烧伤后前臂骨筋膜室综合征的诊治

目的总结烧伤后前臂骨筋膜室综合征的诊治经验。方法回顾性分析近3年来我院收治的9例前臂烧伤后并发骨筋膜室综合征患者的临床资料。结果早期明确诊断6例,果断行筋膜切开减压治疗,上肢未出现功能障碍。3例在14～72小时后才明确诊断,虽经筋膜切开减压、脱水及改善微循环等处理但仍出现不同程度肌肉坏死,上肢遗留功能障碍。结论对于上肢深度烧伤,应早期行焦痂切开减压。上肢切、削痂后植皮创面,包扎不能过紧,术后前臂疼痛需考虑臂丛麻醉后可能减轻疼痛感等因素的影响,并结合观祭指端的感觉和运动功能,及早明确骨筋膜室综合征的诊断。     

骨筋膜室综合征切开减压术后感染的原因分析(附14例报告)

切开筋膜减压是治疗骨筋膜室综合征的关键方法,如术后并发感染则影响治疗效果.收集我院1989～1999年因骨筋膜室综合征行切开减压术14例.其中8例术后感染,感染率57.1%,现针对其发生原因分析报告如下.     

血管穿刺致骨筋膜室综合征分析

20 0 1年 6月～ 2 0 0 2年 5月我院先后收治了 3例因肾功能衰竭行血管穿刺血液透析疗法而致骨筋膜室综合征的病人 ,报告如下。1　临床资料例 1 男 ,2 2岁。因肾小球肾炎慢性肾衰在左肘部行肱动脉穿刺血液透析后发现左前臂肿胀、疼痛 12ｈ来诊。查见左前臂明显肿胀 ,有张力性水泡 ,屈肌触痛 ,桡动脉搏动减弱 ,手指掌侧感觉减退 ,手指呈屈曲位 ,被动伸指时疼痛加重 ,手指末梢血运正常。诊断为左肘部肱动脉破裂合并左前臂骨筋膜室综合征。急诊在臂丛麻醉下行左肘部肱动脉探查、前臂切开减张术。术中见左前臂屈侧深筋膜下及肌间隙内有大量凝血块…     

负压封闭引流治疗骨折并发骨筋膜室综合征的治疗效果

目的对负压封闭引流（VSD）治疗骨折并发骨筋膜室综合征的治疗效果进行评价。方法选取2010年4月至2012年10月间在院治疗的患者46例,经临床诊断均为为小腿或前臂闭合性骨折并发骨筋膜室综合征患者。取其中30例患者作为治疗组,采用切开减压和负压封闭引流技术对其进行治疗;剩余16例患者为参照组,对其行切开减压和普通换药治疗。对两组患者的病情疗效进行观察对比。结果在截肢发生率、感染发生率、肿胀消退时间方面比较,治疗组患者情况明显优于参照组,其间差异具有统计学意义（P〈0.05）。结论负压封闭引流技术对骨折并发骨筋膜室综合征患者疗效较好,能够有效预防切口处发生感染几率,促进切口愈合速度,患者住院成本得以降低,值得在临床上广泛使用。     

胫腓骨骨折并发骨筋膜室综合征的临床观察及护理体会

目的 观察胫腓骨骨折并发骨筋膜室综合征患者采取相应的护理措施后的临床效果.方法 选取2011年1月-2012年2月在我院治疗的56例胫腓骨骨折并发骨筋膜室综合征患者,回顾性分析其病历资料,总结其临床指征及护理方法.结果 56例胫腓骨骨折并发骨筋膜室综合征患者经治疗后均痊愈,膝关节及踝关节恢复良好,无后遗症发生.56例患者行切开减压术,其中49例患者同时行髓内固定术.39例一期缝合良好;9例术后10d缝合;6例二期缝合植皮愈合,2例术后18d缝合.结论 腓骨骨折并发骨筋膜室综合征患者术后恢复良好,护理效果显著.     

急性下肢缺血动脉再通后并发骨筋膜室综合征的护理

目的探讨急性下肢缺血动脉再通后并发骨筋膜室综合征中的观察和护理。方法回顾性分析了我院收治的39例急性下肢缺血行动脉再通治疗后并发骨筋膜室综合征的患者,均行筋膜切开减压术,归纳总结患者护理特点。结果 39例并发骨筋膜室综合征患者平均住院时间(12±6)d,经过积极治疗和护理后,出院前26例患者患肢功能恢复术前水平,9例足下垂,3例截肢,1例死亡。结论护理人员的经验、技术和责任心,在及时发现及处理骨筋膜室综合征中起重要作用,能够避免病情向严重程度发展,增强了患者康复的信心。     

胫腓骨骨折合并骨筋膜间室综合征的疗效观察

目的探讨胫排骨骨折合并骨筋膜间室综合征的临床特点及诊断治疗。方法对12例经早期手术切开筋膜减压骨折内固定治疗胫腓骨骨折合并骨筋膜间室综合征患者,进行回顾性分析。结果完全复位10例,2例不完全复位,按Richardson功能标准优良10例差2例。结论早期诊断及时充分切开减压术是治疗胫腓骨骨折合并骨筋膜间室综合征患者的有效方法。     

冠状动脉介入术后并发骨筋膜室综合征一例护理

骨筋膜室综合征即由骨、骨间膜、肌间隔和深筋膜形成的骨筋膜室内肌肉和神经因急性缺血、缺氧而产生的一系列症状和体征。经桡动脉穿刺行冠状动脉介入治疗后并发骨筋膜室综合征是最严重的术后并发症之一,如不及时确诊和治疗,可迅速发展成为组织坏死或坏疽,造成肢体残废,甚至丧失生命。恰当的治疗及科学的护理可以降低这一并发症带给患者的痛苦,改善患者术后生活质量。现将我科一例经桡动脉途径行冠状动脉介入治疗术后并发骨筋     

经桡动脉途径行左内乳动脉造影的临床分析

目的 探讨经桡动脉途径开展左内乳动脉造影的安全性和有效性.方法 对181例（男119例,女62例）患者经桡动脉途径,采用6F JL3.5冠脉造影导管行左内乳动脉造影.结果 有170例完成左内乳动脉造影,总成功率94.0%,且左内乳动脉造影均获显影满意结果.左内乳动脉造影失败主要原因为主动脉弓迂曲（7例,男6例,女1例;占4%）;桡动脉痉挛（4例,男1例,女3例;占2%）.术后左臂部肿胀淤血4例（2.2%）;左前臂穿刺点近端至肘关节处肿胀淤血7例（3.9%）;穿刺点周围皮肤红疱疹5例（2.8%）.无右桡动脉闭塞、动静脉瘘、假性动脉瘤、穿刺口皮肤破溃感染及前臂骨筋膜室综合征发生.结论 经桡动脉途径行左内乳动脉造影是一种安全、有效、易于接受的检查手段.     

儿童骨筋膜室综合征的观察与护理

目的:探讨儿童骨筋膜室综合征的观察与护理,减少并发症,提高患儿的生命质量.方法:回顾性分析骨筋膜室综合征13例患儿的治疗、观察与护理.结果:13患儿经筋膜切开减压治疗后精心护理,均顺利康复,无发生切口感染,平均随访时间为1.5年,随访期间未见切口疼痛、无功能障碍等情况发生.结论:早期发现,早期进行筋膜切开减压治疗是骨筋膜室综合征治疗的关键,而细心的观察和精心的护理是促进康复的保证.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.