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1.
背景:国外商品化的硫酸钙产品尽管临床应用效果较好,但存在依赖进口和价格较高的缺陷。 目的:自行构建骨植入型硫酸钙/庆大霉素药物释放系统,并评价其生物相容性。 设计、时间及地点:观察对比实验,于2005-10/2006-09在解放军总医院骨科研究所完成。 材料:以自制柠檬酸化半水硫酸钙为庆大霉素的载药基质,制备硫酸钙/庆大霉素植入剂抗生素含量5%。 方法:根据医疗器械生物学评价实验选择指南(ISO标准10993-1,1997)和国家标准GB/T16886-1选择红细胞溶血实验、细胞毒性实验、热原实验、肌肉内植入实验及骨内植入实验评价硫酸钙/庆大霉素抗生素释放系统的生物相容性。 主要观察指标:红细胞溶血率、细胞相对增殖率、体温升高情况及组织相容性。 结果:①抗生素释放系统红细胞溶血率为2.02%,小于阳性标准。②细胞毒性实验:实验组细胞相对增殖率和对照组无显著性差别,毒性评分为0~1级。③热原反应:家兔平均体温升高为0.3 ℃,符合医用材料的热源反应要求。④肌肉内植入实验:抗生素释放系统在肌肉组织内可逐渐降解,材料周围未见大量炎性细胞浸润,组织无排斥。⑤骨内植入实验:骨组织内抗生素释放系统可逐步降解,并逐渐被骨性组织替代,无排斥现象及肝肾毒性。 结论:构建的硫酸钙/庆大霉素释放系统不会引起机体本身的溶血反应,不具有细胞毒性和致热源作用,可逐步降解,无排斥现象,具有良好的生物相容性和安全性。  相似文献   

2.
背景:磨损颗粒引起的骨溶解是导致假体松动的主要原因,已成为骨科学的研究热点之一,但是准确模拟磨损颗粒诱导假体周围骨溶解发生过程的动物模型是首先需要解决的问题。RANKL是细胞因子中调控破骨细胞分化、成熟及激活其功能最关键的因子之一。 目的:拟建立钛颗粒诱导小鼠air-pouch骨溶解模型,模拟人工关节无菌性松动发生的病理过程。 设计、时间及地点:随机对照、动物体内实验,于2008-03/10在苏州大学附属第一医院骨科实验室完成。 材料:选用雌性BALB/c小鼠20只,按随机数字表法分成实验组和对照组,每组10只。 方法:背侧单点皮下注射3 mL无菌空气,间隔1 d补注1 mL气体,连续5 d。囊内植入同种系小鼠颅骨。术后实验组和对照组分别在囊内注射10 g/L的钛颗粒0.5 mL或0.5 mL磷酸盐缓冲液,14 d后处死小鼠将囊及植入颅骨一并取出。 主要观察指标:应用苏木精-伊红染色观察囊壁组织学改变,以定量反转录-聚合酶链反应检测检测标本中RANK、RANKL和破骨细胞成熟标志因子之一蛋白酶K基因mRNA含量。 结果:组织学观察发现,实验组标本囊壁增厚、细胞浸润增多。经钛颗粒刺激后,组织中RANK、RANKL及蛋白酶K基因表达显著高于对照组(P < 0.05)。 结论:钛颗粒诱导的小鼠air-pouch骨溶解模型,简单、灵敏、经济、重复性好,能准确模拟人工关节松动发生的病理过程。 关键词:骨溶解;air-pouch;组织学;定量反转录-聚合酶链反应;BALB/c小鼠  相似文献   

3.
骨科植入物在骨科治疗中已得到了广泛应用,并取得了满意效果。但植入材料需要长期植入人体,在临床应用中存在着安全性、有效性以及患者的知情权等若干伦理学问题。而且应用植入的骨科患者入院时都存在着不同程度的功能障碍,生活自理能力降低或丧失等情况,因此,在围植入期患者及家属心理问题复杂多变,需要每位骨科医生予以认真关注并思考。文章对诊疗过程中医患之间可能出现的心理及伦理问题进行总结并讨论,以期在今后不断地与自身的诊疗行为进行比照。  相似文献   

