ao giae va hoang tifdng ta tu'dng du'dng nhau.
- Ve tan suat cac loai ao giac, Cao Tien Du'c (2016) cho rang ao thj giac la hay gap nhat, sau dd la ao thanh that, Ket qua nghien cifu cua eung tdi d bang 2 cho Wiay ao thj giac chiem 58,23% so benh nhan, ao thinh giac ehiem 24,05% va ao xuc giac chi chiem 15,19%.
- Ve tfnh chat eua ao giae, Kaplan H.I. (1994) cho rang die ao giac do ru'du thu'dng xuat hien lien tuc va ehi phdi hanh vi ciia benh nhan. K^t qua nghien ciiu ciia chung tdi (tiang 30 cijng khang dinh nhan dinh tren vdi 96,55% cd ao giac xuat hien thu'dng xuyen va 60,34% ao giae cd chi phdi hanh vi eua benh nhan.
- Ve cae loai ao giac tren benh nhan, Sadock B.J (2007) cho rang da so benh nhan ehi cd 1 toai ao giac. Cac benh nhan cd 2-3 ao giac hiem gap, Ket qua d bang 4 cung cho thay dai da sd benh nhan (70,69%) ehi cd 1 toai ao giac, 25,86% sd benh nhan ed 2 ioci ao giac va sd benh nhan co 3 loai ao giac rat it gap (3,45%),
4.2. D i e diem hoang tu'dng do ru'du - Ve ty le cac loai hoang tu'dng, Nguyen manh Hung (2009) cho rang da so benh nhan cd hoang
tu'dng bj truy hai. Hp cho rang bj ma quy hoae mot the tUe nao dd tim each hai hg. Nghien ciJu cua chung tdi (bang 5) cho thay hoang tu'dng bj truy hai la hay gap nhat, chiem 59,49%, b'ep theo la hoang tu'dng ghen tudng vdi 18,99%.
- Ve ti'nh chat eua hoang tu'dng, chung tdi nhan thay (bang 6) 82,46% sd Isenh nhan cd hoang tu'dng xuat hien thu'dng xuyen va tat ca eac hoang tu'dng deu chi phdi hanh vi eiia benh nhan.
Ket qua nay la phii hdp vdi Bhat PS (2012) khi cho rang hau liet cac hoang tu'dng deu ton tai suot ngay va chi phdi hanh vio ciia benh nhan.
- Ve so lu'dng hoang tu'dng tren mpt benh nhan, Nguyen Manh Hung (2009) eho rang 73,35% sd benh nhan eh! ed mpt loai hoang tu'dng. Nghien cifu cua chiing tdi (bang 7) cung phu hdp vdi ket qua nay vdi 70,17% so benh nhan ehi ed 1 toai hoang tu'dng.
V. KET LU^N 5 . 1 . Dac diem ao giac
- 45,67% so benh nhan OD ao glae ket hdp vdi hoang tu'dng, ehi od ao giae ehiem 27,85% va so benh nhan chi ed hoang tu'dng ehlem 26,58%.
' - Ao ttii giac chiem 58,23%, ao thinh giac chiem 24,05% va ao xuc giae chi chiem 15,19%
sd benh nhan.
- 96,55% benh nhan cd ao giac xuat hi$n thu'dng xuyen va 60,34% ao giac chi phoi hanh vicua benh nhan,
- Oa so benh nhan (70,69%) chi cd 1 loai ao giac, 25,86% so benh nhan co 2 loai ao giac.
5.2. D | c diem hoang tu'dng
- Hoang tudng bj truy hai chiem 59,49%, hoang tifdng ghen tudng vdi 18,99% so benh nhan.
TAP CHi Y HOC VIET NAM TAP 453 - THANG 4 - SO 2 - 2017 - 82,46% SO benh nhan cd hoang tu'dng xuat
hien thu'dng xuyen va tat ca cae hoang tu'dng deu ehi phoi hanh vi eua benh nhan
- 70,17% sd benh nhan ctii od 1 loai hoang tudng.
TAI UEU T H A M KHAO
1. Cao Tien Du'c, Tran Xuan Tru'dng (2016). Cac roi loan tam than, hanh vi va ton thUdng cd the do rUdu. Nha xuat ban Y hgc-ha Npi. Trang 43-45.
z. Nguyen Manh Hung (2009). Nghien cuV dac diem lam sang sang rddu cap. Luan an Tien sy Y hoc, Hgc vien Quan y.
. BiJi Quang Huy, Nguyen Manh Hiing, Nguyen Thanh Binh (2010). Nghien rddu. Nha xuat ban y hoc. Ha Ngi. Trang 27-67.
. Bhat PS^ Ryali V, Srivastava K, and colab.
(2012). Alcoholic hallucinosis Ind Psychiatry J. Jul;
21(2):155-157. doi: 10.4103/0972-6748.119646 . Kaplan H. I., Sadock B. X, Grebb J. A. (1994).
