血液透析患者无名动脉压迫头臂静脉局限性狭窄1例

1 病历简介 患者,女,53岁,因"左上肢肿胀2年"于2004-08-03入院,2000-12因肾囊肿破裂,行右肾切除术.住院期间检查诊断为慢性肾功能不全、尿毒症期和肾性贫血.行左前臂桡动脉-头静脉内瘘术,开始血液透析治疗,2～3次/wk,4～5h/次,透析过程中常发生低血压反应.2002年以来左上肢肿胀逐渐加重.体格检查: 左上肢比右上肢明显肿胀,左前臂动静脉瘘处可闻及连续性血管杂音,可触及连续性血流震颤,无红肿及压痛.     

血液透析患者无名静脉受压综合征一例

患者男,53岁,因维持性血液透析1年,左上肢肿胀4个月,加重伴疼痛1个月于2010年1月15日入院.患者2009年1月因肾功能不全在我院行右侧颈静脉插管,并行临时血液透析4次,后行左前臂桡动脉-头静脉内瘘术,内瘘成熟后开始规则血液透析治疗,3次/周,每次超滤约3 kg.2009年9月出现左上肢肿胀,能自行消退,未予治疗.近1个月来肿胀加重,伴皮温升高,血液透析过程中静脉压明显增高,回流较差.     

多关节神经营养性骨关节病1例

患者男,43岁,左腕及左肘无痛性肿胀10余年。查体:颈椎无畸形,压痛(+),活动良好。右上肢肌萎缩,右腕及右肘明显肿胀,无红肿、压痛。右肘伸直150°,屈曲正常。痛、温觉基本丧失。右上肢肱二、三头肌反射末引出,霍夫曼征(-)。左腕部X线平片示左腕软组织明显肿胀,部分腕骨碎裂,其内密度不均匀,局部可见密度增高或囊样密度减低区,腕骨间间隙模糊,周围可见游离的骨片,左侧桡骨远端可见     

浮动肘误诊为单纯肱骨干骨折1例

1临床资料病例,男性,30岁,左上肢被木料砸伤后疼痛,功能障碍,上臂骨质外露.在当地医院行肱骨拍片示“左肱骨远端粉碎骨折”.急行伤口包扎,上肢石膏托简单外固定,于伤后18h转至我院.查体:神志清楚,脉搏84次/分,血压14/10 kPa.左上肢长臂石膏托固定.拆除石膏后见整个上肢肿胀明显,皮肤表面有散在的张力水泡且部分已有破溃.上臂远端前     

左肩关节色素沉着绒毛结节性滑膜炎1例

1 病历简介 患者,男,15岁.于半年前无诱因下发现左上肢肌肉较右侧明显萎缩,无疼痛不适.门诊左肩关节X线片示:"左肱骨头外侧骨质缺损,边界清,似有硬化边和骨脊,无软组织肿胀,肩关节间隙正常"(图1),考虑为软骨母细胞瘤可能大.     

超声诊断风湿性心脏病合并房颤并发左上肢动脉血栓栓塞1例

正患者女,51岁。因"左上肢麻木、发凉20天"入院。发现风湿性心脏病10年,院外未规律服药。查体:脉搏:80次/min,血压:128/80mm Hg,左上肢未见明显肿胀,皮温降低,左侧桡动脉搏动未扪及,右侧桡动脉搏动较明显。心界扩大、房颤心率,心律不齐。双下肢无水肿。胸片示:肺淤血、心影增大。超声心动图检查提示:风湿性心脏病,二尖瓣重度狭窄伴轻度反流,主动脉瓣增厚伴轻-中度反流,三尖瓣     

PTA治疗维持性血液透析患者自体动静脉内瘘狭窄1例

病例女,55岁,原发疾病为"慢性肾小球肾炎(尿毒症期)"行维持性血液透析治疗,血管通路为自体动静脉内瘘(右手前臂桡动脉-头静脉端端吻合)。2000年因左乳房乳腺癌行乳腺癌根治术,左手肿胀,诊断为肿胀手综合征,故不能在左手行自体动静脉内瘘成形术,遂于2011年1月右手前臂再次行动静脉内瘘成形术。术程顺利,术后可扪及血管震颤,听诊可闻及正     

人工肱骨头置换治疗肱骨近端粉碎骨折疗效分析

1材料与方法 1．1临床资料患者男性,因车祸致头部、左上肢损伤,于我院就诊,行X线拍片示肱骨近端骨折,骨连续性中断,呈粉碎性,肱骨头向关节盂下脱位。查体发现左关节明显肿胀,广泛压痛,可见青紫及皮下淤血,有骨擦音及骨擦感,无开放伤,无严重血管、神经损伤。诊断为左肱骨头、左肱骨外科颈粉碎性骨折,左肩关节脱位。经充分的术前、术中准备,行人工肱骨头置换术,术后1个月精心治疗,康复训练及护理后患者康复出院。     

十二指肠球部印戒细胞癌胸导管及远处淋巴结转移一例报告

患者男性、27岁，于1993年6月无明确诱因出现左颈部肿胀，未行任何治疗10余天后自行消退，而转为左上肢及左上胸部持续性中度肿胀，余无不适，照常生活工作。1994年1月一次受凉后引起发烧，白细胞24X10‘／L，在当地医院静点青霉素四天体温及血像均恢复正常，但出现会阴部肿胀，接包皮过长感染继续静点青霉素一周后肿胀进行性加重并扩展到双下肢、腹壁及左右胸部、左上肢肿胀加重。B超示双侧胸水、CT示纵隔淋巴结广泛肿大，右锁骨上淋巴结活检病理为印戒细胞癌，肝脾B超，上消化道钡餐及上下腔静脉造影均正常，绘予“PDD、VP－16、CTX…     

FFA治疗维持性血液透析患者自体动静脉内瘘狭窄1例

病例女，55岁，原发疾病为“慢性肾小球肾炎（尿毒症期）”行维挣陛血液透析治疗，血管通路为自体动静脉内瘘（右手前臂桡动脉·头静脉端端吻合）。2000年因左乳房乳腺癌行乳腺癌根治术，左手肿胀，诊断为肿胀手综合征，故不能在左手行自体动静脉内瘘成形术，遂于2011年1月右手前臂再次行动静脉内瘘成形术。术利I顷利，术后可扪及血管震颤，听诊可闻及正常血流杂音，术后长期口服双嘧达莫片、阿司匹林片抗血小板凝集，并嘱患者握拳锻炼及热敷保护内瘘。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.