The role of funduscopy in severe thrombocytopenia: A prospective study

PurposePlatelet transfusions for patients suffering from severe thrombocytopenia are regulated by clinical bleedings and platelet counts. The aim of this study was to assess the prevalence of retinal hemorrhage in patients with hematologic and oncologic malignancies and severe thrombocytopenia, and to determine the benefit of systematic funduscopic examination in this setting.Materials and methodsHospitalized patients with hematologic and oncologic malignancies having a platelet count less than 25,000 per μL underwent indirect ophthalmoscopy. The prevalence of retinal hemorrhage and its correlation with different patients’ characteristics were determined. The decision to transfuse platelets or not following bedside indirect ophthalmoscopy was left at the discretion of the treating physician.ResultsA total of 34 severe thrombocytopenic patients were included in the study. The prevalence of retinal hemorrhage was detected in 10 patients (29.4%). No significant correlation was found between the occurrence of retinal hemorrhage and age, platelet count or thrombocytopenia etiology (P > 0.05). No significant difference was found concerning the rate of transfusion between those with and without retinal hemorrhage.ConclusionAccording to our statistical results, retinal hemorrhage is a frequent finding in severely thrombocytopenic patients. Early detection may lead to an increase in the platelet transfusion threshold from to 30,000 per μL offering additional protection against spontaneous bleedings. Funduscopy is a safe and easy exam to perform systematically in patients with severe thrombocytopenia.     

Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists

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体视学法在颅内血肿体积测量的应用

目的介绍改进后的体视学法测量颅内血肿体积,并验证其准确性。方法在92例颅内出血的CT图像上,同时运用体视法、CT定量法测量颅内血肿体积,以CT定量法的结果为标准验证体视法的准确性。结果按血肿体积大小分为5组,各组CT定量法、体视学法所测得体积采用配对样本的t检验分析P值皆大于0.05,即CT定量法、体视学法所测血肿体积无统计学差异。结论体视学法测量颅内血肿准确可靠,在CT工作站对颅内血肿病例行胶片打印排版时,在图像上加上合适的网格,可方便临床医生快速运用体视法准确测量颅内血肿体积。     

小剂量白蛋白治疗进展型脑梗死临床研究

目的：观察小剂量白蛋白治疗进展型脑梗死疗效及治疗前后血液流变学变化，方法：70例病人随机分为两组：治疗组35例和对照组35例，均应用脱水剂，脑细胞保护剂，保持水电酸碱平衡等常规治疗，治疗组35例脑梗死患者应用白蛋白5g静脉滴注，2次／d，连续10d为1疗程，治疗后15d复查血流变，结果：治疗组控制脑梗死进展的疗效明显高于对照组（P＜0．01），结论：小剂量白蛋白治疗进展型脑梗死有效。     

CT引导下颅内血肿微创清除术治疗高血压性脑出血的临床研究

目的探讨CT引导下颅内血肿微创清除术治疗高血压性脑出血的疗效。方法选择101例中重度血压性脑出血患者,随机分为2组,微创组48例行常规保守治疗加微创颅内血肿清除术,保守组53例仅行保守治疗。比较2组疗效、血肿消失速度和治疗后15 d神经功能缺损评分。结果微创组显效率38%,总有效率65%,保守组分别为15%和40%,2组比较有显著性差异(P均<0.01);微创组病死率为23%,保守组为45%,2组比较有显著性差异(P<0.01);微创组血肿完全消失(16.2±3.6)d,保守组为(41.3±5.2)d,2组比较有显著性差异(P<0.01);治疗15 d后2组神经功能缺损评分比较有显著性差异(P<0.01)。结论颅内血肿微创清除术治疗高血压性脑出血能有效降低病死率,加快血肿清除,促进神经功能恢复。     

介入诊疗十二指肠憩室反复大出血一例

患者男,67岁。因上腹部不适3 d,黑便、呕血2 h入院。2 h前黑便1次量约500 ml,并恶心、呕吐,吐出咖啡色液体约300 ml,伴有头晕、乏力,无明显心慌、气急来诊。入院查体：老年男性,贫血貌,一般状况差,血压60/40 mmHg,腹部无压痛及反跳痛,肝脾不肿大,移动性浊音(-),肠鸣音活跃,双下肢无异常。     

Pelvic Ring Fractures: Utility of Clinical Examination in Patients with Impaired Consciousness or Tracheal Intubation

Abstract Objective: To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation to detect pelvic ring fractures and to identify those with severe bleeding. Methods: Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the iliac wings. Results: From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity 97.0%, positive predictive value 38.1%, negative predictive value 99.9%). Conclusions: Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture as being the source of bleeding quite unlikely.     

下腔静脉损伤的救治经验：附12例报告

目的: 探讨下腔静脉损伤的修复方法。方法:对12例下腔静脉损伤患者临床资料进行回顾性分析。结果:闭合性损伤9例，开放性损伤3例。入院时均伴有休克。均诊断为腹腔内脏损伤，无1例诊断为下腔静脉损伤。12例均手术治疗，直视下修复5例，大网膜填塞后肝实质大块褥式缝合2例，纱布填塞5例。术后并发症7例（58.3%）：胆漏1例，隔下脓肿合并反应性右侧胸腔积液2例，创伤性肝囊肿1例，腔静脉血栓形成1例，大出血2例；死亡3例，病死率25.0%。 结论:腔静脉损伤病情凶险，处理困难，病死率高，改良的全肝血流阻断下行纱布填塞止血效果好，抢救成功率高，值得推广。