臭氧联合激光与单纯激光治疗腰椎间盘突出症的疗效比较

目的:评价臭氧加激光联合应用对腰椎间盘突出症的治疗效果.方法:648例腰椎间盘突出症,男308例,女340例,年龄为24岁到66岁,平均45岁,随机分为两组,A组单纯用激光治疗,B组臭氧加激光治疗.于术前、术后1月、3月、6月、12月及24月应用JOA29分法评分,术后评分改善率在50%以上为优良.结果:术后随访无严重...     

沿海部队官兵幽门螺杆菌感染与上消化道疾病关系

目的探讨沿海部队官兵幽门螺杆菌感染与上消化道疾病的关系,为预防和治疗提供科学依据。方法对沿海某部官兵行胃镜检查,距幽门2cm处于胃窦大弯、小弯各取活组织1块做快速尿素酶试验检测幽门螺杆菌（Helicobacter Pylori,HP）。并按年龄、疾病种类等分类统计。结果受检262例,疾病检出率95.8%,快速尿素酶试验阳性145例,阳性率55.3%。结论沿海部队官兵HP感染率与我国人群感染率基本一致,HP感染与十二指肠溃疡、十二指肠炎、慢性胃炎发生密切相关。针对基层部队官兵营地远离市区,官兵就诊看病有一定困难,基层部队医疗单位应积极做好防治预案,常规准备抑酸、促胃动力、保护胃黏膜等药物。应积极根除HP。     

巨大良性前列腺增生1例报告并文献复习

目的:探讨巨大良性前列腺增生的临床特点、诊断和手术方法。方法:回顾分析1例巨大良性前列腺增生患者的临床资料,并复习国内外文献进行分析及讨论。结果:患者77岁,临床表现主要为夜尿增多、肉眼血尿。最大尿流率10ml/s,PSA37μg/L,CT显示前列腺大小为11cm×10cm×8cm。行耻骨后前列腺切除术,术后前列腺重量450g,病理结果示"良性前列腺增生"。术后21d康复出院,无明显并发症。国内文献报道,重量在200g以上有83例;国外文献报道,重量在500g以上有14例。国内报道的83例均通过手术治疗,大多数学者采用耻骨上经膀胱前列腺切除术,部分学者采用耻骨后前列腺切除术或经尿道前列腺切除术,术后效果良好。国外报道14例中11例采用耻骨上前列腺切除术,2例采用耻骨后前列腺切除术,1例采用两种方法。结论:巨大良性前列腺增生临床少见,定义尚未统一。根据临床表现和经直肠B超、前列腺CT等辅助检查可作出诊断。治疗应行前列腺切除术,手术方式有经尿道前列腺切除术、耻骨上经膀胱前列腺切除术或耻骨后前列腺切除术,以及腹腔镜前列腺切除术,具体术式应根据患者的实际情况及术者的手术经验而定。     

巨大体积前列腺增生的开放性外科治疗

目的 探讨巨大前列腺增生的外科治疗方法选择及临床处理经验.方法 回顾性分析10例巨大前列腺增生的患者的临床资料,患者平均年龄70.5岁,平均前列腺体积225ml,术前平均最大尿流率(Qmax)为4.6ml/s,平均国际前列腺症状评分(IPSS)27分,平均生活质量指数(QoL)5分.结果 10例患者均采用耻骨上经膀胱前列腺摘除术,摘除腺体平均重213g,平均手术时间85min,术中平均出血550ml,2例输血1～2u.术后连续膀胱冲洗平均2d,留置导尿管平均13d,留置膀胱造口管平均14d,术后平均住院时间15d.所有患者安全度过围手术期,拔管(导尿管及膀胱造口管)后能自行排尿,2例出现轻度尿失禁.出院时Qmax平均18.5ml/s,IPSS评分平均7.5分,QoL评分平均1.5分.结论 开放性耻骨上经膀胱前列腺摘除术是治疗巨大前列腺增生的一种安全有效的方法,围手术期的充分准备是减少术后并发症、保证患者安全的有力措施.     

