创伤性膈疝并发骨盆骨折、脾破裂一例

患者 ,男 ,36岁 ,农民。 2 0 0 2年 2月2 6日下午 4时 2 0分钟酒后骑三轮摩托车与拖挂汽车相撞 ,左臀部着地 ,胸部受伤 ,当时下肢不能活动 ,呼吸困难。查体 :BP75 / 5 2 .5 mm Hg,P 12 4次 /分 ,面色苍白 ,四肢湿冷 ,双瞳孔等大正圆 ,对光反应灵敏。胸廓无畸形 ,挤压痛 (+) ,左 5、6、7背肋 ,右 3、5、6背肋可触及骨擦感 ,左肺呼吸音减弱。左上腹肌紧张 ,压痛、反跳痛 (+) ,肠鸣音弱。骨盆挤压、分离试验 (+) ,左肱骨外髁压痛 ,可触及骨擦感 ,左手背肿胀 ,左臀部及左髋关节部大片皮肤淤紫。 CT检查左胸腔内可见胃泡 ,纵隔极度右偏 ,双侧…     

膀胱切开冲击式碎石治疗后尿道巨大结石1例

患者,男,52岁.尿失禁间伴脓尿4年,于1998年10月26日以膀胱及后尿道结石收入院.询问病史得知患者4年前无诱因出现尿失禁,间伴脓尿或会阴部隐痛不适.无血尿,无畏寒发热.体检:体温36.7℃,脉搏69次/min,呼吸20次/min,血压120/79 mmHg(1 mmHg=0.133 kPa),神志清楚.心、肺检查正常.腹部平软,无压痛及包块.直肠指检后尿道(前列腺窝处)可扪及4.0 cm×5.0 cm肿块,质硬,轻压痛,活动差.尿常规检查红细胞3～6个/HP,白细胞++,脓细胞+.血肌酐112 μmol/L.KUB显示膀胱及后尿道结石,大小分别为4.0 cm×6.0 cm和2.2 cm×4.4 cm.CT示前列腺钙化4.0 cm×5.0 cm.     

男性尿道憩室致不育症1例

患者男性、28岁。因婚后3年未生育于1986年3月19日住院检查。3年前患者发现阴茎腹侧近阴囊处有一花生米大肿物,不红、无疼痛,无膀胱刺激征及排尿困难,故未予注意。婚后性生活时发现肿物增大,并有痛感,继之出现红肿,经消炎治疗后症状缓解。1985年11月始排尿不畅,肿物增大,挤压肿物时尿道外口有混浊液体滴出,但无疼痛。此次是因婚后不育来院就诊。体检:外生殖器发育正常,于阴茎与阴囊交界处见一3.5×2.0×1.0cm大肿物,外观皮色正常,触之有囊性感,表面光滑,较固定,挤压肿物时见有淡黄色尿液自尿道外口流出,压痛不明显。血白细胞10.2×10~9/L,中性76％,淋巴24％;尿常规:蛋白( ),白细胞0     

骨盆骨折并迟发性、多发性小肠穿孔一例

患者 ,男 ,35岁 ,因被树木压伤腰骶部 2小时入院。查 :Ｔ36 6 0℃ ,Ｐ74次 /分钟 ,ＢＰ110 / 70ｍｍＨｇ。下腹部稍隆 ,腹软 ,有压痛 ,无反跳痛 ,叩诊呈浊音 ,肠鸣音减弱。骨盆挤压、分离试验 ( ) ,第 5腰椎棘突及棘突旁压痛、叩击痛。Ｘ线片见 :左、右耻骨骨折 ,第 5腰椎椎体爆裂骨折。诊断 :①骨盆骨折 ;②Ｌ5椎体骨折。入院后行止血、止痛、输血、抗感染及对症支持等治疗。第 3天出现腹部阵发性剧痛 ,腹胀 ,腹肌紧张 ,全腹压痛、反跳痛 ,叩诊肝浊音区及肠鸣音均消失。腹部平片提示肠梗阻 ,腹穿抽出肠内容物。立即在硬外麻下行剖腹探查术…     

尿道会师术治疗后尿道断裂

本院自1981年6月至2002年6月,收治骨盆骨折并发后尿道损伤45例,其中29例采用尿道会师加牵引术,取得满意疗效。报告如下。1资料与方法1.1一般资料:本组29例,均为男性;年龄17～60岁,平均36.2岁。致伤原因为交通事故21例、坠落伤5例、砸伤2例、挤压伤1例。均伴有骨盆骨折和不同程度的休克表现(部分病例尚有头、胸、腹、四肢合并伤)。患者伤后均不能排尿,尿道口有血迹,导尿管不能插入。直肠指检触及前列腺向上浮动,前列腺尖部与尿道膜部有血肿及压痛,或触及盘曲的导尿管。1.2治疗方法:休克纠正后立即手术。全麻或硬麻下取平卧位,下腹正中切口进…     

裸支架结合“烟囱”技术及弹簧圈栓塞治疗复杂外伤性腹主动脉夹层一例

患者男,42岁.因"被叉车挤压后腰部及腹部疼痛19h,无尿14h"于2012年8月7日入院.查体:T 36.4℃,P 104次/min,Bp 70/43 mm Hg.腹平软,无压痛及反跳痛,肝脾未触及,肠鸣音正常.肾功能:尿素氮10.3 mmol/L,肌酐368 μmol/L,血钾6.37 mmol/L.腹部CT:脾及胰腺挫裂伤.诊断为脾及胰腺挫裂伤,失血性休克,急性肾功能衰竭.     