4.
背景:硅凝胶乳房植入体在长期的使用中一直存在着与自身免疫性疾病之间是否存在因果联系的争议,尚需对其进行免疫学上的评价。 目的:通过分析硅凝胶植入后小鼠淋巴细胞表型的变化,探讨其对免疫系统的影响。 设计、时间及地点:随机对照动物实验,于2007-07/09中国药品生物制品检定所医疗器械检测中心实验室完成。 材料:6~8周龄SPF级雌性BALB/c小鼠50只,随机分成5组:阴性对照组、阳性对照组、硅凝胶低、中、高剂量组,10只/组。硅凝胶填充人工乳房植入体成品为深圳维恩杰科技有限公司产品。 方法:阴性对照组皮下注射磷酸盐缓冲液;阳性对照组皮下注射与福氏完全佐剂1∶1混合的BSA溶液;硅凝胶低、中、高剂量组先将人工乳房植入体成品中充填的硅凝胶在无菌条件下分装入注射器中,在小鼠背部皮肤穿刺后接注射器分别注入硅凝胶0.6,1.2,1.8 mL。材料植入28 d后,分离小鼠脾脏制备脾淋巴细胞悬液,调整细胞浓度至1×109 L-1。 主要观察指标:流式细胞仪检测淋巴细胞表型及表型频数。 结果:与阴性对照组比较,硅凝胶低、中、高剂量组各淋巴细胞表型参数均值差异均无显著性意义(P > 0.05)。代表T淋巴细胞的CD3+,CD4+,CD8+频数分析结果显示,硅凝胶低、中、高剂量组分别有4,3,6例样本超出阴性对照组均值±2SD范围,并分别有2,3,4例样本超出阴性对照组均值±3SD范围。 结论:硅凝胶植入28 d后,BALB/c小鼠脾淋巴细胞表型统计学分析无显著差异,但对频数分析结果有一定影响,提示硅凝胶对免疫系统可能产生影响。  相似文献   

5.
背景:从目前文献报道来看,生长因子缓释系统在骨科方面的应用研究主要集中在软骨修复方面,关于复合组织工程骨修复骨缺损的研究报道较少。 目的:构建复合组织工程骨,观察其修复骨缺损的效果。 方法:①通过血管内皮生长因子、肝素和纤维蛋白胶的不同组合构建复合支架缓释系统,经检测选取最优组种植成骨诱导的骨髓间质干细胞构建复合组织工程骨。②36只SD大鼠制备股骨干骨缺损模型后随机分为3组,分别植入上述复合组织工程骨和复合支架缓释系统,空白对照组不植入任何材料,3组均予内固定。③ELISA方法检测样本释放的血管内皮生长 因子浓度以评价复合支架缓释系统的缓释性能;于植入后1,4,12,24周行X射线检查及骨组织碱性磷酸酶染色评价各组动物骨缺损修复水平。 结果与结论:经血管内皮生长因子/肝素/纤维蛋白修饰的纳米晶胶原基骨复合支架缓释系统在体外环境缓释30 d后依然高浓度释放血管内皮生长因子,且缓释曲线平直;动物实验中植入的复合组织工程骨在24周内完全降解,骨缺损修复完成,骨缺损部位碱性磷酸酶活性明显高于复合支架缓释系统组、空白对照组。结果显示该复合支架缓释系统具有优异的缓释性能,在该缓释系统上种植成骨诱导的骨髓间充质干细胞后,能够提高骨缺损修复的速度和质量。  相似文献   