长沙地区66772名体检人员尿石症患病情况调查

目的 探讨长沙地区人群尿石症患病率及发病主要危险因素.方法 采用成组病例对照研究方法,对66 772名体检者进行泌尿系B超、血生化、一般物理检查和性别、年龄等问卷调查.结果 该人群尿石症平均患病率为5.5%,男性结石患病率为6.9%,女性为3.4%.随年龄增加尿石症患病率呈上升趋势.肾结石比例最高,其次为输尿管结石、膀胱结石.结论 多因素分析提示:男性、年龄增加、口味偏咸、饮酒、吸烟、血尿酸高是尿石症危险因素.应综合防治,提倡合理膳食结构和保持良好生活习惯,多吃新鲜蔬菜和水果,可控制和降低泌尿系结石.

Abstract：

Objective To determine the prevalence and influencing factors of urinary calculi,to explore the interIrelationships between urinary stone disease and various risk and protective factors,to determine the potential implications for intervention and prevention in Changsha,and to evaluate the relative importance of each risk factor,with the objective of providing scientific guidelines for urinary calculi prevention and diagnosis. Methods A case-control study was designed,and 66,772 people were surveyed.Ultrasound examination,blood biochemistry,general physical examination,gender and age were asked in a questionnaire to determine a diagnosis of urolithiasis.By means of SPSS software a x2 tendency test and non-condition Logistic regression were conducted. Results A multivariate Logistic regression analyses was conducted.The final factors entered into the model were sex,age,profession,dietary habits,drinking habits,smoking and level of uric acid. Conclusions Hazard factors associated with urolithiasis are male gender,age,profession,dietary and drinking habits,smoking and level of uric acid.     

成人白血病中枢神经系统并发症的CT与MRI表现

目的 探讨成人白血病中枢神经系统并发症(CNSCL)的CT和MRI表现及其诊断价值.方法 回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现,其中急性淋巴细胞白血病7例,急性非淋巴细胞白血病10例,慢性粒单细胞白血病1例.CT平扫11例,其中增强1例;MR平扫16例,其中增强11例.结果 颅内受累14例:(1)颅内出血7例,其中脑内血肿4例,脑内血肿合并微出血1例,微出血2例.脑内血肿均为多发病灶.CT表现为团状高密度影;MRI表现为T1WI低信号或高低混杂信号,T2WI高信号或等高信号伴环状低信号环,病灶呈环形强化或无明显强化.脑微出血在磁敏感加权成像(SWI)上表现为多发斑点状及小条状低信号,其病灶检出率明显优于CT及MRI其他常规序列检查;7例中,伴脑梗死及蛛网膜下腔出血各1例.(2)颅内肿块5例:其中左额部内板下梭形病灶或跨颅板肿块2例,T1WI呈低信号,T2WI呈高低混杂信号,并有明显均匀强化,均见脑膜尾征;鞍区肿块1例,CT示鞍区高密度影,MRI示鞍区T1WI稍低信号,T2WI高信号,有不均匀强化;右侧脑室体旁肿块1例,T1WI、T2WI均呈等信号,有明显均匀强化.左额顶叶壁厚囊性肿块1例,呈环形强化.(3)梗阻性脑积水1例,表现为中脑导水管以上脑室系统扩张.(4)脑膜病变1例,MRI表现为广泛脑膜增厚伴明显均匀强化.椎管内病变4例:其中胸腰椎左侧椎旁软组织肿块2例,侵犯椎管内,伴邻近肋骨骨质破坏1例;椎管内肿块1例,表现为胸椎管后方梭形T1WI等高信号,T2WI等低信号灶,无明显强化;胸髓信号异常1例,表现为胸髓条状T2WI及液体衰减反转恢复(FLAIR)序列高信号影.结论 成人CNSCL影像表现多种多样,CT与MRI对该病的诊断价值相辅相成;白血病患者疑脑内病变者,建议常规使用SWI检查,以尽早发现脑微出血,降低脑内血肿发生的风险.

