上海医学会第八届放射学专科委员会名单

名誉主委冯晓源主任委员陈克敏副主任委员李明华，刘士远，耿道颖秘书宋济昌，许建荣委员(排名不分先后)余强，叶剑定，王建华，滑炎卿，赵泽华，潘自来，王篙，张贵祥，曾蒙苏，李克，李群英，李茂全，李玉华，姚伟武，程红岩，彭卫军，杨军上海医学会第八届放射学专科委员会名单@本刊编辑部~~     

军团菌肺炎1例报告

军团菌病罕见，我科收治三例现报告如下：病例介绍患者男性，69岁，干部。发烧二十多天入院，入院前因受凉后出现咽痛、流涕、体温高达39．0℃，平均体温38℃左右，多在下午和晚上发烧，无盗汗现象，不咳嗽，胸不痛，门诊用青霉素、先锋霉素等治疗，效果均不明显，体温忽高忽低，收入院治疗。入院检查：体温37．6℃，脉搏96次／min，血压15／8kpa，发育正常，营养中等，神志清楚，呼吸平稳，查体合作，言语流利，巩黄（一），表残淋巴结不大；咽部充血，扁桃腺不大，心肺听诊未见明显异常，腹部无压痛，肝脾未及，四肢活动正常，双下肿不肿…     

跨颅窝的高密度皮样囊肿一例

患者女，31岁，因恶心，呕吐6个月，头痛伴多饮，多尿，朋经紊乱3个月入院。体检：神志清楚，对答切题，定向力，理解力，记忆力正常；右侧嗅觉丧失；双侧视力，视野正常，双侧瞳孔等大，等圆，直径3mm，双侧眼球活动自如，光反射（＋＋），右侧角膜反射（＋），     

颈静脉孔区神经纤维瘤一例报告

颈静脉孔区神经纤维瘤较为罕见，我院收治1例，现报告如下，女，52岁，病案号：75257，于20年前摔下马昏迷3天，1978年初右耳鸣，听力减退，讲话嘶哑，逐渐出现头痛，头晕，恶心，呕吐，喝水呛咳，咀嚼食物困难，舌右侧半皱缩，转颈受限，右颜面部麻木，步态不稳，因症状加重，于1982年9月25日入院。     

胸腺瘤破裂出血一例

患者 男，48岁，因运动中突发左胸疼痛，呈持续性，伴气促，不能平卧7h就诊，既往身体健康，无类似病史。体检，急性痛苦面容，胸廓无畸形，左侧呼吸运动较右侧稍减弱，胸廓无压痛及叩击痛，心界不大，心率90次/min，心音有力，节律齐，未闻及杂音及心包摩擦音，左下肺叩诊浊实音，呼吸音减弱，余肺呼吸音清晰，未闻及干湿性罗音，生命体征正常，实验室检查未见异常。     

飞行员肾综合征性出血热一例

患者，男，35岁，歼-8飞行员，总飞行时间2000h。因发热4d于2003年2月8日入院。患者入院前4d无明显诱因出现发热，体温在39℃以上，最高达40．2℃，不伴有咳嗽、咯血，无流涕、鼻塞，无胸闷、无呼吸困难，伴有头痛，眼眶痛，腰痛，肌肉酸痛，周身乏力，在当地静滴青霉紊2d无效，入院。患者既往身体健康，无肝炎及其他病史，发病前1个月曾做大体检未见异常，飞行合格。本次患病前一直在飞行。入院时查体：体温39．4℃，呼吸19次／min，脉搏96次／min，血压102／62mm Hg，颜面，颈部，前胸潮红，咽红，眼球结膜充血，周身皮肤黏膜未见出血点，心肺腹未见异常，肾区有叩击痛。     

上肢末稍进行性坏死1例的病原学诊断

上肢末稍进行性坏死１例的病原学诊断１００７００北京北京军区总医院武仰晶，徐建国，刘维伦，魏涛，阵民钧，马纪平，尹秋生，赖心河，许淑珍关键词细菌，厌氧；感染；坏疽，协同性中国图书资料分类号Ｒ６３４１病例报告患者，女性，１３岁，山东籍，于１９９４年７月中...     

