Analysis of intraosseous samples using point of care technology—An experimental study in the anaesthetised pig

Background

Intraosseous access is an essential method in emergency medicine when other forms of vascular access are unavailable and there is an urgent need for fluid or drug therapy. A number of publications have discussed the suitability of using intraosseous access for laboratory testing. We aimed to further evaluate this issue and to study the accuracy and precision of intraosseous measurements.

Methods

Five healthy, anaesthetised pigs were instrumented with bilateral tibial intraosseous cannulae and an arterial catheter. Samples were collected hourly for 6 h and analysed for blood gases, acid base status, haemoglobin and electrolytes using an I-Stat^® point of care analyser.

Results

There was no clinically relevant difference between results from left and right intraosseous sites. The variability of the intraosseous sample values, measured as the coefficient of variance (CV), was maximally 11%, and smaller than for the arterial sample values for all variables except SO₂. For most variables, there seems to be some degree of systematic difference between intraosseous and arterial results. However, the direction of this difference seems to be predictable.

Conclusion

Based on our findings in this animal model, cartridge based point of care instruments appear suitable for the analysis of intraosseous samples. The agreement between intraosseous and arterial analysis seems to be good enough for the method to be clinically useful. The precision, quantified in terms of CV, is at least as good for intraosseous as for arterial analysis. There is no clinically important difference between samples from left and right tibia, indicating a good reproducibility.     

银杏叶提取物对骨内高压下关节软骨代谢的保护作用研究

目的:研究银杏叶提取物对骨内高压下关节软骨代谢的保护作用。方法:采取兔左侧股骨髓腔内灌注聚甲基丙烯酸甲酯骨水泥的方法,复制骨水泥阻塞股骨近中段骨干髓腔模型。实验分为2组,即生理盐水(等容生理盐水)和银杏叶提取物(10mg·kg-1)组,复制模型后腹腔注射给药,每天1次,连续4周。根据不同观察时点分为术后0、4、8、16周组,每时点8只。分别测量各时间点髓内压的改变;通过HE染色观察不同时段远端关节软骨的形态改变;采用RT-PCR检测软骨组织软骨代谢相关基因骨蛋白生长因子(BMP)-2、转化生长因子(TGF)-β1 mRNA的表达差异。结果:与生理盐水组比较,复制模型后4、8、16周银杏叶提取物组兔实验侧骨内压显著降低(P<0.05),未见关节软骨损害出现,BMP-2、TGF-β1 mRNA表达显著增强。结论:银杏叶提取物注射液可以有效降低骨水泥阻塞骨干髓腔后引起的骨内高压,调节BMP-2、TGF-β1的表达从而减轻关节软骨的损害。     

肝脏血管平滑肌脂肪瘤螺旋CT的诊断及病理基础

目的分析10例肝脏血管平滑肌脂肪瘤（HAML）在螺旋CT（SCT）上的各种表现和病理特点,进一步提高CT对该病诊断的准确性。方法所有病例均经手术病理证实,CT全肝平扫后行增强动脉期、门脉期和延迟期扫描。结果 CT平扫9个病灶为低密度,1个病灶为略高密度。动脉期所有病灶均强化,7个病灶可见中心血管影。门脉期及延迟期8个病灶持续强化。结论 SCT能显示HAML的某些特征,有助于术前诊断。     

肺脂肪瘤1例报道并文献复习

目的 分析肺脂肪瘤的流行病学特征及临床特点,提高临床医师对肺脂肪瘤的诊治水平.方法 报道宁波大学附属医院呼吸科1例经病理确诊支气管脂肪瘤病例并对国内54例肺脂肪瘤病例进行回顾性分析.结果 患者女性,57岁,因“咳嗽、咯痰2个月,发热3周”于2010年8月24日入院,当地医院考虑“肺炎”,给予抗菌药物治疗,疗效欠佳转入我院.入院后行纤维支气管镜检查发现左下叶开口处肿物,后转入胸外科手术治疗,确诊为支气管脂肪瘤.到目前为止,国内能检索到的确诊为肺脂肪瘤的病例共54例.54例患者包括男性44例,女性10例,平均年龄(51.7±11.6)岁,支气管内脂肪瘤44例,肺内脂肪瘤10例,48例患者存在症状,主要症状无特异性,包括咳嗽、咯痰、发热、气促、咯血.50例患者存在异常影像表现,肺不张26例,渗出或实变13例,肿块18例,CT扫描下肿块呈低密度灶,CT值范围在-83～-122 Hu之间.23例患者行纤维支气管镜检查,但仅有6例(26.1％)得到正确诊断.34例患者描述手术方式,其中3例进行内镜下切除,术后恢复良好.结论 肺脂肪瘤以中老年男性为主;胸部CT发现脂肪密度肿块,需考虑脂肪瘤;硬质支气管镜镜下切除为支气管腔内脂肪瘤首选的治疗方式,肺内脂肪瘤或支气管脂肪瘤已发生肺实质的不可逆损害应手术切除.     

