不吻合血管的岛状皮瓣或复合皮瓣修复组织缺损

报告了40例不吻合血管的岛状皮瓣或复合皮瓣转位修复组织缺损。急诊修复10例,择期修复30例。逆行岛状皮瓣29例,交腿岛状皮瓣4例。修复创面4×4～17×12cm。40例皮瓣全部成活。对修复适应症、修复方法选择、皮瓣或复合皮瓣选择、手术时机选择、受区准备和术中注意事项进行了讨论。     

Excitability properties of medial forebrain bundle axons of A9 and A10 dopamine cells

A9 and A10 units identified as dopaminergic were recorded with extracellular micropipettes. The units were antidromically activated by electrical stimulation at the level of the preoptic area. The absolute refractory periods ranged from 1.2 to 2.5 ms. During the 2–8 ms of the relative refractory period, conduction was slower than normal by up to 1.5 ms. The time constant, C, of the strength-duration curve ranged from 0.4 to 0.6 ms. The current (I)-distance (D) relationship, tested by moving the stimulating electrode past the axon, was approximately parabolic (I = K D exp 2), with the constant of the equation, K, ranging from 900 to 2000 μA/mm exp 2, for 0.5 ms pulses. This relationship allows calculation of the radius of the field of dopamine axon excitation at any current. These high K values show that axons of dopamine cells cannot be activated unless high current densities are derivered, even when electrodes are placed near the axons. These data allow determination of the extent to which dopamine axons can be the directly activated substrates for behaviors, such as self-stimulation and circling, which are evoked by electrical stimulation of the medial forebrain bundle or internal capsule.     

Long-term Outcomes of Patients Undergoing War-related Amputations of the Foot and Ankle

Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.     

小剂量奎的平作为增效剂治疗难治性抑郁症的疗效观察

目的探讨小剂量奎的平作为增效剂治疗难治性抑郁症的疗效及安全性。方法26例难治性抑郁症患者在原抗抑郁剂治疗的基础上合用小剂量奎的平。观察时间8周,于治疗前及治疗后1、2、4、8周末采用汉米尔顿抑郁量表、临床总体印象量表—严重程度量表评定疗效,采用副反应量表评定药物不良反应.结果自治疗2周末始,汉米尔顿抑郁量表、临床总体印象量表—严重程度量表评分比治疗前均有减少,差异有显著性。治疗8周末痊愈率11.54%,有效率50.00%,无效率38.46%,不良反应较轻。结论小剂量奎的平可作为增效剂用于难治性抑郁的治疗。     

成人顽固性癫痫持续状态的临床分析

目的 探讨成人顽固性癫痫持续状态（RSE）的危险因素、临床特点、治疗及预后。方法 54例癫痫持续状态（SE）．58次发作事件，分为RSE组和非顽固性癫痫持续状态（NRSE）组．对病因、诱因、临床表现、辅助检查、预后等进行对比分析。结果 RSE占SE的43．1％，病毒性脑炎是RSE最主要的病因（P=0．001），相反，既往癫痫发作在NRSE中更常见（P=0．000），相应地药物治疗的改变引起的SE多为NRSE（P=-0．003）；RSE组GCS评分及预后较NRSE组均差（均P=0．000）。结论 SE经一、二线抗癫痫药治疗后仍有很大一部分难以控制，病毒性脑炎是导致RSE的一个重要病因，其预后较差．目前对RSE的治疗还缺乏十分合理的方案。     

创伤早期血清FSH、LH的变化及其临床意义

目的 研究多发创伤患者早期血清促卵泡生成素(FSH)、促黄体生成素(LH)变化与创伤严重度和格拉斯哥昏迷评分的关系.方法 随机选取2003年3月～2004年2月急诊就诊的多发创伤患者93例,就诊时间均在伤后24h内,即时采集血样,采用放射免疫双抗体沉淀法测定血清FSH、LH水平,并另选20名健康体检者作为对照组.93例患者按照ISS评分予以分组(ISS＜16分47例,25≥ISS≥16分24例,ISS＞25分22例),其中合并颅脑损伤者按GCS评分分组ISS＜16分14例,25≥ISS≥16分14例,ISS＞25分12例,并比较各分组间FSH、LH水平.结果 严重创伤组(ISS＞25分)与合并颅脑损伤组患者早期FSH、LH明显升高(P＜0.01).ISS＞25分组、25≥ISS≥16分组、ISS＜16分组血清FSH、LH水平依次降低(P＜0.05或0.01),且前2组明显高于对照组(P＜0.01).合并颅脑损伤者中,GCS＞8分组、8≥GCS＞5分组、5≥GCS≥3分组血清FSH、LH水平依次降低,组间比较差异有显著性(P＜0.05或0.01),且均显著高于对照组(P＜0.05或0.01).结论 血清垂体前叶激素FSH、LH水平的改变与严重创伤、颅脑损伤的严重程度相关,可作为判断伤情、观察预后的参考指标.     

Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

中度视网膜冲击伤后血视网膜屏障改变兔模型的评价

应用ＢＳＴ－Ⅲ型生物激波管致伤建立的中度视网膜冲击伤兔模型，研究视网膜冲击伤后血视网膜屏障（ＢＲＢ）的改变，结果显示，中度视网膜冲击后除有炎症性反应外，可致视网膜细胞部分变性和坏死，ＢＲＢ轻度损害和视网膜电图（ＥＲＧ）ｂ波波幅下降４０％。由于受损细胞在某些因素如自由基的作用下可进一步导致ＢＲＢ严重继发性损害。如早期进行正确处理，可能阻止这种“不稳定”受损细胞的继发性损害。因此，该模型可用于研究视网