Practical selection criteria for unenhanced cranial CT in patients with acute headache

We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p<1.5 – 10⁻¹⁰). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable initial guidelines to select for CT patients with an acute headache.     

Late Effects of Childhood Acute Leukemia and Its Treatment

Late effects of childhood acute leukemia and its treatment were studied in 766 patients (684 ALL, 73 ANLL, and 9 others) in Japan who had remained in remission for more than 1 year after their first complete remission. Delayed adverse sequelae involve a wide variety of organs and their functions. Short stature was present in 2.61%, obesity in 3.79%, abnormalities of growth hormone secretion in 1.5%, delayed secondary sex characteristics in 1.5% of males and 0.6% of females, motor disturbances in 1.17%, sensory disturbances in 0.91%, intellectual and learning disabilities in 2.48%, abnormal findings in routine neurologic examinations in 1.31%, EEG abnormalities in 4.30%, brain CT abnormalities in 5.09% and cardiac dysfunction in 1.07%. Various other disorders were seen in 20 patients. Many of these delayed adverse sequelae are caused by or related to central nervous system prophylaxis and systemic combination chemotherapy. The results suggest that it is needed to improve therapeutic methods through the stratification of patients by risk factors and detailed analysis of prognostic factors. Moreover it is important to render medical and psychosocial support to long-term survivors of childhood leukemia through interactions between the patient, parents and medical staff.     

急性心肌梗塞静脉溶栓治疗冠脉再通者早期ST段再抬高的临床意义

急性心肌梗塞早期静脉溶栓治疗后，一些溶栓再通患者中，可见早期降低的ＳＴ段再度出现抬高现象。本文回顾溶栓成功者８１例，其中早期出现ＳＴ段再度抬高者２１例（占３５％），与ＳＴ段非再度抬高者相比，ＣＰＫ、ＣＰＫ－ＭＢ峰值，心功能及院内死亡率等无显著差异。笔者认为，此现象也为再通的标志之一。因此，急性心肌梗塞溶栓治疗的早期连续监测心电图对确认再通与否非常重要     

利福平引起的急性肾功能衰竭及其机制研究(3例报告及文献复习)

目的：探讨利福平致急性肾功能衰竭的临床病理特点及其发病机制。方法：对3例因利福平所致的急性肾衰竭患者的临床、肾脏病理进行分析，并采用抗人球蛋白试验方法检测患者的抗利福平抗体。结果：3例患者均有前驱感染史，临床主要表现为发热、胃肠道症状，随即出现无尿，伴随肾功能损害、血小板减低及溶血性贫血，部分伴有肝功能损害。肾活检3例均为急性肾小管坏死。3例的血清抗利福平抗体检测均为阳性。结论：利福平可引起急性肾衰竭，对应用利福平的患者应加强对肾功能的监测，肾脏病理及血清抗利福平抗体的检测有助于确诊。     

急性传染性非典型肺炎的影像表现

目的探讨急性传染性非典型肺炎(SARS)的X线表现及变化规律.方法回顾性分析临床诊断SARS的61例患者,对发病后的一系列胸片和CT影像进行统计分析.结果患者以发热为最早起病症状,88.5%患者在起病1周内肺部出现肺局灶性斑片状模糊影,并迅速扩大.2周内病变达高峰,有57.4%患者两肺大部分肺野受累,病情重.83.6%患者在5周内肺部阴影逐渐消散.在恢复期16例CT扫描中,有13例显示肺部遗留纤维化病灶.有6例患者合并感染,病期延长,4例死亡.结论SARS早期出现肺部炎性改变,发展迅速,大部分两肺受累,重症比例高,易致肺纤维化.     

