小肠血管畸形数字减影血管造影的诊断及介入治疗价值

目的：探讨DSA诊断小肠血管畸形的价值。方法：本文分析21例小肠血管畸形患者的临床及DSA特征,其中男性14例,女性7例,所有患者均行肠系膜上、下动脉造影。结果：临床特征：①急性消化道出血为主症状;②常规检查一般为阴性;③血红蛋白含量短期内降至4～6g／mL。DSA特征：①动静脉瘘;②局部肠壁染色增浓;③局部血管异常增多,结构紊乱。其中12例进行了动脉导丝栓塞,2例栓塞后出血,进行外科手术切除。结论：DSA是诊断血管畸形所致小肠出血的最有效的方法,动脉导丝栓塞是安全,有效的治疗方法,同时为外科手术切除提供的正确部位。     

消化道出血的血管造影诊断价值

目的　探讨消化道出血的血管造影诊断价值。方法　收集消化道出血行DSA血管造影患者92例,观察造影表现,评价其诊断价值。结果　造影阳性者4 8例,占5 2 .2 % ,急诊组31例,择期组17例,其中,有出血直接征象者18例,占19 5 %(18/ 92 ) ;行介入治疗2 8例,其中,灌注法2 0例,栓塞法8例。结论　血管造影是消化道出血的有效诊断方法。     

不明原因消化道出血68例诊治分析

目的：探讨不明原因消化道出血的诊断和治疗；方法：将胃镜、肠镜及全消化道钡餐均未明确消化道出血部位及瘸四曲病人行肠道血管造影、双气囊推进式小肠镜及胶囊内镜检查，必要时剖腹探查。结果：小肠血管畸形、克罗恩病、小肠肿瘤及小肠憩室是不明原因消化道出血的主要原因。分别给予内科综合治疗，出血血管栓塞，内镜下介入治疗及外卞牛手术治疗。讨论：对于不明碌因的消化道出血病人选择性做肠道血管造影、双气囊推进式小肠镜、胶囊内镜及剖腹探查是明确诊断的有效方法，根据病情选择不同的治疗方案。     

经皮肾镜取石术术后迟发出血的动脉造影与栓塞治疗

目的 评价数字减影血管造影及超选择性动脉栓塞在诊断、治疗经皮肾镜取石术后迟发出血患者的临床价值.方法 对18例经皮肾镜取石术后迟发出血的患者采取选择性肾动脉造影检查,明确诊断后选用明胶海绵颗粒或弹簧钢圈行超选择性动脉栓塞.结果 18例患者中17例造影阳性,其中表现:单纯假性动脉瘤6例,动静脉瘘2例,假性动脉瘤并动静脉瘘3例,片状对比剂外溢6例.17例阳性患者中16例行1次栓塞后成功止血,1例行2次栓塞后止血,18例均治愈出院,无肾脏切除.随访6个月均未再次出血.结论 经皮肾镜取石术后迟发出血在数字减影血管造影中表现典型,超选择性动脉栓塞创伤小,疗效显著,是治疗经皮肾镜取石术后迟发难以控制的出血的重要方法.     

动脉造影和栓塞治疗在急性消化道出血中的应用价值探讨

目的探讨急性消化道出血的动脉造影表现和栓塞治疗的疗效及临床价值。方法23例急性消化道出血患者分别行腹腔动脉、肠系膜上动脉和肠系膜下动脉造影,对其中造影明确诊断12例进行超选择插管并行栓塞治疗,栓塞材料分别为明胶海绵颗粒、明胶海绵颗粒＋弹簧圈、聚乙烯醇微粒。结果23例中15例出现阳性征象,主要表现为对比剂外溢、动脉瘤、肿瘤血管和染色、动脉侵蚀、局部血管痉挛等,12例接受了栓塞治疗,其中10例出血停止,30d内无再出血,无肠缺血、肠坏死等并发症,1例栓塞后次日死于多器官功能衰竭,1例栓塞3d后复发出血,经外科手术治疗痊愈。结论动脉造影及栓塞治疗是急性消化道出血安全有效的诊断和治疗方法。     

动脉内药物灌注或／和栓塞对消化道出血的治疗价值

本文对75例出血原因不明消化系疾病患者(食管胃底静脉曲张出血6例、胆道出血9例、其它原因上消化道出血15例、小肠出血29例、结肠出血11例)施行了经动脉血管造影检查,不仅明确了诊断,而且经药物灌注(垂体后叶素等)或/和栓塞治疗达到了止血目的。这表明经动脉血管造影系一种重要的诊治手段。     

