车祸伤者创伤后成长状况及相关因素研究

目的：研究车祸伤者创伤后成长状况（PTG），并探讨其相关影响因素。方法选取2014年1月—2015年8月116例车祸幸存伤者，利用基础情况调查表及创伤后成长评定量表（PTGI）调查伤者的一般资料及创伤后成长状态，利用多元线性回归分析影响伤者创伤后成长的相关因素。结果116例车祸幸存伤者的创伤后成长总分为（85.55±13.69）分，性别、损伤程度、预计康复结局是其主要的影响因素，差异均有统计学意义（P<0.05）。结论车祸幸存伤者创伤后成长水平较好，不同类别患者评分不同，临床医护人员应针对不同类别伤者进行护理和心理干预，以促进伤者的信心重建和心理康复。     

意外伤害的紧急救护

<正>当有人发生意外伤害,在得到医生治疗之前有一段急诊期,这段急诊期对受伤者来说是非常重要的。在急诊期,周围的人应该干些什么、不该干些什么,是关系到伤者生死的大事。作为当代军人,应该了解在急诊期快速和正确地急救步骤。意外伤害是指刹那间发生的、意想不到的伤害,如车祸、烧伤、中毒等,如伤者得不到最快、最恰当的急救,重者将危其生命,轻者会导致伤者终生残疾。因此,掌握必要的紧急救护知识和方法,对挽救生命、减轻伤残来说是十分必要的。     

腹部创伤的诊治进展

腹部创伤是战时及意外事故中最常发生的事件之一。尽管随着新设备、新技术的开发应用,腹部创伤的检查手段增多,但利用体格检查和简单设备实现快速检诊仍是影响伤者预后甚至挽救生命的关键。在过去20年,非手术治疗、微创治疗、损伤控制外科技术在腹部创伤中的合理应用取得了重要进展。但无论是非手术治疗,还是微创治疗,还是损伤控制外科技术,其宗旨就是在保证伤者血液动力学稳定的基础上,以最小的二次创伤获得最佳的治疗效果。     

创伤性休克院前急救现状及研究进展

创伤性休克为一种很常见的创伤性疾病，伤者大多伤情复杂，意识较差，情况危险，因此合理而快速的院前急救决定伤者的抢救成功率以及伤者的治疗预后。目前创伤性休克的院前急救现状不令人乐观，受到重视程度，人员素质，观点分歧，医院条件等多方面制约，因此对创伤性休克的院前急救现状进行总结可帮助明确存在的不足，并进行改进，而总结目前的研究进展可提供一定的指导以及明确创伤性休克院前急救的发展方向。     

与飞机有关致命伤者中酒精和一氧化碳的关系:北卡罗来那(1985年～1994年)

前言 飞行员饮酒作为主要安全问题已受到关注,而酒精对飞行员操作的不利影响也有广泛的研究。可是乘客酒后是否在坠机逃生时有危险还知之甚少。本研究调查了与飞行有关的致命伤者中饮酒者的多少,并验证这样的假设:受酒精影响的死者一氧化碳(CO)浓度增高的可能性比另一些死者更大。方法北卡罗来那(NC)是很少的已有全州医疗受检者数据系统的几个州之一。用ICO-9E码(E840-E844)鉴别了记录在这个系统中的所有1985年～1994年间发生的与飞行有关的致命伤者,分析了当事者年龄、性别和坠     

He—Ne激光照射联合维斯克治疗放射性皮肤损伤的临床？…

放射性皮肤损伤是放射治疗常见的并发症之一,一旦出现溃疡,常经久不愈,患者十分痛苦。作者应用ＨｅＮｅ激光照射联合维斯克治疗放射性皮肤损伤,取得满意疗效,现报道如下。一、材料和方法1研究对象及分组本组188例来源于1995年6月至1998年8月中山医科大学附属肿瘤防治中心激光科门诊收治病例,均为恶性肿瘤接受过放射治疗出现放射性皮肤损伤患者,其中男性99例,女性89例,年龄12～75岁,中位年龄48岁。188例中,因鼻咽癌放疗后致伤者118例,因乳腺癌放疗后致伤者45例,因肺癌放疗后致伤者5例,其他恶性肿瘤放疗后致伤者20例。188例患者随机分为两组:…     

高原地区腹部严重刀刺伤83例诊治分析

目的探讨高原地区腹部严重刀刺伤的治疗经验。方法以我院2009年1月~2012年12月收治的83例刀刺伤患者的救治过程为依据,对急救方法和注意事项加以总结。结果除7人因送诊路途遥远导致失血性休克死亡外,其余全部治愈。结论伤者入院后立即投入抢救很关键,抢救过程中尽快探明伤势,做好术前准备,积极给予吸氧、抗休克等可以显著提高伤者生存率。     

行人下肢交通伤成因分析1例

根据交通事故现场图、照片,询问笔录,伤者照片、病历资料,通过比对,分析伤者右股骨骨折和右股动脉断裂是由于轿车撞击造成的还是货车碾压或轮胎挤压造成.分析结果表明,伤者是因轿车撞击导致右股骨骨折,骨折形成的锐利尖角加上碰撞造成的牵拉导致右股动脉断裂;货车与伤者有擦挂,但不至于导致右股骨骨折及右股动脉断裂.     