飞行员甲状腺功能亢进误诊发生空中晕厥两例

１　临床资料例１男，３５岁，歼－７飞行员，总飞行时间１７００ｈ，缘于１９９１年底，患者出现睡眠差，白天精力不集中，头痛，头晕，乏力，心悸，多汗，飞行中常出现困倦、黑视。１９９２年９月３日一次飞仪表科目，平飞状态出现意识丧失约３０ｓ，醒后全身无力，大汗淋漓，由后舱飞行员协助返航。在队休息一周，症状未减轻，活动后又出现气短，故入院。体检无明显阳性体征，血生化，胸片、Ｂ超、心脑电生理等项辅诊检查正常，患者体力极差，难以用功能性疾病解释，又查血Ｔ３３．５８μｇ／Ｌ，Ｔ４１８１μｇ／Ｌ，ＦＴ３１０．８４ｐ…     

色素性肝硬化1例

患者男性，42岁，因“发热、腹痛14小时，呕吐2次，意识模糊2小时”入院，患者入院前6小时因腹部隐痛、低热（37．8℃）于外院门诊进行治疗，家属否认肝病史及饮酒史。入院查体：T39．8℃，R30次／min，P130次／min，BP0／0mmHg。急性病容，消瘦，重病容，皮肤黝黑，色素沉着，以面部及手背为主，面色晦暗，表情淡漠，神志模糊，查体不合作，皮肤粘膜未见出血点、皮诊，浅表淋巴结不肿大，巩膜无黄染,咽和扁桃体未见明显充血肿大，颈软无抵抗，心肺听诊正常，腹部未见腹壁静脉曲张，全腹弥漫性压痛、反跳痛，腹肌轻度紧张。     

挥鞭伤致颅颈交界处硬膜外血肿一例

患者男，48岁，因交通伤20min入院。致伤经过：驾驶高速行驶的汽车紧急避让时，不慎撞上路旁大树，汽车反弹、停驶，过程中患者躯体急速前冲，双前臂、前胸碰撞方向盘后躯干后弹，头颈呈挥鞭样运动，未受直接暴力，伤后昏迷10min。入院时患者意识清楚，较烦躁，稍气促，头颈项疼痛，口咽不适，痰多外流，发音低弱。体检：呼吸浅快，25次／min，双瞳等大，光反射存在，口鼻无出血，咽及气管无异常，颈、胸皮肤无异常，双肺呼吸音清，四肢肌力可，生理反射存在，病理征阴性。头颈CT提示“颅内蛛网膜下腔出血，颈椎无异常。”     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Temporal changes in the oxidation state in in vitro blood

The rates at which the paramagnetic compounds deoxyhemoglobin (Hb) and methemoglobin (MHb) form in vivo within an area of hemorrhage are unknown. The present experiment establishes the baseline concentrations and rates of change in paramagnetic hemoglobin concentrations, as well as the pH in normal heparinized and clotted human blood maintained in vitro at 37 degrees C under anaerobic conditions over 30 hours. There was a moderate increase in Hb concentration in normal heparinized blood (average increase was 15.5%, rate = 0.50%/hour) and a slight increase in MHb concentration in the heparinized blood and clots (average increase was 1.4%, rate = 0.044%/hour). A second experiment was done to verify the activity of the RBC systems responsible for maintaining the hemoglobin molecule in the reduced state. Conversion of MHb to Hb in these samples proceeded at a rate of 5.6%/hour. In a third experiment, blood from 11 normal subjects maintained at 4 degrees C 25 degrees C was analyzed for MHb concentration over the course of 28 days. The level of MHb formation remained in the range of normal for at least 11 days in all subjects. The authors conclude that at basal conditions created in vitro, the blood levels of both Hb and MHb remain at relatively low levels. Therefore, if the accumulation of Hb and/or MHb occurs in acute in vivo hematomas it must be driven by intrinsic tissue factors.     

Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.     

我国医用辐射防护研究概况

医学放射学技术的迅速发展及介入放射学在临床广泛应用，使更多的人受到电离辐射的照射，同时也促进了医疗照射防护工作的发展。文中重点综述了我国医用辐射防护工作者近年来在Ｘ射线ＣＴ的医疗照射防护、对介入放射学工作者的剂量监测以及应用医疗照射防护体系，降低医疗照射剂量等方面所作出的成绩和研究进展     

新时期军医学院人才培养的思考

在新的历史条件下 ,军医学院迎接未来高技术局部战争的挑战 ,适应部队武器装备的不断更新以及医学科技、社会发展对人才素质提出的新要求 ,必须在更为广阔的时空背景下找准人才培养的着眼点 ,科学确立人才培养方向 ,提高人才培养质量。现就人才培养思考如下 :1　改变教育观念 ,     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。