直肠损伤致肛管闭锁的教训

报道 1例外伤性骨盆骨折、后尿道断裂、直肠破裂 ,先后 2次手术 ,术后 3个月发现直肠完全闭锁。笔者总结 :(1)骨盆骨折的病人应考虑有直肠刺伤的可能 ;(2 )患者住院及出院均应协助、指导定期行扩肛并定期检查     

枪弹伤导致双下肢多发动静脉瘘一例

病史摘要患者男,39岁,2个月前右大腿中部、左小腿上部被散弹枪击伤,在当地医院行伤口局部清创、左小腿筋膜室切开减压,伤愈后出院。因双下肢仍明显肿胀,并伴活动后胸闷、心慌等症状而入院。入院查体:心率110次/min,右大腿中部、左小腿内外侧有多处陈旧切口瘢痕,双小腿明显肿胀,肤色暗红,伴皮温增高,双足背和胫后动脉搏动均明显减     

肾癌TACE术后并发脊髓损伤1例

患者男,61岁。查体发现右肾肿瘤10天入院。增强CT检查示右肾门及输尿管上段巨大软组织肿物,约12cm×10cm×6cm,与腔静脉及腰大肌分界不清,失去外科手术切除机会,而行经导管动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）治疗。     

严重高压电接触烧伤后并发双侧视网膜损伤致双目失明1例

本文报道了1例临床少见的严重高压电接触烧伤导致视网膜损伤的病例,提出高压电短路产生的强烈闪光和冲击波是其病因之一.目前无有效治疗,激素和营养神经能减轻其损伤程度,但效果还有待于进一步观察.     

左侧椎动脉损伤致内膜瓣形成影像学诊断1例

患者头向下摔伤后,四肢、肩部不能活动,入院行颈部CT平扫及CT血管成像(CTA),显示环枢关节脱位,C5、6椎体爆裂性骨折,C5、6椎体棘突及C6椎体右侧椎弓根骨折,C5椎体水平左侧椎动脉变扁,C4椎体水平左侧椎动脉血管腔内线样低密度影——考虑内膜瓣形成;颈椎X线片仅显示颈椎骨折及椎管狭窄情况;颈椎MRI扫描除显示颈椎骨折外还能显示脊髓损伤情况及血管腔内线状长T2信号——考虑内膜瓣形成。     

Aplasia cutis congenita of the scalp with large underlying skull defect: a case report

Localised agenesis of the scalp is the most frequent patern in aplasia cutis congenita (ACC), a congenital absence of the skin and occasionally of deeper layers. Several clinical groups are characterised by the location and pattern of skin defects, associated malformations and the mode of inheritance. Death occurs in 20% of cases, secondary to the associated anomalies, to infections or to haemorrhage from ulceration of the sagittal sinus when there is also a defect of the underlying skull. In this latter case, we close the defect by two rotational scalp flaps (Orticochea technique) at birth. A three-dimensional CT study is useful for showing the extent of the skull defect and the deformity of the craniofacial complex and the changes in the bone after treatment.     

Virtopsy: CT and MR imaging of a fatal head injury caused by a hatchet: A case report

Hatchet blows to the human skull often cause fatal injuries. We present a case of homicide by hatchet blow that underwent CT, MRI, and autopsy examination. Skull fragmentation, fracture lines, and brain injuries were demonstrated prior to autopsy. Many of the hatchet-specific characteristics (flaking, crushing, shattering, and fracture lines) described in literature were observed in the post-mortem imaging of this case.     

自体髂骨移植修复桡骨远端创伤性骨缺损1例报告

收治1例桡骨远端创伤性骨缺损的病例,采用自体髂骨移植修复桡骨远端骨质缺损,术后获得良好的腕关节功能,为桡骨远端创伤性骨质缺损的治疗提供了一个新的思路。     

胸透时发生口服阿莫西林致急性过敏性休克1例

患者女,42岁.因发烧、咳嗽.胸透检查:肺纹理增粗,余未见异常.临床诊断为上呼吸道感染,给予静脉点滴0.9%NS250ml加青霉素纳800万单位1天1次.用药5天后病情明显好转,改为口服阿莫西林胶囊0.5g,1日3次. 患者首次服药后约20min,全身出现大片风团疹、瘙痒、感到胸闷急来就诊.行影像学胸透检查时,病人发生休克,立即送往急症室抢救,马上给予50%GS20ml加入5%葡萄糖酸钙10ml、地塞米松10mg,静脉注射,症状未减轻.     