6.
背景:栓塞是小口径血管植入后失败的主要原因,目前常常对血管支架材料进行抗凝改性,以期提高其血液相容性,从而提高血管的有效通畅性。 目的:观察低温等离子体肝素化改性后的内植物修复材料小肠黏膜下层的血液相容性,并探讨其体内构建小口径血管的可行性。 设计:单一样本实验。 单位:上海交通大学附属第六人民医院骨科、上海市四肢显微外科研究所。 材料:实验于2006-01/10在上海市四肢显微外科研究所实验室进行。小肠黏膜下层来自农场猪。 方法:①改性:将猪小肠黏膜下层用氩等离子体处理器照射处理,氩气流量20 mL/min,照射时间分别为0, 2, 4, 6, 8, 10, 12, 14 s,接着浸入肝素钠溶液24 h。②体内抗凝血实验:将20条狗分为2组,分别植入经过改性或未改性的小肠黏膜下层缝合成的3 mm口径血管支架,与股动脉直接吻合,观察6周。 主要观察指标:①血液相容性检测:通过扫描电镜观测表面形态,并通过液滴接触角、凝血时间及血小板黏附实验检测小肠黏膜下层改性前后的抗凝性。②体内抗凝血:通过彩色多普勒和组织学检测,评价血管支架直接在体内循环血流下的长期通畅性和形成血管的可行性。 结果:①改性小肠黏膜下层膜表面呈现出均匀的微结构改变,随着等离子体照射时间增加,表面液滴接触角降低;改性后凝血酶原时间、活化部分凝血活酶时间和凝血酶时间延长;血小板黏附减少。②植入体内后未改性小肠黏膜下层血管支架3 d内栓塞,改性组在6周内仍保持通畅,管腔内表面有完整内皮细胞覆盖。 结论:经低温等离子体肝素化改性后小肠黏膜下层的亲水性、抗凝性有明显提高。  相似文献   

7.
目的:制备聚-(N-异丙基丙稀酰胺/N-羟甲基丙烯酰胺) P(NIPAAm-co-NHMPA),对其体外生物相容性进行观察,进而评价其作为医学植入物的安全性。 方法:传统方法制备P(NIPAAm-co-NHMPA),溶涨率法测定低临界溶解温度(Low critical solution temperature,LCST);参照中国标准出版社第一编辑室编写的《医疗器械生物学评价标准汇编》设计细胞毒性实验、细胞材料符合实验、溶血实验、热原实验,验证材料体外生物相容性。 结果:制备凝胶P(NIPAAm-co-NHMPA)LCST大于37℃,可以满足植入的需求;体外细胞毒性实验证明材料毒性为0~1级;扫描电镜观察,材料和细胞符合良好;材料溶血率为2.54%;无热原性。 结论:P(NIPAAm-co-NHMPA)生物相容性良好,是一种有潜力的医学植入物。  相似文献   

8.
背景:组织工程医疗产品最终要植入体内,植入产品的生物相容性决定其能否长期在体内发挥正常的功能。因此安全性评价是决定组织工程医疗产品最终能否应用于临床的重要环节。 目的:从细胞的毒性试验、与血液的相互作用实验、植入后局部反应试验、免疫学评价等方面,介绍对细胞外基质材料进行安全性评价的方法。 方法:以“组织工程(tissue-engineering),细胞外基质(Extracellular Matrix),生物相容性(Biocompatibility),安全性评价(afety Evaluation)”为检索词,应用计算机检索维普数据库,Pubmed数据库,Elsevier数据库有关文章。纳入与细胞外基质材料安全性评价方法密切相关的文献,排除重复性研究。 结果与结论:共检索到218篇文献,排除无关重复的文献,保留22篇文献进行综述。目前对于细胞外基质材料还没有整体的安全性评价方法,对于生物材料成分的结构和功能特性及生物相容性进行评价主要依据ISO 10993系列医疗器械生物学评价方法。随着细胞外基质材料的广泛应用,对细胞外基质的安全性评价会越来越受到重视,许多问题还有待探讨。  相似文献   

