妇科腹腔内出血病因分析及自体血回输的意义探讨

目的分析妇科急性腹腔内出血的不同原因的临床特征以减少误诊及指导治疗,探讨自体血回输的安全性和有效性。方法对收治的352例妇科腹腔内出血患者进行回顾性分析。结果352例妇科腹腔内出血患者术后诊断为:异位妊娠262例,占74.43%,卵巢破裂74例,占21.02%,出血性输卵管炎12例,占3.41%,其他4例,占1.14%。异位妊娠、卵巢破裂和出血性输卵管炎的术前误诊率分别是4.96%,31.08%和66.67%。腹腔内出血在急诊手术中需要输血的患者188例,其中108例采用了自体血回输,无1例发生严重并发症。自体血回输中加或不加抗凝剂,治疗效果及副反应均没有差异。所有患者预后良好。结论妇科急性腹腔内出血的诊断并不困难,大多数能明确其原因。妇科腹腔内出血急诊手术中应用自体血回输治疗是安全、有效的。     

超声检查异位妊娠60例分析

目的:探讨彩色超声在宫外孕诊断中的价值.方法:患者多取仰卧位,适当充盈膀胱,腹部常规纵、横、斜,扫查盆腹腔了解子宫大小,宫内及附件情况,查看盆腹腔有无液性暗区.结果:本组经腹部超声检查确诊为宫外孕55例,符合率91.5%,1～3 d后复查确诊宫外孕57例,符合率提高到95%,误诊3例.结论:超声诊断宫外孕对临床帮助,尤其是未破裂宫外孕,早期诊断可避免由于宫外孕导致的内出血而危及患者的生命,是宫外孕临床诊断一重要检查手段.     

肾血管平滑肌脂肪瘤自发性出血的CT分析

目的:评价螺旋CT检查对肾血管平滑肌脂肪瘤自发性出血的意义,提高对该病的诊断与鉴别诊断的认识.方法:回顾性分析12例肾血管平滑肌脂肪瘤自发性出血患者的CT和病理特征.结果:12例肾血管平滑肌脂肪瘤自发性出血主要CT表现为肾实质内密度不均的肿块内含更低密度影(脂肪),其CT值为-20～-90 Hu.其中肾肿块内出血5例,肾肿块内出血并包膜下出血3例,肾肿块内出血并肾周积血2例,肾肿块内出血并腹腔积血2例.动态增强扫描肾血管及软组织成分明显强化,脂肪成分及出血均不强化.本组12例术前诊断与手术病理诊断结果符合率100%.结论:螺旋CT及多期动态增强扫描对判断肾血管平滑肌脂肪瘤自发性出血具有重要临床价值,有助于术前定位定性诊断.     

原发性肝癌自发性破裂出血临床特点及影像学诊断

目的 探讨原发性肝癌（ＨＣＣ）自发性破裂出血的临床特点及影像学表现。材料与方法 根据９例ＨＣＣ自发性破裂继发腹腔内出血临床表现,结合超声,ＣＴ,血管造影征象进行分析。结果 ＨＣＣ自发性破裂出血临床主要表现为急性上腹部疼痛,腹腔内出血,失血性休克。超声检查主要显示ＨＣＣ出血部位出现高回声区。ＣＴ扫描显示ＨＣＣ出血区出现高密度影,腹腔内出血表现为腹腔积液ＣＴ增高。血管造影显示肿瘤血管破裂区出现对比剂外     

腹部钝伤的CT

作者应用CT检查了43例腹部钝伤,与最后诊断结果作了比较。脾损伤8例,为脾破裂合并腹腔内出血;胰腺损伤5例,表现为胰肿大及胰液漏出;肾损伤5例,见有被膜下血肿(1例)、肾周间隙血肿(2例)、肾周间隙及肾旁间隙血肿(2例);空肠损伤5例(不包括十二指肠损伤),示消化道穿孔、腹腔内游离气体(1例)及腹腔内出血(2例);肝损伤4例,均为肝破裂,3例伴腹腔内出血;十二指肠损伤2例,示腹腔内及肾旁间隙内气体(1例)、腹腔内出血、十二指肠袢扩张及肾后旁间隙血肿(1例);腹膜后损伤1例,为     

