人源抗狂犬病毒特免血浆筛查方法的建立

目的用ELISA法对人源抗狂犬病毒抗体血浆进行筛查。方法采用国内几家狂犬病毒IgG抗体诊断试剂盒（ELISA法），结合小鼠中和试验测定法，对经0、3、7、14、28日程序免疫的供浆员之血样进行抗狂犬病毒抗体效价检测。结果与小鼠脑内中和法比较，使用不同厂家ELISA试剂盒，检测结果存在一定差异，其中C、D厂家试剂盒检测结果比较接近，线性关系较好（分别为：r=0．997；r=0．996），可以替代小鼠脑内中和法作为采浆站血浆初筛的方法。结论经过反复筛选与比较，为大规模筛查抗狂犬病毒特免血浆提供了技术条件。     

关节镜结合内固定治疗Rüedi-Allg(o)wer Ⅲ型Pilon骨折

目的 探讨关节镜结合内固定治疗Rüedi-Allg(o)wer Ⅲ型Pilon骨折的疗效及可行性.方法 总结2006年11月至2010年3月共28例Rüedi-Allg(o)wer Ⅲ型骨折,男18例,女10例,其中开放伤12例,利用解剖钢板内固定结合关节镜下撬拨复位重建关节面、关节清理、植骨进行治疗.结果 所有患者随访6～24个月,平均18个月.临床疗效满意.无感染、骨折不愈合,术后随访踝关节功能良好.结论 关节镜结合内固定治疗Rüedi-Allg(o)wer Ⅲ型Pilon骨折是一种有效的治疗方法,具有减少术后疼痛、软组织损伤少、改善关节功能及早期踝关节功能锻炼等明显优势.     

低出生体重食管闭锁患儿预后因素的研究

目的 本文回顾性分析影响低出生体重(＜2.5kg)食管闭锁患儿预后的因素,旨在指导临床判断.方法 对1999年1月至2008年12月收治入本院的食管闭锁患儿回顾性分析:①生存率与出生体重相关性;②低出生体重儿术前急性事件(难以控制高热、呼吸衰竭、血流动力学等)和术中急性事件(插管困难、通气困难、血氧饱和度＜90%等)发生率;③出生体重与术后并发症、术后机械通气时间及生存率的关系;④术后应激性高血糖与生存率及术后并发症的相关性;⑤Logistic回归模型分析低出生体重、心脏畸形、术后高血糖对生存率的影响.结果 101例食管闭锁患儿中,出生体重＜2 500 g的患儿29例.总生存率87.2%,低出生体重儿生存率较低(75.9%vs 92.3%,P=0.027),体重越轻,生存率越低,二者正相关(r=0.946,P=0.015).术前急性事件和术中急性事件发生率明显高于正常出生体重儿(67.7%vs 32.9%,P=0.002;70%vs 26%,P=0.001).吻合口瘘和狭窄发生率高,术后机械通气时间延长(P=0.001).术后应激性高血糖者总体生存率低(93.6%vs81.0%,P=0.024),高血糖与生存率呈负相关(r=-0.931,P=0.022),Logistic回归分析资料表明应激性高血糖对食管闭锁预后有独立的影响作用.结论 低出生体重是影响食管闭锁生存率的主要因素,体重越轻,生存率越低;术中、术后并发症较高;术后应激性高血糖是影响生存率的重要因素之一.     

前列腺肉瘤误诊前列腺脓肿1例

患者男性,37岁,因尿频、尿急、尿痛、排尿困难,伴排大便不畅、肛周疼痛2周入院,伴发热,体格检查:肛诊示前列腺增大,质韧饱满,触痛明显,中央波动感,行B超示前列腺增大约7cm×6cm×6cm,初步诊断前列腺脓肿,给予菌必治等抗菌药物治疗5天,效果不佳,应用消炎痛栓肛用无效。于局麻下行经直肠脓肿切开引流,引出少量脓性液,继续应用抗菌药物治疗,效果不佳,行MRI检查示前列腺肿瘤,穿刺组织活检证实     

低出生体重食管闭锁患儿预后因素的研究

Objective To investigate the prognostic factors of survival rate after repair of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF). Methods The clinical data of the 101 patients underwent TEF/EA repair between January 1999 and December 2008 at this center were retrospectively reviewed. The patients were divided into low-birth-weight group (29 patients, birth-weight＜2 500 grams) and normal-birth-weight group (72 patients, birth-weight＞2. 5 kg). The possible prognostic factors were retrospectively analyzed including patients status, the incidence of preoperative and intraoperative critical events, postoperative complications, postoperative mechanical ventilation time,stress hyperglycemia and survival rate. Logistic regression analysis was employed to predict the prognostic factors of the survival rate after repair of EA and/or TEF. Results Of the 29 low-birth-weight EA patients, the survival rate was significantly lower than that of the normal birth weight patients (75.9% vs 92. 3% ,P = 0. 027) ,and the survival rate positively correlated with the birth weight (r=0. 946,P= 0. 015). The incidence of preoperative and intraoperative critical events and postoperative complications in low-birth-weight EA patients were significantly higher than those of the normal birth weight patients (67. 7% vs 32. 9% ,P = 0. 002; 70% vs 26%, P = 0. 001 ). The morbidity of anastomotic stricture and leak was higher, and postoperative mechanical ventilation time was longer compared with the normal birth weight patients (P = 0. 001 ). The survival rate of the patients had postoperative stress hyperglycemia was lower than that of patients without stress hyperglycemia (93. 6% vs 81.0%,P = 0. 024) ,and the survival rate negatively correlated with the severity of postoperative stress hyperglycemia (r = - 0. 931, P = 0. 022). Conclusions Low-birth-weight and postoperative stress hyperglycemia are the prognostic factors of survival rate after repair of EA and/or TEF.