某医院传染性非典型肺炎疫情分析

目的：分析某医院SARS疫情的发生、发展及控制过程，为疫情控制提供一定的参考依据。方法：依照卫生部推荐的统一个案调查表和临床诊断标准，描述疫情的三间分布以及发放防护用品的数量与病例数的关系。结果：某医院疫情暴发曲线由3个暴发高峰组成，前两个峰较大，后一个峰较小，呈散发。提示病例传染共形成“三代”流行。结论：采用严密的综合防护措施，能够彻底控制SARS疫情在医院的暴发。     

急性冠脉综合征中妊娠相关蛋白-A与斑块不稳定性

目的探讨妊娠相关蛋白-A(PAPP-A)在急性冠脉综合征(ACS)中的变化及其与斑块不稳定性的关系。方法26例冠脉正常者作为对照组,稳定性心绞痛(SA)组22例,ACS组40例,包括不稳定性心绞痛(UA)20例、急性心肌梗死(AMI)20例。定量检测外周血PAPP-A、C-反应蛋白(CRP)、肌酸激酶MB同工酶(CK-MB)。对所有冠脉造影显示狭窄≥30%的病变进行影像学分析。结果ACS中PAPP-A含量(13·19±4·04)mIU/L明显高于SA(5·47±3·00)mIU/L(P<0·01)及对照组(5·09±2·19)mIU/L(P<0·01);并且与CRP(r=0·62P<0·01)、复杂性狭窄的数量(r=0·45P<0·05)有显著的正相关。结论PAPP-A在ACS患者外周血中明显升高,可能与斑块的不稳定性有关,对ACS的危险度分层可能具有一定的价值。     

山莨菪碱和无创面罩正压通气治疗急性呼吸窘迫综合征的临床观察

目的比较山莨菪碱联合无创正压面罩通气（654-2＋NIPPV）和传统机械通气（CMV）治疗急性呼吸窘迫综合征（ARDS）的临床效果，评估山莨菪碱联合无创正压通气在ARDS治疗中的作用。方法将各种原因所致ARDS患者42例随机分为654-2＋NIPPV组（21例）和CMV组（21例），在给予病因治疗同时分别实施654-2＋NIPPV和CMV。观察分析两组患者在治疗过程中动脉血气变化、并发症的发生率及治疗效果。结果654-2＋NIPPV组有8例（38．1％）治疗失败转为气管插管实行CMV，其中6例（28．6％）死亡。CMV组死亡7例（33．3％），两组病死率无显著差异（P〉0.05）。两组治疗有效的患者在分别接受654-2＋NIPPV和CMV治疗后1h和6h动脉血气有相似的显著改善。654-2＋NIPPV组患者机械通气时间和住院时间短于CMV组（P〈0.05）。654-2＋NIPPV组的并发症发生率低于CMV组（P〈0.05）。结论在经过选择的ARDS患者中，应用654-2＋NIPPV治疗的临床效果与CMV相似。实施654-2＋NIPPV可缩短机械通气和住院时间，减少并发症。654-2＋NIPPV可作为经过选择的ARDS患者首选的通气支持治疗手段。     

SARS胸部影像表现与评价(附75例分析)

目的：回顾分析75例严重急性呼吸综合症(SARS)病例，探讨该病影像学表现及其与临床治疗有关的问题。方法：全部75例患者均行胸片检查，一般隔日行影像追踪复查。结果：胸部X线表现为肺实质渗出病灶为主，肺内网状改变及肺门片块影较少。影像表现与临床病程有一定关系。结论：胸部影像表现以肺实质渗出病灶较常见。胸片检查是进行本病诊断和评估病程及疗效的重要方法。     

心率变异性与心肌梗塞范围关系的研究

报道７２例急性心肌梗塞患者的心率变异性（ＨＲＶ）值与心肌梗塞范围的关系，并与１２０例正常人的ＨＲＶ值进行对比，结果发现，心肌梗塞急性期ＨＲＶ值明显降低，与正常组对比有显著统计学意义，但ＨＲＶ值降低与心肌梗塞部位、范围无关，可能主要为心肌梗塞引起的应激反应所造成的体液及神经调节改变所致。