5例创伤性膈疝的治疗体会

目的总结创伤性膈疝的治疗经验。方法回顾性分析我院自1996年8月～2004年6月5例创伤性膈疝的临床资料。结果全组急诊手术治愈出院。结论创伤性膈疝一旦确诊，及时手术治疗，应积极处理并发伤，提高治愈率。     

刺激神经干悬吊式助走装置治疗创伤性截瘫

应用刺激神经干悬吊式助走装置治疗创伤性截瘫。结果表明 :获得疗效 ,简便安全 ,减轻了护理强度 ,对截瘫患者的身体和心理状态的恢复极为有利     

创伤性脑损伤的临床康复研究

创伤性脑损伤 (traumaticbraininjury ,TBI)在欧美发病率较高 ,初步统计是创伤性脊髓损伤的 30～ 4 0倍 ,在某些方面 ,接近于脑卒中的发病率。其病因多为交通事故、体育活动、工伤和暴力袭击 ,主要为青年男性患者 ,美国统计 ,15～ 2 4岁青年男性的发病率≥ 5 5 0人 /10 0 0 0 0人口。严重TBI的良好结局依赖于长期的综合性康复治疗 ,大多数患者的社会生活能力较差 ,家庭和社会为此负担较大。1　预后评价和影响因素对TBI急性期患者进行预后评价 ,可以获得一个有意义的功能基线 ,便于今后比较。康复治疗前的临床评价有助于判断治疗效果。有…     

创伤性睾丸脱位5例报告

目的 探讨创伤性睾丸脱位的诊断和治疗。方法 对所收治的5例患的诊治情况进行分析研究，并结合复习有关献。结果 1例手法复位成功，4例行手术复位．1例发生睾丸萎缩后切除患睾。结论 创伤性睾丸脱位临床少见，漏误诊率较高。对骨盆部、会阴部、阴囊部外伤患应警惕本病；详细检查阴囊及睾丸．确诊后尽早行手法或手术复位固定．定期随访。     

Extracellular signal regulated kinases 1/2 signal pathway and responses of astrocytes after diffuse brain injury

