Low-grade thermal injury

It is very popular to use hot-water bottles or some electric heaters to keep one warm when sleeping or sitting in cold days in China.l Unfortunately, people might be burned as a result of prolonged contact with the heaters because of senseless due to falling asleep, drunk or some diseases just like diabetes. This special case we reported here may help us to improve the diagnosis and treatment of low-grade thermal injury.     

正常猪食管的急性热损伤研究

用微波辐射器在正常猪食管腔内加温30min,温度分别为45、46、47、48、49℃共5组。18h后处死动物,以病理组织学表现判断损伤的程度,并以最大可能损伤记分作为100%。食管急性热损伤在上述各组分别为2%、17%、40%和67%。食管急性热损伤的重要表现为血管壁变性坏死及血栓形成和食管肌壁灶性坏死。温度为45℃、46℃时发生率为1(?)9例;而48及49℃时发生率各为7/9例、3/9例。据此认为45℃、30min加温对正常组织是安全的。     

烧伤后胰岛素抵抗的实验研究

目的:探讨大鼠烧伤后葡萄糖耐量,胰岛素敏感性指数和正常血糖高胰岛素钳夹的变化情况,证实烧伤后存在胰岛素抵抗.方法:6周龄SD大鼠(体质量160～170 g)随机分为假烫伤组和烫伤组,每组8只.烫伤组大鼠制成烧伤面积为30%的Ⅲ度烫伤模型,伤后第3天禁食12 h后采血,用自动血糖仪测定血糖;用大鼠胰岛素ELISA试剂盒测血浆胰岛素水平和胰岛素敏感性指数(ISI);测0、30、60、90、120 min血糖值,观察葡萄糖耐量的变化;伤后第4天观察正常血糖高胰岛素葡萄糖钳夹技术10%葡萄糖总输注率的变化情况.结果:与假烫伤组相比,大鼠烫伤后第3天血糖和血浆胰岛素水平显著升高[血糖(8.94±2.22)vs(6.10±0.62)mmol/L,血浆胰岛素浓度(3.14±1.08)vs(1.06±0.45)ng/ml,P＜0.01],而ISI显著下降[(0.58±0.23)vs(1.23±0.16),P＜0.01].烫伤后第3天葡萄糖耐量实验显示烫伤大鼠对于外源性葡萄糖耐受性在各时间点均明显降低.烫伤后第4天正常血糖高胰岛素钳夹技术检测显示10%葡萄糖输注率较假烫伤组显著下降[(7.23±1.35)vs(12.31±0.54)mg/(kg·min),P＜0.01].结论:大鼠烧伤后可引起糖代谢异常并导致胰岛素抵抗发生.     

Esophageal thermal injury in catheter ablation of atrial fibrillation

Pulmonary vein isolation is an established method for the catheter ablation of atrial fibrillation. Esophageal thermal injuries, such as esophageal erosion, ulceration and periesophageal nerve injury leading to gastric hypomotility, are important complications associated with pulmonary vein isolation. In this review article, we describe the mechanisms, characteristics and the predictors of esophageal thermal injury associated with pulmonary vein isolation.     

Nd：YAG激光对兔咽部黏膜热损伤的研究

目的：探讨Nd:YAG激光功率密度与黏膜组织热损伤程度的关系,以及激光照射后黏膜组织愈合的过程。方法：激光功率密度221W/cm^2(10W)、442W/cm^2(20W)、663W/cm^2(30W)、884W/cm^2(40W),持续时间5s,非接触照射新西兰兔舌和咽后壁黏膜组织,测量急性热损伤的深度;相同剂量照射兔咽后壁,术后1、3、7、14d观察咽后壁愈合情况。结果：221W／cm^2（10W）时,组织热损伤深度为0．32－0．53mm;442W/cm^2(20W)时,为0．61－1．27mm;663/cm^2(30W)时,为1．22－1．76mm;884W/cm^2(40W)时,为1．68－2．29mm。激光照射后,黏膜组织主要表现为凝固性坏死和继发性炎症反应,创面愈合过程主要是创面炎症渗出和表皮凝固坏死痂皮下直接愈合。组织热损伤深度随激光功率密度增强而增加。结论：在激光治疗中,采用适宜剂量参数的Nd:YAG激光非接触照射安全、有效。     

沸石对猪血管损伤止血的作用及对组织影响的初步研究

目的:研究沸石对猪大血管损伤出血的止血作用及其对局部组织的影响. 方法:健康家猪12只(12.89±1.16 kg)随机分为实验组和对照组,每组6只,利刀横断股动脉、静脉和部分股四头肌. 致伤后20 s实验组应用沸石粉止血,对照组采用纱布加压止血. 15 min开始输入乳酸钠平衡盐溶液共250 mL. 观察120 min内平均动脉压、出血量、死亡率、死亡时间. 切取血管断缘两侧组织,进行HE染色,观察组织的病理改变. 结果:实验组动物应用沸石后2 min止血成功,动物死亡率0%;对照组止血失败,动物死亡率100%. 实验组血管断缘0.5 cm内部分组织变性坏死,断缘0.5 cm以远组织未见明显病理改变. 结论:沸石能有效控制本模型中动、静脉的致命出血,显著降低死亡率;沸石放热导致局部组织热损伤,但不影响清创血管吻合.     

Fatal haemophagocytic syndrome

A fulminant clinical presentation with high fever and hepatosplenomegaly, together with a course of worsening pancytopenia, coagulopathy and liver failure, is suggestive of the haem syndrome (HPS). Bone marrow examination is diagnostic. We present 3 cases of HPS associated with different aetiologies including acute Ebstein Barr virus infection, T cell lymphoma, and malignant histiocytosis. In all the cases, the diagnosis was made late and the patients succumbed before definitive therapy could be administered.     

Fatal xylenol self-poisoning

A case of fatal xylenol ingestion by a long-stay mental hospital patient is described. The clinical course was similar to that observed in other phenolic poisonings with active bowel sounds, nausea and vomiting, severe metabolic acidosis, hypotension and cardiac and renal failure. The formulation of xylenol ingested contains alcohol which would facilitate absorption; due to the dangers of such poisonings care must be exercised as to access and exposure to xylenol sterilising agents.     

Fatal intestinal amoebiasis

The clinical presentation of amoebic colitis are diverse. Amoebiasis is comparatively rare in the U.K. and, unless the clinician is aware of the condition, wrong diagnosis often leads to delay in appropriate treatment resulting in high mortality. Diagnosis rests on clinical suspicion, stool examination, sigmoidoscopy with rectal biopsy and serological tests. Amoebiasis is readily treatable and death from it should be very rare.