Spinal subarachnoid hemorrhage caused by scleroderma-induced aneurysm: a case report

We introduce a 58-year-old woman who suffered from progressive systemic scleroderma (PSS) associated with trigeminal sensory neuropathy for approximately 10 years. She then had a stroke from spinal subarachnoid hemorrhage (SSAH). Spinal digital subtraction angiography (DSA) revealed two aneurysms and smaller dilations of the afferent vessel that could also be seen by MRI. Three asymptomatic brain infarctions in different vascular regions could be revealed by CCT. The SSAH, ischemic lesions and aneurysms were probably caused by vasculitic affections induced by PSS. Correspondence to: J. Müller     

钢筋束致颈胸部穿透伤并高位截瘫影像学诊断1例

本文报道由钢筋束多方向贯穿颈胸部造成两侧严重气胸、胸椎骨折伴高位截瘫但无大血管损伤者1例,经电视胸腔镜术逐一取出钢筋及放置闭式胸腔引流后患者恢复良好。作者结合国内外文献进展讨论了影像学诊断在复杂性穿透性躯体损伤的诊断与应用价值。     

新生儿阴沟肠杆菌感染致颅腔积气一例

患儿男,5d龄,因胎儿宫内窘迫行剖宫产.皮肤黄染2 d,不哭、不吃、少动7~+h.体检:呼吸急促,双肺呼吸音粗;腹软,脐轮红肿,范围约1.5 cm×1.0 cm,脐窝内有脓性分泌物.血常规:WBC6.8×109/L,中性粒细胞0.72,RBC 4.71×10~(12)/L.临床诊断:新生儿肺炎,新生儿脐炎,病理性黄疸.给予吸氧、心电监护、抗感染等治疗.入院后患儿病情逐渐加重,第4天出现非喷射性呕吐胃内容物,吸气性"三凹征".第5天出现尖叫及右侧肢体强直.复查血常规:WBC 35.8×109/L.N75.4%,RBC 3.73×1012/L.血培养:阴沟肠杆菌生长.     

股总动脉医源性损伤1例

临床资料患者男,72岁。主因突发右足疼痛、发凉2 d入院。查体:右足皮色苍白,未见青紫发花,双下肢皮温低,以右下肢为甚,左股动脉搏动良好,左腘动脉搏动弱,右股动脉搏动弱,右腘动脉、双侧足背动脉及胫后动脉未触及搏动。     

暗色孢科真菌所致骨病一例

患者 男,16岁.10个月余前无明显诱因出现左前臂酸胀、疼痛,症状逐渐加重,伴皮肤破溃、流脓1个月余入院.曾在当地医院抗炎治疗,未见好转,遂来我院求诊.10年前曾有"左前臂骨折"病史,既往有胃溃疡、蛔虫病史.体检:体瘦,营养欠佳,浅表淋巴结无肿大,心、肺、腹无异常,专科检查:左前臂肿胀,向内侧弯曲畸形,左前臂弯侧前端可见一破溃口,溢脓,周边皮温稍高,左手指感觉、运动功能尚可.实验室检查:血和大小便常规检查、肝肾功能无异常,抗链"O"、类风湿因子、结核全套均阴性,血沉不高.脓液细菌培养加药敏试验未见细菌生长.     

胫后动脉药物涂层支架成形术一例

患者男,75岁。2005年1月出现左足第二、三、四趾疼痛,2个月疼痛逐步加重,范围扩大至左足前半部,并出现左足第四趾坏疽。发现糖尿病2年余。体检：左足皮温凉,皮肤暗红色,左足背及胫后动脉搏动未及,左腘动脉搏动可及,左足第四趾干性坏疽。考虑为糖尿病足,入本院内分泌科住院治疗,     

介入栓塞治疗腹腔引流管损伤动脉出血1例

临床资料患者女,68岁。主因反复腹痛腹胀伴腰背部疼痛1个月入院。查体示:皮肤巩膜无黄染,全腹轻压痛及反跳痛,胆囊未触及,墨菲氏征阴性。入院完善相关检查示:白蛋白25.1 g/L,白/球比例0.6,直接胆红素9.6μmol/L;乙肝标志物阳性;上腹部CT增强及B超检查均提示肝硬化、门静脉高压及胆囊多发结石。既往乙肝病史20余年。入院诊断:(1)肝炎后肝硬化;(2)胆囊结石;(3)自发性腹膜炎。