9.
背景:羟基磷灰石人工骨作为骨移植替代物植入人体内不会引起炎症反应、免疫排斥,具有良好的生物相容性,是一种具有骨传导活性的新型植入材料。 目的:观察羟基磷灰石人工骨用于颈椎后路双开门椎管扩大成形治疗的效果,比较羟基磷灰石人工骨与自体骨的差异。 设计、时间及地点:回顾性病例分析,病例来自于2001-03/2008-12中山大学附属第一医院黄埔院区脊柱外科。 对象:颈椎病患者70例,伴3节或3节以上压迫或合并颈椎管狭窄;颈椎管狭窄合并颈椎外伤15例。 方法:行颈椎后路棘突纵切双开门椎管扩大成形治疗,治疗中植入自体骨23例,植入羟基磷灰石人工骨62例。 主要观察指标:①对比观察治疗前后JOA评分、手术时间、术中出血量。②材料与宿主的生物相容性。 结果:85 例患者术后随访>3 个月。两组间手术前后JOA评分比较无显著性意义(P > 0.05)。羟基磷灰石人工骨组手术用时65~110 min,平均85.2 min;自体骨组手术用时75~150 min,平均116.4 min。羟基磷灰石人工骨组术中出血量130~400 mL,平均210 mL;自体骨组手术出血量170~ 500 mL,平均260 mL。羟基磷灰石人工骨组除3 例有羟基磷灰石碎裂外,未发生材料宿主反应及其他严重并发症。 结论:羟基磷灰石人工骨用于颈椎后路双开门椎管扩大成形术的效果好,并发症少;手术用时及出血量少。  相似文献   

10.
摘要 目的:评价不同材料制成义眼台在眶内植入的临床效果、并发症和应用情况及不同植入方法对避免术后并发症所起的作用。 方法:采用电子检索的方式在万方数据库中检索1999-01/2009-12有关义眼台植入的研究,关键词为“眼科新材料的生物相容性”。排除重复研究、普通综述或Meta分析类文章,筛选纳入38篇文献进行评价。 结果:目前眶内植入材料主要有天然珊瑚羟基磷灰石义眼台、多孔生物陶瓷义眼台、聚甲基丙烯酸甲酯义眼台和改性PHEMA多孔水凝胶义眼台等。其中天然珊瑚羟基磷灰石义眼台应用临床效果较好,但因其价格昂贵等原因,不少研究人员正在研究此种材料的替代品。同时义眼台植入方法的选择对避免术后并发症的发生起到很大作用,很多研究文章提出了有价值的成果。 结论:用于制作义眼台的材料选择很多,植入方法有多种,在实际操作中,应根据患者实际情况采取相应的措施,以达到最满意的效果。  相似文献   

11.
Endotoxin-induced platelet activation in human whole blood in vitro   总被引:1,自引:0,他引:1  
The effect of purified bacterial endotoxin was studied on human platelets in vitro. In adding up to 1 microgram/mL of a highly purified endotoxin, we found neither aggregation nor ATP release in heparinized or citrated human platelet-rich plasma. On the other hand; endotoxin at concentrations as low as a few ng/mL (as may be found in septic patients) caused platelet aggregation in both heparinized and citrated human whole blood, as monitored by change in impedance, free platelet count, and size. Unlike collagen, the platelet aggregation with endotoxin occurred after a long lag phase, developed slowly, and was rarely coupled with measurable release of ATP. The platelet aggregating effect of endotoxin was dose-dependent and modified by exposure of the endotoxin to ionizing radiation. Thus, the activation of human platelets by "solubilized" endotoxin in plasma requires the presence of other blood cells. We propose that the platelet effect is mediated by monocytes and/or neutrophils stimulated by endotoxin.  相似文献   

12.
The procoagulant cellular activity (PCA) of leukemic cells was evaluated, before and after endotoxin stimulation, in 38 patients with acute leukemia at presentation subdivided according to the FAB classification. In the M4 and M5 subgroups the stimulated leukemic cells showed a significant increase in the production of PCA compared with freshly isolated cells. No evident PCA was documented in M1 and M2 AML as well as in the majority of acute lymphoid leukemias tested, both before and after endotoxin stimulation. The myeloid and lymphoid leukemic cells appear to behave similarly to normal leucocytes, within which only monocyte/macrophages are capable of producing PCA following endotoxin stimulation. These findings suggest that in human leukemic cells the endotoxin-induced production of PCA may be considered a indicator of monocyte/macrophage differentiation and thus represent a valuable diagnostic tool in the classification of acute leukemias.  相似文献   

