视神经损伤行筛、蝶窦径路减压术的临床观察

目的：探讨提高视神经管内段损伤疗效的方法。方法：经筛、蝶窦径路减压术治疗16例视神经损伤，全程松解视神经。结果：术后随访患者6个月，9例患者视力有不同程度的改善，7例无效，无并发症发生。结论：筛、蝶窦径路视神经减压术视野宽，便于操作且解剖标志清，容易定位，更加安全，尤其适合筛、蝶窦发育不良，骨质增生者。     

585例眼创伤调查分析

目的 研究眼创伤住院患者临床特点。方法 将我院1985～2001年收治的眼创伤患者相关病历资料录入眼创伤数据库，并进行回顾性分析。结果 17年间共收治585例眼创伤患者，男女之比为5：1；患者以青壮年为主，10岁以下儿童眼创伤也非常突出；城市多于农村；在一个月中，1日最为突出，住院人数占10．1％(59／585)；自伤占39．1％(229／585)；机械性因素致伤占92．1％(539／585)，多发生于工矿事故(36．8％，215／585)、攻击事件(21．4％，125／585)、玩耍时(5．1％，30／585)；穿透伤发生率(51．5％，301／585)高于钝挫伤(40．9％，239／585)，且眼内异物发生率高(48．2％，145／301)；眼球破裂发生率高达51．6％(302／585)；治疗后残愈者达49．7％(291／585)，45．8％(268／585)留有后遗症。结论 眼创伤的发生与患者工作性质和社会活动等有关；对少年儿童、高发时段，以及高致伤因素等应引起足够重视。眼创伤在得到合理治疗后仍有很高的残愈率和后遗症发生率。     

γ-射线对淋巴细胞DNA的损伤

目的 了解γ-射线对淋巴细胞DNA的损伤情况，为预放射线对人体的损伤提供科学依据。方法 应用碱性单细胞凝胶电泳法(SCCGE)测定，观察小鼠和人外周血淋巴细胞的彗星率。结果 在小鼠实验中发现不同剂量组的小鼠彗星率明显高于对照组，不同剂量组之间差异也存在显著性，并且在各个时点的不同剂量之间的慧星率差异均存在显著性，在低剂量组各时点间彗星率差异无显著性，而在高剂量组各时点间差异有显著性，并且以一天中16：00时点最高。结论 γ-射线能引起淋巴细胞DNA损伤，且存在剂量反应关系，此外还提示-天中淋巴细胞对γ-射线的敏感性不同。在探伤工人和对照组间差异也存在显著性。     

Changes of interleukin-1 β, tumor necrosis factor α and interleukin-6 in brain and plasma after brain injury in rats

Objective: To study the changes of interleukin-1 β(IL-1β), tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) levels in brain and plasma after brain injury and to assess the relationship between the cytokine levels and injury severity in rats. Methods. A total of 51 male Wistar rats, weighing 280-340g, were anesthetized with chloral hydrate(400 mg/kg body weight) through intraperitoneal injection and fixed on a stereotaxic instrument. Severe brain injury was created in 16 rats (severe injury group) and moderate brain injury in 18 rats (moderate injury group) by a fluid percussion model, and cytokine levels of IL-1β, TNFα and IL-6 were measured with biological assay. And sham operation was made on the other 17 rats (control group). Results: In the control group, the levels of IL-1β,TNFα and IL-6 were hardly detected in the cortex of the rats, but in the ipsilateral cortex of the rats in both injury groups, they increased obviously at 8 hours after injury.The increasing degree of these cytokines had no significant difference between the two injury groups. The levels of IL-6 in the plasma of all the rats increased slightly, whereas the levels of IL-1β and TNFα were undetectable. Conc|usions: The increase of IL-1β, TNFα and IL-6 levels is closely related to brain injury. The increased cytokine levels in the central nervous system are not parallel to those in the peripheral blood. It suggests that inflammatory cytokines play important roles in the secondary neural damage after brain injury.     

心脏外伤的抢救

报告了对6例心脏外伤的抢救,5例成功,1例死亡。对胸部开放性外伤、出血较多休克者,即使无典型体征,亦应考虑到心脏外伤的可能。当术前不能确定心脏伤口位置时,以采用正中劈开胸骨切口为宜。缝合心肌伤口吋,应避免损伤冠状血管的重要分支,迅速诊断、尽快开胸修复心脏损伤是抢救成功的关键。     

手指指腹缺损的修复

目的　研究用手指皮瓣修复指腹缺损的临床效果。方法　应用手指掌侧推进皮瓣 ,指侧方神经血管蒂岛状皮瓣、指侧方逆行岛状皮瓣、指背侧皮瓣修复指腹缺损 78例。创面面积为 1.0cm×1.0cm～ 3 .0cm× 5 .0cm。结果　 78例的皮瓣全部存活。术后随访 1～ 3年 ,指腹外形满意 ,感觉恢复良好。结论　应用手指皮瓣修复指腹缺损 ,手术简单、效果好、供区影响小 ,是理想的手术方法。     

