Hematomas and MRI at 0.15 T. Apropos of 100 cases

One hundred hematomas were examined by magnetic resonance imaging (MRI) at 0.15 T, all explored in SEpT1 and most in SEpT2. The number of cases examined in the acute phase during the first 48 hours was low: 8 cases. At this SEpT1 period the hematoma appears of elevated signal with good muscle contrast but without contrast in hepatic and cerebral parenchyma. In a weighted T2 sequence, the intense signals of cerebral edema and plasma or serum enables detection of the encephalic lesion. Findings from 68 hematomas observed in the subacute or chronic phase suggest that their appearance is pathognomonic with visualization in SEpT1 of a crown of an intense signal at least equal to that of fat. The only difficulty at this period is the discovery of a hematoma within the fat: orbital, retroperitoneal... The collection of a subdural hematoma usually appears homogeneous, the intensity of the signal varying with red cell concentration and time. In the soft tissues, the intensity of signal is a function of concentration of hemoglobin and its derivatives and of volume of serous effusion. Images of 24 hematomas during the sequelae phase confirmed the appearance of a "biochemical shell" without signal in SEpT2 and allowed detection of the hematic contents of an occupying process even after long periods, sometimes after one year.     

肘部训练伤88例报告

肘部训练伤较为常见,且肘部伤后直接影响上肢功能。为进一步了解其诊治及预防,现将我院1992～1998年收治88例肘部训练伤报告如下。     

高原28例疟疾的护理及预防

我院地处西藏高原，海拔3000m左右。近年来由于全球气候变暖，加之大量人员进驻我区造成人为环境污染，蚊虫滋生增多，导致经虫媒传播的传染病疟疾发病呈逐年上升的趋势。现将1998年7月～2002年8月我院收治的28例疟疾患者的护理及预防措施报告如下：     

高空飞行座舱压力突降两例

一、事件经过例1高性能战斗机飞行员,男,27岁,飞行时间800h。2005年12月3日15∶52该飞行员驾新机执行双机高空编队飞行(僚机位置),该架次为飞行员当日第3架次,飞机为第4个起落。在海拔11300m飞行时,飞行员突然出现腹胀,同时供氧系统开始向飞行员面罩加小余压供氧,座舱余压指示0.1kg/cm2(73.5mmHg),正常余压为0.3kg/cm2,座舱高度表指示8000m。立即询问长机座舱高度,回答座舱高度6300m。到海拔11800m时(由于发动机开加力运动贯性又上升了500m),座舱高度继续上升至8022m,座舱压力指示0.8kg/cm2。于是一边报告一边下降高度,降至11400m时告警器…     

高原阑尾炎119例临床分析

目的:分析高原阑尾炎病例的特点、发病原因、治疗及预后。方法:采集2002~2005年3月3年间收治的高原阑尾炎119例,进行临床诊断分析。结果:本组119例急性单纯性阑尾炎及化脓性阑尾炎,均经急诊手术或择期手术治愈。有并发症者经保守治疗或再次手术治疗而痊愈。其中肠瘘1例,死亡1例。结论:高原地区人烟稀少、交通不便,加之风俗习惯及迷信思想的误导,致使误诊误治。故应加强宣传教育、破除迷信,改善医疗条件,提高医务人员责任心和业务水平积极为少数民族防病治病。     

高原地区105例中小面积烧烫伤治疗体会

我院1996-04-1999-10共收治中小面积烧伤患者105例。由于本地区位于青藏高原,海拔3700m,空气稀薄、干燥、寒冷,日照时间长,紫外线强烈,氧含量比平原少三分之一,因而患者的生理特点及烧伤后的治疗反应均与平原地区不同,有待深入探讨。     

同侧股骨颈和股骨干骨折3例

Ｂｅｎｎｅｔｔ回顾了世界资料报告的250例病例,指出这种骨折占全部股骨干骨折的25%～6%[1]。随着我国经济发展,尤其交通工具的发展,这种损伤将会不断增加。本文对其受伤机制、诊断、治疗方面的特点,做一回顾性总结。1　临床资料11　一般资料　本组病例,共3例,男2例,女1例,年龄26～30岁,平均34岁,左2例,右1例,其中2例为交通事故伤,1例为高处坠落。3例都有合并伤,其中2例有膝并节骨折。本组有1例受伤时未发现股骨颈骨折,在外院急诊,原因为未照髋关节Ｘ线索片,入我院后行骨盆平片时发现无移位的骨颈基底部骨折。12　治疗方法　3例中均手术切开…     