Abstract：

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.     

封闭负压引流术治疗血管损伤术后下肢缺血创面

下肢主要血管损伤是骨科常见损伤之一。临床上常由于合并致命的创伤需首先予以救治而使下肢主要血管损伤错过了其血管修复的黄金时期（即血管受伤血流阻断到血管修复手术血流再通6～8h）,使下肢留有不同程度的后遗症。     

脑胶质瘤病人^131Ⅰ-chTNT单抗放射免疫治疗的临床初步应用

目的：应用^131Ⅰ-chTNT（^131I-肿瘤细胞核人鼠嵌合单抗）通过局部化疗囊注入脑胶质瘤残瘤腔内,探讨其治疗复发性脑胶质瘤患者的临床疗效及安全性。方法：12例复发性脑胶质瘤病人,均经手术病理证实为WHO分级Ⅲ-Ⅳ。所有病人均行手术切除肿瘤后,于肿瘤残腔内放置Ommaya化疗囊,手术后2周囊内注入^131Ⅰ-chTNT1110MBq,14d后重复注入一次。治疗期间对患者的一般情况、症状改善、毒副反应等进行观察和记录,并进行KPS评分;治疗前、治疗后3个月和6个月观察血常规、肝肾功能、甲状腺功能及CT和MR的肿瘤影像学变化。结果：^131Ⅰ-chTNT治疗脑胶质瘤的总有效率为66.67%,CR：50%,PR：16.67%。MR和CT影像观察到有不同程度的放射性脑水肿。^131Ⅰ-chTNT治疗前后血常规、肝功能、肾功能等观察指标均在正常值范围内波动,未观察到严重的肝功能损害。而甲状腺功能在治疗期间有波动。结论：^131Ⅰ-chTNT通过局部化疗囊注射给药是安全、可靠的给药途径,具有疗效高、毒副反应轻的优点,是一种治疗恶性脑胶质瘤的新型放射免疫治疗制剂,值得进一步的临床使用。     

急性冠脉综合征患者血浆C反应蛋白的变化

目的：观察急性冠状动脉综合征（ACS）患者血浆C反应蛋白（CRP）水平的变化,并探讨其意义。方法：81例ACS患者入选,其中急性心肌梗死（AMI）患者41例,不稳定型心绞痛（UA）患者40例,测定人院时血浆CRP水平,另测定稳定型心绞痛（SA）、非冠心病患者各30例的血浆CRP水平作为对照。结果：AMI、UA、SA与非冠心病患者人院时血浆CRP水平分别为（56．19±83．00）mg／L、（26．23±31．45）mg／L、（2．96±1．94）mg／L和（3．32±2．99）mg／L,总体上差异有统计学意义（P〈0．05）。其中AMI组CRP水平高于UA组（P〈0．05）,显著高于SA、非冠心病两组（P〈0．01）。UA组CRP水平亦高于SA、非冠心病两组（P〈0．05）。结论：ACS患者的CRP水平明显增高,高危ACS患者CRP水平更高。     

1205例住院患者的医院感染现患率调查

目的监测综合性医院感染率及医院感染的相关情况,为医院感染控制提供科学依据。方法对1205例住院患者采取床旁调查与查阅在架病历相结合的方法填写统一的个案调查表,就医院感染现患率进行调查。结果调查住院病人1205人,实查1205人,实查率（100%）,查出医院感染76人83例次,现患率6.31%,例次现患率6.89%;现患率前5位的科室有：综合ICU（50%）、神经内科（18.52%）、其他内科（15.62%）、血液内科（9.23%）和神经外科（7.69%）;感染部位较高的依次为下呼吸道感染（50%）、泌尿道感染（10.84%）、血管相关感染（10.84%）;检出的病原菌以G-菌占优势,为68.75%;抗菌药物使用率为38.30%。结论进行医院感染现患率调查可以及时发现问题和调整医院感染管理工作中存在的问题。