大剂量甲基强的松龙冲击治疗急性脊髓损伤疗效分析

目的研究大剂量甲基强的松龙(MP)治疗急性脊髓损伤的临床效果.方法对87例急性脊髓损伤患者进行回顾性研究,根据伤后时间并按自愿选择用药原则分为应用MP治疗组(MP组,45例)和未应用MP治疗组(对照组,42例),以ASIA分级标准进行分级,并比较疗效和并发症.结果两组患者在治疗前后感觉及运动功能均有明显改善(P＜0.05).但MP组的感觉及运动功能恢复均优于对照组(P＜0.05).MP治疗组中24h治疗组(A组)与48h治疗组(B组)并发症发生率比较无显著性差异(P＞0.05),而MP组与对照组比较并发症的发生率明显增加,有显著性差异(P＜0.05).结论早期应用MP大剂量冲击治疗急性脊髓损伤是一项有效措施,但会显著增加患者治疗中并发症的发生率.     

161例肾损伤的处理

目的探讨严重肾损伤的概念及治疗方案。方法对１９６５至１９９６年收治的１６１例严重肾损伤病例资料进行回顾分析。结果１６１例病人,伴有合并伤１１６例（７２．０％）。保守治疗７７例,发生并发症６例,治愈率９２．２％;手术治疗７３例,其中肾切除３２例,切肾率１９．９％;选择性肾动脉栓塞治疗１１例,治愈率１００．０％;死亡１５例,死亡率为９．３％。结论（１）强调手术治疗与非手术治疗的指征。（２）对有合并伤者,应全面、准确、及时的进行伤情评估。（３）对疑有内脏损伤者,应仔细探查,发现损伤应一并处理。     

Hypoxic-ischaemic brain injury (HIBI) after cardiopulmonary arrest

Hypoxic-ischaemic brain injury (HIBI) is unfortunately a common complication after cardiopulmonary arrest (CPA) with devastating neurologic complications. Intensive care unit (ICU) management is initially aimed at cardiovascular stabilization and correction of the underlying cause of arrest such as ventricular fibrillation (VF), myocardial infarction from symptomatic coronary artery disease (CAD), or respiratory arrest. Once the patient is stabilized from a cardiac standpoint, growing evidence suggests that therapeutic hypothermia may provide cerebral neuroprotective benefit for VF-related CPA. Practical ICU evaluation and implementation of therapeutic hypothermia is discussed. Evaluation and management of HIBI-related autonomic disturbances or paroxysmal autonomic instability with dystonia (PAID) is discussed. Finally, we review the literature regarding neurological prognostication after cardiac arrest and the tests with highest specificity that can aid in the decision-making process.     

Dupatta (scarf): a unique cause of cervical spine injury in females

INTRODUCTION: Dupatta (scarf) is a part of the traditional dress for females in the Indian subcontinent. Working near machinery, riding a motorcycle or cyclerickshaw, can result in entanglement of dupatta in moving parts of machinery and subsequent cervical spine injury. It is seen most commonly in rural areas, with farmyard equipment. MATERIAL AND METHODS: A retrospective study was performed between January 2004 and January 2006, on all the patients presenting with cervical spine injury secondary to dupatta entanglement in machinery. They were assessed for mode, level of injury, neurological status, associated complications, radiological picture and clinical outcome. RESULTS: There were 12 such cases of cervical spine injury. The most common cause of injury was a threshing machine. All cases except one had quadriplegia (ASIA grade A) with bladder and bowel involvement. There was loss of consciousness in nine patients. Three patients expired. There was no neurological recovery in any patient. CONCLUSION: Dupatta is a unique cause of cervical spine injury in females, especially in rural areas. Easy methods of prevention may be helpful in preventing such injuries.     

Computerized tomography (CT) in patients with head injuries

Summary In a retrospective series of 144 patients with cranial trauma admitted to the Department of Neurosurgery, 96 were initially examined by CT. The initial clinical assessment, operative findings, if any, and the clinical course were compared to the results of the primary CT scan. In patients presenting lateralizing deficits, 49% had lesions on the expected side, and 23% on the opposite side. Thirty-one per cent of brain stem affected patients had a supratentorial mass lesion requiring craniotomy. Three decerebrate patients who died had an initially normal CT scan. Thirty craniotomies were performed on the basis of the CT scans, and six cases deviated from the expected, but no case showed a false positive indication for surgery. The final diagnosis was in accordance with the initial clinical diagnosis, and with the initial CT scan in 44% and 84%, respectively, of all cases.Parts of the material have been presented at the Congress of Scandinavian Neurosurgical Society at Oulu, 1979.     

