Symptomatic compression of the optic nerve by the carotid artery: clinical profile of 18 patients with 24 affected eyes identified by magnetic resonance imaging.

OBJECTIVE: To characterize the clinical features and course of patients with magnetic resonance imaging (MRI)-defined optic nerve compression by the supraclinoid carotid artery. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eighteen patients with 24 affected eyes were identified by reviewing case records from the author's referral-based neuro-ophthalmology practice. Predetermined inclusion and exclusion criteria were applied to potential participants. MAIN OUTCOME MEASURES: The following variables were abstracted from the medical record: age, gender, presenting symptoms, past medical problems, visual acuity, color vision, visual field, pupillary reactions, optic disc appearance, other neurologic signs, and previously documented and follow-up examinations. RESULTS: There were eight women and ten men ranging in age from 28 to 86 years (median age, 72 years) at the time of diagnosis. Ten (56%) of 18 patients had hypertension. Twelve patients had unilateral optic neuropathy, whereas 6 patients had bilateral optic neuropathy. One patient presented with subacute superior orbital fissure syndrome due to mass effect of a dolichoectatic carotid artery. Another patient had oculomotor nerve palsy with signs of aberrant regeneration due to intracavernous mass effect of a dolichoectatic carotid artery. One patient had a bitemporal hemianopia associated with bilateral compression of the immediate prechiasmatic optic nerves by dolichoectatic carotid arteries. The predominant pattern of visual field loss in most patients reflected nerve fiber bundle injury. A central scotoma or absolute central visual field loss was noted in only 6 (25%) of 24 affected eyes. Most patients demonstrated saucerlike excavation of the optic disc. Progression of visual acuity loss occurred at a relatively slow rate. CONCLUSIONS: Although uncommon, intracranial compression of the optic nerve by the carotid artery should be considered in a patient with unexplained or progressive unilateral or bilateral optic neuropathy. This entity can be diagnosed using clinical skills to exclude more common causes of optic nerve injury and coronal-oriented MRI to confirm anatomic compression of the symptomatic optic nerve. Although many affected patients have excavation of the optic disc and nerve fiber bundle visual field defects, most have additional signs atypical for glaucoma, minimizing the potential for diagnostic confusion between the two disorders.     

Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.     

镁离子对脑保护作用的前瞻性临床实验研究

目的探讨分析镁制剂在重型颅脑损伤临床治疗中的实用价值.方法对76例重型颅脑损伤患者按随机方法分成实验组和对照组,对照组按常规方法治疗,实验组在常规治疗的基础上加用大剂量硫酸镁.治疗后从颅内压、NSE、CT、GCS评分和G0S评级等几个方面进行统计分析.结果实验组与对照组比较,颅内压和NSE水平明显下降,CT显示脑水肿程度减轻,而GCS和G0S则有明显提高,经统计学检验有显著性差异(P＜0.01和P＜0.05).结论镁制剂对重型颅脑损伤治疗确有实用价值,且经济、安全,值得推广.     

138例已绝经与未绝经子宫内膜癌患者临床病理分析

目的 回顾研究已绝经与未绝经子宫内膜癌的病理分型,组织分级和手术病理分期等.方法 分析1987年1月～1996年12月上海第一妇婴保健院收治的138例子宫内膜癌患者,其中已绝经者93例,未绝经者45例.所有的病人都进行了分段诊刮,134例经过手术治疗.标本均进行了病理诊断,并根据1988年FIGO标准进行分期,所得资料用X~2Fisher’s exact test分析.结果 已绝经组与未绝经组比较,早期患者(IaG_1)比例明显偏低,分别占6%与32%.(P<0.001).G_2、G_3和非内胰腺癌的发生率是高的,分别是71%和51%(P<0.05).Ⅰc、Ⅱ、Ⅲ、Ⅳ期所占的比例较大,分别是40%和30%(P<0.001).五年生存率:已绝经组为74.2%,未绝经组91.4%,两者比较有明显意义(P<0.05).结论 已绝经子宫内膜癌患者预后较未绝经者差与临床和病理特点有关.     

探索在综合性医院建立医疗量化考核体系

文章作者结合综合性医院临床工作的特性 ,探索如何建立医疗量化考核体系 ,并在大量的实践过程中 ,不断修改和完善 ,使医疗量化考核在综合性医院的业绩考核中更具科学性、合理性。文章简要论述了医疗量化考核工作的原则、方法以及实施医疗量化考核后取得的实效。     

医用电子直线加速器在使用中应注意的安全性问题及对策

简要介绍了医用电子直线加速器在日常使用工作中应注意的一些安全性问题，并提出了相应的解决对策和建议，为同行们在医用电子直线加速器的安全管理和使用操作提供参考。     

中西医结合治疗216例哮喘儿童的临床效果与生活质量评价

目的对中西医结合治疗支气管哮喘（简称哮喘）患儿临床疗效与生活质量进行评价,并以单纯西医治疗为对照,探讨哮喘中西医结合治疗的优势。方法在GINA方案的基础上将444例哮喘患儿随机分为观察组和对照组,观察组加用中药汤剂及穴位贴敷,总疗程2年,观察两组治疗前后临床疗效指标及生活质量变化。结果在改善肺功能、减少呼吸道感染次数方面,两组比较差异有统计学意义（P〈0．01）,观察组优于对照组。观察组在住院率、急诊率、缺课率（节）、心理障碍率、运动受限率等方面优于对照组,P〈0．01,提高哮喘患儿生活质量方面优于对照组。结论中西医结合治疗小儿哮喘能显著改善哮喘患儿临床症状及肺功能,具有较好的远期疗效,并能显著提高哮喘患儿的生活质量。     

门急诊静脉输液患者综合护理管理干预效果观察

目的：探讨对门诊、急诊静脉输液患者进行综合护理管理干预的效果。方法：将140例（820例次）门急诊静脉输液病人随机分为两组,观察组70例（414例次）和对照组70例（406例次）,对照组采取常规护理,观察组在常规护理基础上进行综合护理管理干预,观察两组护理效果。结果：观察组患者首次穿刺成功率、输液中发生皮下肿胀以及拔针后出血的情况明显少对照组（P〈0．05）,患者满意度高（P〈0．05）。结论：对输液患者进行综合护理管理干预能对患者的治疗起到积极作用,是一种安全、有效的护理方法,值得临床进一步探索推广。