颈动脉加压注射复方维脑路通合剂治疗脑梗死180例临床分析

本科自 2 0 0 0年 6月以来 ,采用颈动脉加压注射复方维脑路通合剂治疗脑梗死 180例 ,并与静脉给药组相比较 ,现总结如下。1　资料与方法1.1　临床资料　治疗组 180例 ,男 117例 ,女 6 3例 ,年龄 37岁～ 76岁 ,平均年龄 5 7.2 0岁。均为颈内动脉系统脑梗死。其中大面积脑梗死 4例 ,脑梗死 85例 ,腔隙性脑梗死 91例。大面积脑梗死组 4例 ,其梗死灶涉及 2个脑叶或以上 ,均无意识障碍及脑疝者 ,在发病 10d后即脑水肿高峰期后开始颈动脉加压注射。治疗组病例选择除下列禁忌 :①严重高血压病(血压≥ 2 6 .6 / 16kPa) ;②脑出血、出血性梗死 ;③严…     

中国原发性肝癌临床分期预测肝癌肝移植预后的临床研究

目的评价“中国原发性肝癌临床分期”对肝癌肝移植疗效的预测价值。方法对1993年4月至2003年1月我科59例采用肝移植治疗的肝癌病人临床资料进行回顾性分析,按中国原发性肝癌临床分期原则进行分期,比较各期间肝癌肝移植疗效。结果Ⅰb、Ⅱa、Ⅱb、Ⅲa和Ⅲb期移植术后1年生存率分别为83·33%、66·67%、50·00%、35·71%和16·67%,各期间术后累计生存率有统计学差异(P<0·01);Ⅰb~Ⅱb和Ⅲa~Ⅲb期移植术后1年生存率分别为66·67%和25·00%,2年生存率分别为45·71%和25·00%,两组间术后累计生存率有统计学差异(P<0·05)。结论中国原发性肝癌临床分期适用于肝癌肝移植术前分期。     

90例慢性牙周炎临床分析

目的评价不同治疗方法对慢性牙周炎的临床效果。方法对90例慢性牙周炎患者,随机分成三组:龈上洁治术 抗生素组(A组),单纯龈上洁治术组(B组)和单纯抗生素组(C组)。分别给予不同的治疗,在治疗后1周、2周和4周记录牙周袋探诊深度(PPD)、探诊附着水平(PAL)、菌斑指数(PLI)、龈沟出血指数(SBI)。结果治疗1周和2周后各指标显著减轻(P<0.05),2周比1周减轻更明显(P<0.05),4周与2周比较无明显差异(P>0.05),A组各指标减轻比B组显著(P<0.05);B组比C组疗效显著(P<0.05)。结论A组作用优于B组(P<0.05),B组优于C组(P<0.05)。     

Anterior Cruciate Ligament Reconstruction: State of the Art

Abstract The rupture of the Anterior cruciate ligament (ACL) belongs to the most common ligament injuries of the human knee joint. ACL rupture results in an increased anterior translation and internal rotation of the tibia. Untreated knee instability causes a disintegration of the roll and sliding movement and a high incidence of secondary meniscus and chondral damages with consecutive or advanced arthritic changes. For deciding on a conservative or operative therapy, it is necessary to develop a high-risk profile. Elderly, inactive patients without instability symptoms can be treated conservatively; younger, active people and complex ligament injuries should receive an ACL replacement. The goal is to eliminate instability by maintaining the physiological kinematics of the knee. Anterior cruciate ligament may be reconstructed arthroscopically assisted by autologous tendons. Predominantly, hamstring- and bone-patellar-tendon grafts are used. No significant differences in knee laxity, clinically and functionally, were observed between both grafts. Various reconstruction techniques, single- or double-bundle techniques, were described. Successful replacement depends on a correct tunnel placement and reconstruction of the physiological band tension, a sufficient mechanical stability of fixation, an impingement-free range of motion and an adequate rehabilitation. A high degree of patient satisfaction in clinical and functional outcome could be evaluated.     

闭合性脑外伤患者恢复后期的记忆研究

目的探讨闭合性脑外伤患者恢复后期的记忆障碍特点。方法用临床记忆量表对 2 0例闭合性脑外伤患者恢复后期及 2 0例正常人进行记忆测验。结果闭合性脑外伤患者恢复后期 5项分测验及记忆商均明显低于正常人对照组 ,MQ≤ 79的比例较正常人明显增高。结论闭合性脑外伤患者恢复后期有非常严重的记忆障碍 ,其回忆比再认受损更严重     

A suggested clinical score to predict the severity of adenoid obstruction in children

Chronic nasal obstruction in children is a very common disorder. Obstructing adenoid is usually the first to blame. Though the clinical assessment is essential, it is often considered unreliable or insufficient. We conducted a prospective clinical study to validate a clinical score predicting the severity of adenoid obstruction in symptomatic children. The clinical score (CS) included mouth breathing, snoring, restless sleep, frequent waking-up at night and obstructive breathing during sleep. Each item received a score of 0 or 1. The palatal airway was evaluated on a lateral nasopharyngeal x-ray. The degree of obstruction was assessed intra-operatively by a laryngeal mirror using a 3-grade scale. The volume of each adenoid specimen was measured. Eighty-six patients were enrolled, 51 boys and 35 girls, aged 13–181 months (mean 52, median 45). The CS correlated very well with the intra-operative findings (p < 0.01) and with the degree of palatal airway obstruction (p < 0.05) but not with the volume of the adenoid removed (p > 0.05). The CS was higher in children younger than 3 years (CS > 3 in 85.7% vs. 29.2%), having more frequent obstructive breathing during sleep (71.43% vs. 21.54%). A CS of three or higher, predicted severe obstruction in 96.5% of patients, as detected intra-operatively. The suggested CS is simple to use and is highly reliable in identifying children in need for adenoidectomy, in the context of normal anterior rhinoscopy and tonsils less than grade three.This work was presented at the podium of the XVIII IFOS in Rome, Italy on June 26, 2005.     

合并心律失常的心力衰竭56例治疗评价

目的探讨心力衰竭并发心律失常的发病规律及治疗方法。方法回顾性分析了93例慢性心力衰竭病人的临床资料，包括临床特点、诊断治疗方法以及预后。结果心律失常发生率为60．2％，以室性早搏发生率最高32．1％，其次是房性早搏26．8％，心房纤颤21．4％，其他19．7％，经治疗有效71例，总有效率76．3％。结论纠正心功能不全是治疗的关键，应根据具体情况选择性地应用抗心律失常药。     

Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.     

Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei （PM） infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results （1） The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture. All the 12 cases （100%） had irregular fever （38-41℃） and enlarged lymph nodes, 8 cases （66%） had skin rashes; 8 cases （66%） had hepatomegaly; 9 cases （75%） had splenomegaly while 8 cases （66%） had anemia. （2） Imaging manifestation： Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 cases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung, and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS （CD4 T lymphocytes 〈50/μ L） with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver, spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of ＂cakes＂.     

慢性多发性肌炎临床及病理分析

目的探讨慢性多发性肌炎的发病机制、临床和病理特征。方法回顾性分析95例慢性多发性肌炎患者临床表现、肌酶学和肌电图检查结果,总结肌肉病理学特征。结果慢性多发性肌炎以四肢近端肌无力、肌萎缩为主要表现,血清酶谱轻-中度增高,肌电图以肌源性损害为主,病理改变为灶性坏死、炎性细胞浸润与再生肌纤维共存。结论临床特点结合病理学检查有助于慢性多发性肌炎的诊断,多数患者激素治疗有效。