MEBO纱条治疗腹部外科术后切口感染62例

目的：观察湿润烧伤膏（MEBO）纱条治疗腹部外科手术后切口感染的疗效。方法：拆除感染伤口缝线，将MEBO纱条填塞感染伤口，隔日换药治疗；较大感染伤口Ⅱ期缝合。结果：所有病例全部治愈，87.1%Ⅰ期愈合，12.9%Ⅱ期清创缝合愈合，平均愈合时间12天。结论：MEBO纱条治疗腹部外科术后切口感染疗效显。     

MEBO在外科手术切口感染的治疗

目的 观察外科手术后感染切口采用湿润烧伤膏(MEBO)治疗的疗效.方法 2002年1月～2008年12月共收治65例外科手术后切口感染创面,全程使用MEBO换药方法治疗,观察感染创面愈合情况.结果 应用MEBO换药治疗,术后切口感染创面全部愈合,愈合时间最短7 d,最长50 d.结论 MEBO对术后切口感染创面具有一定的抗感染作用,可促进创面愈合,方法简便.     

湿润烧伤膏治疗包皮环切术后创面临床体会

目的 探讨湿润烧伤膏（MEBO）治疗包皮环切术后创面的疗效.方法 对34例包皮环切术后创面,应用MEBO药纱包扎治疗的同时,结合冠状沟外涂MEBO以保持局部湿润,防止粘连.结果 34例患者均于术后7d去除敷料,局部外涂MEBO治疗,切口愈合良好,无任何并发症发生.结论 MEBO治疗包皮环切术后创面疗效显著,安全可靠,值得推广.     

MEBO治疗慢性难愈性皮肤溃疡的临床疗效观察

目的观察湿润烧伤膏(Moist Exposed Burn Ointment,MEBO)治疗慢性难愈性皮肤溃疡的临床疗效。方法对2010年1月-2014年12月收治的344例慢性难愈性皮肤溃疡患者创面采用"药刀结合"的方法治疗,药即MEBO,刀即外科清创术、植皮术等。患者初诊时尽量清除创面坏死组织,不能耐受一次性清创者行蚕食疗法;清创后创面均匀涂抹MEBO并外敷MEBO药纱包扎治疗,存在潜腔的创面用MEBO药纱填塞引流,待肉芽组织填满创面后行肉芽创面游离植皮术。观察患者创面愈合时间及愈合情况。结果344例患者中除38例患者好转后自动出院,3例患者死于基础疾病外,其余303例患者创面均完全愈合,愈合率达88.1%,创面平均愈合时间为80.4 d±15.8 d。其中,193例患者经MEBO换药治疗后创面自行愈合(56.1%);48例合并趾骨坏死的糖尿病足患者进行了坏死组织剜除术(14.0%);34例骨外露创面进行了钻孔术(9.9%);54例患者进行了肉芽创面植皮术(包括接受趾骨剜除术及骨钻孔术后的创面)。89例烧伤残余创面愈合较快,最短为7 d,最长为29 d,平均愈合时间为18.8 d±4.9 d。结论MEBO可有效控制创面感染,促进坏死组织液化脱落及肉芽组织生长,缩短创面愈合时间,减轻患者疼痛,适时配合"刀法"还可进一步加速坏死组织脱落,促进肉芽组织生长,及时封闭创面,减少瘢痕增生,是治疗慢性难愈性皮肤溃疡的理想方法。     

湿润烧伤膏(MEBO)对手术切口感染的疗效观察

目的:观察湿润烧伤膏(MEBO)对腹壁、会阴部术后切口感染的治疗效果.方法:拆除感染伤口缝线,治疗组用MEBO换药治疗,对照组用1%利凡诺尔纱布条包扎治疗,每日换药1次,换药超过4周伤口Ⅱ期缝合.结果:所有病例全部治愈,治疗组Ⅰ期愈合率100%,对照组Ⅰ期愈合率84.2%;治疗组切口愈合时间明显较对照组短.结论:湿润烧伤膏治疗腹壁、会阴部术后切口感染疗效显著,可缩短创面愈合时间,优于传统疗法.     

