亚低温治疗特重型颅脑损伤疗效观察

目的:探讨亚低温对特重型颅脑损伤患者的疗效。方法:将70例特重型颅脑损伤患者随机分为实验组(亚低温组)和对照组(常规手术组)。实验组在常规治疗的基础上在给予亚低温治疗,每组35例,并比较两组的临床疗效。结果:实验组恢复良好率37.14%明显高于对照组11.43%,死亡率25.71%明显低于对照组42.86%,(P<0.05)。结论:在常规治疗的基础上加用亚低温疗法治疗特重型颅脑损伤可以明显改善患者的预后。     

Akuttherapie lebensbedrohlicher tachykarder Rhythmusstörungen

Life-threatening supraventricular tachyarrhythmias include atrial fibrillation, atrial flutter, AV-nodal reentrant tachycardia with rapid ventricular response and preexcitation syndromes combined with atrial fibrillation. Ventricular tachyarrhythmias still remain one of the leading causes of death; these arrhythmias include monomorphic and polymorphic ventricular tachycardia, torsade de pointes tachycardia, ventricular fibrillation and ventricular flutter. In all patients with tachycardias, an attempt should be made to differentiate between narrow (QRS duration < 0.12 s) or wide QRS complex (QRS duration ≥ 0.12 s) tachycardias. In the assessment of patients (pts) with supraventricular/ventricular tachyarrhythmias, attention should be given to identify whether the tachycardia is associated with worsening angina or low cardiac output. In pts with narrow QRS complex tachycardias or pts with atrial fibrillation and preexcitation syndromes immediate synchronized cardioversion should be performed if signs or symptoms of instability (hypotension, evidence of end-organ dysfunction, worsening angina) exist. In pts with a stable hemodynamic situation, vagal maneuvers, adenosine or calcium channel blockers can be used. Management of atrial flutter usually centers on cardioversion or rapid atrial pacing to normal sinus rhythm. In the treatment of patients with deemed unstable ventricular tachycardia (VT), electrical cardioversion is the treatment of choice. In more stable patients, ajmaline is the preferred agent after myocardial infarction and lidocaine if myocardial ischemia is present. In pts with torsade de pointes tachycardias aggressive steps must be taken to prevent degeneration of this rhythm to ventricular fibrillation (VF). Magnesium sulfate has recently been demonstrated efficacious and is currently considered first-line drug therapy. Transcutaneous overdrive pacing should be attempted if magnesium is unsuccessful. The pt with pulseless VT or VF demands early electrical countershock.     

乙肝疫苗初免失败婴儿再免疫方法研究

目的探索乙肝疫苗初次全程免疫失败婴儿的再免疫方法.方法对乙肝疫苗全程免疫后乙肝病毒表面抗体(抗-HBs)和乙肝病毒表面抗原(HBsAg)均阴性的144名婴儿,随机分成5组,1组为对照组,其余4组分别采用不同的再免疫方法,观察再免成功率.结果抗-HBs总阳转率为93.79%,抗-HBs几何平均滴度(GMT)为546.97mIU/ml,各组抗-HBs阳转率分别为87.88%、90.91%、100%、96.88%;各组GMT分别为475.34mIU/ml、658.65mIU/ml、625.18mIU/ml、455.90mIU/ml.结论乙肝疫苗初免失败婴儿,再免成功率达93.79%.     

脑卒中患者医院感染的临床分析及预防对策

在我国大规模人群调查显示，脑卒中年发病率为109．7～217/10万，且随年龄而增长，脑卒中患者为医院感染的高危人群，其感染发生率明显高于其他疾病。为了解脑卒中患者的医院感染危险因素，预防和控制医院感染的发生，现对海安肿瘤医院院收治的396例脑卒中患者病历资料进行调查，分析脑卒中患者医院感染的危险因素和特点，为有效控制院内感染提供依据。     

Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine

Objective : To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course.
Methodology : Serosurvey (antibody prevalence study) in two groups: infants aged 5-9 weeks who had not received any immunizations ( n = 25), and infants aged 7-10 months who had received two ( n = 25) or three immunizations ( n = 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent-held child health record, or the local council or family doctor who immunized the infant.
Results : Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA-determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre-immunization and post-immunization subjects were compared.
Conclusions : These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.     

Belastungsdyspnoe durch Impression des linken Vorhofs

We report a case of an 87-year-old woman who suffered from dyspnoea. Cardiac catheterization excluded significant coronary artery stenosis, but showed elevated left ventricular end-diastolic pressure. We assumed heart failure with normal ejection fraction (HFNEF) as the genesis of her breathlessness, as HFNEF is one of the most common causes of heart failure symptoms including dyspnoea. Surprisingly, additional echocardiography showed a dorsal compression of the left atrium, and further imaging visualized an upside-down stomach.     

Optimized visualization of contrast medium dependent differences in CT/MRI scans by RGB transformation.

OBJECTIVE: In order to be able to assess the contrast medium enhancement of vessels and regions with disturbed blood-brain barrier, the neurosurgeon must mentally perform a subtraction of the corresponding native and contrast-enhanced scans of the CT or MRI. The principle disadvantages of this comparison are the amount of time required and the potential errors which may result from false interpretation. METHODS: The process presented here combines corresponding scans without and with contrast medium offline on a PC. In this process each couple of the black and white scans is assigned to the colour channels of the RGB system (red, green, blue) and transformed to one colour picture of the RGB colour space (additive colour mixture). RESULTS: We demonstrate that contrast medium-dependent changes can be represented in a colour contrast of complementary colours in one single picture. Additionally, the unchanged structures remain in the black and white contrast as they were before. CONCLUSION: Thanks to the optimized visualization of contrast medium dependent differences there are besides saving in time further advantages such as the reduced amount of pictures and an objective representation.     

Tachykardie mit breitem QRS-Komplex bei einem jungen Mann

Der vorliegende Bericht beschreibt den Fall eines 35-j?hrigen Mannes, der seit Jahren über anfallsweises Herzjagen mit leichter Dyspnoe klagt. Der QRS-Komplex w?hrend Sinusrhythmus zeigte keine Pr?exzitation. Bei der elektrophysiologischen Untersuchung konnte die dokumentierte, spontan aufgetretene Tachykardie mit Linksschenkelblockmorphologie ausgel?st werden. W?hrend der Tachykardie lie? sich das His-Bündel-Potential im QRS-Komplex nachweisen. Bei vorzeitiger atrialer Stimulation zeigte der QRS-Komplex eine deutliche Pr?exzitation. Der QRS-Komplex mit maximaler Pr?exzitation entsprach dem QRS-Komplex w?hrend der Tachykardie. Die antegrade Erregung der Kammern erfolgte über eine rechtsseitig gelegene akzessorische Muskelfaser mit ausschlie?lich antegrader Leitung und dekrementalen Leitungseigenschaften, sodass die Diagnose eines Mahaim-Syndroms gestellt wurde. Rechtslateral konnte atrialseitig am AV-Ring ein Mahaim-Potential registriert werden. An dieser Stelle wurde die Spitze eines Ablationskatheters positioniert. Hier gelang die Ablation der atrioventrikul?ren Mahaim-Faser durch Hochfrequenzenergieabgabe. W?hrend der Nachbeobachtungszeit von 5 Monaten ist der Patient beschwerdefrei.