输尿管镜术后感染性休克临床分析

目的 探讨输尿管镜术后感染性休克的临床特点及诊治方法.方法 研究对象来源于泌尿外科收治的输尿管镜碎石术后感染性休克患者20例,确诊后即刻开展尿标本与血标本细菌培养与抗感染休克治疗.结果 经密切观察与积极治疗后抢救成功率为95％,1例因术前双肾积水与严重肾功能不全死亡.结论 输尿管镜术后感染性休克为严重并发症,需积极预防与有效处理.     

多层螺旋CT鉴别全髋关节置换术后迟发性无菌及感染性并发症

目的:全髋关节置换术后迟发性无菌性并发症和感染性并发症的鉴别对于合理的手术计划和及时的抗菌治疗至关重要.本研究目的是探讨多层螺旋CT在诊断翻修术前全髋关节置换术患者无菌性机械松动、肉芽肿病和假体周围感染应用价值.方法:8年内共83例疑似假体周围并发症患者接受翻修手术,所有患者术前均行多层螺旋CT扫描.两位肌骨放射科医师...     

肝门部胆管癌大范围肝切除术前胆道引流作用的临床研究

目的评价大范围肝切除治疗伴有梗阻性黄疸的肝门部胆管癌术前胆道引流的作用。方法回顾性研究2005年6月至2011年4月在解放军总医院行大范围肝切除治疗的伴有梗阻性黄疸的肝门部胆管癌患者临床及术前影像学资料,测量预留肝体积,根据公式:余肝体积(RLV)/标准总肝体积(SLV)计算标准余肝率(standardizedremnant liver volume ratio,SRLVR)。根据术前胆道引流与否,分为两个亚组,比较两亚组术后近期结果。结果大范围肝切除治疗的伴有梗阻性黄疸的肝门部胆管癌共117例,所有病例均进行了肝体积测量,平均标准余肝率为52.3%,术后病死率为6.8%,总并发症发生率为41.9%,肝衰竭发生率为14.5%,感染性并发症发生率为9.7%,术后平均住院日数17.8 d(5～64 d)。多因素分析显示,SRLVR≤40%(OR:71.63,95%置信区间:8.07～635.96,P<0.001)和术前总胆红素>186.7μmol/L(OR:17.29,95%置信区间:1.97～151.92,P=0.01)为肝门部胆管癌术后肝衰竭的独立危险因素。SRLVR>40%时术前胆道引流亚组感染性并发症发生率显著高于非引流亚组,两亚组间术后病死率、总并发症发生率、肝衰竭发生率、术后住院日数差异无统计学意义,而SRLVR≤40%时,术前胆道引流亚组术后病死率、肝衰竭发生率、术后住院日数显著小于非引流亚组,两亚组间总并发症发生率、感染性并发症发生率差异无统计学意义。结论肝门部胆管癌伴有梗阻性黄疸患者肝切除术前,SRLVR≤40%时术前胆道引流显著降低术后病死率、肝衰竭发生率及术后住院日数,推荐常规使用术前胆道引流,而SRLVR>40%时术后感染性并发症发生率显著增加,选择性使用术前胆道引流更为合适。     

内外科综合治疗感染性心内膜炎

目的探讨内、外科综合治疗感染性心内膜炎的价值。方法对62例感染性心内膜炎,术前使用大剂量青霉素与庆大霉素,其中15例行急诊手术,16例行亚急诊手术,31例行择期手术。手术主要清理赘生物、被感染的瓣膜组织及瓣周脓肿,并矫治心内病变。结果无手术死亡。术后死亡4例,58例治愈出院。除3例失访外,其余随访2年心功能均恢复到Ⅰ~Ⅱ级。结论在抗感染同时积极采取外科干预治疗能有效降低感染性心内膜炎的病死率。     

儿童间质性肺疾病高分辨率CT分型分析

目的 探讨儿童间质性肺疾病(ILD)高分辨CT(HRCT)表现及其分型.方法 儿童间质性肺疾病60例,男49例,女11例,平均年龄3.4岁.60例中感染性41例,非感染性19例.60例均行HRCT扫描.扫描范围:5岁以下从肺尖到肺底连续扫描.5岁以上取主动脉弓水平、隆突水平和膈顶上1 cm 3个区域扫描.5例感染性ILD随访观察.2个高年资放射科医师双盲读片.重点观察支气管血管束改变、磨玻璃影的形态及分布、支气管扩张等并结合临床对60例儿童ILD的HRCT表现进行分型.结果 60例中支气管血管束增粗49例,僵直27例,其中41例感染性ILD中支气管血管束增粗39例,僵直26例,19例非感染性ILD中支气管血管束增粗10例,僵直1例.60例中小叶性磨玻璃影41例,感染性32例,非感染性9例;既有支气管血管束异常又并有小叶磨玻璃影27例,其中感染性20例,非感染性7例;大片状磨玻璃影18例,其中感染性16例,非感染性2例.支气管扩张4例.结合临床及病理演变可分为:①早期,支气管血管束异常型,此期可合并小叶性磨玻璃影;②进展期,大片磨玻璃影型,病变虽可恢复,但病程较长;③支气管扩张型,提示病变不可逆转.结论 HRCT是确诊儿童ILD的首选无创检查方法.     