Elastofibroma dorsi: A soft tissue masquerade

Elastofibroma dorsi (ED) is a soft tissue tumor found in the subscapular region. The pathogenesis of ED is unclear, but may involve a regenerative or reactive hyperproliferation due to mechanical microtrauma. Magnetic resonance imaging (MRI) is preferred to diagnose ED and complete excision is curative. When bilateral, subscapular masses are identified in the elderly patient and MRI characteristics are typical, biopsy and excision can be avoided. Symptomatic EDs should be excised, and recurrence is rare. Three hundred and thirty cases of ED have been reported since 1980. Fourteen case series and 43 isolated case reports involved 263 women and 67 men (F:M ratio = 3.9:1), with a mean age of 62 years (range 6-94 years). Bilateral ED was present in 164 patients and unilateral ED in 157. The reported prevalence in the elderly population ranges from a minimum of 2% to a maximum of 24%.     

兔骨内高压型膝关节骨性关节炎模型的建立**

背景：虽然实验中使用的膝关节骨性关节炎动物模型众多,但研究中医手法作用机制所采用的动物模型应能承受“动”的作用并发挥出正常“动”产生的效应。 目的：确定建立骨内高压型膝关节骨性关节炎动物模型的效果。 方法：无菌条件下显露新西兰兔右侧臀部的臀下静脉,右下腹部的股静脉和大隐静脉,结扎并切断;以同样手术显露相应血管但不结扎切断血管的动物及正常组动物作为对照。术后8周末处死所有动物,取动物右膝内侧胫骨平台软骨组织通过大体观察及苏木精-伊红染色、光镜观察软骨组织的结构变化,评估动物模型的造模效果。 结果与结论：模型组关节面粗糙、灰黄色,可见明显缺损及骨赘形成,达到初中期变化。假模组关节面粗糙,灰白色无光泽,处于早期变化。正常组关节面光滑,边缘规整,软骨半透明有光泽,无变化。结果提示,通过结扎动物臀下静脉、股静脉及大隐静脉8周后,可形成早中期膝关节骨性关节炎动物模型。     

Hémangiome caverneux intradiploïque du vertex : à propos d’un cas et revue de la littérature

We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.     

超声造影诊断胃脂肪瘤1例

患者女,57岁,因"反酸、胃灼热、腹胀、腹痛3个月"来我院就诊,无呕血、黑便史.胃镜:胃体部隆起性病变,约4 cm,局部黏膜光滑,建议超声进一步检查.嘱患者饮水300ml后行超声检查,胃壁黏膜光滑,于胃体前壁肌层见约4.0 cm×3.3 cm×3.2 cm中等回声肿物(图1),向胃腔内隆起,边界清晰、光滑.CDFI:肿物周边可见少量点状血流信号,内部未见血流信号.超声造影:经左肘静脉注入SonoVue后10s胃壁开始增强,肿物始终呈极低增强(图2).超声提示:胃体前壁肌层实性肿物,考虑胃脂肪瘤.行肿物摘除术,术中见肿物呈类圆形,质软,表面光滑完整,有包膜呈淡红色,切开可见内部为均匀的黄色物质.病理诊断:脂肪瘤.     

骨内脂肪瘤的X线及CT表现（附6例报告并文献复习）

目的：探讨骨内脂肪瘤的X线及CT表现,提高其诊断准确率。方法：收集6例经病理证实的骨内脂肪瘤的X线及CT影像资料,结合文献对其临床、病理及影像表现进行回顾性分析。结果：6例均为单发病灶,其中1个病灶位于肩胛冈、1个病灶位于第四腰椎下关节突、3个病灶位于股骨头、1个病灶位于跟骨。X线平片表现为边界清或不清的圆形、类圆形或不规则形透亮区,可伴硬化缘。CT图像上病灶表现为圆形、类椭圆形或不规则形脂性密度区,CT值为-3 5～-110HU,其中1例病灶中央见结节状钙化,病灶最大径为1.8～2.6cm。边缘不规整,伴有厚薄不等的硬化边。结论：X线平片有助于显示骨内脂肪瘤的发生部位,而CT检查能够在术前对其做出定性诊断,从而为临床制定治疗方案提供影像学依据。