子宫动脉灌注化疗栓塞联合宫颈搔刮术治疗宫颈妊娠的临床价值

目的:探讨子宫动脉灌注化疗栓塞联合宫颈搔刮术治疗宫颈妊娠的临床价值.方法:回顾性分析15例宫颈妊娠患者的资料,均行双侧子宫动脉灌注氨甲喋呤(MTX),并使用明胶海绵粉和颗粒栓塞子宫动脉,栓塞术后24h观察血人绒毛膜促性腺激素(β-HCG)值与手术前的变化,第3天实施宫颈搔刮术.结果:15例患者双侧子宫动脉插管成功率100%.造影后经导管注入化疗药物及栓塞剂栓塞双侧子宫动脉,术后无严重并发症,术后24h血人绒毛膜促性腺激素(β-HCG)与术前比较明显下降,术后第3天行宫颈搔刮术胚胎组织易于剥离,出血量少在5～20ml之间.结论:子宫动脉灌注化疗栓塞联合宫颈搔刮术治疗宫颈妊娠,可有效的杀死胚囊,减少药物用量,易于刮除胚胎组织,防止发生致命性大出血,缩短病程,保全了患者的生育能力和生命安全.     

急诊行髂内动脉栓塞治疗16例骨盆骨折并大出血

目的探讨髂内动脉栓塞治疗骨盆骨折并大出血的临床效果。方法对16例骨盆骨折并大出血患者,经保守治疗无效,急诊行单侧或双侧髂内动脉造影,明确出血部位后,经导管用明胶海绵或弹簧圈栓塞。结果 16例骨盆骨折并大出血患者经髂内动脉栓塞后活动性出血停止,除1例死于术后70h外,绝大多数患者的出血性休克得到明显控制。结论髂内动脉栓塞是治疗骨盆骨折并大出血的一个快速、合理、有效的方法。     

宫颈妊娠的介入治疗

目的探讨子宫动脉化疗灌注加栓塞在治疗宫颈妊娠中的作用。方法对11例宫颈妊娠患者急诊行双侧子宫动脉选择性插管,灌注甲氨蝶呤(methotrexate,MTX)后,再用明胶海绵颗粒栓塞双侧子宫动脉,1周内再在B超引导下行刮宫术或吸宫术。结果11例患者均成功施行了子宫动脉化疗灌注加栓塞术,1周内顺利行刮宫术或吸宫术,术中出血量少。结论子宫动脉化疗灌注加栓塞术为宫颈妊娠患者的保守治疗提供了安全保障,为一种安全有效的治疗方法。     

子宫动脉化疗输注加栓塞术治疗剖宫产后子宫切口妊娠

目的:探讨子宫动脉化疗输注加栓塞术对剖宫产后子宫切口妊娠的应用价值。方法:对9例剖宫产后子宫切口妊娠患者急诊行双侧子宫动脉超选择性插管,输注氨甲喋呤(MTX)后,再用明胶海绵颗粒栓塞双侧子宫动脉,1周内再在B超引导下行刮宫术或吸宫术。结果:9例患者均成功施行了子宫动脉化疗输注加栓塞术,1周内顺利行刮宫术或吸宫术,术中出血量少。结论:子宫动脉化疗输注加栓塞术为剖宫产后子宫切口妊娠患者的保守治疗提供了安全保障,使患者避免子宫被切除,是一种安全、有效的治疗方法。     

子宫动脉化疗栓塞术在剖宫产瘢痕妊娠保守治疗中的作用

目的：探讨双侧子宫动脉化疗栓塞术在剖宫产瘢痕妊娠保守治疗中的作用。方法：回顾性分析我院自2007年1月-2009年3月临床确诊的剖宫产术后瘢痕妊娠患者38例,均合并程度不等阴道出血。其中28例出血相对较重患者行双侧子宫动脉氨甲喋呤灌注化疗及明胶海绵颗粒栓塞,术后第2-4天行人工流产（吸-刮宫术）,10例轻症患者药物保守治疗4-7 d后行吸-刮宫术。结果28例行双侧子宫动脉MTX化疗灌注及栓塞术的患者阴道出血迅速停止,吸-刮宫术中及术后出血量均少于100 ml。10例药物保守治疗患者中,5例吸刮宫术中大出血（其中1例子宫切除,4例行急诊子宫动脉栓塞止血）,5例出血少于1000 ml,采用宫缩剂、宫内填塞及输血等措施,出血逐渐停止。结论：双侧子宫动脉化疗栓塞术结合吸-刮宫术能快速终止妊娠,有效预防大出血,保留患者子宫,可以作为治疗此类疾病的常规保守治疗方法。     