如何抢救断指伤员?

我国显微外科发展迅速,断指再植水平居世界前列。许多手指受伤离断的病人在医生的及时抢救和精心治疗下,断指再植成活,功能基本恢复。这一方面要靠医院的优良设备、医生的高尚医德和精湛技术, 另一方面现场正确处理也十分重要。正确保存断指是再植成功的基础和前提。但在外伤现场,伤者往往难以得到医务人员的正确指导,抢救人员惊慌失措,往往     

46例心脏穿透伤急诊救治的体会

目的总结心脏穿透性损伤的救治经验。方法回顾性分析1988年2月～2008年11月救治的46例心脏穿透性损伤患者的诊断和治疗资料,总结其临床特点及救治经验。结果全组均急诊下开胸止血,死亡6例,其余伤者全部痊愈出院。心脏压塞型及亚临床型伤者无1例死亡;受伤至就诊时间30分钟内患者均抢救成功。结论迅速明确伤情,果断剖胸探查是提高心脏穿透伤抢救成功率的关键。     

PET, CT, and MRI in the evaluation of neuropsychiatric disorders: current applications

Positron emission tomography (PET) is emerging as a very useful clinical tool and is adding a great deal to our understanding of the pathophysiology of central nervous system (CNS) disorders. Although computed tomography (CT) and magnetic resonance imaging (MRI) have had a dramatic impact on patient management, there is often an important associated function abnormality which is best assessed by PET. In normal aging and in dementia, the CT and MRI brain changes of atrophy and white matter abnormalities are frequently nonspecific. PET has been more diagnostic, showing characteristic regional metabolic abnormalities. Evaluation of brain tumors such as astrocytomas with PET has demonstrated better correlation with histologic grade compared to CT. Unlike CT or MRI, PET can help to distinguish radiation necrosis from recurrent tumor, and can differentiate the extent of metabolically active tumor from surrounding edema. PET is useful in evaluating stroke patients, providing better prognostic information and demonstrating abnormalities sooner than CT. In epilepsy, PET appears to be superior to MRI in localizing seizure foci in patients with partial seizures. In head trauma patients, metabolic patterns are being described which will likely have an effect on patient management. The use of PET in schizophrenia has yielded very interesting results, with common patterns of metabolic abnormalities being demonstrated. CT and MRI in these patients have not been very useful. PET has also shown promise in movement disorders such as Huntington's disease. It is now clear that PET is already clinically useful and can provide valuable information unobtainable by CT and MRI. As new radioligands are developed, PET is certain to assume an even more important role in the future.     

Local cerebral glucose abnormalities in mild closed head injured patients with cognitive impairments

Mild-moderate closed head injury (CHI) can be followed by neuropsychological impairments in recent memory and attention, despite the absence of discernible structural abnormalities in a significant number of patients. To determine whether CHI may result in cerebral glucose metabolic abnormalities, we used fluorodeoxyglucose (FDG) technique with PET imaging to measure local cerebral metabolic rates for glucose (LCMRGlu) in three CHI patients and three matched normal controls. The CHI patients were between 3-12 months post-injury. All had deficits in attention and recent memory shown by neuropsychological testing. CT, MRI, EEG and drug screens were negative at the time of PET scanning. Subjects were engaged in a vigilance task throughout the initial 30 min following FDG administration. Group comparisons were made using t tests. There were no significant group differences found in global glucose metabolic rate. Nevertheless, the CHI group exhibited significantly decreased LCMRGLu in medial temporal, posterior temporal, and posterior frontal cortices, as well as in the left caudate nucleus. LCMRGlu was significantly increased, relative to controls, in anterior temporal and anterior frontal cortices. These results suggest that CHI patients can have regional glucose metabolic abnormalities, indicative of altered neuronal function, despite the absence of discernible anatomic abnormalities.     

PET in the assessment of therapy response in patients with carcinoma of the head and neck and of the esophagus.

In patients with carcinoma of the head and neck and of the esophagus, metabolic and functional imaging by PET with (18)F-FDG has a pivotal role in the evaluation of tumor response to therapy, specifically, in the prediction of progression-free survival and overall survival. Metabolic imaging allows the detection of biochemical changes within tumor cells as opposed to identifiable morphologic changes. Anatomic imaging modalities do not reliably differentiate between responders and nonresponders early during the course of follow-up. The correlation between histopathologic tumor response after preoperative therapy and clinical prognosis is well established for many cancers. Squamous carcinoma of the head and neck and esophageal carcinoma demonstrate avid (18)F-FDG uptake. For these cancers, (18)F-FDG PET parallels histopathologic findings in its ability to detect residual viable tumor; therefore, it is a valuable tool for the noninvasive assessment of histopathologic tumor response in advanced-stage cases after neoadjuvant therapy before surgery. Early determination of nonresponders is of prime importance, as timely therapy modification can be accomplished for patients who do not demonstrate a response to therapy. This determination is exceptionally important for head and neck and esophageal malignancies, both of which are known for their unfavorable prognosis, as early modifications in therapy regimens for nonresponders may improve patient outcome. There is now evidence that (18)F-FDG PET is a sensitive and specific method for determining therapy response and for providing important prognostic information for these cancers. Therefore, (18)F-FDG PET may change patient management and lead to improved survival for a selected group of patients with carcinoma of the head and neck and of the esophagus.     

Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours

Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory.     

Imaging and clinical spectrum of rhabdomyosarcoma in children

We retrospectively analyzed the MRI findings of rhabdomyosarcoma (RMSA) in 23 patients to evaluate its role in staging and management. Heterogeneous signal abnormalities were noted in the sarcoma lesions with significant contrast enhancement. Seven head and neck cases showed direct bone invasion and destruction; only one had distant bony metastasis. Metastasis was noted in the lymph nodes, lung, bone, abdominoperitoneum, and head and neck soft tissue. MRI findings of RMSA are most helpful in staging and assessing therapeutic response.     

Fetal central nervous system biometry on MR imaging

OBJECTIVE: We sought to compare the biometry of the fetal head on MR imaging with sonographic measurements in fetuses with and without suspected central nervous system abnormalities. MATERIALS AND METHODS: Blinded retrospective measurements of biparietal diameter, head circumference, and cerebellar width obtained on MR imaging were assigned a gestational age on the basis of median sonographic measurements and compared with sonographic and clinical assignment of gestational age in fetuses with no central nervous system abnormalities. In fetuses with central nervous system abnormalities, the same MR measurements were compared with sonographic measurements obtained within 1 week. Single-shot fast spin-echo sequences were obtained. Pearson's product moment correlation coefficients and paired sample t tests were performed. RESULTS: In 22 fetuses with no suspected central nervous system abnormalities, significant correlation was seen in the assignment of gestational age by MR measurements and sonographic gestational age. In 25 fetuses with central nervous system abnormalities, significant correlation was also seen between biparietal diameter and head circumference measurements. The mean biparietal diameter on MR imaging was greater than on sonography in those fetuses with central nervous system abnormalities (p = 0.038). CONCLUSION: MR imaging measurements of biparietal diameter, head circumference, and cerebellar width are strongly correlated to gestational age in fetuses without central nervous system abnormalities. Significant correlation is found between MR imaging and sonographic measurements of biparietal diameter and head circumference in fetuses with central nervous system abnormalities. Larger biparietal diameter measurements were seen with MR imaging than with sonography in the abnormal group. Fetal central nervous system biometry can be performed as part of the MR imaging evaluation of the fetal central nervous system.     

Chronic gastric torsion in infancy: a revisited diagnosis

Twenty out of 108 infants with vomiting, who underwent an upper gastrointestinal X-ray study during a period of 2 years, showed a peculiar shape and position of the stomach already described as chronic gastric torsion. We examined clinical, radiologic and laboratory findings of these 20 infants. Our results showed that chronic gastric torsion is frequently associated with gastroesophageal reflux and has a wide spectrum of symptoms, complications and nutritional abnormalities.     

Technetium-99m-HMPAO SPECT in the evaluation of patients with a remote history of traumatic brain injury: a comparison with x-ray computed tomography.

The functional imaging modality has potential for demonstrating parenchymal abnormalities not detectable by traditional morphological imaging. Fifty-three patients with a remote history of traumatic brain injury (TBI) were studied with SPECT using 99mTc-hexamethylpropyleneamineoxime (HMPAO) and x-ray computed tomography (CT). Overall, 42 patients (80%) showed regional cerebral blood flow (rCBF) deficits by HMPAO SPECT, whereas 29 patients (55%) showed morphological abnormalities by CT. Out of 20 patients with minor head injury, 12 patients (60%) showed rCBF deficits and 5 patients (25%) showed CT abnormalities. Of 33 patients with major head injury, 30 patients (90%) showed rCBF deficits and 24 patients (72%) showed CT abnormalities. Thus, HMPAO SPECT was more sensitive than CT in detecting abnormalities in patients with a history of TBI, particularly in the minor head injury group. In the major head injury group, three patients showed localized cortical atrophy by CT and normal rCBF by HMPAO SPECT. In the evaluation of TBI patients, HMPAO SPECT is a useful technique to demonstrate regional brain dysfunction in the presence of morphological integrity as assessed by CT.     

Gastrointestinal tract malignancies and positron emission tomography: an overview

(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is highly accurate in restaging colorectal cancer, esophageal cancer, and gastrointestinal stromal tumors. Overall, it compares favorably with anatomical imaging in the evaluation of tumor recurrence because metabolic abnormalities usually precede a structural change. Initial staging of these malignancies with PET is best used in patients with locally advanced disease who may benefit from curative resection if distant metastases are not found. It also appears to have great potential in predicting histopathologic response to neoadjuvant therapy and in monitoring the success of radiofrequency ablation and (90)Y microspheres radioembolization soon after intervention. FDG-PET can be used in other gastrointestinal malignancies as a prognostic tool and to detect distant disease but its role has not yet been well defined.