BACKGROUND: The treatment of diffuse brain injury during an acute period is focused on relieving degrees of secondary brain injury. Generation and development of pathological changes of secondary brain injury depend on signal conduction, so down-regulating over response of astrocyte through interfering a key link of signal conduction pathway may bring a new thinking for the treatment of diffuse brain injury. OBJECTIVE: To observe the effect of over activity of extracellular signal regulated kinases 1/2 (ERK1/2) signal pathway on the response of astrocyte during an acute period of diffuse brain injury. DESIGN: Completely randomized grouping and controlled animal study. SETTINGS: Department of Neurosurgery, the Third Affiliated Hospital, Nanchang University; Department of Neurosurgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. MATERIALS: A total of 158 healthy male SD rats, of 11 weeks old, weighing 320–370 g, were provided by Experimental Animal Faulty, Tongji Medical College, Huazhong University of Science and Technology. Rabbit-anti-phosphorylated ERK1/2 (pERK1/2) polyclonal antibody was provided by R&D Company; rabbit-anti-glial fibrillary acidic protein (GFAP) polyclonal antibody, SP immunohistochemical kit and horseradish peroxidase (HRP)-labeled goat-anti-rabbit IgG by Santa Cruz Company; specific inhibitor U0126 of ERK1/2 signal pathway by Alexis Company. METHODS: The experiment was carried out in the Laboratory of Neurosurgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from September 2004 to March 2006. ① Detection of pERK1/2 expression: A total of 110 rats were randomly divided into sham operation group (n =5), model group (n =35), high-dosage U0126 group (n =35) and low-dosage U0126 group (n =35). Rats in the sham operation group were only treated with incision of epicranium and fixation of backup plate, but not hit. Rats in the model group were used to establish diffuse brain injury models based on Marmarou free falling body without drug intervention. Rats in the high- and low-dosage U0126 groups were injected into caudal vein with 0.1 and 0.05 mg/kg U0126, respectively, and then, rats were hit to establish injured models. Every 5 rats were collected from model, high- and low-dosage U0126 groups at 5, 30 minutes, 3, 12, 24, 72 hours and 7 days after diffuse brain injury to detect pERK1/2 expression in cortex of parietal lobe based on Western blot technique. ② Distribution of pERK1/2 and positive GFAP cells in brain tissue: Another 48 rats were randomly divided into sham operation group (n =3), model group (n =15), high-dosage U0126 group (n =15) and low-dosage U0126 group (n =15). The intervention and administration were dealt as the same as those mentioned above. Every 3 rats were collected from model, high- and low-dosage U0126 groups at 30 minutes, 3, 12, 24 and 72 hours after model establishment to observe the distribution of pERK1/2 and postive GFAP cells in brain tissue which was cut from coronal section at Bregma –4.8 mm layer with immunohistochemical staining. MAIN OUTCOME MEASURES: pERK1/2 expression in cortex of parietal lobe and distribution of pERK1/2 and positive GFAP cells in brain tissues. RESULTS: ① pERK1/2 expression: After diffuse brain injury, pERK1/2 expression in cortex of parietal lobe was rapidly increased in the model group, reached at peak at 5 minutes and then decreased gradually. But the expression was still in a high level until the 72nd hour and fallen to the basic level on the 7th day. pERK1/2 level was lower in high- and low-dosage U0126 groups than that in model group at various time points (P < 0.01); meanwhile, pERK1/2 level was lower in high-dosage U0126 group than that in low-dosage U0126 group. The results showed that there was a certain dosage dependence on pERK1/2 expression. ② Distribution of pERK1/2 and positive GFAP cells in brain tissue: Positive expression of pERK1/2 lasted in brain tissue from 30 minutes to 72 hours after diffuse brain injury (P < 0.05). In addition, from 30 minutes to 3 hours, brown-yellow stained cells were mainly distributed in plasma, but rarely in nucleus. A lot of positive cells had tree-like apophysis, which was similar to neurons. With the time passing by, more and more nuclei manifested positive stains; moreover, nuclei mainly manifested positive staining until 24 hours after diffuse brain injury. Immune-positive pERK1/2 cells were widely distributed in brain tissue, especially mainly in binding site between deep cortex and cerebral white matter, and then in hippocampus. In addition, ependymal cell and vascular endothelial cells of choroids plexus also manifested strongly positive staining. As compared with model group, positive cells were decreased gradually in high- and low-dosage U0126 groups. However, number of positive cells was less in high-dosage U0126 group than that in low-dosage U0126 group. CONCLUSION: Diffuse brain injury strongly induces the activity of ERK1/2 signal pathway and response of astrocyte; in addition, U0126 can inhibit response of glial cells during an acute period, and the effect manifests dosage dependence.     

急性闭合性创伤性膈疝28例分析

急性闭合性创伤性膈疝２８例分析沈宇飞（南京市妇幼保健院外科，南京２１０００４）陈亮（南京医科大学第一附属医院胸外科，南京２１００２９）关键词创伤性膈疝；Ｘ线；修补闭合性创伤性膈疝是较少见的临床急症，早期常常缺乏典型的临床征象，加之严重合并伤的掩盖，...     

双瞳散大患者手术治疗经验

双瞳散大患者手术治疗经验胡开树，蔡学见，陈铮立，王玉海，顾中贤，房文峰，许永军，刘斌本文总结十年来双瞳散大病人１２２例，未手术２３例，死亡１９例，手术９９例，死亡６３例。与国内外文献报告的双瞳散大病人死亡率５７％～１００％相似（１）。现将本组病人救治...     

甲基门冬氨酸受体与兴奋毒性

本文对甲基门冬氨酸受体在继发性脑损伤兴奋毒性机制中的病理生理作用进行了综述。该领域的研究成果提示甲基门冬氨酸受体拮抗剂有希望成为防治脑损伤新的治疗药物。