Fracture of the thoracic spine with paralysis and esophageal perforation

A 17-year-old young man presented with a highly unstable fracture dislocation of the third and fourth thoracic vertebrae with neurological deficit, in which the fractured spine had perforated the thoracic esophagus. Open reduction and internal fixation of the spinal fractures in combination with aggressive treatment of the mediastinitis caused by esophageal perforation, consisting of two re-thoracotomies, was performed. Two years after the accident, the patient had recovered well. The neurological deficit had recovered, and there were no difficulties with swallowing.     

冠心病行为模式与心理状态的相关性探讨

目的为探讨Ａ型行为在冠心病（ＣｏｒｏｎａｒｙＨｅａｒｔＤｉｓｅａｓｅ，ＣＨＤ）中的作用及与心理状态的相关性。方法对１１４例ＣＨＤ及３７例非ＣＨＤ应用心理测验方法对照调查。结果发现Ａ型行为的人易患ＣＨＤ。ＣＨＤＡ型行为者在焦虑、抑郁、人际关系、认识、敌对性症状因子分较ＣＨＤ非Ａ型行为者有明显增高。ＣＨＤ非Ａ型行为者也具有一些特有的心理症状。结论ＣＨＤ病人的行为模式与病后的某些心理表现呈正相关。     

自发性食管穿孔的治疗改进

报道７例自发性食管穿孔治疗经验，并对诊断和治疗和治疗新方法进行了讨论，自发性食管穿孔早期诊断的重要依据是迅速获得完整，详细的发病史。可疑时通过食道造影，胸腔穿刺刺液的分析而确诊。一经确诊应急取早期食管修补，对发病时间长，全身情况差的病人，经积极准备后仍应急取食管修补，对不宜手术者给予食管冲洗促进穿孔愈合。同时给予有效的食管腔内外引流。     

Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease – connection through depressive symptoms?

The aim of this study was to investigate factors associated with life dissatisfaction in symptomatic patients (n = 144) with chest pain subsequently diagnosed as coronary heart disease (CHD) by coronary angiography. Life dissatisfaction was assessed with a four-item life satisfaction scale (LS), depression with the 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with the symptom check list (SCL). DSM-III-R Axis I and Axis II psychiatric diagnoses were performed by means of the Structured Clinical Interview. All assessments took place one day before angiography. Twenty-four per cent of CHD patients were dissatisfied with their lives. Life dissatisfaction was associated with being unmarried. Dissatisfied patients had Axis I mental disorders and Axis II personality disorders more frequently than others. Psychiatric and depressive symptoms according to the SCL and BDI, respectively, were also higher among dissatisfied patients. In multiple logistic regression analyses, mental disorders were related to life dissatisfaction when age, sex, employment status, New York Heart Association class, duration of chest pain symptoms and work load were controlled in the model. Married subjects had a lower probability of being dissatisfied with their lives than other subjects (Odds Ratio, OR: 0.23). When BDI scores were included in the model, the only factor independently associated with life dissatisfaction was the severity of depressive symptoms (OR: 1.81). To conclude, life dissatisfaction is not primarily determined by the severity of CHD but by the existence of depressive symptoms.     

多巴酚丁胺负荷及运动试验~(99m)Tc-MIBI心肌断层显像与冠状动脉造影的对比研究

比较６９例冠心病患者多巴酚丁胺负荷９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与８２例运动试验９９ｍＴｃＭＩＢＩ心肌断层显像的结果，以探讨它们对冠心病的诊断价值。结果表明：以冠状动脉造影结果为标准，多巴酚丁胺负荷诊断冠心病的敏感性和特异性分别为９１２％和８００％，运动试验分别为８９４％和８２９％。多巴酚丁胺负荷检出冠状动脉病变的敏感性和特异性：左前降支为７８１％和９１３％，回旋支为６６７％和９８２％，右冠状动脉为１００％和８３７％；运动试验分别为７８３％和９１１％，６００％和９６８％，９０９％和８５０％，差异均无显著性（Ｐ＞００５）。提示两者结果相近，对于不能进行运动试验的病人，多巴酚丁胺试验是一种有价值的诊断冠心病的方法。     