人工髋关节置换术治疗非感染性髋臼骨缺损:附42例报告

目的探讨人工髋关节置换手术在非感染性髋臼骨缺损的治疗经验。方法回顾性分析42例人工髋关节置换术对非感染性髋臼骨缺损的处理结果,探讨植骨、固定和髋臼置换的方法。结果本组手术全部成功,术后无感染发生。随访6～63个月,平均33.4个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨时应辅以颗粒骨,并选用牢固的钉板系统固定,并尽量采用非骨水泥型臼杯,短期疗效好。     

感染性心脏瓣膜心内膜炎的外科治疗

目的:总结感染性心脏瓣膜心内膜炎外科治疗的经验。方法:回顾性分析1998年6月～2007年6月成都军区总医院心外科手术治疗感染性心脏瓣膜心内膜炎38例。其中先天性心内畸形18例,风湿性心脏瓣膜病16例,原发性细菌性心内膜炎4例。术前22例行血液培养,阳性14例。术前心功能NYHA分级:Ⅱ级4例,Ⅲ级19例,Ⅳ级15例。行主动脉瓣置换11例,二尖瓣置换6例,主动脉瓣及二尖瓣置换18例,主动脉瓣、二尖瓣置换、三尖瓣置换3例,单纯心内分流修补8例,主动脉置换合并心内分流修补2例。术后应用足量敏感抗生素4～6w。结果:术后早期死亡3例,死因1例为多脏器栓塞后合并脑出血,1例心脏骤停,1例术后低心排。余术后心功能恢复NYHA分级Ⅰ～Ⅱ级33例,Ⅲ级2例。结论:感染性心脏瓣膜心内膜炎经外科治疗能够取得良好的治疗效果。     

2005-2014年新疆兵团其他感染性腹泻报告病例分析

目的:了解2005-2014年新疆兵团其他感染性腹泻报告病例的流行病学特征,探索监测系统中可能存在的问题,为有效控制其他感染性腹泻提供数据支持.方法:收集国家监测信息报告管理系统中2005-2014年新疆兵团上报的其他感染性腹泻病例,对其进行描述性流行病学分析.结果:2005-2014年兵团疾控共报告其他感染性病例22471例,年发病率范围为35.1275-111.7556/10万,在2009年出现发病率高峰后大致呈上升趋势.3岁以下占全部发病数的0.5213％(11714/22471),其中1岁以下报告病例在所有年龄组别中是最多的,占到全部发病数的0.3080％(6922/22471).5月开始其他感染性腹泻发病逐月增加,7-8月达到发展高峰,之后逐月减少,9月又开始增加,10月达到高峰.散居儿童53.4％、离退人员10.3％、农民7.9％,这三类人群的年报告发病率及发病数位居前三位.结论新疆建设兵团2005-2014年其他感染性腹泻流行主要集中在低年龄组的散居儿童和离退人员的高年龄组,夏秋季是其他感染性腹泻的好发季节.     

感染性主动脉瘤的CT征象研究

目的 探讨感染性主动脉瘤的CT表现.方法 回顾性分析2009年6月至2016年1月期间本院9例感染性主动脉瘤患者(其中4例经外科手术确诊,5例经临床抗炎治疗后行支架置入术)的临床资料,总结感染性主动脉瘤的CT表现.结果 9例患者共10个动脉瘤,其中2个位于主动脉弓降部,8个均位于腹主动脉.动脉瘤处管壁均出现多发钙化,管腔呈瘤样扩张,腔内见不规则充盈缺损;管壁明显增厚,血管周围见不规则软组织密度影包绕;增强扫描动脉期轻度强化,延迟扫描见不规则片絮状及环状强化.结论 感染性主动脉瘤及其周围组织在CT增强扫描上表现为斑片状及环状强化,是区别于常见动脉瘤的典型表现,可作为确诊感染性主动脉瘤的首选影像检查方法.     

负载万古霉素人工骨与外固定架治疗感染性长骨不连

目的观察负载万古霉素的硫酸钙人工骨与外固定架治疗四肢长骨感染性骨不连的临床效果。方法应用负载万古霉素硫酸钙人工骨与外固定架治疗感染性四肢长骨骨不连11例。术前均使用抗生素治疗7～12d,取出内固定,彻底清创,清除炎性肉芽、坏死组织及死骨,植入负载万古霉素的硫酸钙10-20g,均采用外围定架固定。定期X线拍片观察其感染控制情况和成骨作用。结果随访平均14个月,11例感染均控制,硫酸钙植入后3～4个月完全吸收并被新生骨逐渐替代,10～15个月骨不连均骨性愈合,无感染复发。结论负载万古霉素的硫酸钙人工骨与外国定架治疗四肢长骨感染性骨不连是良好的选择。     

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,     

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.     

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.     

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.