外伤性鼓膜穿孔446例临床分析

自1991年8月至2002年8月我科共收治外伤性鼓膜穿孔住院患者381例,加上门诊患者资料齐全者65例,共计446例,现分析如下。1资料与方法1.1临床资料446例患者中,男性182例,女性264例,男女比为1∶1.5;年龄最小者4岁,最大者78岁,平均29岁;病程最短者30min,最长者5个月。病因均明确,其中掌击耳部324例,占的72.65%,拳击耳部和棍棒等击伤耳部者39例,占8.74%,颅底骨折伴/不伴脑脊液耳漏者33例,占7.40%,工伤事故致面部外伤合并鼓膜穿孔者16例,占3.59%,挖耳致伤11例,占2.47%,其余例数较少的有:炮震5例,化学制剂(如氨水等)4例,跳水3例,矿渣3例,咽鼓管吹张2…     

纤维蛋白封闭剂在肝脾手术中止血的临床应用

纤维蛋白封闭剂(FS)是一种源自人血浆,由数种蛋白成分组成的复合制剂,作为一种新型的生物可降解的组织粘合剂和局部止血药,国际上已广泛用于许多外科领域。丰联TM FS纤维蛋白封闭剂是由上海利康瑞生物工程有限公司生产,本研究旨在观察FS用于肝脾手术中断面止血的临床疗效。临床资料一、一般资料因肝脾疾病接受手术患者86例,其中男52例,女34例。平均年龄48.3岁。①肝肿瘤切除患者56例。试验组(FS组)28例:男19例,女9例。年龄32~68岁,平均年龄48.3岁。其中肝血管瘤2例,肝囊肿2例,肝内胆管结石5例,原发性肝癌19例。病变切除后肝断面4.3 cm×…     

骶髂关节结核多次误诊1例分析

患者,男,３３岁,汉族。因左臀间断疼痛２年,加重并左腹股沟包块１月,于１９９８年１０月入院。平素体健,无传染病史。１９９６年７月开始出现左臀部疼痛,间歇性发作,曾４次在不同医院住院治疗,分别诊断为“腰椎间盘突出症、坐骨神经骨盆出口狭窄症、臀上皮神经炎及类风湿性关节炎”,经理疗、局部封闭及抗风湿治疗,症状稍缓解,１９９８年９月出现低热和乏力,考虑“上感”,对症 处理１周,继而厌食、消瘦,左腹股沟处发现一包 块,行走困难。查体：发育正常,消瘦,心、肺、肝功 能正常,脊柱无畸形,诸椎间及椎旁无压痛及放射 …     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

发挥和运用自身优势实践中小医院可持续发展战略

在改革开放的新形势下,社会主义市场经济的确立,为我国卫生事业的发展注入了新的活力和生机,也给医院带来了机遇和挑战.同时,对中小医院的生存发展提出了更高的要求.中小医院如何适应新形势,积极参与市场竞争,不断加速全面建设,实现可持续发展战略,是值得认真研究的课题.我院地处沿海城市,经过50年的建设发展,在驻地医疗市场上确立了服务的良好形象和自身优势.     

心肌梗死与心肌损伤(104)

近年来,出现了更为敏感与特异的心脏生物标志物的检测技术,以及更为敏感的心脏影像技术,这些新进展使小面积心肌梗死及心肌损伤都能被有效检出。此外,心肌梗死的各种治疗技术也取得显著提高,因而正确区分心肌梗死与心肌损伤有着重要临床意义。心肌梗死新定义自2000年起已先后三次被修订。[心肌梗死](1)诊断:心肌梗死可经临床与病理学两种方法诊断,而更为敏感,更特异的心脏生物标志物检测技术的问世,使两者更为接近,即原来只能经病理或尸检才能诊断的小面积心梗(面积<1%的心梗),