早期地塞米松－脑脊液置换治疗蛛网膜下腔出血临床观察

目的：观察探讨早期地塞米松－脑脊液置换治疗蛛网膜下腔出血（ SAH）的临床疗效,为临床蛛网膜下腔出血寻找安全有效的治疗方法。方法将救治的68例SAH患者随机分为两组（观察组和对照组、每组34例）。两组患者均给予常规治疗,观察组在此基础上行地塞米松－脑脊液置换治疗。连续治疗2周后观察两组疗效、脑血管痉挛及再出血发生率。结果两组治疗总有效率：观察组88.2％、对照组61.8％,两组比较有统计学差异（ P＜0.05）;脑血管痉挛发生率：观察组8.8％、对照组20.6％,两组比较有统计学差异（ P＜0.05）;再出血发生率：观察组11.8％、对照组8.8％,两组差异无统计学意义（ P＞0.05）。结论早期地塞米松－脑脊液置换作为安全、有效的治疗SAH的方法,能明显缓解病情、减少并发症且无明显的药物毒副作用。     

131I治疗前刺激性Tg在分化型甲状腺癌风险评估及治疗决策中的意义

甲状腺球蛋白(Tg)是分化型甲状腺癌(DTC)患者长期随访的重要指标之一。DTC患者的血清Tg监测包括刺激性Tg(sTg)(TSH>30μIU/ml刺激状态下的Tg水平)和非刺激性Tg (TSH抑制状态下的Tg水平)测定,前者对于DTC患者的病情监测具有更高的灵敏度和特异度。目前,"清甲"治疗后sTg是DTC患者病情监测的重要手段;而131I治疗前sTg (ps-Tg)由于受残余甲状腺组织的影响,在DTC病情评估及治疗决策方面的意义尚存在争议。自2009年美国甲状腺协会的相关指南中指出ps-Tg水平可能对DTC患者的疾病状态有一定的预测作用后,近5年来有关ps-Tg与131I治疗后疾病状态与预后间关系的研究备受关注。笔者主要就ps-Tg在DTC风险评估及治疗决策中的意义进行综述。     

黄葵胶囊联合健脾益肾方对慢性肾脏病脾肾阳虚型患者的疗效观察

目的观察黄葵胶囊联合健脾益肾方对慢性肾脏病(CKD3－4期)脾肾阳虚型的临床疗效。 方法58例患者随机分为治疗组(28例)和对照组(30例),两组患者均接受西医基础治疗及自拟健脾益肾方治疗,方剂1剂/d,100 ml/次煎服,2次/d,连用3个月,治疗组在此基础上加黄葵胶囊治疗,5粒/次口服,3次/d,连用3个月。于治疗前、治疗3个月时检测血液相关指标：Hb、Alb、TC、TG、BUN、Cr、UA、eGFR、CRP及β2微球蛋白(β2－MG)、血清超氧化物歧化酶(SOD)、丙二醛(MDA)、内皮素(ET)、一氧化氮(NO)。 结果治疗前以上两组相关指标差异无统计学意义(P> 0.05);治疗后两组收缩压、舒张压、TC、TG、BUN、Cr、UA、β2-MG、CRP、MDA、ET显著降低,Hb、Alb、NO、SOD、eGFR显著升高,差异均有统计学意义(P<0.05);与对照组比较,治疗组于治疗3个月后舒张压、TC、TG、BUN、Cr、UA、β2-MG、CRP、MDA、ET降低更明显,Hb、Alb、NO、SOD、eGFR升高更明显,差异均有统计学意义(P<0.05)。治疗3个月后,治疗组中医脾肾阳虚型主证表现消失,标实证表现明显减少,尤以湿热证减少明显;对照组脾肾阳虚型主证及标实证表现减少。 结论黄葵胶囊联合健脾益肾方治疗慢性肾脏病(CKD3-4期)脾肾阳虚型合并湿热的临床疗效优于单纯使用健脾益肾方。     

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia.     

Solitary necrotic nodule of the liver: radiologic–pathologic correlation in a case with unusual imaging features

Solitary necrotic nodule of the liver (SNNL) is rare. Generally thought to be nonmalignant, it is often mistaken for malignancy based on imaging findings alone. We present a case of a hepatitis B carrier who was found to have a new sonographically detected hepatic lesion. The lesion was further evaluated with CT and MRI, and as appearances were suggestive of a hypovascular hepatoma, the lesion was surgically resected. This case is unique in that while it demonstrates several characteristic features of SNNL, several other imaging and histological features have not been previously described.     