肾损伤的诊断和处理（附185例报告）

目的提高肾损伤的诊疗水平。方法分析185例肾损伤的临床资料并结合献讨论本病的诊断和治疗。结果B超检查128例,105例有异常表现(8296),IVU检查阳性56／72例(77．8％),CT检查阳性68／68例(100％),非手术治愈156例(84．3％),手术治愈24例(13％),选择性肾动脉栓塞治愈2例(1．1％)。结论B超检查快速安全无损伤,可初步判断肾损伤情况,CT检查准确率高,并能同时了解其他脏器损伤的程度,治疗取决于肾损伤的程度,保守治疗是重要的治疗方法。     

尿道会师术325例

报告４４年间因新鲜尿道损伤行尿道会师术并有随访结果者３２５例，总治愈率为５８．７％。认为尿道会师术应作为膜部尿道损伤的首选治疗方法；其操作强调动作轻巧，不宜反复勉强会师；严格掌握尿道会师术指征；后期坚持尿道扩张十分重要，须由专科医师实施     

十二指肠损伤的诊断和外科治疗(附16例报告)

目的探讨十二指肠损伤的诊断和外科治疗方法。方法回顾性分析16例十二指肠损伤患者的外科手术治疗方式。结果16例十二指肠损伤患者中12例为腹部多发伤,全部病例均手术治疗,术后并发症发生率为18.8%,死亡率6.25%。结论早期诊断、果断的手术探查、选择合理的手术方式、有效的十二指肠减压和充分的引流是提高治愈率、降低术后并发症的关键。     

Neuropsychiatric correlates of traumatic brain injury (TBI) among Australian prison entrants

Primary objective: To investigate the association between reported past traumatic brain injury (TBI) and demographic, neuropsychiatric and criminographic parameters among individuals recently received into custody.

Research design: A random sample of men recently received into the New South Wales (Australia) criminal justice system were screened for a history of TBI and the details of up to five separate TBI episodes were obtained. We also screened for depression, psychosis, personality disorder, drug and alcohol use, and 'social connectedness'.

Main outcome and results: Among the 200 study participants, 82% reported past TBI. TBI was associated with a history of engagement in contact sports, school expulsion, daily illicit drug use, depression and psychosis.

Conclusions: Past TBI is common among prisoners entering the criminal justice system and, amongst other correlates, appears to be highly associated with increased rates of major mental illness.     

New injury severity score (NISS) outperforms injury severity score (ISS) in the evaluation of severe blunt trauma patients

Purpose: The injury severity score (ISS) and new injury severity score (NISS) have been widely used in trauma evaluation. However, which scoring system is better in trauma outcome prediction is still disputed. The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes, including mortality, intensive care unit (ICU) admission and ICU length of stay. Methods: The data were collected retrospectively from three hospitals in Zhejiang province, China. The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics. Results: A total of 1825 blunt trauma patients were enrolled in our study. Finally, 1243 patients were admitted to ICU, and 215 patients died before discharge. The ISS and NISS were equivalent in predicting mortality (area under ORC curve [AUC]: 0.886 vs. 0.887, p ¼ 0.9113). But for the patients with ISS 25, NISS showed better performance in predicting mortality. NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay. Conclusion: NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS. Considering the convenience of NISS in calculation, it is advantageous to promote NISS in China’s primary hospitals.     

胰腺外伤的诊治和治疗(附3例报告)

目的探讨胰腺外伤的诊断、分型和治疗。方法本文对近1年诊治的腹部外伤中胰腺外伤3例进行回顾性分析,其中1例为胰腺头体交界处横断伤,1例为胰体尾裂伤,1例为胰腺外伤误诊后假性胰腺假性囊肿形成。结果3例胰腺损伤患者,均经手术治疗后痊愈出院,无并发症发生。结论对于有上腹部外伤的患者,外科医生要警惕胰腺外伤的可能,怀疑胰腺外伤的术中应仔细探查胰腺。强调胰腺外伤的早期合理治疗,有利于减少并发症和降低死亡率,手术方式视外伤分类而定。     