腹腔血血清β-HCG定性检测对异位妊娠的诊断价值

目的:探讨腹腔内游离血β-HCG定性检测对异位妊娠的诊断价值。方法:采用尿试纸法定性检测61例异位妊娠和11例非异位妊娠腹腔内出血患者的腹腔血β-HCG,并与其尿β-HCG定性和血清β-HCG定量分析结果进行比较。结果:定性检测腹腔血β-HCG与尿试纸法定性检测,两者比较差异有统计学意义(P<0.05)。定性检测腹腔血β-HCG诊断异位妊娠的特异性为90.91%,敏感性为96.72%,准确性为95.83%。结论:对腹腔内出血患者,采用腹腔血β-HCG定性检测诊断异位妊娠方便、快速、准确。     

超声检查在腹部闭合性损伤诊断中的应用

<正>腹部闭合性损伤常为一个或多个腹腔脏器损伤或破裂,多伴有内出血和休克表现,如得不到及时诊断及治疗,可致死亡。近年来,随着我国工业的发展和汽车的普及,此类患者越来越多,因此探讨有效的早期诊断与治疗干预方法,日渐成为急诊外科研究的焦点。超声检查以二维图像的形式来反映腹腔脏器的形态、大小等,并可以实时对腹腔脏器周围的毗邻关系进行显示,对腹部闭合性损伤的检查具有不可替代的作用[1],广泛应用于临床。本文回顾性分析我院     

新生儿脑室内出血的超声诊断及分析

目的:探讨影响新生儿脑室内出血(IVH)严重程度的相关因素及床边头颅超声检查对IVH的诊断价值.万法:经床边颅脑超声诊断有脑室内出血的297例病例,把出生体重、Apgar评分、出生胎龄、有无窒息史、有无上呼吸机史、有无呼衰史这6个可能对脑室内出血严重程度有影响的因素,进行数据资料统计分析.结果:出生体重、出生胎龄、窒息...     

螺旋CT平扫早期诊断肠和肠系膜钝性伤的临床价值

目的 探讨螺旋CT平扫对肠及肠系膜钝性伤的早期诊断价值.方法 回顾性分析32例经手术证实的急性肠及肠系膜钝性伤的CT表现和临床资料,所有病例均行CT平扫及增强检查,总结其CT征象的临床意义,并对CT平扫及增强检查结果进行对比分析.结果 螺旋CT平扫及CT增强在腹腔积液或血肿、腹腔游离气体、肠系膜渗出及血肿、肠壁肿胀、肠管破裂、肠管扩张伴积液方面,诊断率无显著性差异.结论 螺旋CT平扫对早期诊断急性肠和肠系膜钝性伤有较大临床价值,增强检查可作为CT平扫的重要补充.     

彩色多普勒超声诊断上消化道穿孔的价值分析

目的探讨彩色多普勒超声对上消化道穿孔诊断的应用价值。方法对72例急症上腹痛患者行彩色多普勒超声检查,通过分析超声影像有无腹腔游离气体及腹腔间隙游离液区,初步诊断上消化道穿孔。结果72例患者,应用彩色多普勒超声检查,有31例观察到隔下、剑突下、右上腹部出现游离气体声像,经临床手术证实上消化道穿孔28例,诊断符合率为90%,2例急性胰腺炎,1例高位肠梗阻;41例观察到右上腹小网膜囊间隙、右侧髂窝间隙或左侧腹小肠间隙游离液区,经临床诊断有14例为上消化道穿孔,诊断符合率为34%,其余27例中分别为4例肠梗阻,4例回盲部肠炎,19例急性阑尾炎。同时观察到腹腔游离气体和腹腔积液17例,临床诊断为上消化道穿孔14例,诊断符合率为82%,其余3例为急性胰腺炎。讨论彩色多普勒超声作为简便、无创、对气体及液体敏感性较强等优点,能够及时对急性上消化道穿孔做出较为准确的诊断,从而为临床诊断提供重要的临床价值,争取在短时间内治愈疾病,减轻患者痛苦,值得临床推广。     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Long-term follow-up of patients with primary amyloidosis with MRI