Stent management of coil herniation in embolization of internal carotid aneurysms

BACKGROUND AND PURPOSE: Coil herniation into the parent artery after detachment is an uncommon complication of embolization of the intracranial aneurysm. We report our experience with stent reconstruction of the lumen and flow of the internal carotid artery (ICA) after coil herniation during embolization for intracranial ICA aneurysms and the possible mechanisms of coil herniation.MATERIALS AND METHODS: A series of 216 consecutive patients was treated by endovascular coil embolizations for intracranial aneurysms. Of these patients, there were 9 (4 men, 5 women; 32–68 years of age) complicating with coil herniation into the ICA and undergoing stent deployment to reconstruct the ICA lumen (n = 8) or both lumen and flow (n = 1). Wide-neck aneurysms were found in 8 and narrow-neck, in 1. Aneurysms were in the posterior communicating artery (n = 5) and the paraophthalmic (n = 3) and cavernous portions (n = 1) of the ICA. Self-expandable stents were deployed in the ICA in 6; balloon-mounted stents were selected in 3.RESULTS: The causes of coil herniation appeared to be coil instability after detachment (n = 6), excessive embolization (n = 1), microcatheter-related problems (n = 1), or being pushed by subsequent coil embolization (n = 1). Endovascular stent placement to reconstruct the lumen and/or flow of the ICA was technically successful in all 9 patients; 1 needed a second stent due to further coil migration. No significant procedure-related complications were found. Clinical follow-up was 8–35 months.CONCLUSION: Coil herniation occasionally occurs during endovascular embolization of ICA aneurysms because of coil instability after detachment, excessive embolization, microcatheter-related problems, or pushing by subsequent coil embolization. In this small series, stent placement was safe and effective in the reconstruction of the arterial lumen and/or restoration of flow past a herniated coil mass.

Endovascular detachable coil embolization of intracranial aneurysms has increasingly become an alternative treatment technique to neurosurgical aneurysm clipping.¹ Despite increasing clinical experience and technologic improvements, endovascular treatment still has inherent risks of morbidity and mortality. The most common complication of endovascular embolization of the aneurysm is thromboembolic events, which may result from poor technique, endovascular devices, and/or poor flushing of the catheter systems. These complications may occur in 2.5%–28% of patients treated.^2-4 Stent-assisted aneurysm embolization is a well-known tool in the management of intracranial wide-neck aneurysms to prevent coil protrusion into the parent vessel and may allow safer and denser packing of the aneurysm sac.^5-8 However, to our knowledge, stent as a salvage procedure to reconstruct the lumen and/or blood flow of the parent artery during the procedure has not been well evaluated.The purpose of our study was to report our experience using stents to reconstruct the lumen and/or blood flow of the parent artery after coil herniation in the internal carotid artery (ICA) during embolization of intracranial ICA aneurysms and to report possible mechanisms of coil herniation.     

逆行交锁髓内钉治疗股骨髁上骨折及关节僵硬

目的：探讨应用逆行交锁强内钉治疗陈旧性股骨碟上骨折钢板断裂不愈合并膝关节僵硬的临床意义。方法：对5例患采用断裂钢板拆除，手术松解粘连，矫正畸形，股骨碟逆行交锁铝内钉固定，术后早期应用CPM机锻炼。结果：5例随访8—12个月，肢体无畸形，骨折愈合时间6—9个月，平均7．5个月，膝关节功能按Kolmert评定标准，优4例，良1例。结论：应用逆行交锁铝内钉治疗股骨碟上陈旧性骨折钢板断裂骨不愈合并膝关节僵硬，操作简便，固定牢靠，可早期功能锻炼，效果良好。     

重症手足口病患儿合并肺炎支原体感染实验室检测指标对于临床诊断及治疗的提示性作用

目的 探讨肠道病毒71型合并肺炎支原体感染的重症手足口患儿的检测指标对于临床诊断及治疗是否起到提示作用。方法 收集2014年3月至8月于首都医科大学附属北京地坛医院住院的手足口病患儿100例,非手足口病患儿50例,对其粪便标本采用荧光定量RT-PCR方法检测,得出核酸定性结果。对其血清标本采用被动凝集法检测以得出肺炎支原体抗体效价。分析肺炎支原体感染在手足口病组和非手足口病组中的差异,探讨肠道病毒71型合并肺炎支原体感染与手足口病严重程度的相关性。结果 重症手足口病组患儿的肺炎支原体阳性率(76%)高于轻症手足口病组患儿的肺炎支原体阳性率(48%),差异有统计学意义(χ²=8.319,P=0.004)。结论 肠道病毒71型阳性合并肺炎支原体感染的重症手足口病患儿,应在临床诊治中引起关注。对于降低重症手足口病患儿向危重症的转化具有提示意义。     

重庆地区丙型肝炎病毒基因型分布及临床意义

目的:了解重庆地区近年来丙型肝炎病毒(hepatitis C virus,HCV)基因型分布、演变和可能的临床意义,为更好防治丙型肝炎提供依据。方法:回顾性研究2010年1月至2013年12月期间在重庆医科大学附属第二医院就诊并有基因分型结果的丙型肝炎患者的基因型分布,并与该地区其它文献报道的数据相比较,探讨基因型演变的可能影响因素。结果:共收集941例HCV感染者,检出4种基因型、9种基因亚型,成功进行基因分型有857例(均为单一基因型,分型率91.1%)。其基因型分布为:1a 30例(3.5%)、1b 238例(27.8%)、2a 42例(4.9%)、2b 1例(0.1%)、3a 132例(15.4%)、3b 244例(28.5%)、3k 6例(0.7%)、6a124例(14.5%)、6b 40例(4.7%)。与5年前的结果比较发现HCV 1b、2a亚型明显下降,3型、6型比例上升,差异具有统计学意义。结论:3b、1b型为目前重庆地区丙型肝炎患者感染HCV的主要基因型,3a、6a型亦占有较大比例,提示重庆地区HCV流行的基因型呈现多样性。