闭合性腹部损伤120例临床分析

闭合性腹部损伤是腹部创伤中最常见的腹部外伤。腹部实质性脏器易损伤,致伤原因复杂,临床诊断,治疗难度大。我们通过回顾性总结闭合性腹部损伤患者120例的诊疗情况,旨在探讨其诊治方法。     

闭合性腹外伤509例诊治分析

由于腹腔内脏器多，加之腹部损伤时多数致伤机制复杂，病情严重，给临床诊治带来一定难度，如急救不当，常造成严重后果，甚至危及患者生命，现就腹部闭合伤509例诊断及治疗体会报告如下。     

35例闭合性腹外伤急救措施探讨

腹部损伤是常见的外科急腹症,由于腹腔内脏器多,加之腹部损伤时多数致伤机制复杂,病情严重;常合并多器官,多部位损伤,并且早期诊断困难,常危及病员生命,病死率可高达10%.我院自1990年1月～2004年12月,急诊手术治疗闭合性腹部外伤35例,报道如下：     

瓦斯爆炸伤及几种特殊烧伤的急诊处理

1 瓦斯爆炸伤 煤矿井下有可燃气体如甲、乙、丙烷,乙烯,硫化氢等统称瓦斯。瓦斯狭义概念是指甲烷,在井下安全浓度不超过1％,达5％时就有爆炸危险,达8％～10％爆炸力最强。它的主要致伤原因有:①压力:通常约7.4～10大气压,其冲击波和反冲击波作用于人体易发生复合性损伤如颅脑、胸部、腹部及骨骼等。冲击伤特点是多发伤、内轻外重、病情发展迅速很快休克。②温度:爆炸的一刹那间,温度可高达2850℃,但因冲击波作用下风     

成批瓦斯爆炸烧伤特点及治疗体会

近年来瓦斯爆炸烧伤在烧伤治疗中时有发生.爆炸时多人同时受伤,且致伤因素多、伤情复杂,救治任务繁重.现将我科1999年至2004年收治的11批煤矿瓦斯爆炸烧伤83例住院患者资料进行分析,报告如下.     

外伤性胃损伤9例诊治体会

胃的损伤在腹部损伤中比较少见,在腹部穿透伤中多见。在腹部闭合伤中很少发生．许多人对此不太认识,易于误诊,其临床表现也有一些明显的特点。我院自1988年至2004年3月,共收洽外伤性胃破裂9例,均在术前有较明确的诊断,治疗效果良好,无死亡及相关的并发症,现介绍如下。     

上腹部损伤的CT表现

上腹部损伤是较为常见的事故性损伤。由于受伤突然、病情进展快,病死率较高。本研究通过对66例上腹部损伤患者影像学检查资料进行观察和分析,旨在为提高临床诊断准确率,降低致死率提供可靠的理论依据,现报告如下。     

腹腔镜在外科急腹症和腹部创伤的应用及进展

七十年代后，随着冷光源、光导纤维技术的高速发展，腹腔镜技术进步很快，应用范围日益广泛。现就诊断和治疗性腹腔镜检查在外科急腹症和腹部创伤的应用及进展的有关问题加以综述，供参考。一、诊断性腹腔镜检查直至目前，外科急腹症和闭合性腹部损伤的早期诊断仍然是急症外科需要进一步解决的重要问题之一［１－３］。外科急腹症往往由于临床征象不十分典型而造成误诊。闭合性腹部损伤的早期诊断也比较困难，这是因为在闭合性腹部损伤伴有引起意识障碍的多发性损伤（颅脑损伤、多发性骨折、脊柱和骨盆骨折等）时，腹部临床症状常常不典型，…     

诊断性腹腔穿刺

诊断性腹腔穿刺的临床意义? 诊断性腹腔穿刺(以下简称为腹穿),国内外许多学者均在临床应用中证实了它的价值。以腹部损伤有无脏器破裂为例,借助于腹穿而早期获得确诊的阳性率可高达83%。对于那些临床表现不典型,或疑难复杂的腹部疾患,往往可以通过对腹穿     

腹部外伤98例诊治分析

目的总结分析腹部外伤的致伤原因、临床特点和治疗措施。方法通过观察98例患者致伤情况、临床表现，结合B超、腹腔穿刺等，做出早期诊断，并实行手术治疗。结果98例患者均行剖腹探查证实。93例治愈出院，5例死亡。结论腹腔脏器多，致伤机制较复杂，尤其是闭合性腹外伤和复合伤容易延误诊断和漏诊，及时剖腹探查甚为重要。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.