正反特伦德伦伯格卧位对呼吸循环功能影响

目的观察腹腔镜手术期间正反特伦德伦伯格(Trendelenburg)卧位对患者呼吸循环功能的影响。方法女性腹腔镜胆囊切除术患者30例(A组)术中取反向特伦德伦伯格卧位;女性卵巢囊肿切除术患者30例(B组)术中取特伦德伦伯格卧位,监测气腹前、气腹后、体位改变前、体位改变后15、30 min、术毕气管导管拔除后10 min时的MAP、HR、SpO2、肺胸顺应性(Comp)、气道阻力(Raw)、气道峰压(Ppeak)、PETCO2。结果气腹及体位改变后两组患者MAP、HR、SpO2、Paw、Ppeak、PETCO2明显升高,Comp降低,组内分别与气腹前相比,差异均有统计学意义(P<0.05);组间比较气腹后A组Paw、Ppeak、PETCO2明显高于B组,Comp低于B组,差异均有统计学意义(P<0.05),拔管后B组HR、MAP明显高于A组。结论气腹与体位均使患者循环动力学发生改变,通气功能下降,其中以特伦德伦伯格卧位下降更为明显。     

Bilateral Musculocutaneous Nerve Palsy From Strength Training

Musculocutaneous nerve palsy resulting from strenuous weight training is a rare condition characterized by biceps atrophy or weakness. It usually affects the dominant side, but the authors describe an 18-year-old football player who developed the condition bilaterally after weight lifting—a presentation not found in the literature. Clinicians should keep the diagnosis in mind for active patients who perform repetitive biceps curls. When other neurologic conditions have been clinically ruled out, electrodiagnostic testing can confirm the diagnosis. Musculocutaneous nerve palsy typically resolves when weight training routines are modified to reduce intensity and biceps curls are eliminated for at least 3 months.     

Sports tumors

We present 36 patients who initially were thought to have sports-related injury but ultimately were diagnosed with a primary bone or soft tissue tumors or tumor-like condition. The awareness of this possibility in the individual with a sports-related complaint, who does not respond to standard management, may assist in earlier diagnosis and treatment of the suspected neoplasm.     

MRI in kernicterus

Kernicterus (bilirubin encephalopathy) is a disease entity with a very high rate of mortality in neonates. The children who survive are left with neurological deficits such as choreoathetosis, sensorineural deafness and mental retardation. Magnetic resonance imaging of the brain in this condition has specific findings which aid in the accurate diagnosis of the condition, along with clinical and biochemical criteria. Reports have shown involvement of the globus pallidus, putamen, and less commonly the thalamus. More specific involvement may be isolated lesions of the globus pallidus. Magnetic resonance imaging has shown a good sensitivity in this condition.     

Prognistic relevance of radiation induced immune suppression in breast carcinoma

The extent of radiation induced immune suppression was analysed in 100 patients with carcinoma of the breast. The relative changes of lymphocyte counts and stimulations by PHA and PPD were similar in patients who differed with regard to age, size of tumour and its malignancy grade or axillary node condition. Moreover, no difference in the degree of radiation induced immune suppression existed between patients who developed recurrent disease and those who remained free of disease during a follow-up period of 4 1/2 to 7 years.     

Pneumosinus dilatans of the ethmoid sinus presenting with exophthalmus: a case report and review of the literature

Pneumosinus dilatans (PSD) is a rare condition of unknown aetiology in which there is enlargement of the paranasal sinuses by air, where the affected sinus expands beyond the normal boundaries of bone without thinning of its bony walls. The case of a 28 year old male with PSD, who had gradually increasing exophthalmus and diplopia, is presented and characteristics of this condition are reviewed with literature data.     

The Role of Interventional Radiologists in the Use of Extracorporeal Membranous Oxygenation in the Catheter-Directed Treatment of Pulmonary Embolism

Patients with pulmonary embolism who are in hemodynamically unstable condition present a special challenge to the interventionalist. When treating such patients, extracorporeal membranous oxygenation (ECMO) can help to stabilize these patients’ condition; however, specific criteria for its use do not exist. Two patients are presented here to familiarize the reader with the use of ECMO and to demonstrate its utility for the interventional radiologist.     

Multiple limb compartment syndromes in a recruit with sickle cell trait

Sickle cell trait, as opposed to the disease, is a rare condition with fewer medical complications. We present a case of a 24 year old Army recruit, who required multiple fasciotomies for limb compartment syndrome, associated with sickle cell trait. We discuss the management, complications and screening programmes of the condition and make suggestions for the training of sickle cell trait personnel in planning a career in the Armed Forces.     

Scapula winging in a sports injury clinic.

Scapula winging is an uncommon condition but one which may be underdiagnosed. Four patients with scapula winging referred to a sports injury clinic are presented. None of the patients was aware of any trauma and a traction injury to the long thoracic nerve is proposed as the aetiology of this condition. These case reports emphasize the importance of excluding winging of the scapula in patients who present to sports injury clinics with shoulder pain.     

