Peripheral seventh nerve palsy due to transorbital intracranial penetrating pontine injury

The case of a child injured by a knitting needle penetrating transorbitally and intracranially, resulting in carotid cavernous fistula and pontine injury, is reported. After receiving medical and endovascular treatment, the only remaining abnormal neurological manifestation was right peripheral facial nerve palsy. The clinical sequences of events and the demonstration of a pontine lesion leading to peripheral facial palsy are presented. Facial nuclear injury with a penetrating trauma is an extremely rare condition. It is important to identify the anatomical regions injured in penetrating traumas. The lesions must be identified by computerized tomography, magnetic resonance imaging, clinical and laboratory investigation.     

Unusual Delayed Manifestation of a Penetrating Chest Trauma

Abstract Pericardial tamponade remains a diagnostic challenge to the clinician especially when the patient is well compensated hemodynamically. We report an unusual case who sought medical help 1 month after having been stabbed in his chest. An investigation revealed a perforation of the myocardium and a pericardial tamponade. The patient survived thanks to a large organized clot that plugged the perforation. The patient was exposed to increased risk due to delayed onset, recognition, and therapy of the tamponade. Most reports on this subject deal with acute pericardial tamponade. Only few cases of delayed pericardial tamponade have been reported. A review of the relevant literature and the therapeutic approaches are discussed.     

大肠重复癌MMR、p53、Bax、PCNA表达及微卫星不稳定性研究

目的探讨微卫星不稳定性 (MSI)在大肠重复癌与单发癌中的变化规律 ,及MMR、p5 3、Bax、PCNA表达与MSI的关系。 方法采用免疫组化、PCR SSLP法对 38例大肠重复癌患者的 5 1处癌灶及 35例单发大肠癌分别进行MMR、p5 3、Bax、PCNA表达的检测和 5个微卫星位点MSI检测。结果重复癌组复制错误阳性率为 5 3% (2 7/ 5 1) ,单发癌组为 17% (6 / 35 ) ,差异有显著性意义 (χ2 =11 2 5 ,P <0 0 1)。重复癌组中 ,RER 与MMR表达缺失有密切的相关性 ;RER 与 p5 3表达呈负相关 ;RER 组PCNA标记指数显著低于RER-组 ;RER 与低分化、近端大肠癌密切相关。结论MSI在大肠重复癌的发生上起着重要作用 ,MSI可作为预测大肠重复癌发生的重要标志。     

76例轮状病毒性肠炎临床症状观察

目的 :分析 76例轮状病毒 (RV)性肠炎患者的临床症状。方法 :对 76例不同年龄组 RV肠炎患儿的临床症状进行回顾性分析。结果 :1同时出现呼吸系统症状并伴流涕、鼻塞、咳嗽、气促 59例 ;支气管炎 19例 ;肺炎 5例。 2出现抽搐7例。 3生化检查结果门冬氨酸氨基转移酶 (AST)明显增高 76例 ;肌酸激酶 (CK)增高 52例 ;丙氨酸氨基转移酶 (AL T)轻度增高 48例 ;乳酸脱氢酶 (L DH)增高 13例。 4X线胸片肺纹理增粗 8例 ;双肺斑片影 4例。 5心电图表现窦性心动过速 4例 ,T波改变 1例。结论 :RV感染可造成病毒血症 ,且可呈多系统播散 ,使机体各脏器组织损伤 ,致婴幼儿发病。故要对这一弱小群体实行早期预防保健 ,有关部门应引起重视     

海水浸泡对失血性休克并腹部开放伤实验大鼠肿瘤坏死因子α及肠道热休克蛋白HSP-70的影响

目的探讨海水浸泡失血性休克并腹部开放伤对实验大鼠血浆肿瘤坏死因子α(TNFα-)和肠道热休克蛋白HSP-70水平变化的影响。方法建立失血并腹腔海水浸泡伤动物模型。实验大鼠随机分为对照组(n=6)、失血创伤组(n=14)、失血创伤海水浸泡组(n=14),失血创伤组为单纯失血性休克并腹部开放伤,失血创伤海水浸泡组将动物致伤后置入人工配置的海水中,于伤前和浸泡后30m in及1,1.5,3 h取血测定TNFα的变化,取肠道组织测定HSP-70的表达。结果失血创伤海水浸泡组血中TNFα较失血创伤组伤后明显升高并且高峰出现时间明显提前,肠道损伤病理变化明显重于失血创伤组,肠道组织中HSP-70含量在创伤早期显著升高,后又明显降低。结论TNFα-的过度表达在失血性休克并腹部开放伤后海水浸泡的病理生理变化中起重要作用,肠道组织细胞中HSP-70的异常表达在肠道组织细胞的应激反应机制中,可能有重要的意义。     

