平时颅脑火器伤108例预后分析

目的 分析影响颅脑火器伤预后的因素，确定颅脑火器伤的预后。方法 对第二军医大学附属长征医院神经外科等军内5家医院21年收治的108例平时颅脑火伤进行回顾性分析。结果 对71例头颅CT检查表明，非性颅脑火器伤占11．3％（8／71），其预后良好；穿透性颅脑火器伤占88．7％（63／71），其中脑穿透伤和双侧半球损伤预后较差；颅内血肿的发生率为46．5％（33／71），其中脑内血肿、硬膜下血肿和蛛网膜下腔出血明显增加颅脑火器伤的死亡率。结论 非透穿性颅脑火器伤一般预后较好；格拉斯哥错迷评分（GCS）＜5分的性脑火器伤、GCS＜8的双侧半球损伤和脑室透伤一般预后较差；伴有硬膜下血肿、服内血肿和蛛网膜下腔出血的颅服火器伤患者预后较差。     

海水浸泡软组织火器伤伤口局部应用吲哚美辛的实验研究

目的探讨吲哚美辛在海水浸泡火器伤伤口局部应用对浸泡组织活力的影响.方法以高速钢球射击兔后肢,伤后将致伤兔浸泡于海水中1小时,出水后将吲哚美辛生物陶瓷缓释体放置于伤口内,测定伤前及浸泡后火器伤组织肿瘤坏死因子(TNF)、一氧化氮(NO)、ATP、Na+-K+-ATP酶活性.采用激光多普勒法测定伤区的血流量.结果吲哚美辛能明显减少浸泡后24小时内伤口内TNF、NO生成,增加ATP含量以及Na+-K+-ATP酶活性,提高组织灌流.浸泡后36小时内上述变化逆转,继发损伤加重.结论吲哚美辛应用于浸泡火器伤伤口能在浸泡后24小时内抑制伤口过度炎症反应,减轻继发损伤.     

抗菌抗炎药物缓释体在海水浸泡肢体软组织火器伤救治中的应用

目的探讨抗菌、抗炎药物缓释体对海水浸泡肢体软组织火器伤的治疗作用.方法磷酸三钙药物载体盛装环丙沙星、替硝唑和吲哚美辛,采用紫外分光光度法测定药物缓释体在生理盐水中释放的药物浓度,采用高效液相测定缓释体放置兔浸泡肢体软组织火器伤伤口时,组织和血液药物浓度,观察用药后损伤组织的病理变化和细菌计数.结果缓释体体外药物释放稳定,组织内药物浓度高,伤后36小时放置缓释体的火器伤组织继发损伤轻,无明显感染.结论抗菌、抗炎药物缓释体适宜在海水浸泡火器伤救治中应用.     

两侧椎动脉颅外段动脉瘤

由于Seldinger技术的使用使椎动脉动脉瘤发现增加。大部分是颅内段椎动脉瘤,而颅外段椎动脉动脉瘤很少见,本文首次报告两侧的颅外段非外伤性的椎动脉动脉瘤。病例为一女性,39岁,既往健康,因右上肢无力和剧烈枕区痛伴吞咽困难而入院。因突然中风、剧烈枕区痛而行股动脉穿刺插管行选择性左和右椎动脉造影,发现颅外段相当第一颈椎后弓水平的两侧椎动脉动脉瘤。左椎动脉动脉瘤表现为双叶样。 Heifetz强调颅外段椎动脉动脉瘤大多是继发     

现代战时颌面部火器伤观察与护理

颌面部是战时最易致伤的部位.颌面部火器伤多以伤势复杂,损伤面广、损伤后污染重,盲管伤多为特点,症状主要表现为：出血、肿胀、语言功能、视功能障碍及呼吸困难等,颌面部伤主要威胁是窒息、出血及感染.伤情重时,可累及相邻器官和脑组织,危及生命.因此颌面部火器伤后进行紧急救治,实施有效的病情观察与护理,对及时挽救伤员生命,提高战伤治愈率,最终保持部队战斗力,起到关键作用.     

四肢火器伤继发气性坏疽的特点及原因分析

目的分析四肢火器伤并发气性坏疽的病例特点及其诱发原因。方法回顾性研究我院1968～2006年收治的13例四肢火器伤并发气性坏疽患者的发病及诊断治疗情况,分析并发气性坏疽的临床特点,探讨其诱发原因。结果主要治疗方式为清创、常规抗感染、换药及抗生素应用,其中10例接受截肢,3例行保肢治疗;5例残愈,8例死亡。分析气性坏疽发生的诱因主要为：创伤伤情重、后送过晚、诊断不及时、清创不彻底以及治疗不规范。结论四肢火器伤继发气性坏疽发病急、进展快、伤情危重,及时诊断并彻底清创是治疗的关键,截肢是晚期减少气性坏疽病死率的最好办法。     

火器伤下颌骨缺损引起上下颌骨继发畸形的观察与防治

根据对下颌骨火器伤骨缺损病例晚期治疗中的观察,下颔本身和下颌残余牙列,及其相对的上颌骨和上颔牙列常出现继发畸形。在以往有关颌面创仿的文献中对这种病例的预防和矫治方面讨论很少。我们观察了43例下颌火器     

坐骨神经高速弹丸震荡伤后腰段脊髓病理改变

目的　研究坐骨神经高速弹丸震荡伤后腰段脊髓的病理改变。方法　火器伤组致伤靶点为兔右后肢外侧坐骨神经体表投影线中点 ,切割伤组在同一水平切断右坐骨神经 ,分别在光电镜下观察伤后 1天、3天 ,1周、2周、4周、12周时腰段脊髓的病理改变。结果　火器伤组可见腰段脊髓有小出血灶、神经元水肿、空泡样变、运动神经元数量减少等变化 ,切割伤组则未见这些病理改变。结论　火器伤组腰段脊髓损伤较切割伤组重 ,运动神经元存活数量显著减少     

周围血管间接火器伤的病理与临床诊治

周围血管火器伤包括直接损伤和间接损伤。直接损伤是指机体致伤后血管断裂或撕裂 ,诊断不难 ,按常规处理即可。间接伤是指肢体的血管未被投射物直接击中所发生的损伤 ,受损的血管多位于伤道边缘或伤道外 ,诊治较复杂。作者主要阐述周围血管间接火器伤的病理与诊治 ,以供参考。1　病理改变周围血管间接火器伤除血管外膜连续性尚存或部分断裂外 ,主要表现为血管外膜出血、血肿 ,血管内膜呈创伤及营养不良性改变 ,内弹力膜断裂、内膜出血、血栓形成[1] 。采用钢球射击猪后肢 ,伤后活杀解剖可见 ,股动脉位于伤道外 12～ 80mm或伤道边缘 ,约 77 8…     

战伤继发性出血88例报告

继发性出血为火器伤常见的并发症之一,往往突然发生,而且来势凶猛,若发现不及时,将造成严重后果。即或发现及时,如处理不当,亦可造成缺血性挛缩,甚致肢体坏死。故继发性出血实为值得重视的急诊。本组伤员中发生继发性出血者共88例,现分析于下:     

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.