妙用硬纸板

随着医学事业的不断发展,输液方法日益普及,但在临床输液治疗中常会遇到因恐惧害怕而不愿意合作的患儿。由于小儿天性好动,自制力差.在输液过程中他们将有意或无意识的手指或手脚乱动,可能导致针头移位致药液外漏或者将针     

失血性大鼠休克后肠、肝、肺组织中细胞因子表达、释放时相及其伴随的病理变化

目的：探讨休克后促炎细胞因子的表达、释放时相及伴随的肠、肝、肺组织病理变化。方法：80只SD大鼠随机均分为失血性休克组和对照组。采用RT-PCR、ELISA方法检测失血性休克后30、60、90min及复苏后30、90min肠、肝、肺组织内TNF-α、IL-6 mRNA表达及血清中TNF-α、IL-6含量；HE和IHC染色检测伴随的组织病理变化。结果：①休克30min时，肠、肝、肺内的促炎细胞因子表达未见升高；60min时肠道先出现TNF-αmRNA表达升高（P〈0．05）：而肝脏在90min开始表达升高（P〈0．05），肺脏则在复苏后30min开始表达升高（P〈0．05）。复苏后90min肠、肝、肺的细胞因子表达都继续显著升高（P〈0．01）。②TNF-α 在肠、肝、肺的表达升高最早，其后为IL-6 mRNA。③30min时门静脉和外周血中TNF-α、IM的含量与对照组相比无显著差异，而60min时门静脉血中含量显著升高（P〈0．01）。④休克后肠黏膜坏死脱落；肝组织结构紊乱、肝窦增宽、肝细胞变性坏死；肺脏间质水肿、炎症细胞浸润。结论：失血性休克时细胞因子的释放顺序是肠道、肝脏和肺脏，推测存在“肠-肝-肺”细胞因子释放轴的可能，有待进一步确定。     

双能量CT头颅血管成像的影像质量、辐射剂量及初步临床应用

Objective To assess the clinical value of dual-energy intracranial CT angiography (CTA).Methods Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group.Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametrie test and independent-samples t test, respectively.Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA.There was no significant difference between the two groups(Z= -0.455, P=0.650).Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P= 0.000).Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy · cm respectively.Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA.Out of the 41 patients,19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results.Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques.Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) nun, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1.71), (5.10±1.60) ,(3.83±1.65) nan,respectively.There was no significant difference for the diameters of aneurysm between dual energy CTA and DSA ((t=-0.734,1.936,0.12.5 respectively, P=0.482,0.085,0.903 respectively), and good correlation was found between diameter measurements using the two techniques(r=0.964,0.976,0.973, respectively, all P=0.000) Conclusions Compared with conventional subtraction CTA, dual energy CTA has good image quality for intracranial vessels; however, image quality of the skull base vessels is worse, especially for the petrosal and syphon segment.Dual energy CTA has decreased radiation dose and a high diagnostic accuracy, being a practical imaging madality for diagnosis of intracranial vascular lesions.     

腰椎间盘突出症致痛机理探讨

腰椎间盘突出是引起腰腿痛的最常见原因之一。椎间盘是上下两个椎体的连接物,椎间盘的中心为髓核,呈胶冻状,其成分80%为水,髓核的外周包绕一层纤维组织称为纤维环,人到20～30岁后,椎间盘的纤维环开始退变,逐渐出现裂隙。在退变的前提下,遇扭闪外力,髓核或连同纤维环便会凸出到椎管内,压迫相邻的神经根,产生腰椎间盘突出症。     

张景岳"中年求复再振元气"思想

“中年求复，再振元气”是明代著名医家张景岳关于我国中老年医学的一个独具特色的学术思想。对其所提的“中年求复，再振元气”的意义和学术价值进行了探讨，并分析了中年求复，贵在复元惜元的思想和重要意义，以倡其中兴延寿之旨。     

富氧水防治急性高原病的效果观察

目的:观察饮用富氧水防治急性高原病的效果。方法:36名受试者自海拔1400m驻地乘汽车2天到达海拔3700m当日随机分两组,实验组(18人)口服5%葡萄糖注射液制成的富氧水,对照组(18人)口服5%葡萄糖注射液,均每次500mL,一日2次,直至进入海拔5200m某哨卡第6天,共服液8天。以军用卫生标准GJB1098-91"急性高原反应的诊断和处理原则"随访记录受试者进入哨卡第2天、4天、6天急性高原反应症状,然后分度与评分。同时检测血氧饱和度(SaO2)和脉率。结果:进驻哨卡第2天和第4天实验组较对照组急性高原反应分值减少,而SaO2增高(P<0.05或P<0.01),进驻哨卡第2天实验组较对照组脉率降低(P<0.05)。结论:饮用富氧水有防治急性高原病的效果。     

2004全国便秘基础与临床新技术演示研讨会纪要

由中国医师协会和中华医学会外科学分会肛肠外科学组主办，重庆第三军医大学大坪医院野战外科研究所承办的2004全国便秘基础与临床新技术演示研讨会于2004年11月18至21日在重庆召开。来自全国从事便秘基础与临床研究的212名代表参加了这次会议；大会共收录了82篇论文，反映了近年来便秘基础与临床的研究进展及难点问题。本次大会有幸请到我国从事便秘基础与临床工作的著名专家喻德洪、张胜本、杨新庆、张东铭、柯美云、闫于悌和曹吉勋等教授，     

镍钛记忆合金环抱器治疗锁骨骨折5例并发症分析

目的回顾应用镍钛记忆合金环抱器治疗锁骨骨折26例,统计其并发症的分布,并分析出现原因。方法26例应用镍钛记忆合金环抱器内固定治疗的锁骨骨折,随访3～11个月,统计并发症的分布。结果内固定松动造成骨折畸形愈合4例,再骨折1例。骨折不愈合、神经血管损伤、胸膜损伤等并发症均未出现。结论镍钛记忆合金内固定器是一种安全有效的锁骨骨折治疗材料,但因为型号选择不当易发生松动,去除时因降温不均匀、暴力操作会引起再骨折。     

手部的去污方法

据报道在英国用于治疗与保健护理相关的感染的费用每年约10亿英镑，导致约5000人死亡。据估计，这些感染中有1／3是可以预防的。     

腰椎结核流注脓肿误诊为嵌顿疝1例分析

患者，女58岁，因右上腹不适1周就诊，考虑患者为熟人未给予全面检查。B超：于右侧胸腔位置锁骨中线第四、五肋间以下，肩胛线第七肋以下，均探及无回声暗区，最大直径20．0cm，内见分隔，肋下剑突下探及部分肝组织。肺部查体：右侧第四前肋以下第七后肋以下叩诊浊音，听诊呼吸音由减弱至消失，右侧肋弓下4．0cm处可触及肝下缘。考虑为右侧胸腔积液，收入院准备实施胸穿排液，入院后常规检查发现：胸片示双肺纹理清晰，双侧肋膈角锐利、右侧横膈上提于第四间肋间(2004年10月12号片号04001)。