急诊选择性动脉造影栓塞治疗产后大出血18例

目的:评估急诊选择性动脉造影栓塞治疗产后大出血的效果和安全性。方法:18例产后大出血病人,出血量1 000~3 500 ml,经保守治疗无效,使用急诊选择性动脉造影栓塞治疗。结果:动脉造影显示14例(77.8%)有造影剂渗漏,16例立即止血或逐渐止血,总有效率为88.8%。2例止血失败,行子宫切除术后止血。本组未出现严重并发症,除行子宫切除术的2例,所有病人术后月经正常。结论:急诊选择性动脉造影栓塞止血迅速、安全有效,当保守治疗无效时,是一种值得推荐的子宫切除术替代方法。     

剖宫产术后大出血的造影表现及介入治疗

目的探讨剖宫产术后大出血的造影表现及子宫动脉栓塞术治疗剖宫产术后大出血的临床疗效。 方法收集26例剖宫产术后大出血患者资料,出血量500～2500 ml。局麻下经股动脉穿刺,将4F Cobra导管选择至双侧子宫动脉,用自制的明胶海绵颗粒将子宫动脉分支栓塞,最后用明胶海绵块（条）栓塞子宫动脉主干。栓塞满意后,将导管退出子宫动脉至髂内动脉造影,证实栓塞完全。 结果患者均一次性插管成功,其中25例患者成功止血,栓塞后48 h内出血停止,血红蛋白（HGB）术前与术后分别为(65.3±7.4)g/L和（83.5±5.6）g/L,差别有统计学意义(P<0.01),无严重并发症发生。患者子宫动脉栓塞术后至康复出院的时间为1～8天,平均(3.9±2.2)天。 结论子宫动脉栓塞术治疗剖宫产术后出血,创伤小,成功率高,并发症少,住院时间短,大大降低了医疗风险,值得临床推广。     

产后大出血急诊栓塞治疗的不良反应及并发症探讨

目的:探讨动脉栓塞法治疗急诊产后大出血的不良反应及并发症及其防治。方法:对57例急诊产后大出血患者的双侧子宫动脉或和髂内动脉以及部分患者的卵巢动脉用明胶海绵颗粒进行栓塞。结果:所有病例均出现有栓塞术后综合征;1例患者出现血尿(1.8%);13例患者出现髋部及下肢疼痛、麻木(22.8%);19例患者出现臀部疼痛、红肿、硬结(33.3%);1例患者出现子宫性闭经(1.8%);全组病例未出现子宫坏死或卵巢功能减退等其它严重并发症。结论:产后大出血急诊栓塞治疗会出现一定的不良反应及并发症,在治疗过程中进行超选择性栓塞,不进行过度栓塞,严防栓塞剂返流,可避免大部分严重并发症的发生。     

急诊动脉栓塞治疗产后子宫大出血的临床应用

目的 :探讨产后子宫大出血急诊动脉栓塞的应用价值。方法 :本组 13例产后子宫大出血患者平均出血量2 2 0 0ml ,采用Seldinger法先行腹主动脉造影 ,明确出血动脉后 ,选择或超选择性插管 ,经导管注入明胶海绵颗粒和真丝线段栓塞。结果 :13例子宫大出血患者全部栓塞成功 ,随访 3个月仍无复发。结论 :急诊动脉栓塞治疗产后子宫大出血既安全、有效 ,又无严重并发症发生 ,值得临床推广使用。     

子宫动脉化疗栓塞缓解中晚期妊娠合并前置胎盘引产术出血的临床应用

目的 探讨子宫动脉化疗栓塞预防和治疗中晚期前置胎盘引产术中大出血.方法 2008年2月至2012年2月收治32例妊娠中晚期合并前置胎盘需终止妊娠者,按引产方式分为对照组14例(利凡诺羊膜腔注射引产)和介入组18例(选择性双侧子宫动脉化疗栓塞术联合依沙吖啶(利凡诺)羊膜腔注射引产),术后24 h应用低分子右旋糖酐、复方丹参促进子宫侧支循环建立.比较两组产后出血率和输血率.结果 对照组产后大出血7例,输血7例,其中有3例采用选择性双侧子宫动脉栓塞术,1例行子宫切除术,平均出血量为(930±163)ml;介入组均未发生大出血,平均出血量为(228±20)ml,无输血及子宫切除病例,两组间差异有统计学意义(P＜0.05).结论 选择性子宫动脉化疗栓塞术可以有效预防和治疗中晚期妊娠因合并前置胎盘引产而引起的产道大出血.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.