蛇伤口服液1号治疗青竹蛇咬伤的观察及护理

目的 :比较常规治疗与蛇伤口服液 1号治疗青竹蛇咬伤的疗效。方法 :将常规治疗加蛇伤口服液 1号口服与单纯常规治疗进行比较。结果 :在肿胀开始消退、肿胀完全消退、止痛时间、疗程等方面 ,两种方法有显著性差异 (P <0 0 1)。结论 :常规治疗加蛇伤口服液 1号缩短了肿胀时间、疼痛时间和疗程 ,是治疗青竹蛇咬伤的有效方法     

The triangle sign: A CT sign of intraperitoneal fluid

Ninety-four abdominal CT examinations of 91 patients with intraperitoneal fluid were reviewed, and in 25 scans (27%) triangular fluid collections were found within the leaves of the mesentery or adjacent to bowel. In a control group of 30 patients without CT evidence of intraperitoneal fluid, no triangular densities were identified. Triangular fluid collections were visualized in a higher percentage of patients when the quantity of intraperitoneal fluid was moderate to large, IV contrast was given, good bowel opacification was obtained, the amount of mesenteric fat was moderate to large, and the abdominal CT examination included cuts through the pelvis. A triangular fluid collection was reproduced in a cadaver by intraperitoneal infusion of saline. Percutaneous needle aspiration confirmed that the saline collection was responsible for the CT findings. The CT appearance of this new triangle sign is demonstrated.     

Persistent fibrinogen deficiency after snake bite: A case report

BACKGROUNDVenom-induced consumption coagulopathy (VICC) is characterized by coagulation dysfunction accompanied by decreased coagulation factor activity and fibrinogen (FBG) concentrations. We report a patient with VICC caused by snake bite who manifested persistent FBG deficiency without abnormal coagulation factor activity. This information may be helpful in diagnosing and treating VICC.CASE SUMMARYA 49-year-old man who had been bitten by a snake 13 h previously was admitted to the Emergency Department of our hospital with visible swelling of a finger and a bleeding puncture site. The provisional diagnosis was VICC, this being made based on persistent bleeding from the puncture site and subcutaneous hemorrhage. Laboratory evidence of coagulation abnormalities, including fibrinolysis, and findings on thromboelastography confirmed VICC. He had persistent afibrinogenemia requiring intravenous infusions of cryoprecipitate and fresh frozen plasma, together with continuous large doses of human FBG. After this treatment, the patient’s right upper limb swelling improved significantly and his subcutaneous hemorrhage resolved. All of his abnormal laboratory findings returned to normal by day 25. During 6 months’ of follow-up, the patient had no further hemorrhagic events.CONCLUSIONHemorrhagic snake venom can result in coagulation dysfunction characterized by persistent FBG deficiency without abnormal coagulation factor activity.     

Patterns of fluid accumulation in splenic trauma: Demonstration by CT

Detection of hemoperitoneum in splenic trauma is as important as detection of the visceral injury itself. Observation of a consistent spectrum of fluid accumulation in patients with splenic trauma prompted us to investigate the patterns in more detail. Twenty-three computed tomographic (CT) scans in 20 patients were evaluated with respect to presence of fluid collections in various peritoneal and retroperitoneal compartments. These were correlated with severity of injury and operative and pathologic findings. Hemoperitoneum was detected in the pelvis (65%), paracolic gutters (52%), left subphrenic space (48%), perihepatic space (48%), Morison's pouch (17%) and in the lesser sac (9%). In addition to free fluid, pleural fluid (39%) and retroperitoneal hematoma in the left anterior pararenal space (13%) were also encountered. These ancillary findings may help to substantiate the diagnosis of splenic trauma in equivocal cases, particularly when the spleen itself is obscured by artifacts. Early detection may reduce mortality and morbidity associated with splenic trauma.     