13.
Purpose: Sacral neuromodulation (SNM) is an approved method for second‐line treatment of different therapy refractory disorders of the urinary bladder. Alongside success in overactive bladder symptoms for detrusor overactivity, SNM also was shown to succeed in chronic urinary retention (UR) of various etiology. Methods: From October 2007 to December 2010, a cohort of 20 patients received two‐stage InterStim tined‐lead® (Medtronic Inc., Minneapolis, MN, USA) SNM therapy for UR. The number of electrodes implanted was decided by surgeons on the basis of patients' clinical presentation and extent of UR. Dependent on the treatment success, patients received either implantation of the implantable pulse generator (IPG) or the electrodes were removed. Median follow‐up time was 12 months (1–38 months). Results: All 20 patients, of whom 80% were female, suffered from idiopathic or neurogenic UR for a median 60 months (7–440 months) before SNM. Median patient age was 51 years (34–68 years). Eighteen (90%) of the stimulated patients showed significant success with implantation of IPG within a median of 43 days (15–93). In the follow‐up period, postvoid residual (PVR) urine of the permanent stimulated patients was reduced from a median of 350 mL to 135 mL. While this just did not reach statistical significance (p= 0.057), the median number of intermittent catheterizations (ICs) could be reduced relevantly from four to one per day (p= 0.021). The subgroup analysis of idiopathic and neurogenic UR showed relevant improvement of the vital parameters, but the number of patients was obviously too small to yield statistically significant results. Subgroup analysis according to the number of electrodes implanted revealed statistically significant reduction of IC only after unilateral SNM. PVR of ≤400 mL was a statistically significant predictor for success of SNM treatment. In the presented treatment period, only one mild adverse event occurred that could be handled conservatively. Conclusions: SNM can be a successful and secure second‐line therapy option for patients with chronic UR. Data suggest a more success‐promising situation for idiopathic cause of disease, but the number of patients was too small to reach statistical significance. Further prospective, randomized multicenter data concerning indications and number of electrodes are necessary and highly appreciated.  相似文献   

14.
The paper describes a methodological approach to the investigation of maternal-fetal transfer of lead in a non-human primate species, with particular focus on skeletal tissue, which is known to be a site of lead deposition. Eight female cynomolgus monkeys were dosed with lead acetate during gestation, and in four of the animals, the isotopic composition of the lead was modified by enriching the amount of the stable isotope 204Pb included in the dose. Biopsy and dissection procedures for the preparation of bone samples for lead analysis and stable lead isotope analysis are described. Emphasis is placed on the containment of potential contamination of the samples by lead during preparation. Containment procedures included: use of a Class 100 clean room, special cleaning regimes and use of Teflon containers and stainless steel instruments. Preliminary data of lead concentrations in adult bone (trabecular and cortical) and fetal bone subsequent to the dosing regimen of lead during pregnancy, suggest notable differences between the two bone "compartments" examined. The bone samples of fetuses from the dams which had received enriched 204Pb showed drastically reduced 206Pb/204Pb isotope ratios.  相似文献   

15.
背景:术后认知功能障碍与老年人术后并发症的发生及死亡率密切相关。设定相同麻醉条件下硬膜外镇痛比静脉镇痛对老年患者下肢关节置换及内固定后早期认知功能的影响较小。 目的:比较两种不同的镇痛方法对老年患者下肢骨科手术后早期认知功能的影响。 方法:60例拟行择期下肢手术的老年患者,随机接受椎管内麻醉继以术后静脉镇痛或以硬膜外镇痛。 结果与结论:术后认知功能障碍发生率静脉镇痛组为47%(14/30),硬膜外镇痛组为30% (9/30例),两组间差异非常显著 (P < 0.01 )。Logistic回归分析显示受教育年限短和髋关节置换术是发生术后早期认知功能障碍的独立危险因素。结果表明,老年患者在下肢关节置换及内固定后早期有38%的患者发生了认知功能障碍,且硬膜外镇痛较静脉镇痛发生术后认知功能障碍明显降低。受教育年限短和髋关节置换本身是术后早期认知功能障碍的危险因素。  相似文献   