外伤性肾上腺畸胎瘤破裂入腹腔1例

患者 ,男 ,32岁。右腰背部摔伤后疼痛 1 d,伴腹痛、发热 0 .5d,于 1 998年 8月 31日入院。体检 :体温 38.5℃ ,血压 1 0 8/60 mm Hg( 1 mm Hg =0 .1 33k Pa) ,脉搏 78次 /min,急性痛苦面容 ,右侧腰背部见 3cm× 6cm青紫淤斑 ,未扪及明显肿块 ,右肾区叩痛及压痛明显 ,全腹壁紧张 ,右侧中下腹部有压痛、反跳痛 ,胸廓挤压痛及右第 1 0肋腋段压痛阳性。血常规 WBC:1 0 .9× 1 0 9/L,N0 .857。尿常规镜下未见红细胞。B超示右肾上极可见 54mm× 54mm稍低回声光团 ,肾包膜不完整 ,考虑为右肾肾周积血。X线胸片示右第 1 0肋腋段横行骨折。诊断为…     

经尿道2 μm激光脐尿管囊肿切除1例

<正>患者,女,62岁,尿频伴无痛性镜下血尿1个月余,无腰痛,发热,乏力,消瘦。查体:腹软,稍膨隆,无压痛及反跳痛,未触及明显包块,脐部未见异常分泌物,双肾区未及膨隆,肋脊角无压痛及叩击痛;输尿管走行区无压痛点,膀胱区无压痛。双侧腹股沟区无肿大淋巴结。尿道外口未见明显异常。尿常规:潜血1+,RBC 6个/HP,WBC 5个/HP。尿细胞学:未见肿瘤细胞。B超:膀胱充盈可,容量约200ml,前壁肌层可见直径约1.1cm近似无回     

肾上腺结核一例

患者,女,64岁.因右上腹隐痛不适约1年经B超检查示“右肾上腺肿瘤”而入院.患者无其他伴随症状,既往无结核病史和高血压病史.入院检查:血压16/10kPa,脉搏86次/分.心肺正常;腹部及肾区无明显叩压痛,未及包块.挤压患侧腰部观测血压无明显改变.B超检查:左侧卧位斜切,在右肾上极内     

高楼坠落伤、休克

1 病历摘要患者女性,18岁,上海籍,学生.于10米高处坠地约1h入我院急诊科.从4层高楼坠落受伤后,被上海市急救中心急救入院.病人感右上肢疼痛,无恶心与呕吐.入院体检:急性面容,面色苍白,四肢厥冷,烦躁不安,呻吟,呼吸快、弱,30次/min.脉搏108次/min,血压10/7kPa.心肺无异常,腹部膨隆,右下腹部有压痛,无反跳痛,肠鸣音消失.骨盆挤压分离试验( ),右上肢畸形变,右肩背部创面渗血,腹腔穿刺抽出不凝固血液.急诊室摄片:颅脑、心肺无损伤.诊断:(1)右髋臼粉碎性骨折,股骨头中心性脱位,左坐骨耻骨支骨折,腹膜后出血,右肱骨中下段骨折;(2)创伤失血性休克;(3)肝、脾破裂.迅速输入平衡盐液及706代血浆及全血.检查、急救过程中血压不升反而下降到测不出,脉微弱,决定在急诊室行紧急剖腹手术.     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

Methotrexate, Azathioprine, Cyclosporine, and Risk of Fracture

We studied the fracture risk associated with use of methotrexate, azathioprine, and cyclosporine. The study was designed as a case-control study. All patients with a fracture (n = 124,655) in the year 2000 in Denmark served as cases. Information on fractures and confounders was retrieved from the National Hospital Discharge Register and a number of other national registers. For each case, three age- and gender-matched controls were randomly drawn from the general population (n = 373,962). Exposure was use of the drugs and a number of covariates including other immunosuppressive drugs, corticosteroids, any cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, liver and kidney disease, prior fracture, and alcoholism. Azathioprine was associated with an increase in overall fracture risk, but besides this, none of the drugs was significantly associated with overall fracture risk or risk of hip, spine, or forearm fracture. Liver [odds ratio (OR) = 1.55, 95% confidence interval (CI) 1.42–1.69] and kidney (OR = 1.26, 95% CI 1.16–1.37) diseases were significantly associated with increased risk of fractures. Azathioprine was associated with an increase in overall fracture risk but not in the risk of spine, hip, or forearm fractures. Methotrexate and cyclosporine were not associated with fracture risk. It thus seems that the underlying disease for which the treatment is administered may be responsible for much of the increase in fracture risk rather than the drugs used to treat the disorder in question.