慢性硬膜下血肿术后并发症原因分析及应对措施

目的探讨慢性硬膜下血肿（chronic subdural hematoma，CSDH）术后并发症的原因及应对措施。方法回顾2000年至2004年手术治疗的85例CSDH患者，并结合有关文献进行相关分析。结果术后血肿复发3例，张力性气颅1例，脑挫裂1例，硬膜外血肿3例，脑脊液漏1例，脑内血肿1例。结论认识CSDH术后并发症的原因，早期采取有效措施，可有效预防并发症。     

Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness.

BACKGROUND: Portugal has one of the highest mortality rates from stroke, a high prevalence of hypertension and probably a high salt intake level. AIM: To evaluate Portuguese salt intake levels and their relationship to blood pressure and arterial stiffness in a sample of four different adult populations living in northern Portugal. METHODS: A cross-sectional study evaluating 24-hour urinary excretion of sodium (24 h UNa+), potassium and creatinine, blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult populations of sustained hypertensives (HT), relatives of patients with previous stroke (Fam), university students (US) and factory workers (FW), in the context of their usual dietary habits. RESULTS: We evaluated a total of 426 subjects, mean age 50 +/- 22 years, 56% female, BMI 27.9+/-5.1, BP 159/92 mmHg, PWV 10.4+/-2.2 m/s, who showed mean 24h UNa+ of 202 +/- 64 mmol/d, corresponding to a daily salt intake of 12.3 g (ranging from 5.2 to 24.8). The four groups were: HT: n = 245, 49 +/- 18 years, 92% of those selected, 69% treated, BP 163/94 mmHg, PWV 11.9 m/s, 24 h UNa+ 212 mmol/d, i.e. 12.4 g/d of salt); Fam: n = 38, 64 +/- 20 years, 57 % of those selected, BP 144/88 mmHg, PWV 10.5 m/s, 24 h UNa+ 194 mmol/d, i.e. 11.1 g/d of salt; US: n = 82, 22 +/- 3 years, 57% of those selected, BP 124/77 mmHg, PWV 8.7 m/s, 24h UNa+ 199 mmol/d, i.e. 11.3 g/d of salt; FW: n = 61, 39 9 years, 47% of those selected, BP 129/79 mmHg, PWV 9.5 m/s, 24 h UNa+ 221 mmol/d, i.e. 12.9 g/d of salt. The ratio of urinary sodium/potassium excretion (1.9 (0.4) was significantly higher in HT than the other three groups. In the 426 subjects, 24h UNa+ correlated significantly (p < 0.01) with systolic BP (r = 0.209) and with PWV (r=0.256) after adjustment for age and BP. Multivariate analysis showed that BP, age and 24h UNa+ correlated independently with PWV taken as a dependent variable. CONCLUSIONS: Four different Portuguese populations showed similarly high mean daily salt intake levels, almost double those recommended by the WHO. Overall, high urinary sodium excretion correlated consistently with high BP levels and appeared to be an independent determining factor of arterial stiffness. These findings suggest that Portugal in general has a high salt intake diet, and urgent measures are required to restrict salt consumption in order to prevent and treat hypertensive disease and to reduce overall cardiovascular risk and events.     

Cardiovascular protection from alcoholic drinks: scientific basis of the French Paradox.

This article discusses the cardiovascular protection afforded by low to moderate consumption of ethanol and the role of ethanol-induced preconditioning. Ethanol, a compound that is found in many popular beverages, has a whole range of cardiovascular protective effects when consumed in low to moderate doses. Although they have yet to be totally clarified, recent data suggest that a combination of several actions at the biochemical and molecular levels play a role in this protection. These include favorable changes in lipid metabolism, antioxidant effects, changes in hemostasis and platelet aggregation, arterial vasodilation mediated by NO release, induction of the expression of cardioprotective proteins, insulin sensitization and lower levels of inflammatory markers. Special emphasis will be given to ethanol-induced preconditioning. Some of the compounds present in red and white wine, such as resveratrol and quercetin, are also partly responsible for some of the cardioprotective effects of alcoholic drinks. These are due to antioxidant effects and changes in platelet aggregation, endothelial function and inflammatory response. The last part of the paper will focus on the clinical applications and possibilities raised by these new findings.     

98例尿道下裂手术的体会

目的通过对尿道下裂手术的改进,进一步完善尿道下裂手术的技巧和护理。方法A组50例尿道下裂Ⅰ期成形术中,采用皮下连续内翻缝合形成新尿道,且固定于阴茎海绵体,由阴茎根部自下而上多层次,多点缝合皮瓣皮下组织至阴茎海绵体上,均无间隙和死腔。B组48例采用常规手术方式作对照。结果A组50例尿道下裂Ⅰ期成形术成功44例,B组48例成功17例,A组与B组相比成功率显著提高(P＜0．05)。结论尿道下裂Ⅰ期成形术成功率关键在于术者对术式掌握的熟练程度和术中及术后对每个细节的认真处理。     

小肝细胞癌的螺旋CT诊断

目的探讨小肝细胞癌的CT影像表现。方法回顾我院2001年2月-2005年2月经病理证实的12例小肝细胞癌的CT表现。结果通过平扫、动脉期、门脉期及部分延迟扫描均可对小肝细胞癌作出定性诊断。结论螺旋CT作为非创伤性容积扫描技术对小肝细胞癌的早期检出、定位、定性诊断具有十分重要的临床价值。     