高原地区血栓性静脉炎124例临床分析

临床和病理上都已证实,机体在高原环境下,易致血栓形成[1]。血栓性静脉炎是静脉的一种血栓性疾病,伴有不同程度的炎症。我院(海拔3658m)收治的124例血栓性静脉炎患者,探讨了高原地区血栓性静脉炎的发病特点及防治措施,现报告如下:     

高原颌面部雷管爆炸伤3例

通过对3例高原地区颌面部雷管爆炸伤救治病例分析,建议对高原环境下颌面部爆炸伤救治中及早吸氧并行气管切开术;只要伤口无明显感染症状,在彻底清创,严密缝合口内伤口的前提下,伤后48～72小时进行Ⅰ期清创缝合和骨折内固定术是可行的。     

A cluster of disseminated coccidioidomycosis cases at a US military hospital

We recently evaluated a cluster of cases of disseminated coccidioidomycosis referred to the Naval Medical Center San Diego. Between March and June of 2002, seven cases were diagnosed and treated. In a 5-year record review (March 1997-February 2002), we found only seven cases of disseminated disease attributable to Coccidioides immitis at the same institution. This report of seven cases over a 3-month period represents a 20-fold increase in the number of complicated C. immitis infections. All cases were non-Caucasians, had disseminated disease to bone and/or skin without meningeal involvement, and had a delay of 1.5 to 6 months from symptom onset until the diagnosis of coccidioidomycosis. Four of our cases occurred in previously healthy, young active duty members, emphasizing the importance of this mycosis in U.S. military personnel.     

38例院前猝死回顾性调查

目的分析老年患者发生院前猝死的危险因素。方法回顾性分析北京某社区1993-2004年38例老年院前猝死病例,调查猝死患者生前已诊断疾病情况,猝死前状态及诱因、发病季节及时间。结果高血压、冠心病、糖尿病是老年猝死患者生前罹患比率最高的前三位基础疾病,分别占78．94％、55．26％和44．73％。4月份猝死事件发生最多;73．68％发生在早6时～晚6时;发生在患者家中占81．57％。结论老年患者心血管疾病可能是导致猝死的主要原因,有心肌梗死、心律失常、心功能不全的患者是发生猝死的高危人群;事件发生突然,往往无明显先兆。     

Rhabdomyolysis observed at forensic autopsy: a series of 52 cases

Rhabdomyolysis is characterized by skeletal muscle injury resulting in the release of intracellular proteins (such as myoglobin) and electrolytes into the blood circulation, which cause acute kidney injury, myoglobinuria and electrolyte imbalances. Clinical diagnosis of rhabdomyolysis is made on the basis of biochemical analysis; however, for forensic autopsies, biochemical data are often not available, and it is necessary to diagnose rhabdomyolysis via histopathological examinations. This study analyzed 52 cases with rhabdomyolysis and applied myoglobin immunohistochemistry to kidney, urine and blood samples. We found that blunt force injuries were the most common cause of rhabdomyolysis across all age groups, and drugs were the second most common cause. The drugs included ketamines, amphetamines, synthetic cathinones, entheogens, benzodiazepines, opioid analgesics, and anesthesia. Less than 60% of our cases had biochemical data, including myoglobin (92.5~416,978 ng/mL), creatine kinase (220~774,015 U/L), potassium (1.6~10.3 meq/L), calcium (2.7~29.2 mg/dL), and phosphorus (2.6~14.2 mg/dL). In the kidney tissue sections, we found that 95% of the rhabdomyolysis cases were positive for myoglobin immunohistochemistry and that 96% were associated with acute tubular necrosis. Our findings describe the features of fatal rhabdomyolysis in a large series and suggest that myoglobin immunohistochemistry can be used in post-mortem blood and urine cell blocks to detect myoglobin.     

