肾上腺素对颅内微创血肿清除术患者的影响

目的探讨肾上腺素对颅内微创血肿清除术后的影响。方法对86例基底节区脑出血行微创血肿清除术,术后随机分成两组。A组使用尿激酶加肾上腺素液化血肿,B组予常规尿激酶液化血肿。将两组治疗结果进行临床对比。结果 A组43例中,恢复良好生活能自理27例(62.79%),部分生活自理中残10例(23.26%),重残4例(9.30%),死亡2例(4.65%)。B组43例中恢复良好生活能自理的22例(51.16%),部分生活自理中残12例(27.91%),重残5例(11.63%),死亡4例(9.30%)。术后第1天复查头颅CT,血肿体积A组明显比B组小;两组术后血肿体积及神经功能评分存在显著性差异(P<0.05)。结论颅内微创血肿清除术后尿激酶加肾上腺素液化血肿,治疗效果明显优于常规尿激酶液化血肿。肾上腺素对于颅内血肿有明显收缩血管、止血、防止血肿因尿激酶溶解血块后继发性出血作用。     

小儿急性外伤性颅内血肿52例诊治总结

目的探讨小儿急性外伤性颅内血肿的临床特点及治疗特点。方法总结52例小儿急性外伤性颅内血肿的临床资料,分析血肿发生的部位、性质、特点、治疗措施及疗效。结果 52例患儿中,7岁以下儿童多为跌伤和(或)坠落伤,血肿类型则以硬膜下血肿为主;而7岁以上患儿为车祸伤及打击伤为主,以硬膜外血肿多见。患儿易发生失血性休克。结论及时手术清除血肿,解除颅内高压是治疗的关键;若治疗及时正确,小儿预后相对成人较好。     

Acute aortic syndromes: aortic dissections,penetrating aortic ulcers and intramural aortic hematomas

Acute aortic syndromes, including dissections, intramural hematomas and penetrating aortic ulcers, are a catastrophic clinical entity that are relatively uncommon. A high index of clinical suspicion along with proper imaging modalities are critical in making a prompt and accurate diagnosis for immediate management and to improve survival of the patient.     

颅脑外伤性迟发性出血的CT诊断

目的：用ＣＴ随访研究颅内迟发性血肿,方法：在２３２例颅脑外伤患者中行ＣＴ随访检查,结果：６１例发现有迟发性颅内出血,其中３８例为原血肿增大或出现新的血肿;８例为对冲伤血肿,１５例为脑挫伤与小量散在出血灶,结论：在外伤病例中,即使开初ＣＴ扫描为阴性者,如病人的临床表现有改变,如症状加重,意识丧失,抽搐等,应立即行ＣＴ复查,对ＣＴ随访的价值及迟发出血的机理也进行了讨论。     

Subepicardial Aneurysm: Echocardiographic Evaluation and Evolution

Subepicardial aneurysms (SEA) are an infrequent and serious form of subacute cardiac rupture complicating myocardial infarction. An early diagnosis and surgical repair may be life saving. SEA comprise an abrupt interruption of the myocardium, with a narrow neck and thin wall containing only the epicardium. It may progress to fatal cardiorrhexis. We describe the echocardiographic evolution of this type of cardiac rupture and the contribution of contrast-enhanced echocardiography. A possible pathophysiological mechanism is proposed.     

Myocardial Hematoma Documented by Transthoracic Echocardiography After Sequential Coronary Artery Stenting

We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition.     

急性脑出血患者血浆N端脑钠肽前体、和肽素的检测及其临床意义

目的：探讨急性脑出血患者血浆 N 端脑钠肽前体（NT-proBNP）及和肽素与病情严重程度及脑出血量之间的关系。方法选取该院2011年12月至2013年6月期间诊断为急性脑出血患者109例（脑出血组）和同期体检的健康者32例（对照组）,对脑出血组患者和对照组健康者血浆 NT-proBNP、和肽素水平与格拉斯哥昏迷评分（GCS）进行比较。结果脑出血组血浆NT-proBNP 及和肽素水平明显高于对照组,随病情严重程度及出血量增加呈显著升高,差异有统计学意义（P ＜0．05）。血浆 NT-proBNP、和肽素水平与脑出血量呈正相关（r＝0．63,r＝0．58,P ＜0．01）,与 GCS 呈负相关（r＝－0．52,r＝－0．46,P ＜0．01）。结论血浆 NT-proBNP、和肽素水平和急性脑出血关系密切,能反映急性脑出血患者病情严重程度。     

Traumatic Lingual Hematoma Resulting in Bilateral Temporal Mandibular Joint Dislocations

Background

Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.

Postbiopsy intramural hematoma of the duodenum in an adult with Noonan's syndrome

Intramural duodenal hematoma is a rare complication of endoscopic biopsy. It is usually seen in children with growth failure and in patients with bleeding disorders or who are anticoagulated. It is frequently associated with acute pancreatitis. We present a case of an adult patient with Noonan's syndrome who developed postbiopsy intraduodenal hematoma. Abdominal ultrasound and computed tomography scan established the diagnosis. Conservative treatment was successful. According to a brief review of the literature, patients with Noonan's syndrome may develop hematoma after sampling of the duodenum because they present all the main predisposing factors. Additionally, pulmonic valve stenosis may be another predisposing factor, but this may warrant further investigation.     

Femoral artery catheterization complications: A study of 503 consecutive patients

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.