应用胰岛素对颅脑外伤后高血糖预后探讨

目的:探讨及早应用胰岛素对颅脑外伤后高血糖患者治疗转归的影响。方法:对83例颅脑外伤后血糖升高者于入院时及伤后第1、2、3、5、7、10、14(如血糖仍未恢复正常者酌情延长时间)日晨空腹抽血检测血糖。且在使用胰岛素期间对末梢血糖进行动态的监测直至清晨空腹静脉血糖连续2次正常,同时制定饮食护理措施及对患者或家属进行相应的健康教育。结果:血糖升高者中72.12％(59例)的患者血糖在1-3d内恢复正常,且预后与血糖正常者无差别。组中仅7例患者血糖持续升高,均因伤情重而死亡,占本组重症(GCS≤8分)患者(25例)的29.41％,明显低于文献报道组。结论:对颅脑外伤后高糖血患者尽早应用胰岛素,能改善患者预后,降低死亡率。     

Validation of Probabilistic Linkage to Match De-identified Ambulance Records to a State Trauma Registry

Objectives: To validate the accuracy of using probabilistic linkage for matching de‐identified ambulance records to a state trauma registry. Methods: This was a retrospective cohort analysis. Three thousand nine hundred nineteen true matches between ambulance and state trauma registry data from 1998 to 2003 were identified by deterministic matching on trauma identification number and verified by human review. Two thousand thirty‐eight ambulance records from trauma patients not meeting criteria for a true match, and an identical number of trauma registry records randomly selected from the one local county served by a different EMS provider, were included as nonmatches. There were 17 variables considered for linkage, which included the following: age, gender, race, county, hospital, date, rural setting, call and arrival times, mechanism, penetrating injury, vital signs, intubation, and intoxication. Probabilistic linkage was used to link the two data sets, using seven different combinations of common variables (maximum, 17; minimum, 4). The sensitivity and specificity of identifying true matches and nonmatches (95% confidence intervals [95% CI]) were calculated for each combination of variables. Results: Using all 17 available variables, 3,766 of 3,919 true matches were appropriately linked (sensitivity, 96.1%; 95% CI = 95.4% to 96.7%), with eight mismatches (specificity, 99.6%; 95% CI = 99.2% to 99.8%). Sensitivity fell below 95% with < 15 variables; however, sensitivity was very dependent on the inclusion of variables with high discriminatory power. Specificity remained >98% regardless of the number of variables included. Conclusions: Probabilistic linkage is a valid method for matching ambulance records to a trauma registry without the use of patient identifiers; however, the sensitivity of identifying true matches is critically dependent on the number and type of common variables included in the analysis.     

Post–traumatic Alzheimer''s disease: preponderance of a single plaque type

The cause of Alzheimer's disease is unknown. Several factors have been proposed including head trauma. At present, the link between head injury and a subsequent neurodegenerative process is largely circumstantial, except in the case of dementia pugilistica (punch drunk syndrome) found in boxers. Recent studies have shown that the brains of boxers with this syndrome contain large numbers of 'diffuse' beta-protein immunoreactive plaques. We supposed that this plaque type might be associated with trauma induced Alzheimer-like degeneration. In order to test this hypothesis we have re-investigated a previously reported case of post-traumatic premature Alzheimer's disease. Immunocytochemistry using antibodies to amyloid beta-protein revealed large numbers of 'diffuse' non-Congophilic plaques with little or no neuritic component. A similar preponderance of this plaque type is present in the brains of boxers with dementia pugilistica. Our observations support the idea of a trauma induced Alzheimer-like degenerative process and indicate that such a condition is associated with a marked preponderance of 'diffuse' plaques.     

增龄过程中心脏径限的变化及其影响因素

为探讨年龄增长及伴随的一些生理性变化对心脏径限的影响,对300余例20—81岁(平均46±16岁)的正常成人进行了超声心动图研究。多元逐步回归及协方差分析表明,左室壁厚度随年龄俱增,而左室舒张未期内径变化不大;室间隔/左室后壁厚度比值亦渐有增长,反映了室间隔的随龄增长稍快于左室后壁,故在增龄过程中,左室流出道稍有缩小;左房、主动脉根部和右室内径均有随年龄而增长的变化。二尖瓣舒张期 EF 斜率随年龄增长渐有下降,可能反映了左室顺应性的降低及二尖瓣弹性的减退。此外,一些心脏测值有性别差异,不少径限尚与体格大小或血压水平有相关关系。对于不同年龄组间心脏径限差异的原因,以及心脏径限彼此间的关系进行了分析和讨论,认为在临床上评价心脏径限正常与否和异常程度时,应考虑年龄、性别、体格大小、血压等因素的影响。