宫腔纱条填塞治疗剖宫产术中前置胎盘剥离面出血

目的：总结24例子宫腔填塞纱条治疗前置胎盘剖宫产术中大出血的临床经验。方法：对1996年3月～2005年10月用子宫腔填塞纱条治疗前置胎盘剖宫产术中大出血24例进行分析。结果：24例前置胎盘剖宫产术中大出血纱条填塞子宫腔后均成功止血，24～36小时后阴道顺利取出，未发生阴道大出血。产后42天随访子宫复旧良好。结论：子宫腔填塞纱条是治疗前置胎盘剖宫产术中大出血的有效方法。     

Neonatal adrenal hemorrhage with intraperitoneal spill managed conservatively

A neonate presented with anemia, hyperbilirubinemia and bilateral flank fullness at 23 days of age. Ultrasound abdomen showed bilateral adrenal hemorrhage with intraperitoneal extension on the left side. This was managed nonoperatively and the hematoma resolved completely. Literature regarding this rare entity is described.     

Non-traumatic abdominal emergencies: imaging and intervention in acute pancreatic conditions

Pancreatic emergency, unrelated to traumatic events, can occur as a consequence of the more significant pancreatic pathologies (acute and chronic pancreatitis, tumors) or of the interventional or surgical treatment carried out as therapy for the above-mentioned lesions. Acute pancreatic conditions are represented by pancreatic infections, the involvement of organs, structures, and adjacent spaces within the pancreatic disease, and, lastly, vascular complications. Acute pancreatic conditions are common in pancreatic diseases and can be catastrophic; even if there is a gamut in the severity of clinical presentation, each can be potentially life threatening. Immediate radiological detection of the lesions together with a correct therapeutic percutaneous radiological approach whenever an interventional procedure is preferable to surgery or, when performed before surgery, whenever it can optimize its results, is of fundamental importance in the management of these patients. This article focuses on the essential role of radiology and the integration of imaging and intervention in acute pancreatic conditions.     

A modified surgical technique for the emergent treatment of giant ulcers concomitant with hemorrhage in the posterior wall of the duodenal bulb

BACKGROUND: One of the most challenging and lethal complications of the giant duodenal ulcer is massive bleeding, but management of the bleeding ulcer and the difficult duodenal stump remains controversial. METHODS: We developed a modified surgical technique involving a partial gastrectomy, duodenostomy, and a duodenostomy tube placed through the duodenal stump enveloped around an omental patch. The surface of the ulcer was closed with a fibrin sealant. RESULTS: Between January 1994 and December 1999, 12 patients underwent this surgical technique. All of the patients had massive giant bleeding ulcers in the posterior wall of the duodenal bulb. No deaths occurred. The duodenostomy tubes were removed between postoperative days 12 and 22. The other complications after operation were few. The mean hospital stay was 18 days. No rebleeding or duodenal stump leaks were found within the 12- to 60-month follow-up. CONCLUSIONS: This technique completely eradicated the ulcer as seen at the 12- to 60-month postoperative follow-up examination.     

善得定和垂休后叶素治疗食管静脉曲张破裂出血的临床对比研究

方法　食管静脉曲张破裂出血１２７例,善得定组治疗６２例,垂体后叶素组治疗６５例。结果　善得定止血有效率为７３．４％,优于垂体后叶素有效率５０．７％（Ｐ＜０．０５）;再出血发生率明显小于后者（Ｐ＜０．０５）;副作用发生率为６．４％,明显小于垂体后叶素组３２．２％（Ｐ＜０．０５）。结论　善得定为治疗食管静脉曲张破裂出血的有效药物。     