国产4环／7层PET仪初试

对我国１９９６年研制成功的４环／７层ＰＥＴ仪（轴向视野８ｃｍ）进行试用。先进行模型试验和动物实验，然后对１例正常志愿者和７例患者进行１８Ｆ脱氧葡萄糖（ＦＤＧ）ＰＥＴ显像。静脉注射１８ＦＦＤＧ３７０ＭＢｑ后约１５小时显像，成人全身显像行１１个床位采集，约１５小时，心脑局部显像行２～３个床位采集，约半小时。直径１～３ｃｍ的阴模和阳模皆可显示。８例全身冠状和矢状断层影像清晰，正常志愿者（正常进食）可见脑和心肌显影，膀胱内放射性较多。２例恶性肿瘤患者的６处病变浓聚１８ＦＦＤＧ。２例恶性肿瘤患者手术和化疗后无复发征，显像阴性。２例良性病变处未见１８ＦＦＤＧ浓集。１例陈旧性心肌梗塞患者１８ＦＦＤＧ心肌断层显像与９９ｍＴｃ甲氧基异丁基异腈心肌血流灌注显像匹配良好。正常心肌显影与否受葡萄糖负荷的影响。８例脑皮质横断影像良好，基底节和丘脑影像有时尚欠清晰。初试结果表明，该ＰＥＴ仪相当于至今尚在国外广泛使用的８０年代中期４环／７层ＰＥＴ仪水平，但具有９０年代ＰＥＴ仪全身整体冠状和矢状断层显像的功能，可用于全身肿瘤显像、心肌活性判断和功能性癫痫灶术前定位，但仪器操作性能和软件功能尚需进一步完善。     

Myocardial metabolic imaging by means of fluorine-18 deoxyglucose/technetium-99m sestamibi dual-isotope single-photon emission tomography

The detection of preserved glucose uptake in hypoperfused dysfunctional myocardium by fluorine-18 deoxyglucose (FDG) positron emission tomography (PET) represents the method of choice in myocardial viability diagnostics. As the technique is not available for the majority of patients due to cost and the limited capacity of the PET centres, it was the aim of the present work to develop and test FDG single-photon emission tomography (SPET) with the means of conventional nuclear medicine. The perfusion marker sestamibi (MIBI) was used together with the metabolic tracer FDG in dual-isotope acquisition. A conventional SPET camera was equipped with a 511-keV collimator and designed to operate with simultaneous four-channel acquisition. In this way, the scatter of 18F into the technetium-99m energy window could be taken into account by a novel method of scatter correction. Thirty patients with regional wall motion abnormalities at rest were investigated. The results of visual wall motion analysis by contrast cine-ventriculography in nine segments/heart were compared with the results of quantitative scintigraphy. The scintigraphic patterns of MIBI and FDG tracer accumulation were defined as normal, matched defects and perfusion-metabolism mismatches. Spatial resolution of the system was satisfactory, with a full width at half maximum (FWHM) of 15.2 mm for ¹⁸F and 14.0 mm for ^99mTe, as measured by planar imaging in air at 5 cm distance from the collimator. Image quality allowed interpretation in all 30 patients. 88% of segments without relevant wall motion abnormalities presented normal scintigraphic results. Seventy-five akinetic segments showed mismatches in 27%, matched defects in 44% and normal perfusion in 29%. We conclude that FDG-MIBI dual-isotope SPET is technically feasible with the means of conventional nuclear medicine. Thus, the method is potentially available for widespread application in patient care and may represent an alternative to the ²⁰¹T1 reinjection technique.     

潘生丁ECT显像诊断冠心病临床可行性研究：附110例冠脉造影对照报告

110例疑冠心病病人以冠状动脉造影为对照，研究潘生丁核素心肌断层显像在诊断冠心病中的临床可行性。73例冠脉造影阳性（50％以上狭窄）及37例造影阴性病例中，潘生丁心肌显像检出的敏感性为95．3％，特异性为89．2％。单支、双支及三支病变检出的敏感性分别为92．7％、100％、100％。受累血管检出的敏感性分别为左前降支84．2％，回旋支82．1％，右冠状动脉90．6％。     

准分子激光冠脉成形术─—附8例报道

本文报道准分子激光冠脉成形术（ＥＬＣＡ）８例，均为男性，年龄平均６１岁。心梗４例（２例有梗塞后心绞痛），４例仅表现为心绞痛。冠脉造影显示ＬＡＤ狭窄６支，ＬＣＸ狭窄４支，ＲＣＡ狭窄４支。按ＡＣＣ／ＡＨＡ分型Ｂ型５例，Ｃ型３例。均用ＥＬＣＡ＋ＰＴＣＡ。根据血管直径选用１．３ｍｍ（能量密度１４．５ｍＪ）和１．６ｍｍ（能量密度２１．０ｍＪ）激光导管，频率２０Ｈｚ。１例导引钢丝未能通过狭窄，ＥＬＣＡ失败，另１例二次心梗，经旁路移植后仍有心绞痛发作，心功能较差，其ＥＬＣＡ虽获成功，但因病情严重死亡。８例中ＥＬＣＡ成功７例，手术成功６例。     

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.