高原不同人群创伤失血性休克的综合治疗

目的 探讨高原（海拔〉3658m）不同人群创伤失血性休克患者综合治疗的特点。方法 对高原世居藏族（A组,n=276）、移居高原汉族（B组,移居高原〉3个月,n=189）和急进高原汉族（C组,进入高原1周以内,n=16）中度创伤失血性休克患者的救治过程进行回顾性分析。结果 高原创伤失血性休克患者的综合治疗措施主要有：（1）早期适量个体化液体复苏;（2）尽早输注浓缩红细胞、提高血液的携氧能力;（3）减轻创伤应激、积极保护胃肠道功能、预防全身和局部感染的发生;（4）减轻全身的脂质过氧化损伤,积极调节机体的免疫状态;（5）改善休克后机体的代谢状态;（6）改善组织的缺氧状态、纠正酸中毒;（7）特别注意防治肺、脑水肿。结论 A、B、C组患者对综合治疗措施依赖性具有显著差异,依次为C组〉B组〉A组。     

同时救治与护理3例严重烧伤病人的体会

目的：总结同时治疗与护理严重烧伤病人的经验体会。方法：对2006年8月,同时收治的3例严重烧伤病人予以综合性治疗,局部应用湿润烧伤膏（MEBO）治疗,全身实施以加强内脏保护为重点的治疗方案。结果：本组3例病人全部治愈,浅Ⅲ度以下的创面自行愈合,无内脏并发症。结论：大面积烧伤病人的治疗护理焦点在于,早期实施MEBO处理创面,实行全身系统治疗措施,保护内脏功能,加强整体护理,预防并发症的发生。     

高原部队胫骨结节骨软骨病42例

目的探讨高原特殊环境对胫骨结节骨软骨病（Osgood-Schlatter disease）发生的影响及在部队训练中的防治措施。方法结合文献复习，回顾分析本院近10年来收治的42例Osgood—Schlatter病的资料。结果42例48侧胫骨结节损伤中，非手术治疗5例6侧，手术治疗37例42侧。随访0．5～4年，疗效评价结果优良率87．5％。结论Osgood—Schlatter病在高原部队中发生率较高，部队应科学制定训练计划，改善训练方法和训练场地，加强训练过程中的防护，加强军训期间的卫生监督，以减少非战斗减员。     

Ganglion cysts at the gastrocnemius origin: a series of ten cases

Objective To describe ganglion cysts arising close to the origin of the medial and lateral head of gastrocnemius as identified on magnetic resonance (MR) imaging. Design and patients We present a series of ten cases of ganglion cysts arising close to the gastrocnemius origin from the medial and lateral femoral condyles. These were collected over a 6-year period from our imaging database. All patients attended for routine MR imaging of the knee with a variety of clinical presentations. Data collected included patient demographics, ganglion size, ganglion site, clinical presentation and ancillary MR imaging findings. The ten patients in this series consisted of seven males and three females, five right and five left knees, age range 27–68 years, mean age 40.6 years. Results The mean maximal dimension of the ganglion cysts was 26 mm, range 15–40 mm. The medial gastrocnemius origin was involved in eight patients and the lateral origin in two patients. The MR imaging findings consisted of both uni- and multi-loculated cysts, often containing numerous septations with fluid signal characteristics. The cysts were extra-capsular with no clear communication with the joint. One patient presented with a popliteal soft tissue mass and none of the cases required surgical intervention for cyst removal. Conclusions MR imaging may identify ganglion cysts arising in an intra- or extra-articular site around the knee. This series documents the MR imaging characteristics of ganglion cysts arising close to the gastrocnemius origin and discusses the relevance of this imaging finding.     

1 142例生活性手外伤的流行病学分析

目的 了解生活性手外伤的构成、分布特征及其影响因素。方法 对１９９７年４月￣１９９８年３月应诊的１１４２例急诊生活性手外伤患者进行问卷调查,并随机对其中１０２例患者进行随访。结果 患者的平均年龄为３６．２岁,男女性别比为１．７７：１;２０￣５０岁的青壮年占６２．２％（７１０／１１４２）;在家中发生的手外伤占４８．１％（５４９／１１４２）;开放性外伤占所有生活性手外伤的６９．０％（７８８／１１４２）