16.
背景:目前已对纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶材料进行了细胞毒性、致敏、刺激及局部反应试验,证明均具有良好的生物相容性和安全性,但是对肝肾功能的影响尚不清楚。 目的:观察两种不同关节软骨替代材料纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶植入兔骨组织后对其肝肾功能的毒性反应。 设计、时间及地点:血液生化指标观察,随机对照动物实验,于2008-11/2009-03在解放军南京军区总医院比较医学科完成。 材料:纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶均由南京理工大学生物材料研究所熊党生教授提供。 方法:健康清洁级新西兰大白兔30只,随机分成3组,纳米羟基磷灰石/聚乙烯醇水凝胶组10只,聚乙烯醇/吡咯脘酮水凝胶组10只,空白对照组10只。分别将两种关节软骨材料植入已制备好的兔模型股骨软骨缺损部位。空白对照组施行同样的手术,但不作任何材料植入。 主要观察指标:于术后1,4,8,12周行肝肾功能检测,对比3组动物植入前后肝肾功能变化。 结果:植入前3组肝肾功能指标差异无显著性意义(P均 > 0.05)。3组植入后丙氨酸转氨酶、天冬氨酸转氨酶、白蛋白、球蛋白、尿素氮、肌酐水平分别与植入前比较,差异无显著性意义(P均 > 0.05)。植入后3组各项肝肾功能指标差异也无显著性意义(P均>0.05)。 结论:两种不同的软骨替代材料对兔肝肾功能无影响。 关键词:纳米羟基磷灰石/聚乙烯醇水凝胶;聚乙烯醇/吡咯脘酮水凝胶;关节软骨;肝肾功能;毒性  相似文献   

17.
背景:成人股骨头缺血性坏死可导致股骨头塌陷和髋关节破坏,但其真正的病因和发病机制尚未完全明了。因此建立实验性动物模型是目前研究激素性股骨头缺血性坏死的重要手段之一。 目的:建立兔激素性股骨头缺血性坏死模型,探讨其可能的发病机制。 方法:将健康成年新西兰白兔以抽签法随机分成4组。对照组,注射生理盐水;激素组,注射甲基泼尼松龙3次;单次内毒素组,静脉注射大肠杆菌内毒素24 h后,立即注射甲基泼尼松龙3次;双次内毒素组,大肠杆菌内毒素注射24 h后重复给药1 次,随后注射甲基泼尼松龙3次。造模前及造模后行X射线片、MRI 检查及组织学检查、透射电镜观察,并计算空骨陷窝率。 结果与结论:造模第8周时激素组、单次内毒素组、双次内毒素组空骨陷窝率较对照组明显增高(P < 0.01),并且双次内毒素组空骨陷窝率明显高于激素组和单次内毒素组(P < 0.01)。双次内毒素组较激素组及单次内毒素组股骨头出现坏死的时间更早、坏死的效果更显著,并且随着时间的推移股骨头坏死的效果越来越明显。说明在相同的实验条件下,实施双次内毒素与激素联合诱发股骨头坏死出现最早、坏死效果最明显,且骨陷窝空虚率随时间的延长而增加。 关键词:股骨头缺血性坏死;甲基泼尼松龙;激素;内毒素;动物模型;骨陷窝  相似文献   