The various manifestations of ruptured hepatocellular carcinoma: CT imaging findings

Hepatocellular carcinoma (HCC) has a tendency to rupture spontaneously which leads to a life-threatening condition. Disruption of the tumor surface or a tear in a parasitic feeding artery can cause HCC rupture leading to hemoperitoneum. When evaluating patients with a ruptured HCC, CT can detect tumors, determine tumor extent, define the presence of tumor bleeding, and show serial hematoma density changes. Thus, familiarity with the various CT findings of ruptured HCCs is essential to ensure proper diagnosis and treatment. In this pictorial essay, the authors illustrate the usual and unusual manifestations of ruptured HCCs, as visualized by CT, and include some angiographic correlations. CT findings predictive of HCC rupture are also discussed.     

机械通气及大黄在抢救毒蛇咬伤致呼吸衰竭的应用

目的探讨毒蛇咬伤致急性呼吸衰竭治疗措施。方法选择毒蛇咬伤致呼吸衰竭患者46例,治疗方法：①机械通气治疗：患者出现呼吸困难或者呼吸浅慢时,及时气管插管行机械通气。上机模式为辅助／控制通气或同步间歇指令通气,注意观察患者胸廓起伏情况及肺部体征,动态监测脉搏血氧饱和度、X线胸片及血气分析,并视病情变化调整通气参数,使其逐渐达到脱机标准;②生大黄20g＋清水250ml水煎15min,管饲,qd,连用3～5d;③常规治疗：伤口切开排毒及药物局部封闭,及早足量应用抗蛇毒血清等。结果患者住院时间6～20天,平均（13．4±5．2）d。通气时间〈48h者28例（60．9％）,48～72h者12例（26．1％）,〉72h者6例（13．0％）。治愈44例（95．7％）,死亡2例（4．3％）。死亡者均是就诊时合并多器官功能障碍者。结论机械通气联合大黄、抗蛇毒血清等集柬治疗是抢救毒蛇咬伤致呼吸衰竭有效的方法。     

Heterotaxy syndrome with pancreatic malrotation: CT features

We report the case of an asymptomatic elderly man with heterotaxy syndrome who presented with incomplete pancreatic rotation and an aplastic pancreatic uncinate process, polysplenia, nonrotation of the intestine, a midline liver, a midline gallbladder, a right-sided stomach, and interruption of the inferior vena cava with azygos continuation. To our knowledge, pancreatic malrotation with resultant oblique placement has not been described in patients with heterotaxy syndrome, and we speculate that the pancreatic rotation was interfered with by the left lobe of the midline liver in the embryo.     

乳胶凝集抑制试验快速诊断致伤蛇种的临床应用

目的总结蛇伤的蛇种快速诊断法的临床应用。方法用蛇伤的蛇种快速鉴定药盒对３１１例６种蛇伤病人伤口的组织液标本，做玻片法天然乳胶凝集抑制试验，成功地进行了蛇伤的致伤蛇种快速诊断。结果五步蛇伤、银环蛇伤、烙铁头蛇伤、竹叶青蛇伤、眼镜蛇伤和蝮蛇伤的阳性检出率分别为１００％（４１／４１）、１００％（６６／６６）、９１６６％（４４／４８）、９３６５％（５９／６３）、９４１１％（３２／３４）和９４９１％（５６／５９）。总阳性率为９５８１％（２９８／３１１）。皆于５～８分钟内得出结果。阳性结果中无一例交叉抑制现象，其中８４例病人在被咬伤时看清毒蛇，其检测的蛇种与所见蛇种完全一致。结论以上结果说明该快速诊断法具有操作简便、快速、准确、特异性强，阳性率高等特点。可以在基层和农村医疗单位或野外推广应用，它为抢救蛇伤病人提供了及时准确的客观依据，对提高临床治愈率有很大临床意义。     

Peritoneal serous papillary carcinoma: a reappraisal of CT imaging features and literature review

We evaluated the imaging features of primary serous peritoneal carcinoma (PSPC) on computed tomography (CT) and reviewed the literature. Preoperative CT images of 11 women with PSPC were retrospectively reviewed. The clinical presentations and serum levels of CA-125 were recorded. Special attention was paid to the operative and histopathologic findings of the ovaries. Imaging features were correlated with those in the literature. An elevation of serum CA-125 was found in 91% of cases. The CT findings included ascites (82%), peritoneal nodules or masses (73%), and omental nodules or omental caking (64%). Absence of an overt ovarian mass was observed in 64% of cases. The clinical manifestations and imaging features in our patients were consistent with those in the literature. Eighty-five percent of the ovaries in our study were superficially involved by PSPC in histopathologic examination. In none of our cases could the ovarian size be clearly assessed in the CT images. In conclusion, the presence of diffuse peritoneal disease and the absence of an ovarian mass on CT and an elevation of serum CA-125 level is suggestive of PSPC. However, in our experience, the evaluation of ovarian morphology and size by CT alone may not be as reliable.     