The effect of chemotherapy on subjects with primary amyloidosis (AL-amyloidosis) were studied with MRI in five patients. The MRI was performed every 3–5 months for 23–60 months, and the T1 and T2 relaxation times were determined in liver and subcutaneous fat. In the patients as a whole T1 was significantly prolonged (P < 0.05), whereas T2 was within normal range. On follow-up with repeated MRI increasing T1 values could be measured in progressive disease (one patient) whereas decreasing T1 values seemed to parallel clinical improvements in four patients. The effect of different treatment schedules in AL-amyloidosis may be evaluated with MRI and the amount of amyloid deposits may be quantified. Correspondence to: K.-Å. Thuomas     

小腿穿支血管筋膜蒂皮瓣修复胫骨外露创面

目的 探讨小腿不同部化胫骨外露创面的修复方式。方法 应用小腿内、外、后侧穿支血管的筋膜蒂皮瓣邻近转位，对胫骨外露创面进行修复共32例。结果 术后1例皮瓣远端表皮坏死结痂，其余皮瓣均完全成活；1例皮瓣下肌肉坏死感染，伤口经换药延迟愈合，其余伤口均愈合良好。无一例骨髓炎发生。结论 小腿穿支血管筋膜蒂皮瓣切取方法简便、血供可靠，是胫骨外露中小型创面修复的较好方法之一。     

Treatment with 177Lu-DOTATOC of patients with relapse of neuroendocrine tumors after treatment with 90Y-DOTATOC.

Therapy with [(90)Y-DOTA(0), Tyr(3)]-octreotide (DOTATOC, where DOTA = tetraazacyclododecane tetraacetic acid and TOC = D-Phe-c(Cys-Tyr-D-Trp-Lys-Thr-Cys)-Thr(ol)) is established for the treatment of metastatic neuroendocrine tumors. Nevertheless, many patients experience disease relapse, and further treatment may cause renal failure. Trials with (177)Lu-labeled somatostatin analogs showed less nephrotoxicity. We initiated a prospective study with (177)Lu-DOTATOC in patients with relapsed neuroendocrine tumors after (90)Y-DOTATOC treatment. METHODS: Twenty-seven patients, pretreated with (90)Y-DOTATOC, were included. The mean time between the last treatment with (90)Y-DOTATOC and (177)Lu-DOTATOC was 15.4 +/- 7.8 mo (SD). All patients were injected with 7,400 MBq of (177)Lu-DOTATOC. Restaging was performed after 8-12 wk. Hematotoxicity or renal toxicity of World Health Organization grade 1 or 2 was not an exclusion criterion. RESULTS: Creatinine levels increased significantly, from 66 +/- 14 micromol/L to 100 +/- 44 micromol/L (P < 0.0001), after (90)Y-DOTATOC therapy. The mean hemoglobin level dropped from 131 +/- 14 to 117 +/- 13 g/L (P < 0.0001) after (90)Y-DOTATOC therapy. (177)Lu-DOTATOC therapy was well tolerated. No serious adverse events occurred. The mean absorbed doses were 413 +/- 159 mGy for the whole body, 3.1 +/- 1.5 Gy for the kidneys, and 61 +/- 5 mGy for the red marrow. After restaging, we found a partial remission in 2 patients, a minor response in 5 patients, stable disease in 12 patients, and progressive disease in 8 patients. Mean hemoglobin and creatinine levels did not change significantly. CONCLUSION: (177)Lu-DOTATOC therapy in patients with relapse after (90)Y-DOTATOC treatment is feasible, safe, and efficacious. No serious adverse events occurred.     

Quantitative evaluation of muscle perfusion with CEUS and with MR

Functional imaging might increase the role of imaging in muscular diseases, since alterations of muscle morphology alone are not specific for a particular disease. Perfusion, i.e., the blood flow per tissue and time unit including capillary flow, is an important functional parameter. Pathological changes of skeletal muscle perfusion can be found in various clinical conditions, such as degenerative or inflammatory myopathies or peripheral arterial occlusive disease. This article reviews the theoretical basics of functional radiological techniques for assessing skeletal muscle perfusion and focuses on contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) techniques. Also, the applications of microvascular imaging, such as in detection of myositis and for discriminating myositis from other myopathies or evaluating peripheral arterial occlusive disease, are presented, and possible clinical indications are discussed. In conclusion, dedicated MR and CEUS methods are now available that visualize and quantify (patho-)physiologic information about microcirculation within skeletal muscles in vivo and hence establish a useful diagnostic tool for muscular diseases. Invited review article to European Radiology.