外伤性结肠破裂27例治疗体会

目的探讨创伤性结肠损伤的处理方法以及一期手术的安全性和有效性。方法回顾性分析2001年5月～2007年5月收治的27例结肠损伤病例的临床资料。结果本组病例合并多发伤患者21例。全部病例均经急诊手术,23例(85.2%)行一期手术,其中17例行单纯修补术,切口感染2例;6例行破裂结肠部分切除吻合术,吻合口漏1例,切口感染1例。4例(14.8%)行单纯近端结肠造口 局部引流术,切口感染1例。除1例因胸腹部严重复合伤死于MODS外,其余患者均痊愈出院。结论创伤性结肠损伤一期手术对绝大多数结肠损伤是安全可靠的,值得临床应用。     

肾动脉栓塞术的临床应用（附57例报告）

报告肾动脉栓塞术５７例均栓塞成功。以明胶海绵、钢丝圈采用整体式栓塞用于肾恶性肿瘤５０例，７ｃｍ以上的肿瘤４８例，占９６％。根治性肾切除者平均出血量１１５ｍｌ；５例栓塞前未能切除或放弃手术而栓塞后得以切除。以自家凝血块，明胶海绵超选择性栓塞用于肾出血７例，均获立即止血。栓塞后患者可有程度不等的腰痛，发热。栓塞后４８小时以内手术者４０例（８７．５％）。本组未见合并症。认为肾动脉栓塞术迅速、安全、有效，可用于肾癌术前的辅助治疗及肾癌晚期的姑息治疗和各种出血性疾病。     

Laparoscopy and major retroperitoneal vascular injuries (MRVI)

Injury to major retroperitoneal vessels is a potential serious complication of laparoscopy occurring when the Veress needle or trocar is inserted. This report is a review of major retropertioneal vascular injuries (MRVI) occurring during laparoscopy, as these injuries have not been well documented in the literature. A retrospective, observational review of general surgical laparoscopy cases was conducted over a 3.5-year period in three community, university-affiliated hospitals. We identified 4 MRVI in 3591 laparoscopic procedures. These cases were critically analyzed and compared. The incidence of MRVI was 0.1%. All cases occurred with the closed (blind) insertion technique of Veress needle and primary trocar insertion technique with disposable safety shield trocars. All patients sustaining MRVI had acute hypotension introperatively and significant blood loss necessitating postoperative transfusions. Recognition and rapid conversion to laparotomy are keys to enhancing outcome. There is significant potential for morbidity and mortality with laparoscopic MRVI, although each patient in this series was discharged without obvious short-term problems. The advantages of an open approach for primary trocar insertion are numerous and should alleviate the risk of MRVI associated with general laparoscopic surgery.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, FL, USA, 11–14 March 1995; and the Third European Congress of the European Association for Endoscopic Surgery, Luxembourg, 13–17 June 1995     

British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury

Injuries to the bladder and ureter are uncommon but usually require prompt urological management. Due to their infrequent nature, Urologists maybe unfamiliar with managing these acute problems and may not work in specialist centres with readily available expertise in open and abdominal surgery. We aim to provide advice in the form of a consensus statement led by the Female, Neurological and Urodynamic Urology (FNUU) Section of the British Association of Urological Surgeons (BAUS), in consultation with BAUS members and consultants working in units throughout the UK, to create a comprehensive management pathway and a series of statements to aid clinicians.     

Pneumatosis intestinalis (PI) following severe traumatic brain injury

Primary objective: To report a case of pneumatosis intestinalis complicated with sorbitol containing medicines.

Research design: Case report.

Methods and procedures: Clinical course and literature review.

Experimental interventions: Chart review.

Main outcomes and results: Large amount of sorbital may cause a reversible gastrointestinal complication, pneumatosis intestinalis.

Conclusions: In the assessment of enteral abnormalities, all components of medications, active and 'inactive', must be evaluated as possible aetiological factors of pneumatosis intestinalis.     

肝损伤105例临床分析

目的　探讨肝损伤的诊断、治疗 ,以及如何降低死亡率。方法　对我院自 1981年至2 0 0 1年收治的 10 5例肝损伤的病因、伤情、诊治经验及死亡原因进行回顾性分析。结果　手术治疗94例 ,治愈 77例 ,死亡 17例。非手术治疗 11例 ,治愈 10例 ,1例在术前准备时死亡。结论　仔细体格检查、腹腔穿刺、B型超声、CT是诊断的可靠手段。正确选择治疗方案 ,重视围手术期和合并伤的整体处理 ,是提高治愈率 ,降低病死率的关键