12例Dandy—Walker综合征的临床CT与MRI分析

目的分析Dandy—Walker综合征的临床及cT与MR!影像特征。方法采用cT与MRI常规扫描，对12例Dandy—Walker综合征的临床表现、CT与MRI征象进行回顾性分析；结果12例Dandy—Walker综合征的CT与MRI表现归纳为①小脑蚓部缺失，小脑半球发育不良、完全分离，分离的小脑半球可以不对称；②第四脑室呈囊状、扇形、三角形显著扩张或后颅窝巨大囊状阴影与第四脑室相通；③窦汇异常抬高，越过人字缝／天幕抬高；④幕上脑室对称性扩张，脑积水。结论对Dandy—Walker综合征的诊断，CT扫描能够显示后颅凹及天幕上下脑的形态与结构，其CT表现具特征性；MRI可多平面扫描，无骨质伪影，显示后颅凹优于CT，在矢状面上可显示小脑、第四脑室、导水管、后颅凹囊肿以及与天幕的关系。CT与MRI扫描对Dandy—Walker综合征能够做出定性诊断，是术前诊断的主要依据，检查无痛苦，有重要的诊断和鉴别诊断价值。     

地震伤中小腿开放性骨折的特点及治疗经验

四川汶川发生里氏8.0级地震后,第二军医大学第七医疗队于5月15日凌晨抵达重灾区江油市,至7月7日离开54d中,共处理开放性胫腓骨骨折43例.山于地震伤在不同时期、不同震级、不同地理环境及建筑物条件下都有其不同的特点,加上胫腓骨开放性骨折的高致残率(截肢、感染、肢体短缩)在地震伤中的高发生率[1],故将这43例的病例特点及我们的救治体会总结如下.     

回盲部恶性肿瘤的诊治

目的：分析回盲部恶性肿瘤的诊断和治疗过程，总结经验．以期提高早期确诊率和患者生存率。方法：回顾性分析近5年53例住院治疗的回盲部恶性肿瘤患者的临床资料。结果：53例患者中腺癌、黏液腺癌50例，恶性淋巴瘤3例。首次确诊率为75．5％。误诊或延迟诊断的疾病主要为阑尾炎、阑尾脓肿，胆囊炎、胆石症、下消化道出血、贫血待查等。结论：60岁以上的老年患者为回盲部恶性肿瘤的主要人群，肿瘤类型主要为腺癌。尽管首发症状缺乏特异性，但提高警觉性，详细询问病史，通过大便隐血试验、钡灌肠或气钡双重造影、纤维结肠镜检查仍能有效的提高首次确诊率，积极手术冶疗，可显著改善患者的预后。     

非创伤性充填技术在乳磨牙龋病治疗的推广总结（附112例，225颗乳磨牙病例介绍）

目的:推广适应儿童的非创伤性充填技术(ART)总结应用ART治疗乳磨牙龋病的临床效果。 方法 于2001年选取112名6岁-8岁儿童 225颗乳磨牙 采用ART技术 跟踪随访1年。 结果 成功195颗 失败30颗 成功率86 8％。结论 ART技术是一项只用手工器械去除龋坏组织 并用粘结性修复材料修复 龋洞的治疗技术 对儿童乳磨牙龋病早期治疗有实用价值 并有利于开展群防群治。     

EST+胆胰管引流治疗急性胆源性胰腺炎

目的 探讨内镜下乳头奥迪氏扩约肌切开(endoscopic sphincterotomy,EST) 胆胰管引流技术在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)诊治中的应用价值.方法 将入选的315例ABP患者随机分为EST治疗组(n=132)和非EST对照组(n=183),并根据APACHEⅡ评分,将每组再进一步分为重症组和轻症组.两组患者均给予中西医结合治疗.EST治疗组在入院后24 h内行ERCP(endoscopic retrograde cholangiopancreatography) EST,如发现胆管或胆胰共同通道有结石,则行网篮气囊取石或碎石器碎石取石,如结石多、结石直径大,结石难以一次取尽则急诊不强行取石术.如ERCP证实胰管狭窄或胰管有结石,则行胰管支架植入或鼻胰管引流.所有患者EST术后均行鼻胆管引流术(endoscopic naso-billiary drainage ENBD).结果 对重症ABP,EST治疗组的并发症发生率、转开腹手术率、住院天数及住院费用均明显低于非EST对照组(X12=7.12,X22=5.64,t1=2.57,t2=2.28,P＜0.05);而两组轻症之间无显著差异.结论 早期应用EST技术治疗ABP是可行的、有效的和安全的.     

Arthroscopic treatment of lateral epicondylitis: Indication, technique and early results

The purpose of this study is to present the results of the arthroscopic treatment of lateral epicondylitis. Twenty patients with lateral epicondylitis (mean age 42 years) were treated arthroscopically. The average duration of symptoms prior to surgery was 14 months. The arthroscopic joint inspection showed an intact capsule in seven patients (type-I lesion), in eight patients a linear capsule tear (type-II lesion) and in six patients a complete rupture of the capsule (type-III lesion). An associated intraarticular pathology was documented in eight patients. Within an average follow-up period of 1.8 years, local pain and function were documented and analyzed. Subjective pain at rest was reduced from 5.0 to 0.5 points, pain at daily living activities from 6.0 to 1.0 points and pain at athletic activities from 7.3 to 1.2 points in the VAS score. Function increased from 5.2 to an average value of 10.9 (max. 12 points). Patients returned back to work after 3.2 weeks. In conclusion, the arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period.     

Open rhinoplasty for treatment of nasal tip haemangioma

Haemangiomas are the most common tumours of infancy. They typically proliferate then involute with considerable variation as regards to their rates of proliferation and involution. Haemangioma of the nasal tip is a lesion of special characteristics. During proliferation, it expands, contracts and deviates the nasal cartilages. Particularly, it regresses slowly and frequently involutes incompletely. That is why excision of the lesion is frequently suggested. The present study was conducted to evaluate open rhinoplasty after initial non-excision treatment modalities namely, intra-lesional corticosteroid injections and laser treatment, as a protocol of treatment for nasal tip haemangiomas. Twelve patients with nasal tip haemangiomas were included in the present study. Patients of both sexes, of different ages, with deep and mixed haemangiomas were studied. Disfigurement was the constant presenting symptom. Initial non-excision treatment reported different responses as denoted by the regression of the lesions’ size. Haemangiomas constantly extended between the medial crura of the alar cartilages as noted by the constant widening of the columella pre-operatively and the obvious separation of the nasal cartilages intra-operatively. This separation was constantly found to require approximation by sutures. The results of the present study concluded that whenever an early presentation with nasal tip haemangioma could be established, initial non-excision treatment followed by open rhinoplasty could be a useful protocol of treatment. Within the limitations of the present study, this protocol could achieve an early, safe and effective treatment for nasal tip haemangiomas with provisionally acceptable cosmetic outcomes so far.     

Spinal arteriography: a primer

Spinal arteriography is an esoteric procedure that is seldom nerformed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the procedure should be aware of,especially about spinal dural arierioyenous fistulae (SDAVF).