Omental infarct: CT imaging features

Background The aim of this study is to describe contrast-enhanced computed tomographic (CT) features of acute omental infarction and to study the evolutionary changes on follow-up CT imaging. Methods Fifteen cases of omental infarction were evaluated for their initial CT imaging features. The imaging features evaluated included size of the fatty lesion, location, peripheral rim, and relation to colon. CT findings were correlated with etiology, clinical presentation, and leukocytosis. Follow-up CT images were available in eight patients and the imaging features were studied. Results Eight omental infarcts were of unknown etiology and seven were secondary to abdominal surgery. In 53% of patients (eight of 15), the location of the omental infarct was in the right lower, mid, or upper quadrants. These eight right-side infarcts occurred in six patients with primary omental infarcts. In 13 of 14 patients who underwent CT within 15 days of onset of omental infarct, the margin of the lesion was ill defined. Primary omental (n = 8) infarcts were seen in younger patients (p = 0.02) and were larger on CT (p = 0.02) compared with secondary omental infarcts. CT findings evolved from an ill-defined, heterogeneous fat-density lesion to a well-defined, heterogeneous fat-density lesion with a peripheral hyperdense rim in all six secondary omental infarctions for which acute stage and follow-up CT images were available for interpretation. Conclusion There is a significant difference in the age distribution and CT findings in terms of size of the omental infarction between primary and secondary etiologies. On follow-up CT, secondary omental infarcts progressively shrank and developed a well-defined, hyperdense rim around a fatty core.     

毒蛇咬伤患者心电图特征与临床病情相关性研究

目的探讨毒蛇咬伤患者的心电图特点。方法对100例毒蛇咬伤患者的心电图(A组)进行回顾性分析,与100例正常体检者的心电图(B组)对照。结果心律失常、P波改变、T波改变及窦性心动过速等两组间有显著性差异(P＜0．01)。病情越重心电图改变越明显,两者有明显的相关性。结论毒蛇咬伤患者有心电图改变往往是具有血循毒的毒蛇咬伤者,可出现多种心电图变化,病情越重心电图改变越明显。早期使用抗蛇毒血清可以减少对心肌细胞的损害。     

A bite by the Twin-Barred Tree Snake,Chrysopelea pelias (Linnaeus, 1758)

Introduction.?The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species.?Case report.?The patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis. Discussion?.?The properties of Duvernoy's secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia.?Conclusion.?Such a facility could expedite safe and appropriate management of envenomed patients.     

Acute torsion of uterine leiomyoma: CT features

Acute torsion of a subserosal leiomyoma is a rare acute condition that is infrequently diagnosed preoperatively. It is a recognized surgical emergency, especially when additional systemic symptoms are associated. There are two main differential diagnoses: ovary/adnexal torsion and massive infarct inside a common leiomyoma. The diagnosis can be established by computed tomographic features. Ultrasound examination is less sensitive.     

Acute torsion of uterine leiomyoma: CT features

Acute torsion of a subserosal leiomyoma is a rare acute condition that is infrequently diagnosed preoperatively. It is a recognized surgical emergency, especially when additional systemic symptoms are associated. There are two main differential diagnoses: ovary/adnexal torsion and massive infarct inside a common leiomyoma. The diagnosis can be established by computed tomographic features. Ultrasound examination is less sensitive.     