Synopsis of psychiatry. Seventh edition. Wasington D.C. Page: 396-410.
. Sadock B. 3., Sadock V. A. (2007). Kaplan and Sadock's. Synopsis of psychiatry. Tenth edition.
William and Wilkins. Page: 189-217.
KHAO SAT MOT SO DAC DIEM GlAl PHAU MACH MAU - c a s a THIET Kf VAT DA CAN THU-gNG DON
Tran Van Anh*
T O M TAT
Dat van de: Tai Viet Nam, vat da can thUdng don (DCTD) ia mot chat lieu tot dUdc cac phlu thuat vien tao hinh lUa chgn trong khoang hdn 10 nam trd lai d§y trong dieu trj phau thuat seo co keo viing co. Day la mpt vat dang true, ed dp an toan cao, hieu qua tot.
Nghien cifu ve giai phau ciia vat nay it dUdc thong bao, trong khi thong tin trong cae sach giao khoa ve gial phau kinh dien thi ehUa dUdc viet chi tiet, chua dil cd sd de ifng dung tren thifc te lam sang. D61 tu'dng va phu'dng phap nghien ciiu: 20 xac dUdc bao quan iiang dung di'ch Formalin tai Bg mon giai phlu tru'dng dai hpc y dUdc thanh pho Ho Chi Nlinh.
Nghien cifu bao gom dac diem giai phau ciia dpng mach tren ddn (ben phai va ben trai) ve: nguon gde, dudng di, lien quan, dp dai, dUdng kinh va viing cap mau. Ket qua: Bong mach tren ddn co mat d tat ca 20 xac vdi 40 tiSu ban giai phau, cd nguyen iiy ttf dpng mach co ngang, diem xuat phat chii yeu nam trong khoang 1/3 giffa xUdng ddn (95%), each dau trong xUdng don trung binh 7,56 em, chieu dai ciia dgng mach tren don khoang 3,5-4,5 cm, dudng kinh triing binh 1,19mm. Viing cap mau cua dgng mach tren ddn dat dUde: chieu dai trung binh: 20,2cm, ehieu rpng trung binh: 10,5cm. Ket luan: Vat da can ttiUdng ddn la mpt vat cd dg tin cay cao bdi mach mail nuoi vat hang djnh, chieu dai mach tren ddn dam bao cho vat co dp linh hoat cao trong ifng dung lam sang. Vijng cap mau ciia dong mach tren ddn mang lai chat lieu cd kich thUdc kha rpng, rat hieu qua trong phau thuat tao hinh phu. DUdng kfnh cua dpng maeh tr§n ddn ed the giiip cho vat dUde sif dung d dang vat tif do.
T&kiida: Dpng mach tren don, vat da
*Vien Bong Qude gia Li Hihi Trac Chiu trach nhiem chinh: Tran Van Anh Email: [email protected] Ngay nh^n bai: 10/1/2017 Ngay phan bien khoa hpc: 3/2/2017 Ngay duyet bai: 20/2/2017
SUMMARY
ANATOMICAL FEATURE OF SUPRACLAVICULAR ARTERY AND USING
FOR HAVESTING FLAP Introduction: Recently, supraclavicular flap is an excellent flap that has been used widely in treatment post burn scars contracture at the neck. However, its vascular reliability remains unclear. Thus, auttiors analyzed anatomical feature in this study that are useful fbr havesting flap. Patient and Method: 40 flaps from 20 preserved cadavers to dissected at Anatomy department of Ho Chi l^inh city medical and pharmacy university. Supraclavicular artery were examined including origins, courses, lengths, diameters and its anatomical territory. Results: The supraclavicular artery was found in all twenty cadavers with forty anatomical specimens, the origin was transverse cervical artery and arised at the level of the middle third of the clavicle in 95%, the distance of the origin of the artery from the inner border of the clavicle was 7.56cm, the lenqth of the artery was about 3.5-4.5cm, the average diameter was 1.19mm, the blood-supplied region of the artery could reacti 20.2cm in length and 10.5cm in width. Conclusion:
Supraclavicular flap is reliable, pedicle length enough for fleable using in flap deslgn.The artery diameter of ttie pedicle could be used as free flap in reconstuctive surgery.
Key word: Supraclavicular artery, flap I. DAT VAN DE
Vat da can thu'cfng ddn du'dc Lamberty thdng bao lan dau tien nam 1979, sau dd du'dc Pallua va Machens ap dung thanh edng eho 8 benh nhan seo eo keo cam co vao nam 1997.
Dang vat nay da gdp phan giai quyet du'dc ntiieu han che eua nhieu phu'dng phap tao hinh khac, dap ifng diidc yeu cau tao hinh vung cam cd, dac biet la yeu cau tham my bdi nd mang lai chat lieu mdng, hda ddng vdi da lanh lan can viing cam ed [3]. Tif dd den nay vat da can