18.
The effects of methylprednisolone sodium succinate (MP) on main inhibitors of the classical pathway of complement and on the contact system were studied in citrated pool plasma. Endotoxin (2.10(9) ng/l, lipopolysaccharide B, E. coli 026: B6 Difco Laboratories, Detroit, Michigan, USA) and/or MP in doses of 0.1, 1, 5 and 10 mg/ml were incubated with plasma at 37 degrees C. Plasma samples were obtained at timed intervals up to 24 hours for determination of C1 inhibitor (C1inh) and alpha 2-macroglobulin (alpha 2M) values using both functional and immunochemical assays. Plasma containing endotoxin without MP revealed decreases of C1inh and alpha 2M values after 12 hours. Addition of MP in high doses (10 mg/ml) gave an additive effect on the endotoxin-induced decreases of C1inh and alpha 2M values, evident 1 and 12 hours after the beginning of incubation, respectively. When MP alone was added to plasma (5 and 10 mg/ml) also significant decreases in C1inh and alpha 2M values were seen. MP in low doses (0.1 and 1 mg/ml) did not either influence the endotoxin-induced changes in the protease inhibitor functions, or induce significant changes in C1inh and alpha 2M values when incubated in plasma without endotoxin. This study demonstrates that MP in high doses induces marked decreases in plasma C1inh and alpha 2M inhibitory functions and that MP has an additive effect on the endotoxin-induced decreases of these inhibitors.  相似文献   

19.
BACKGROUND AND PURPOSE: We review preliminary experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomographic (CT) guided thrombolysis and aspiration and assess procedure feasibility and safety. METHODS: Twelve patients with supratentorial ICH >/=25 mL without suspected underlying structural etiology or coagulopathy and an initial Glasgow Coma Scale (GCS) score of >/=5 were treated. A catheter was directed stereotactically or manually into the ICH through a burr hole under CT guidance. Hematoma aspiration was followed by instillation of urokinase (5 000 to 10 000 IU). This was repeated every 6 to 8 hours at bedside, with interval CT imaging, until the ICH volume diminished to <25 mL, less than half of its initial volume, or after a maximum of 10 aspirations/instillations. RESULTS: Mean age was 69 years (range 55 to 82 years). Median initial GCS was 12 (range 5 to 14). There were 7 ganglionic and 5 lobar ICH, and baseline hematoma size ranged 29 to 70 mL (mean 46 mL). Final ICH volume ranged from 14 to 51 mL (mean 21 mL), with ICH volume reduction by an average of 57% (range 38% to 70%). One patient (8. 3%) suffered hematoma expansion during the procedure. At 6 months after the procedure, 3 patients (25%) had achieved a good recovery (Glasgow Outcome Scale [GOS] score of 5), 5 patients (42%) were dependent (GOS 3), and 1 (8.3%) remained vegetative (GOS 2). Three patients (25%) died in hospital (1 from cardiac arrhythmia and 2 from respiratory failure). CONCLUSIONS: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, disability outcome, time until convalescence, and cost of care in treated and untreated patients.  相似文献   

20.
A G Timoney  P J Shaw 《Paraplegia》1990,28(9):556-563
A review of 52 female patients with spinal cord injury is presented. Twenty five of 38 patients seen within 3 months of their injury were discharged on a clean intermittent catheterisation regime. Of the 14 patients seen at an interval of 3 months or greater after the injury, only 3 practised clean intermittent catheterisation but 8 had a long-term indwelling urethral catheter as the method of management. At 49 months median follow-up, only 14 (50%) continue on the programme of intermittent catheterisation and 9 (32%) are dry. This lack of success was due to incontinence, despite drug therapy in 17 patients. Recurrent symptomatic urinary tract infection occurred in 10 (36%). Thirteen of the 14 patients (92%) on long-term indwelling urethral catheter developed complications. Five patients voided normally. Automatic bladder emptying was employed in only 2 patients but was associated with the development of a non-functioning kidney in 1 and severe incontinence in another. Upper tract changes occurred in 7 patients (13%) including 3 on indwelling catheter drainage and 2 on intermittent catheterisation. Four patients have had implantation of the Brindley intradural sacral anterior root stimulator because of recurrent symptomatic urinary tract infections and incontinence in all 4. Post-operatively the incidence of infection has been reduced. Improvement in the degree of incontinence is related to the completion of posterior root section. Those patients who have no alternative to long-term catheter drainage are managed by the suprapubic route to avoid urethral incompetence. This is combined with catheter clamping for 2 hours daily to maintain bladder capacity and anti-cholinergic therapy to reduce detrusor contractility.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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