汶川地震后野外条件下111例麻醉经验总结

背景"5.12"汶川大地震后,第二军医大学长征医院医疗救护队赴四川绵阳建立野战医院,展开医疗救治工作。期间共通过伤员2715例,在麻醉下实施紧急手术111例。方法回顾分析在野战医院条件下实施的111例麻醉资料,就患者伤情、麻醉方法和围术期麻醉管理进行总结。结果在接受麻醉下手术的111例患者中,年龄最大者81岁,最小仅5个月。实施静吸复合全身麻醉19例,椎管内麻醉40例,基础麻醉41例,臂丛神经阻滞11例。所有患者均安全度过围术期,包括成功实施2例新生儿复苏,没有出现严重麻醉并发症。结论地震伤员伤情复杂,野战医院的医疗设备和资源有限,麻醉应以保证患者生命安全、减轻患者痛苦、简单有效为原则,尽量避免出现麻醉并发症。     

Post traumatic stress disorder and the forensic radiographer

The term post traumatic stress disorder (PTSD) is used to describe the psychological issues resulting from any traumatic event. An individual's ability to function is impaired by experiencing emotional responses to a traumatic event. Forensic radiographers need to be aware of the potential debilitating effects of this condition and those writing forensic protocols must take the condition into account and build in safeguards and welfare strategies.This narrative review looks at the origins of the term PTSD and highlights those who may be at increased risk of developing the condition including, in particular, forensic radiographers involved in mass fatality work. Signs, symptoms and possible treatments are also reviewed.     

Collapse in the Endurance Athlete

KEYPOINTS Mostcasesofcollapsearebenigninnatureandoccurafteranathletecrossesthefinishlineorstopsexercising.Ath leteswhocollapsebeforefinishingaremorelikelytohaveaseriouscondition.Athleteswhoareawakeandalertafterthecollapsearelesslikelytobeseriouslyillthanthosewhohaveadimin ishedlevelofconsciousness.Inevaluatingthecollapsedathlete,itisessentialtocheckvitalsigns(especiallyrectaltemperatureifheatstrokeissuspected),assessfluidstatus(dehydratedvs.fluidoverload),andperformlaboratorytests(bloodsod…     

Natural course in tennis elbow—lateral epicondylitis after all?

Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.     

肝移植术后肝动脉狭窄行介入治疗的护理

目的 探讨肝移植术后肝动脉狭窄介入治疗的围手术期护理措施,为减少相关并发症、改善患者预后提供参考.方法 结合患者情况及介入治疗的特殊性,以移植病房20例肝移植术后肝动脉狭窄行介入治疗的患者为样本,从术前准备、术后护理及出院指导3方面对患者进行护理.结果 20例介入治疗患者均无出血倾向及急性血栓形成,症状明显好转.结论 介入治疗对于肝移植术后肝动脉狭窄是一种有效的治疗方法.加强介入治疗后的护理可有效预防与手术相关的并发症的发生、巩同治疗效果.     

骨盆型严重多发伤失血性休克的限制性容量复苏

目的通过采集骨盆型严重多发伤的病例资料,总结和分析其病情特点,为临床上骨盆型严重多发伤应用损害控制提供初步依据。方法对我院2000年1月~2007年7月间的60例骨盆型严重多发伤患者进行回顾性研究。对其中21例伴有失血性休克患者通过损伤严重度评分(ISS)、早期复苏输液量、复苏时间等指标进行量化分析和疗效评估。结果21例伴有失血性休克,根据早期复苏方法分为限制性复苏组(11例)和常规复苏组(10例)。限制性复苏组:ISS评分30.72,复苏输液量1009.09ml,复苏时间102.72分钟,复苏后血红蛋白(HGB)98.36g/L;常规复苏组:ISS评分30.90,复苏输液量3 175ml,复苏时间246分钟,复苏后HGB 79.90g/L。限制性复苏组和常规复苏组ISS评分无显著性差异(P0.05),复苏输液量、复苏时间、复苏后HGB均有显著性差异(P0.05)。结论在急救复苏过程中,对伴有失血性休克的骨盆型严重多发伤患者进行限制性复苏,能使输液量更少,控制出血更好,复苏效果更显著。     

Pancreatic cystosis in cystic fibrosis

Two patients with cystic fibrosis and pancreatic cystosis are described who had complete replacement of the pancreas by multiple macroscopic cysts. The possible causes and clinical significance of this condition are discussed.     

Thrombophlebitis diagnosed on indium-111 labelled white cell scan

A 64-year-old lady with type 2 diabetes and a non-resolving right foot ulcer, had an indium-111 labelled white cell scan (indium-111 WCS) to investigate the possibility of underlying osteitis. The scan suggested the possibility of infective thrombophlebitis. Unknown to the clinical team who requested the scan and the radiologist who performed it, the lady was admitted to hospital 2 days following the procedure with cellulitis and septic thrombophlebitis in the right leg. There is only one previous report in the literature of septic thrombophlebitis being diagnosed in this way. Perhaps indium-111 WCS has something to offer in the diagnosis of this condition and in determining those who require antibiotic treatment.     

Embolization of dissecting aneurysms of the petrocavernous segment of the carotid artery

The authors present two patients who had dissecting aneurysms of the petrocavernous segment of the internal carotid artery. They successfully treated the condition with balloon embolization of the artery proximal to the aneurysm.     

Idiopathic dilatation of the pulmonary artery

Idiopathic dilatation of the pulmonary artery is an uncommon cause of a large main pulmonary artery whose diagnosis is dependent on the exclusion of other causes of central pulmonary artery dilatation. We present four new cases who have been known to have large central pulmonary arteries for many years, and suggest that a long period of observation should be considered to be a further criterion for diagnosis as, in some patients who appear to have this condition, an underlying pathology will become apparent.