胸部外伤致食管破裂的X线诊断2例报告

胸部外伤性食管破裂少见,易误诊。现将我院经X线诊断证实2例报告如下。 例1.患者男,20岁。5天前酒后骑摩托车与汽车相撞,当即昏迷,送当地医院诊治。当日患者饮水后即呕吐,为胃内容物。次日出现胸闷,呼吸困难,烦躁不安。胸透见两侧胸膜腔大量液气胸,钡餐检查见食管破裂。遂予以胸腔闭式引流转入我院。外科情况:胸廓饱满,双肺叩实,呼吸音减低,经两侧胸膜腔引流出大量带恶臭味脓液。X线检查:鉴于患者一般情况较差,予以半卧位透视,见两侧液气胸,右肺组织被压缩约10％。左侧液气胸伴多发性包裹性液气胸,肺组织压缩约40％。随即仰卧位服70％泛影葡胺100ml,见造影剂迅速经食管下段破裂处进入双侧胸膜腔,确诊为食管下段破裂,虽经积极抗感染、深静脉高营养,输血、空肠造瘘及各种支持疗法等,但因患者不配合治疗,多次趁人不备,自拔引流管及多次饮水,终因中毒性休克、呼吸循环衰竭死亡。     

变异型心绞痛的发作诱因和合并症

本文报告3例饮酒诱发变异型心绞痛者,2例发展为急性心肌梗塞,1例合并Ⅲ度房室传导阻滞.另3例无诱因的典型变异型心绞痛发作皆无合并症.上述结果提示:饮酒是变异型心绞痛发作的最常见诱因,与无诱因者相比,予后更为严重.因此,有冠状动脉痉挛倾向者如变异型心绞痛,不稳定型心绞痛,卧位或夜间发作的心绞痛等,应避免饮酒.     

寰枢椎椎弓根钉固定治疗伸直型齿状突骨折合并寰枢关节半脱位

Objective To explore the clinical outcome of atlantoaxial pedicle screw instrument in treatment of extension-type odontoid fracture combined with aflantoaxial subluxation. Methods From December 2002 to December 2006, seven patients with extension-type odontoid fracture combined with at-lantoaxial subluxation were reduced and fixed with atlantoaxial pedicle screw instrument of Vertex system under general anesthesia. There were five males and two females, at mean age of 39.2 years (range 21-59 years). All odontoid fractures were fresh type Aderson Ⅱ. JOA scores of spinal core function was 8.6-14.9 (average 10.7) preoperatively. The X-ray examination, CT scanning and skull traction were performed in all patients preoperatively. Results There found no severe complications such as injuries of vertebral artery, nerve root and spinal cord postoperatively. All patients obtained complete reduction and healing of the fracture and dislocation. The mean off-bed time was four days (3-6 days) after opera-tion. A follow-up for 12-36 months (average 22 months) in all patients showed that the clinical symptom was improved significantly six months postoperatively and that all screws were in proper position verified by X-ray and CT scanning. All patients obtained solid bony union on radiographs, with no loosing or breakage of instrument. The postoperative JOA scores was 13.5-16.9 (average 15.8). Conclusions Allantoaxial pedicle screw fixation has advantages of intraoperative reduction, reliable fixation and high fusion rate and can be used as an effective method for extension-type odontoid fracture combined with at-lantoaxial subluxation.     

锂-匹罗卡品癫(癎)模型中核转录因子的表达及干预机制

目的探讨癫发作时核转录因子(nuclear factor kappaB,NF-κB)在神经元损伤中的表达变化以及拉莫三嗪、黄芪注射液对这一过程的影响。方法干预组大鼠预处理3d后制作大鼠锂-匹罗卡品(lithi-um-pilocarpine,Li-PC)癫模型,造模后24h、3、7d应用光镜及电镜进行神经元形态学观察,利用免疫组织化学法半定量检测NF-κB的表达含量。结果与正常组比较,模型组海马内NF-κB表达明显增多(P<0.01),在24h达峰值;与模型组比较,拉莫三嗪、黄芪注射液能够使NF-κB表达增加(P<0.05)。结论NF-κB的主要作用是有利于神经元生存,拉莫三嗪、黄芪注射液可通过调控凋亡因子的表达而发挥对癫的神经元保护作用。     

中西医结合治疗皮肤粘膜淋巴结综合征

皮肤粘膜淋巴结综合征(川畸氏病)的病因至今未明,认为与病毒、细菌、立克次体或原虫有关。最近研究认为是某种超淋巴性感染因子即逆转录病毒(retro Virus)与本病关系更为密切。主要病变为全身各脏器血管炎性改变,发病急、病情重、病程长,临床症状表现不一。其特点为持续性高热5天以上;眼结合膜充血,唇红而干裂,口腔粘膜充血,扬梅舌,躯干有多形性红斑,急性非化脓性淋巴结炎等。     

脑干脑炎27例MRI与MRS的临床分析

目的 探讨脑干脑炎MRI、MRS及临床特点。方法 对27例脑干脑炎发病年龄、临床特点、MRI与 MRS及药物疗效进分析,并结合文献对病因、MRI与治疗方法进行探讨。结果 病前有上呼吸道或消化道症状,男女发病率相等,以青壮年居多,多侵犯脑桥,以单侧第Ⅵ、Ⅶ脑神经损害最多见,锥体束受损较轻,MRI及强化对诊断有一定价值,MRS可监测病灶部位代谢改变,对判断预后有一定帮助。     

心脏直视术气管插管病人的护理

心脏直视手术后,病人心肺功能尚未恢复,需要带气管插管进行呼吸机辅助呼吸以度过危险期,此时病人的各种需求只能通过面部表情、手势等来表达。有资料表明:81%的病人感觉不能说话是非常痛苦的[1]。因此护理人员能采取恰当的措施与病人进行有效的沟通,对病人早日康复起到重要的辅     

中西医结合治疗外伤性瞳孔散大的临床观察

外伤性瞳孔散大是眼球钝挫伤的常见并发症，轻者影响视力，重者可继发青光眼。我院采用中西医结合的方法治疗外伤性瞳孔散大取得较好的临床疗效，现将结果报告如下。     

1131例心电向量图束支传导阻滞发生率分析

临床资料一、对象:1981～1987年,我院共描记1131例心电向量图,其中男835例,女296例。年龄3～82岁,40～69岁者818例,占72.33％。二、方法:1131例中前881例采用上海医用电子仪器厂出产的XX—2型心电向量图机检查,后250例采用同济医科大学附属同济医院出产的T—J—Ⅱ型心电向量图自动分析诊断系统直接描图。检查前先询问病史,体格检查,描记心电图及作有关的其它