脑出血并发消化道出血临床研究

目的研究脑出血并发消化道出血的发生机理和治疗原则。方法174例脑出血病人中选择34例并发消化道出血病例,对消化道出血发生的时间、部位和出血量进行研究。结果脑出血并发消化道出血发生时间平均为脑出血后5.4天。4例少量出血;28例中等量出血;2例大量出血。临床采用常规止血、降血压、降颅压、抗感染等综合治疗。消化道出血发生率为19.5%,死亡率为67.6%。结论消化道出血与原发脑出血的部位和出血量有关。下丘脑—垂体一肾上腺皮质轴受损是并发消化道出血的原因。大剂量应用糖皮质激素可诱发消化道出血。其死亡率与脑出血相关而与消化道出血不相关。临床应有效治疗脑出血,应用H_2受体拮抗剂可以减少消化道出血的发生。     

The incidence of low-pressure urethra as a function of prolapse-reducing technique in patients with massive pelvic organ prolapse (maximum descent at all vaginal sites)

OBJECTIVE: Our aims were to compare several prolapse-reducing techniques during urodynamic evaluation and prospectively evaluate their usefulness in identifying the incidence of low urethral closure pressure in continent patients with massive prolapse. STUDY DESIGN: This preoperative, prospective, repeated-measures urodynamic study evaluated the maximum urethral closure pressure with the use of four different techniques in 30 consecutive continent patients with grade 4 prolapse at all vaginal sites. Twenty patients with grade 0 prolapse served as the control group. All patients from the prolapse group underwent surgical treatment and were followed up clinically for a minimum of 1 year. RESULTS: Use of the Scopette (Birchwood Laboratories, Eden Prairie, Minn.) reduction technique to reduce the prolapse in a linear orientation during multichannel urodynamics revealed a 56% incidence of low-pressure urethra and an overall genuine stress urinary incontinence of 83% in patients with massive pelvic organ prolapse but without clinical urinary incontinence. CONCLUSIONS: There may be an increased indication for sling urethropexy in patients with massive prolapse.(Am J Obstet Gynecol 1997;177:14)     

贲门癌大出血的诊治体会

报道１９８２年至１９９２年间共收治上消化道大出血病人９５例，其中２２例贲门癌引起的大出血全部手术切除，手术切除率为１００％，取得较满意效果。贲门癌引起大出血常因癌瘤侵犯胃壁较大血管而发生出血，并不意味着癌瘤范围广泛而不能手术切除。因此，只要病人无特殊手术禁忌证，应积极手术治疗。文中重点对贲门癌大出血的诊断及手术治疗等方面进行了讨论。     

Structural considerations of the snake venom metalloproteinases, key members of the M12 reprolysin family of metalloproteinases

The importance of proteinases in the pathologies associated with Viperid envenoming has long been appreciated. Over the past 40 years substantial research has clearly implicated metalloproteinases in the venom (snake venom metalloproteinases; SVMPs) as playing key roles in the development of such symptoms as hemorrhage, edema, hypotension, hypovolemia, inflammation and necrosis. In spite of this wealth of information there are still many unresolved questions pertaining to the structural basis for the various SVMPS giving rise to the diversity of activities. In this short review we will not attempt to provide an exhaustive collation of structural studies on the SVMPs; however, we will give a brief outline of the structural classification of the SVMPs; as well as relate them to the other members of the reprolysin family of metalloproteinases, the ADAMs. The information put forth in the text does not allow specific conclusions to be drawn on the structural basis for SVMP functional diversity, but it is our goal that it will allow for the development of testable hypotheses that can be experimentally pursued. What the reader will observe is that there are very interesting structural features displayed by the various SVMP classes and subclasses that provide insight into their functional characteristics.     

针刺在药物流产中的作用

目的:观察针刺对药物流产的影响.方法:将要求药物流产的早孕妇女226例分为治疗组、对照A组、对照B组,治疗组在最后一天服药后给予针刺治疗,对照A组予生化汤口服,对照B组不做其他治疗.结果:针刺组在完全流产率、出血时间、出血量方面优于两对照组(P<0.05),差异有显著性意义.对照A组在完全流产者总出血量方面优于对照B组(P<0.05).结论:针刺可提高完全流产率,缩短出血时间,减少出血量,提高机体对药物的敏感性.