腰大池穿刺持续引流治疗难治性脑脊液漏的临床观察

目的探讨腰大池穿刺持续引流治疗难治性脑脊液漏的临床效果及注意事项。方法选择52例明确诊断为难治性脑脊液漏患者,均行腰大池穿刺持续引流及抗炎治疗。结果腰大池穿刺持续引流治疗难治性脑脊液漏疗效确切,持续引流2周后,脑脊液漏明显减少或消失。结论腰大池穿刺持续引流是治疗难治性脑脊液漏一种行之有效的方法,值得临床广泛推广,持续引流2周以上,而脑脊液漏无消失或减少趋势的患者应加强抗生素治疗,并根据情况选择手术治疗的可能。     

腰大池持续引流在神经外科中的临床应用体会

目的探讨腰大池持续脑脊液引流在神经外科应用的临床价值。方法回顾性分析2007年1月-2009年9月,12例患者进行了持续腰大池脑脊液引流治疗,其中切口漏8例,术后颅内感染2例,脑室内出血2例。结果持续腰大池脑脊液引流治疗脑脊液漏、颅内感染及脑室内出血的治愈率为91.66%,无颅内感染及脑疝等严重并发症。结论腰大池持续脑脊液引流是一种安全、有效、简单的治疗脑脊液漏、颅内感染及脑室内出血的方法。     

腰穿持续引流治疗难治性脑脊液漏

目的：探讨腰穿持续引流治疗难治性脑脊液漏的临床疗效。方法：对60例临床上由于各种原因导致的难治性脑脊液漏行腰穿持续引流，观察其疗效。结果：经治疗后有56例患者治愈，治愈率为93．3％。有1例并发颅内感染，经强效抗生素治疗后治愈。结论：腰穿持续引流为一种行之有效的治疗难治性脑脊液漏的方法。     

腰大池引流加鞘内注射治疗术后颅内感染及脑脊液漏

目的探讨腰大池持续引流加鞘内注射抗生素治疗颅内感染及脑脊液漏的方法及疗效。方法回顾性分析2004年1月至2008年12月收治的29例颅内感染合并脑脊液漏患者的临床资料。结果所有病例均行腰大池持续引流,其中18例行鞘内注射,临床治愈28例,死亡1例,临床治愈率96.6%,取得满意疗效。结论腰大池持续引流加鞘内注射抗生素能有效治疗颅内感染及脑脊液漏,感染控制时间短,有效降低颅内压,死亡率大大下降。     

持续腰大池引流在神经外科治疗中的应用

目的探讨持续腰大池引流在神经外科中应用的临床疗效。方法回顾性分析2004年7月至2009年10月经持续腰大池引流脑脊液治疗的110例神经外科患者的临床资料。在110例患者中,难治性脑脊液漏12例,颅内感染13例,蛛网膜下腔出血40例,脑室内出血45例。结果 12例脑脊液漏患者全部治愈,13例颅内感染患者治愈12例,40例蛛网膜下腔出血患者治愈38例,45例脑室内出血患者积血全部清除。引流期间无再出血、脑疝及继发颅内感染等并发症发生。结论持续腰大池引流脑脊液是治疗难治性脑脊液漏、颅内感染、蛛网膜下腔出血及脑室内出血的一种安全、有效的方法 。     

289例持续腰池脑脊液引流在神经外科应用的临床总结

目的：探讨持续腰池脑脊液引流在神经外科应用的临床价值。方法：回顾性分析１９９３年３月～１９９９年８月间,对２８９例患者进行持续腰池脑脊液引流治疗,其中切口漏４２例,脑脊液算漏２１例,硬膜下积液,颅内感染４３例,蛛网膜下腔出血１６１例。结果：持续腰池脑脊液漏、颅内感染、蛛网下腔出血的治愈率为１００％,无颅内感染与脑疝等严重并发症。结论：持续腰池脑脊液引流是一种安全、有效、微创的治疗脑脊液漏、颅内感染     

腰大池置管持续引流治疗颅内感染9例分析

目的探讨腰大池置管持续引流在临床上治疗颅内感染的疗效。方法分析阜新市中心医院2006-01-2010-12应用腰大池置管持续引流方法治疗颅内感染患者9例。结果临床治愈8例,死亡1例,治愈率为89%。结论腰大池置管持续引流治疗颅内感染安全可行,疗效确切,并发症少。     

腰池置管脑脊液外引流治疗颅内感染临床分析

目的 观察持续腰池置管脑脊液外引流治疗颅内感染的疗效.方法 2008年9月-2009年11月,将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例,外引流组进行持续腰池置管脑脊液外引流,定期取引流脑脊液进行常规和生化检查;抗生素组采用静脉抗生素治疗.对两组颅内感染情况进行对比分析.结果 外引流组经持续腰...     

腰大池引流治疗脑脊液漏及颅内感染的护理

目的探讨腰大池引流治疗脑脊液漏及颅内感染的护理要点。方法对68例用腰大池引流治疗病例的临床资料进行分析。结果23例颅内感染患者及45例脑脊液鼻漏患者经密切观察和护理后全部治愈。结论采用腰大池引流手段治疗脑脊液漏及颅内感染后,对患者进行密切观察及护理,是治疗成功的保障。     

脑外伤术后脑脊液漏伴颅内感染并发症的临床观察

目的探讨脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症的临床治疗方法及疗效。方法将83例脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症患者分为观察组(n=42)与对照组(n=41),入院后均行常规给予扩血管药物、改善脑循环药物以及抗抑郁药物进行对症治疗,对照组患者加行传统反复腰穿方法释放脑脊液,同时于鞘内注入稀释头孢曲松5~10 ml,1次/d;观察组采用腰大池置管持续引流进行治疗,同时经引流管行鞘内注射稀释头孢曲松5~10 ml,2~3次/d,另再加行高压氧治疗,比较两组治疗效果。结果观察组的临床症状缓解时间与感染控制平均时间均显著短于对照组(P0.001),脑脊液漏治愈及感染完全控制患者比例显著高于对照组(P0.01),重残率及死亡率显著低于对照组(P0.05);同时头颅CT检查结果显示,治疗后观察组颅内积气消失,对照组虽有一定程度缩小,但颅内积气仍然存在;治疗后两组患者的SAS、SDS评分均较治疗前显著降低,且观察组评分低于对照组,差异均有统计学意义(P0.001)。结论采用腰大池置管持续引流联合高压氧治疗脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症疗效满意,建议在临床广泛推广应用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.