火器伤后胸心异物存留

目的：探讨火器伤后胸心异物存留摘除的指征、时机、方法及结果。方法：回顾性分析了３９例火器伤后胸心异物存留摘除者的一般资料、临床表现、不同处理方法的选择及效果。结果：１９例患者早期因凝固性血胸及肺持续漏气伴异物存留或异物存留伴胸腔及心包腔化脓性感染，在开胸清创时做了异物摘除；另２０例患者为胸伤伤情恢复后单纯异物存留，因异物位于肺门、心脏及大血管旁或远期并发症等，而后期开胸异物摘除。结论：火器性胸部穿透伤后，因异物本身或其他原因所致早期并发症者，应在开胸清创的同时摘除异物；胸伤伤情恢复而单纯胸心异物存留，应选择性摘除或因并发远期并发症而摘除。     

Use of epr oximetry with india ink to measure the po2 in the liver in vivo in mice

The partial pressure of oxygen (pO₂) of the liver in vivo in unanesthetized mice was determined using electron paramagnetic resonance (EPR) oximetry with India ink. The EPR spectra were obtained using a low-frequency (1.2 GHz) EPR spectrometer with a loop gap cavity resonator. The line width of the India ink used in this experiment was reversibly broadened by oxygen and was particularly sensitive to pO₂ below 30 torr. After the administration of India ink into the tail vein, the India ink particles were taken up mainly by Kupffer cells in the liver and in part by phagocytes in the spleen. The pO₂ measured in the normal liver was about 14 torr and was constant for the 2-week experimental period. The pO₂ decreased when measured at 1, 2, and 6 days after treatment with a hepatotoxin (carbon tetrachloride (CCI₄)); within 2 weeks, it returned almost to the initial level. Measurements by EPR at sacrifice of controls and CCI₄-treated mice indicated that more than 90% of the India ink went to the liver; the spleen contained 4.7% of total amount in control mice and 8.8% in CCI₄-treated mice when measured 2 weeks after the treatment. These data indicate the usefulness of India ink for measuring the pO₂ of the liver in vivo and that the pO₂ in the Kupffer cells is decreased when the liver is damaged by CCI₄.     

糖皮质激素及异烟肼预防食管碱性腐蚀伤后瘢痕狭窄的实验研究

实验家犬采用Ｄａｖｉｓ食管碱性腐蚀伤模型，结果显示：甲基强的松龙治疗组，狭窄段食管的管径和食管的顺应性均明显大于对照组，而胶原含量及图象分析瘢痕组织中胶原纤维的密度均显著低于对照组，表明甲基强的松龙确有控制食管腐蚀伤后瘢痕狭窄的作用。但异烟肼组所测得的上述指标，均显著优于甲基强的松龙组，说明异烟肼预防食管腐蚀伤后瘢痕狭窄的效果优于甲基强的松龙，且其不良反应小，可以长期应用。无论甲基强的松龙或异烟肼，如同时应用青霉素均可加强治疗效果。     

手部热压伤的早期修复(附43例报告)

目的 探讨早期清创、组织修复在热压伤治疗中的临床疗效。方法 分析43例不同程度手部热压伤患的病损特点并行临床分度，以便准确诊治、判断预后；全部病例采用早期手术治疗，轻度热压伤(即浅Ⅲ度烧伤)早期行切痂全厚或中厚皮片修复，中度和重度热压伤早期彻底清创保留间生态组织，应用血循环丰富的组织瓣修复创面。结果 42例创面一期修复，手功能和外形恢复满意：1例创面二期修复，手功能恢复差。结论 手部热压伤应早期手术清创，据病损程度选择良好的方法及时修复组织缺损，可最大限度地恢复手功能和外形，减少致残率，缩短疗程，获得较好的临床疗效。     

冠脉内皮细胞在离体大鼠心脏再灌注损伤中的作用

在Ｌａｎｇｅｄｏｒｆｆ离体大鼠心脏模型上比较了去冠脉内皮（实验组）和保留冠脉内皮（对照组）的心肌再灌注损伤。结果：实验组的左室峰值和最大升降速度、心肌超氧化物歧化酶及ＡＴＰａｓｅ活性明显高于对照组（Ｐ＜０．０５），而冠脉灌注压和冠脉流出液中乳酸脱氢酶及磷酸肌酸激酶、心肌过氧化产物丙二醛则明显低于对照组（Ｐ＜０．０５）。表明：去冠脉内皮可减轻心肌再灌注损伤。提示：冠脉内皮细胞在心肌再灌注损伤中起重要作用。     

电针对大鼠脑局部缺血-再灌流损伤的保护作用

再灌流前电针“环跳”穴３０ｍｉｎ，观察对左大脑中动脉（ＭＣＡ）缺血 再灌流模型大鼠早期运动功能、自由基代谢、脑水肿及神经电生理活动的影响。结果：缺血再灌＋针刺组大鼠再灌流后神经功能缺损状况有较明显的改善，病灶侧脑组织过氧化物歧化酶（ＳＯＤ）活性及丙二醛（ＭＤＡ）含量恢复到接近假手术对照组的水平。皮层体感诱发电位（ＳＥＰ）测量表明缺血侧Ｐ１潜伏期及Ｐ１ Ｎ１波幅亦有显著性改善。结果表明：于再灌流前电针处理对本模型脑缺血 再灌流损伤有保护作用     

Evaluation of loose bodies in the elbow with MR imaging

The evaluation of loose bodies in the elbow is usually done by means of clinical examination, radiography, and postarthrographic computed tomography (CT). The authors review their experience with magnetic resonance (MR) imaging in place of postarthrographic CT for the evaluation of loose bodies in the elbow. The prospective interpretation of MR studies of the elbow in 20 patients was compared with arthroscopic findings. All elbows were imaged in multiple planes with thin sections, surface coils, and combinations of T1, T2, and proton-density weighting. The sensitivity for showing loose bodies with MR imaging was 100%, and the specificity was 67%. Because this was a nonblinded study, the results are biased and caution must be used when extrapolating these results to the general population. In this limited experience, MR imaging has reliably shown loose bodies in the elbow, and in the authors' institutions has replaced postarthrographic CT for that purpose.     

预防肝硬化上消化道出血的临床研究

目的　探讨普萘洛尔和低剂量兰索拉唑长期维持治疗对预防肝硬化门脉高压消化道出血的疗效。方法　1 1 9例肝硬化门脉高压患者随机分为 3组 :Ⅰ组 :给予口服普萘洛尔加上护肝治疗。Ⅱ组 :联合给予低剂量兰索拉唑和普萘洛尔。Ⅲ组 :仅给予护肝治疗。兰索拉唑维持服药 6个月 ,普萘洛尔及一般对症治疗维持 1年。观察治疗前后各组患者所伴发溃疡、门脉高压性胃病 (PHG)、急性胃黏膜病变 (AGML)情况 (发生率 ) ,各组消化道出血的复发率、门静脉直径 (PVD)、脾静脉直径 (SVD)的变化。结果　经 1年观察 ,结果显示 ,普萘洛尔组、联合治疗组、对照组出血的复发率分别为 1 5 0 %、2 2 %、48 5 % ,组Ⅰ、组Ⅱ复发率显著低于组Ⅲ ,同时 ,组Ⅰ与组Ⅱ间的差异有显著性意义。治疗可见组Ⅰ、组Ⅱ患者所伴发的溃疡、PHG、AGML明显改善 ,PVD、SVD缩小。结论　普萘洛尔组联合抑制酸维持治疗 ,可预防引起消化道出血多种病因 ,较单用普萘洛尔的疗效好     

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.