β-受体阻滞剂在心肌梗死溶栓治疗中的应用

β-受体阻滞剂在急性心肌梗死（AM I）的药物治疗中颇受争议。部分学者认为早期使用β-受体阻滞剂可明显缩小心肌梗死面积、减少病死率和心脏猝死率,并且能够积极改善患者预后。2004年5月-2006年5月,我们在AM I患者溶栓治疗中加用β-受体阻滞剂,并评价其有效性和安全性。现报告如下。     

扩张后胸三角皮瓣在面颈部瘢痕修复中的应用

<正>皮肤扩张术是面颈部瘢痕常用的修复方法,但当瘢痕面积较大时,局部皮瓣转移和面部皮肤扩张术均不能取得理想效果。传统的胸三角皮瓣转移可以修复面颈部较大面积瘢痕,因皮瓣供区需要植皮,且皮瓣较厚术后臃肿无表情,为克服以上不足,近年来我科采用扩张后的胸三角皮瓣修复面颈部瘢痕,临床取得了满意效果,极大地改善了面部外观。     

Vitapex与氧化锌丁香油糊剂治疗乳牙根尖周炎的疗效观察

宫颈糜烂是妇女常见多发病,约有50%育龄妇女患有此病[1].对于宫颈糜烂面积大和炎症浸润较深的病例微波治疗疗效较好,但其缺点是术后有多量水样白带及长时间出血,创面愈合约4～8周.应用聚甲酚磺醛栓配合微波治疗宫颈糜烂,可减少术后阴道流液量,缩短出血及创面愈合时间,是治疗中重度宫颈糜烂疗效好、疗程短的方法.     

下唇鳞癌1例

患者男,82岁,农民。因下唇肿物3年余增大半年,于2008年6月来我院就诊。3年前无明确诱因患者下唇正中出现一米粒大小的赘生物,后逐渐增大,糜烂不愈,时有出血,偶疼痛,近半年皮损糜烂面积扩大明显。有吸烟史60余年,否认有外伤及放射线接触史。     

麻风图谱

患者男,41岁。因全身起红斑1年多,于2008年4月23日就诊于我科。2007年3月无明显诱因面部突然出现红斑,逐渐波及躯干、四肢,无瘙痒及疼痛感,皮损持续不消退。在多家医院就诊均诊断为“皮炎”等予以抗过敏治疗,无明显疗效,皮损面积扩大,数目增多。既往无其他传染病史,无麻风病家族史及接触史。体格检查：一般情况好,系统检查未见异常。皮肤科检查：面部、躯干、四肢共有9个指头至银币大小的红斑及浸润性斑块,边界清楚,部分呈环状,边缘隆起,中央凹陷,环状皮损中央皮肤干燥,无汗,毳毛消失,躯干部分皮损触、压、冷、温、痛觉略有减退,个别皮损表面有少许鳞屑,无糜烂、渗出。     

急性心肌梗死患者家属的健康教育及其意义

急性心肌梗死（AMI）是在冠状动脉病变的基础上血栓形成造成完全或不完全阻塞,导致心肌缺血性坏死的一种心血管急症,并发症多,病死率高,且多是突发病,发展迅速,患者情绪多表现为惊恐不安,紧张慌乱,甚至有濒死感。而患者的这些焦虑恐惧情绪可加重心绞痛发作,促使心肌梗死面积扩大,诱发心源性猝死及心脏并发症从而影响患者的预后。为了探讨尽快解除患者焦虑情绪的方法,我们在对AMI患者实施常规护理的同时,针对患者焦虑恐惧因素同步对家属实施健康教育,收到良好效果。现报告如下。     