原发性胃肠道淋巴瘤的多层螺旋CT表现

目的探讨原发性胃肠道淋巴瘤（PGIL）的多层螺旋CT（MDCT）表现,以提高该病的诊断和鉴别诊断水平。方法收集36例复旦大学附属肿瘤医院2006年1月—2014年6月经病理证实的PGIL患者资料,总结其CT特征表现及诊断和鉴别诊断要点。结果 36例PGIL均为非霍奇金淋巴瘤（NHL）,28例为弥漫大B细胞淋巴瘤（DLBCL）,8例为黏膜相关淋巴组织（MALT）淋巴瘤。病变位于胃20例,空、回肠10例,十二指肠3例,回盲部2例,直肠1例。CT检查示32例胃肠道管壁呈弥漫增厚伴均匀强化,周围常有肿大淋巴结影;4例胃壁局限性增厚呈结节、肿块影。动脉瘤样扩张是肠道淋巴瘤的特征性表现。病灶周围增粗血管或增粗血管穿行于病灶是胃肠道淋巴瘤的重要表现。结论 PGIL的CT表现有一定特征性,有望提高诊断正确率。     

支气管囊肿的CT表现及特征

目的 探讨支气管囊肿的CT征象及诊断价值。方法收集20例经手术病理证实的CT影像,进行回顾性分析。结果 20例支气管囊肿,纵隔内10例,肺内9例,膈肌1例;单发病灶16例,多发病灶4例;含液囊肿8例,含气液囊肿7例,含气囊肿2例,实质性囊肿3例,单房囊肿15例,多房囊肿5例;薄壁囊肿14例,厚壁囊肿6例;8例病灶作了平扫与增强对照,表现为囊液无强化,囊壁有均匀强化;7例病灶合并感染,6例支气管囊肿压迫相邻气管地气管及血管;CT正确诊断为支气管囊肿17例,正确率85%。结论 纵隔型及肺内型支气管囊肿有特征性CT表现,CT诊断价值大,异位型支气管囊肿缺乏特征性CT表现,仅借助CT诊断有一定困难。     

Extensive abdominal splenosis: imaging features

We present the case of a 22-year-old patient who had splenectomy in childhood after trauma and had a known chronic active infection with hepatitis C. Imaging procedures in different radiologic modalities diagnosed diffuse intraabdominal splenosis. Splenosis is a rare, severe complication of splenic trauma or surgery, but the pathogenesis is not clear. Imaging features play a key role in the diagnosis of ectopic splenic tissue, which must be differentiated from malignancies, especially from lymphoma. Splenosis itself may induce relapse of hematologic diseases, mainly autoimmune thrombocytopenia.     

贵州遵义地区蛇咬伤流行病学特点分析

目的:分析贵州遵义地区蛇咬伤的发病情况,为该区预防及治疗蛇咬伤提供参考。方法:回顾性分析2009-2011遵义医学院附属医院急诊蛇咬伤病例90例,分析蛇咬伤患者人群、年龄、性别,咬伤发生的季节、时间、部位,致伤蛇种。结果:90例病例中农民居多,年龄集中在30～50岁,男女性别无差异,咬伤多发生于夏、秋两季,以蝮蛇为主。结论:了解蛇咬伤发生季节及时间等特点,做好宣传工作,减少蛇咬伤发生的概率,同时为我院的接诊与救治提供一定的帮助。     

Hepatic artery aneurysm: CT and MR features

The authors report a case of common hepatic artery aneurysm diagnosed by computed tomography (CT) and magnetic resonance (MR). Features of both techniques are described and discussed. The surgical and radiologic literature is reviewed.     

腹部结核的CT征象分析

目的 分析部分腹部实质器官结核的CT表现,试提出鉴别诊断要点。方法 对10例经病理或临床治疗性诊断明确的腹部结核病例进行了CT征象的回顾性分析。结果 肝脏、脾脏及胰腺结核灶CT平扫均表现为实质性或中央液化的结节和肿块,增强扫描病灶无强化或轻微强化;腹部肿大的淋巴结是结核的一个重要重象,增强扫描部分为周缘环行高密度、中心液化的低密度结节。结论 腹部实质器官结核的CT表现呈多发性、多样性：干酪化的淋巴结具相对特征性表现;增强后三期扫描有助于肝脏结核性病灶与肝脏肿瘤的鉴别诊断。