MEBO 治疗跟骨骨折术后皮肤坏死疗效观察

目的　观察湿润烧伤膏(MEBO) 纱条治疗跟骨骨折术后皮肤坏死的临床疗效。方法　2008 年7月~2012 年7 月, 应用MEBO 纱条治疗跟骨骨折术后切口皮缘坏死18 例, 先将消毒后的纱布剪成与创面形状大小相仿的纱条, 再将药膏均匀涂于纱布上, 药膏厚约0． 3 mm, 覆盖于单纯皮肤坏死创面, 无菌敷料覆盖, 纱布包扎, 每天换药1 次; 坏死组织界限已清楚, 但仍有部分未脱落坏死组织的创面, 剪除坏死组织后覆盖MEBO 纱条, 无菌敷料包扎, 3 d 换药1 次。结果　15 例表浅皮缘坏死创面和2 例皮肤全层坏死创面完全愈合, 愈合时间最短10 d, 最长28 d, 皮肤质地良好, 1 例患者于术后4 个月骨折愈合, 取出钢板后, 创面继续应用MEBO 纱条治疗, 直至愈合。结论　MEBO 纱条治疗跟骨骨折术后皮肤坏死疗效可靠, 无不良反应, 操作方法简便易行。     

湿润烧伤膏联合创疡贴治疗压疮的疗效观察

目的观察、探讨湿润烧伤膏(MEBO)联合创疡贴治疗Ⅲ~Ⅳ期压疮的临床疗效。方法对2009年1月-2013年12月收治的68例压疮患者(89处创面),创面外涂MEBO后覆盖创疡贴包扎治疗,每日换药1次,观察创面愈合时间及愈合效果。结果除2例患者(4处Ⅳ期压疮创面)自动出院外,其余66例患者经MEBO联合创疡贴换药治疗后,创面均完全愈合,其中Ⅲ期压疮创面平均愈合时间为(17.0±1.4)d,Ⅳ期压疮创面平均愈合时间为(45.0±2.1)d。结论 MEBO联合创疡贴治疗压疮疗效满意,操作简便,患者易于接受。     

原位再生医疗技术治疗腹部术后切口感染的临床经验

目的 观察湿润烧伤膏（MEBO） 联合创疡贴在腹部术后切口感染伴坏死性筋膜炎治疗过程中加速创面愈合与控制感染的效果.方法 随机选择5 例妇科术后切口感染的患者,其中2 例患者伴有坏死性筋膜炎.所有患者在进行切口清创处理后,不再进行外科手术缝合,创面直接外涂湿润烧伤膏,然后用创疡贴覆盖治疗.结果 5 例患者创面全部愈合.结论 皮肤原位再生医疗技术（MEBT/ MEBO） 治疗腹部术后切口感染伴坏死性筋膜炎可有效地控制创面感染,促进创面愈合.     

MEBT/MEBO治疗糖尿病足的临床疗效观察

目的观察、探讨MEBT/MEBO对糖尿病足的治疗效果。方法将23例患者随机分为两组,MEBT/MEBO组(12例)于常规清创术后应用湿润烧伤膏包扎治疗,每日换药1次:常规组于常规清创术后应用生理盐水纱布包扎治疗,每日换药1次,对比观察两组创面愈合时间及愈合效果。结果 MEBT/MEBO组的创面平均愈合时间为41.00 d±1.26 d,与常规组(62.00 d±2.23 d)相比,差异具有统计学意义(P<0.01);MEBT/MEBO组有1例患者创面愈合后形成瘢痕,常规组有3例患者创面愈合后形成瘢痕,差异无统计学意义。结论MEBT/MEBO可有效控制糖尿病足溃疡创面感染,促进创面组织再生修复,缩短创面愈合时间,疗效显著,是治疗糖尿病足的有效疗法。     

股动脉假性血管瘤破裂人工血管植入术后创面感染1例

目的观察原位再生医疗技术(Moist Exposed Burn Therapy/Moist Exposed Burn Ointment,MEBT/MEBO)治疗股动脉假性血管瘤破裂人工血管植入术后创面感染的临床疗效。方法对2010年10月福安市医院外科收治的1例因吸毒而导致一侧股动脉假性血管瘤破裂,Ⅰ期采用人工血管植入术治疗后创面感染的患者,采用MEBT/MEBO规范治疗,无损伤地清除创面坏死组织后均匀涂抹湿润烧伤膏,并用湿润烧伤膏药纱覆盖,治疗过程中严格保护裸露的人工血管,严密观察肢端的血液循环变化及创面愈合情况。结果治疗70 d后创面愈合,患者出院。出院后3个月随访,创面愈合良好,无明显瘢痕增生,剧烈活动时会出现轻微的患肢无力、疼痛等症状,但不影响日常生活,正常活动时无不适感。结论 MEBT/MEBO治疗股动脉假性血管瘤破裂人工血管植入术后感染创面的疗效显著,能够改善创面微循环,控制创面感染,促进创面愈合及微血管再生。     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.