新型记忆合金节段内固定器治疗腰椎峡部裂的实验研究

目的 :设计一种治疗腰椎峡部裂的新型记忆合金节段内固定器 ,测试其材料力学特性 ,并评价其生物力学稳定性。方法 :测量 2 0具干燥完整成人腰椎标本获得数据 ,按数据采用镍钛记忆合金设计固定器并行材料力学测试。取 6具新鲜成人腰椎标本 ,先后形成正常脊柱组、峡部裂组、横突棘突钢丝捆绑组、钩螺钉固定组、Buck螺钉固定组、新研制记忆合金固定器固定组 6组实验模型。利用脊柱三维运动实验机 ,分别测试 6组的前屈 /后伸、左 /右侧弯及左 /右轴向旋转 6种运动的活动范围。结果 :材料力学测试表明其形态记忆功能良好 ,体温状态下会产生稳定可靠的回复力。 6组在前屈、后伸及左右旋转状态 ,峡部裂组稳定性最差 ,同其他 5组差别明显。而使用新研制记忆合金内固定器组可明显恢复腰椎稳定性 ,同正常脊柱组及其他 3种内固定组均无显著差别。另两种状态左右侧弯 6组均无显著性差别。结论 :新设计的内固定器符合腰椎的生物力学要求 ,较先前的半环状内固定器优势明显 ,具有很好应用前景     

微创固定系统治疗膝关节周围复杂骨折

目的应用微创固定系统(less invasive stabilizing system,LISS)治疗膝关节周围复杂骨折,探讨其手术适应证及疗效。方法2003年12月至2004年6月应用LISS技术治疗膝关节周围复杂骨折41例,男29例,女12例;年龄24￣67岁,平均40.6岁。胫骨近端骨折28例,股骨远端骨折13例。多发伤22例(53.7%),陈旧性骨折6例(14.6%),翻修手术1例。新鲜骨折均采用关节面切开复位、干骺端闭合复位及经皮钢板固定技术;陈旧性骨折及翻修手术采用有限切开及经皮钢板固定技术。结果单侧LISS手术时间平均87.2min。全部病例随访13～21个月,平均16个月。3例股骨远端骨缺损患者平均于术后21.3周(19～24周)行植骨术,植骨术后22.3周(18～24周)骨折愈合。其余患者愈合时间平均15.1周(11～23周),完全负重时间平均16.8周(12～25周)。术中发生螺钉脱落1例,提拉复位装置断裂1例,工具断裂1例,螺钉未能按计划置入2例。术后发生关节面复位丢失1例,无感染、内固定松动、断裂及失败病例。按照Rasmussen骨折复位评分标准,优31例、良10例。术后1年关节活动范围2.4°～95.6°。术后1年HSS评分平均88.4分(58～98分),其中优27例、良10例、中3例、差1例,优良率90.2%。结论LISS为膝关节周围复杂骨折提供了一种新的治疗方法,特别是对常规方法难以处理的骨折。但其手术理念及手术技术与传统手术不同,还需要一定病例与随访的积累才能确定其疗效。     

维生素D衍生物联合供者骨髓细胞输注诱导异基因大鼠心脏移植免疫耐受

目的 探讨同种异基因心脏移植后免疫耐受的诱导。方法 建立大鼠颈部异位心脏移植模型，按分组分别给予门静脉输注供者骨髓细胞(DBMC)(B组)、骨化三醇灌胃(C组)、输注DBMC及骨化三醇灌胃(D组)以及环孢素A(CsA)灌胃(E组)。观察移植心脏的存活时间及心肌组织病理改变，测定心肌组织中肿瘤坏死因子及细胞间粘附分子-1 mRNA的表达以及血清钙、磷浓度，进行受者与供者及无关第三品系大鼠脾细胞混合淋巴细胞培养(MLR)。结果 D组移植心脏的存活时间较其它各组显著延长(P＜0．05)；术后7d，C组、D组、E组受者脾细胞均能显著抑制供者及第三方无关供者脾细胞作为刺激细胞引起的MLR；D组手术前后血磷、血钙浓度的差异无显著性(P＞0．05)；各组急性排斥反应的程度，D组最轻；D组肿瘤坏死因子及细胞间粘附分子-1 mRNA的表达受到显著抑制，与对照组(A组)、B、C组比较，差异有显著性(P＜0．05)。结论 骨化三醇灌胃联合DBMC输注可显著延长移植心脏的存活时间，二者具有协同作用。     

中国部分地区妇幼卫生信息系统的现状分析

本文通过研究卫生 项目地区报表资料和现场调查 ,对项目地区妇幼卫生信息系统的建设及运作情况进行了分析 ,并对报表数据质量进行了评价。分析显示 :卫 项目推动了贫困地区信息系统建设 ,项目地区已建立起系统的妇幼卫生信息管理体系 ,但分析也反映出项目地区妇幼卫生常规报表的数据质量仍存在一定问题。分析结果提示 ,应进一步加强妇幼卫生信息系统建设 ,提高妇幼卫生统计信息专业队伍的业务水平。