经导管动脉栓塞术治疗骨盆骨折大出血

目的评价经导管髂内动脉栓塞术治疗骨盆骨折大出血的疗效。方法35例骨盆骨折伴大出血患者,其中车祸23例、坠落伤5例、重物砸伤4例、挤压伤3例。有合并伤18例。选择腹股沟区无血肿侧或血肿相对轻侧穿刺股动脉,将导管选择性地插入髂内动脉造影,明确出血部位后,超选择进入出血动脉分支;不能超选者,则于髂内动脉主干注入明胶海绵颗粒栓塞至血流明显缓慢,再以直径5～8mm弹簧圈栓塞髂内动脉主干。对于骨盆双侧或中心部骨折者行双侧髂内动脉栓塞。结果35例患者造影均见有不同程度动脉痉挛,其中29例见对比剂外溢,呈斑片状或条状染色。栓塞后于患侧髂总或髂内动脉造影复查,对比剂外溢现象消失。35例患者血压均于术后2h内逐步平稳回升,24h内恢复至正常水平。1例出现拇趾远端皮肤轻度坏死。未出现与栓塞有关的严重并发症。结论经导管动脉栓塞术治疗骨盆骨折大出血,措施简捷、微创、安全,疗效满意。     

早期妊娠流产引起出血97例临床分析

目的 探讨早孕妇女流产出血的原因、诊断和处理。方法 选择2001年10月至2006年10月因流产出血收入本站早孕妇女97例。结果 流产出血的原因中不全流产是最主要原因，其次是生殖道畸形和异位妊娠。结论 根据不同的流产原因，应采取更有效的止血方法，以减轻患者的痛苦，降低死亡率，减少并发症。     

Super-selective angiographic embolisation of a branch of the anterior pudendal artery for the treatment of intractable post-operative bleeding

We describe a case of post-operative bleeding after a posterior fascial defect repair. This was refractive to exploration and vaginal packing so laparotomy would have been necessary. Superselective cannulation demonstrated bleeding from a branch of the anterior pudendal artery which had crossed the midline making identification difficult during vaginal exploration. The bleeding vessel was embolised using a mixture of PVA300 and Spongistan gel foam and the bleeding ceased. The use of embolisation in the peri-operative phase is discussed.     

针刺对急性高血压脑出血大鼠HSP70mRNA表达的调整作用

目的：探索针刺对急性高血压脑出血治疗作用的分子机制。方法：采用分子生物学手段，动态观察针刺对急性高血压脑出血大鼠脑组织HSP70mRNA表达的影响。结果：针刺能促进HSP70mRNA在高血压脑出血大鼠脑组织中表达。结论：针刺促进高血压脑出血大鼠脑组织HSP70mRNA表达是针刺治疗急性高血压脑出血的重要机制。     

锁孔入路内镜辅助治疗自发性脑出血23例

目的探讨神经内窥镜在自发性脑出血手术中的应用。方法总结德国Rudolf神经内窥镜手术治疗23例自发性脑出血的临床资料。结果本组病例术后复查CT示：血肿完全清除16例,占70％,近全部清除者5例,大部分清除者2例。结论锁孔入路内镜辅助下手术治疗自发性脑出血具有定位精确可靠,手术损伤小,术后并发症少,康复快等优点。     

Complications of endoscopic resection techniques for upper GI tract lesions

Adverse events can occur during and after the endoscopic resection of upper gastrointestinal lesions. Their incidence can be minimized through the adoption of preventive measures and their final outcomes can be optimized through prompt identification and adequate treatment. In this evidence-based review we describe the risk factors for adverse events, preventive measures to avoid them and their management when they occur. Algorithms of action are also provided. Oesophageal strictures can be prevented with corticosteroids (either locally injected or systemically administered) and treated with endoscopic dilatation. Bleeding can be minimized through the adoption of prophylactic coagulation and novel preventive measures are emerging and being evaluated. Bleeding management includes coagulation therapy, clips and haemostatic powders. Perforations can nowadays be successfully treated endoscopically in the majority of the cases and conservative treatment is associated with favourable outcomes although optimal management is unclear.     

Apoplexia uteri: A rarely described post-mortem finding

We present a case of apoplexia uteri, a rarely described condition of haemorrhagic necrosis in an atrophic endometrium and myometrium associated with terminal stress. This entity is well recognised in older literature but few recent publications have addressed this condition. It is thought to occur in association with hypoperfusion with passive hyperaemia and reperfusion injury.This case serves to highlight this rarely encountered entity as a possible cause of haemorrhage in an atrophic endometrium in the ‘perimortem’ period. Incidental findings are occasionally observed in the course of forensic autopsy practice and knowledge of rarely encountered entities, such as that described in this case, is essential to prevent diagnostic uncertainty and misdiagnosis.     

Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes.

Antithrombotic therapy and invasive risk stratification in selected high-risk patients have improved outcomes from non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but carry a risk of bleeding and blood transfusion. Although the true incidence of bleeding depends on the population studied (i.e. clinical trial vs. registry), the definition used, and the use of invasive procedures, it is becoming clear that bleeding is associated with an increased risk for adverse outcomes including myocardial infarction and death. Blood transfusion itself may carry a risk for ischaemic outcomes that is independent of bleeding. Therefore, therapies that provide an adequate level of anticoagulation to reduce ischaemia while simultaneously minimizing the risk of bleeding and transfusion have the potential to improve outcomes among patients with NSTE-ACS. Anticoagulants studied in recent clinical trials that have focused on bleeding reduction include fondaparinux and bivalirudin. In this review, we discuss the clinical trial evidence for these agents, the association between bleeding and clinical outcomes, the biology of blood transfusion and potential mechanisms underlying its association with adverse outcomes, and propose strategies to deal with bleeding complications. Future directions for research and clinical practice are also discussed.     

肝硬化合并上消化道出血患者的临床护理

目的：总结32例肝硬化合并上消化道出血患的临床护理经验。方法：针对上消化道出血的护理难点，制定并实施护理措施。结果：抢救成功29例，成功率为90．6％。结论：做好心理护理及休克期护理，加强病情观察，严格遵守输血规程，合理安排局部止血药物的灌注或口服时间，重视三腔二囊管对胃底食管曲张静脉出血的止血作用，以及积极预防肝性脑病的发生等，是圆满完成此类患临床护理的关键。     

Nuestra experiencia en el tratamiento urgente de la hemorragia renal

Introduction

Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option.