颈脊髓损伤MRI的诊断分型(附66例手术所见分析)

本文报告66例急性颈髓损伤,通过MRI检查,有三种压迫颈髓情况:1.单纯椎间盘突出,2.椎间盘与骨折块一起压迫颈髓;3.单独骨折块压迫颈髓。在脊髓成像上显示的病理变化;1.硬脊膜与脊髓水肿,在T_2—wis上为明亮的高信号成像;2.脊髓信号呈暗淡的低信号成像;3.脊髓信号变化的脊段没有脊髓受压现象。在治疗上:单纯椎间盘突出患者效果比较满意,椎间盘与骨折块同时压迫者或单独骨折块压迫者效果比较差;脊髓信号变化与受压平面不一致者,可给予保守治疗,必要时,手术能获得满意效果。     

颈髓损伤与低钠血症

颈髓损伤后出现低钠血症的并发症尚未引起广泛重视，此文观察了３９例颈椎外伤住院病例，认为低钠血症与颈髓损伤及其程度明显相关，与感染、发热相关（Ｐ＜０．０５），且认为颈髓损伤后低钠血症是由交感抑制、血浆醛固酮水平不足导致。     

Cardiotoxic Effect of Primaquine in Mammals:Histological and Ultrastructural Investigation

It has been known that the antimalarial drugs of aminoquinolinesincluding 8-aminoquinolines may cause inhibition of heart conduction or evenAdams-Stokes syndrome,but their morphologic bases were obscure.The purposeof the present study is to define the histological and ultrastructural features ofprimaquine in mammals including dogs,monkeys and rats in the subacute toxicexperiments with the stress on the morphological alteration of the heart.In most(11/16)of the intoxicated dogs,granular degeneration,eosinophilic degeneration,coagulation necrosis,vacuolar degeneration and colliquative myocytolysis werefound in the myocardium and conduction systems.Under electron microscopicstudy,the myocardial cells of intoxicated dogs showed swelling of mitochondria,dilatation of transverse tubules and sarcoplasmic reticulum,fusion or dissolutionof myofibrils,deformity of nuclei,clumping of chromatin,and eventually cellnecrosis.The severities of lesions were dose dependent.These lesions weresupposed to be the morphologic evidence of the toxic symptoms and signs caused byprimaquine.A few rats also revealed myocardial eosinophilic degeneration.Noimportant cardiac lesions were found in the monkeys,but the pathologic changesin the liver were obvious.Different species of laboratory animals showed differentorgan sensitivities to primaquine,but the heart lesions should be considered as animportant toxic effect of primaquine.     

眼外伤性病变的影像学诊断

回顾性分析６８例（８０眼）眼外伤的Ｘ线平片、Ｂ超、ＣＴ和ＭＲＩ资料，比较其对眼外伤性病变的诊断价值。８０只伤眼中５７眼合并眼部异物，在合并的６９枚眼眶部异物中非磁性异物６５枚，磁性异物４枚。Ｘ线平片、Ｂ超、ＣＴ和ＭＲＩ对６９枚异物（眼球内４８枚，眼球壁１３枚，球后６枚，眼睑２枚）诊断的阳性率分别为４９％、７４％、９１％和９０％。６枚球壁和邻近球壁异物Ｘ线平片定位错误。ＭＲＩ诊断伤后１０～６２ｄ眼内出血１３眼，Ｂ超诊断４眼，ＣＴ未诊断１眼。Ｂ超诊断玻璃体混浊５８眼，ＭＲＩ和ＣＴ分别诊断３３眼和１１眼。４０眼外伤性白内障经Ｂ超、ＣＴ和ＭＲＩ分别诊断２０眼、２１眼和１８眼。ＣＴ和ＭＲＩ诊断２例球后脓肿，而Ｂ超未能诊断。ＣＴ诊断４例眼眶骨折，Ｘ线平片和ＭＲＩ各诊断２例。结果提示：ＣＴ和ＭＲＩ是检出眶内异物的最有效方法，Ｂ超主要适用于眼内和眼球壁异物的诊断；ＭＲＩ可检出Ｘ线平片和ＣＴ不能显示的少数非金属异物和较小铁异物；ＭＲＩ诊断眼内亚急性和慢性期出血优于ＣＴ和Ｂ超；ＣＴ诊断眶壁骨折优于ＭＲＩ和Ｘ线平片；Ｂ超诊断玻璃体混浊优于ＣＴ和ＭＲＩ