急性消化道大出血的造影诊断及介入治疗

目的：研究急性消化道大出血的造影诊断及介入治疗的临床应用。方法：对21例急性消化道大出血的患者采用Seldinger技术经股动脉穿刺插管，分别行超选择性腹部动脉分支数字减影血管造影检查。明确出血部位后，经导管行病变血管栓塞术或保留导管灌注垂体后叶素。结果：本组21例患者．16例发现异常，阳性率约76％，表现为造影剂外溢征8例、动脉瘤样改变3例、肿瘤3例、畸形血管团2例。13例经介入栓塞治疗后止血成功率为100％；5例经介入治疗后手术切除病灶。结论：超选择性腹部动脉血管造影对急性消化道大出血的定位及定性诊断有重要价值，同时经导管栓塞或灌注治疗是一种安全有效的止血方法，也为手术切除病灶创造了条件。     

Dieulafoy 病的诊断与治疗(附17例报告)

目的 分析Dieulafoy病引起消化道大出血的发病机制,探讨其临床特点和诊断、治疗方法.方法 回顾性分析10年间经内镜、消化道造影及实验室检查和/或手术、病理确诊的17例患者的临床资料.结果 17例确诊为Dieulafoy病的住院患者均行急诊胃镜检查,阳性9例,其中2例为胃镜复查阳性;结肠镜检查9例,阳性6例;血管造影2例,阳性1例;胶囊内镜检查1例阳性.手术治疗小肠Dieulafoy病2例,其余内镜下止血治疗均一次成功.所有患者出血停止出院.结论 消化道大出血是Dieulafoy病的主要临床表现,其诊断主要依靠内镜检查和血管造影,确诊须靠手术和病理诊断.内镜诊断和治疗是Dieulafoy病诊治的首选方法.内镜治疗安全方便,创伤小;手术对Dieulafoy病的治疗仅适用于多次内镜治疗无效、小肠血管畸形以及诊断未明而大量反复出血患者.     

数字减影血管造影诊断及介入治疗不明原因下消化道出血

目的:分析数字减影血管造影诊断及介入治疗不明原因下消化道出血的临床效果。方法:选取我院2018年1月-2019年10月收治的不明原因下消化道出血患者144例为研究对象,将其随机分成对照组和观察组两个组别,每组患者各72例。对照组患者实施胃镜检查和常规治疗,观察组患者采用数字减影血管造影诊断及治疗。诊断治疗后,分析血管造影显示结果以及两组治疗有效率。结果:观察组患者检查出出血病灶的61例,检出率为84.7%。造影显示血管粗大,丛状、囊状扩张则为血管畸形25例;造影显示血管紊乱、肿瘤染色引流静脉粗大则为肿瘤,小肠肿瘤10例,回盲部肿瘤6例,结肠肿瘤8例;造影显示血管团异常,结构复杂则为小肠憩室7例;造影显示血管变粗,造影剂外溢则为回盲部溃疡5例。54例患者使用栓塞治疗,7例采用灌注垂体后叶素治疗;观察组患者痊愈例数为31例,有效例数为39例,无效例数为2例,总有效率为97.2%,对照组患者痊愈例数为26例,有效例数为37例,无效例数为9例,总有效率为87.5%,观察组患者的治疗总有效率显著高于对照组患者的总有效率。数据差异显著(P<0.05)。结论:对不明原因下消化道出血疾病采用数字减影血管造影诊断及介入治疗,可以提高检查出血病灶的检出率,明确出血位置,有效止血,提高治疗有效率。在临床中具有重要作用,值得推广普及。     

数字减影血管造影对不明原因消化道出血的诊断和治疗价值

目的:探讨数字减影血管造影(digital subtraction angiography,DSA)对不明原因消化道出血病例的诊断和治疗价值。方法:回顾性分析67例因不明原因的消化道出血行DSA的患者的临床资料。DSA采用Seldinger技术,行肠系膜下动脉、肠系膜上动脉、腹腔动脉造影,分析造影征象以对出血部位和病因作出诊断。根据不同出血原因采用栓塞、药物收缩血管等方法进行介入治疗,并对外科手术治疗的病例采用导丝或导管进行术前定位。结果:DSA检测出血病灶的阳性率为43.3%,其中小肠出血占37.9%,结肠出血占62.1%。手术和造影证实,肿瘤性出血8例(27.6%),非肿瘤出血21例(72.4%),两者差异有统计学意义(P<0.01)。结论:DSA对不明原因消化道出血有较好的诊断和治疗价值;并且在造影中发现出血部位后置入标记物,可以为手术中寻找病变部位提供很有效的定位标记。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.