去骨瓣减压术治疗大面积脑梗死的临床指征分析

目的探讨去骨瓣减压术治疗大面积脑梗死的手术指征、手术时机和治疗效果。方法对2012年1～6月天津市环湖医院手术治疗的17例大面积脑梗死患者的临床资料进行回顾性分析。结果本组患者17例,死亡3例。在随访的14例患者中,13例恢复满意,GCS、BI和MRS评分均较术前有显著提高。结论去骨瓣减压术不仅可明显降低大面积脑梗死患者的病死率,而且可以获得较好的功能预后。对大面积脑梗死的患者,经积极内科治疗无效者,在正确掌握适应证的前提下,应尽早行去骨瓣减压术,以便得到更积极的治疗。     

Aplasia Cutis Congenital - A case of large scalp and skull defects treated with conservative approach

Aplasia cutis congenita (ACC) is an uncommon congenital disease characterized by focal absence of the epidermis, subcutaneous tissue, galea, and, in rare cases, calvarial bone. We herein show that a boy born with ACC presented with a large scalp and skull defect and was treated conservatively with wet dressings. This conservative approach produced complete epithelialization of the skin defect with secondary closure of the cranial vault.     

Usefulness of lumen area parameters determined by intravascular ultrasound to predict functional significance of intermediate coronary artery stenosis

Background  Coronary artery disease is the leading cause of death in China. Percutaneous coronary intervention is a recent milestone technology for treatment coronary artery disease. However, clinical decision making for patients with intermediate coronary stenosis is still controversial. We designed this study to assess the optimal intravascular ultrasound (IVUS) criteria for predicting functional significance of intermediate coronary lesions.

Methods  We enrolled 141 patients with 165 intermediate coronary lesions located in vessels with a diameter ≥2.50 mm. IVUS of intermediate coronary lesions were performed before intervention. Pressure-derived fractional flow reserve (FFR) was measured at maximal hyperemia induced by adenosine infusion. An FFR <0.80 was considered as abnormal functional significance.

Results  For the overall 165 lesions, the mean FFR value was 0.84±0.09. The diameter of the stenosis by visual estimation on angiogram was (59.63±11.29)%. Minimum lumen diameter (MLD), minimum lumen area (MLA) and plaque burden (PB) were (2.00±0.36) mm, (3.88±1.34) mm², (67.28±9.89)% respectively by IVUS measurements. An FFR <0.80 was seen in 43 lesions (30.5%). There was a moderate correlation between IVUS parameters and FFR, including MLD (r=0.372, P <0.001), MLA (r=0.442, P <0.001) and PB (r=−0.172, P <0.05). MLA was a predictor for FFR as a continuous variable independent of possible confounding variables (P <0.05), and MLA and PB, were predictors for FFR <0.80 as binary variables (P <0.05). The best cutoff value of MLA to predict FFR <0.80 was <3.15 mm², with a 73.6% diagnostic accuracy; sensitivity 71.4%, specificity 67.0%, AUC=0.709, and P <0.001. The cutoff value of the PB to predict FFR <0.80 was 65.45%; sensitivity 82.6%, specificity 41.2%, AUC=0.644, and P <0.01. If both MLA and PB were taken into account, the negative predictive value and the positive predictive value were 88.7% and 64.8% respectively.

Conclusions  Anatomic measurements of intermediate coronary lesions obtained by IVUS showed a moderate correlation to FFR values. IVUS-derived MLA ≥3.15 mm² may be useful to exclude FFR <0.80, but poor specificity limits its applicability for physiological assessment of lesions <3.15 mm². MLA was one of many factors affecting coronary flow hemodynamics. Both MLA and PB should be taken into account when determining functional ischemia.

     

Catheter-directed intervention and thrombolysis for the treatment of massive pulmonary embolism that caused cardiac arrest

To the editor：Massive pulmonary embolism （PE）,defined as PE with a systolic arterial pressure less than 90 mmHg （1 mmHg=0.133 kPa）,is potentially lethal condition with mortality rate between 30% and 60%.1 In addition to anticoagulation,the standard medical management for massive PE is systemic thrombolysis.2 If there are contraindications,catheter-directed intervention or surgical embolectomy is another choice.