腹部重症脓毒症老年患者术后T淋巴细胞亚群的变化

目的探讨重症脓毒症患者免疫治疗及各免疫指标的变化对严重脓毒症患者预后的影响。方法将20例腹部无明显感染的患者、20例腹部脓毒症患者不伴器官功能障碍、18例腹部严重脓毒症及脓毒性休克患者分为A、B、C组,A组术前及A、B、C组术后第1、3、7天,各抽取外周静脉血5ml于肝素管内,分别测定T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)。同时记录生命体征的变化和预后转归。结果A、B、C三组在术后1、3天,CD3、CD4、CD4/CD8均下降,C组下降明显,与A、B组比较,差异具有显著性意义(P<0.05),术后第7天A、B、C组(病情好转者)均上升,C组恶化者CD3、CD4、CD4/CD8持续低下,与A、B、C组(病情好转者)比较,差异具有显著性意义(P<0.05)。结论手术对T淋巴细胞CD3、CD4抑制明显,术后1、3天抑制明显,7天明显上升至正常。对于术后脓毒症不伴器官功能障碍者对T淋巴细胞亚群影响不大,其变化与手术对机体免疫功能的变化一致。对于术后重症脓毒症及脓毒性休克患者IgA、IgM、IgG,C3、C4及T淋巴细胞亚群CD3、CD4、CD4/CD8明显降低,且随病情恶化,持续在较低水平。     

Unusual course of an epidural rhabdomyosarcoma of the upper thoracic spine

Summary This report deals with a case of rhabdomyosarcoma in the upper thoracic spine. It is of particular interest, not only for the rarity of type and location of this tumour, but for its clinical course, which presented fluctuations of neurological status, included an acute demonstration of complete paraplegia followed by full recovery after conservative treatment, and gradual relapsing of neurological deficit, one year later.     

胸腰椎稳定性重建方法的改进

为了改进胸腰椎脱位的治疗方法，更好地重建脊柱稳定性，设计了一种新的脊柱固定器械，由滚花钉及连接板构成，并通过椎弓根进行的一种脊柱后路短节段固定方法，脊柱固定范围限制在两个椎体间。１９８９年～１９９５年，临床应用这种新器械矫正胸腰椎脱位１２例，经１～４年随访，畸形矫正满意，固定牢固。结果表明：该器械具有手术方法简单、固定牢固和手术创伤小等优点。认为，该项技术适用于胸腰椎稳定性的重建。     

B超诊断先天性无睑裂囊性眼临床分析(附2例报告)

报告 2例先天性无险裂囊性眼的B超图像,例 1左眼球前后径 28.2 mm,横径 31.3 mm,未见角膜、前房、虹膜及晶体回声,整个眼球均为暗区;例2右眼球均为暗区,前后径16.6 mm,未见角膜、前房、虹膜及晶体回声,眼球前外方另见13.8 mm×9.1 mm 的暗区。并对其发病机理与B超图像的关系进行讨论。     

胫骨延长后骨痂直径与新生骨预后关系的临床分析

目的探讨胫骨延长后骨痂直径与新生骨预后的关系.方法 1996年1月～2001年12月,对68例胫骨延长者测量达所需延长长度时的骨痂直径,计算骨痂直径率(callus diameter ratios,CDR);统计拆除外固定架后2～4周时新生骨发生骨折例数及畸形角度,比较骨折和成角畸形与CDR的关系.结果拆除外固定架前胫骨前屈角度5度以上畸形19例,其中11例发生骨折;拆除外固定架后胫骨出现5度以上畸形6例,其中2例骨折;其余43例胫骨延长骨痂正常愈合.计算CDR值:CDR值小于80% 23例,其中发生新生骨骨折13例,成角畸形5度以上者21例;CDR在81%～85%之间6例,成角畸形5度以上4例;CDR值超过86% 39例,无畸形或新生骨骨折.结论胫骨延长时CDR小于80%时,容易发生新生骨骨折和畸形;CDR大于85%时,无新生骨骨折和畸形发生;两组间具有统计学意义(P＜0.05).CDR是判断骨痂能否正常愈合较为理想的检测指标.     

原发性胸椎原始神经外胚层肿瘤的动态增强MRI表现

目的 初步探讨原始神经外胚层肿瘤(PNET)的动态增强MRI表现，以及对其诊断及鉴别诊断的价值。方法 用动态增强MRI方法对已手术和病理证实的2例胸椎PNET行3次MR检查并进行前瞻性研究。结果 在信号强度-时间和对比增强率．时间曲线上，2例PNET3次检查均表现为快升慢降型，即肿瘤早期就开始迅速增强，上升峰极陡，60～120s即达到高峰水平，然后保持平坦，3．5min内未见明显下降曲线。结论 动态增强MRI扫描能帮助对PNET进行早期诊断和鉴别诊断，从而为临床选择治疗方案及估计预后提供较为可靠的依据。     

沐舒坦治疗重型颅脑损伤后肺部感染的临床分析

目的:探讨沐舒坦对重型颅脑损伤后肺部感染的治疗作用.方法:选择GCS3～8分重型颅脑损伤后肺部感染的患者90例,随机选45例(实验组)加用沐舒坦治疗,另45例(对照组)未予沐舒坦治疗。所有患者其他治疗措施均基本相同。结果:实验组有42例感染控制,感染控制时间平均(7.8±2.6)d:对照组有35例感染控制,感染控制时间平均(14.1±3.2)d。实验组肺部感染控制率显著高于对照组(P<0.05),而控制感染平均时间显著短于对照组(P<0.05)。结论:沐舒坦治疗重型颅脑损伤后肺部感染有较好的临床疗效,值得临床推广应用。     

重症肺炎患者中性粒细胞胞吐作用的改变

目的　研究重症肺炎患者中性粒细胞的功能改变。方法　采用免疫化学法测定 32例重症肺炎患者中性粒细胞胞吐作用和氧化酶反应的变化 ,并与健康对照组比较。结果　重症肺炎患者血液中性粒细胞的基础和PMA刺激的胞吐作用均明显下降 (P <0 .0 1) ;重症肺炎患者的基础和PMA刺激的反应性氧属 (ROS)产生明显增加 ;重症肺炎患者肺部中性粒细胞释放乳铁蛋白、髓过氧化物酶 (MPO)和ROS增加 ,PMA刺激后相似 ;肺炎的严重性与血液中性粒细胞释放乳铁蛋白呈负相关。结论　重症肺炎患者中性粒细胞胞吐作用明显受损 ,与预后相关。     

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: A 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50–80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6–3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3–4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4–5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1–2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1–3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7–5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.     

汽油添加剂甲基叔丁基醚的毒性研究

目的　通过研究汽油添加剂甲基叔丁基醚 (MTBE)对小鼠体内谷胱甘肽 (GSH)、谷胱甘肽过氧化物酶 (GSH -Px)活性的改变以及骨髓微核、精子畸变率的影响 ,了解汽油添加剂甲基叔丁基醚的毒性。方法　 40只健康昆明种成年小鼠 ,体重 3 3 .3± 6 .9g ,随机分为 4组。灌胃染毒 ,染毒剂量分别为1 6 0 0、40 0、1 0 0和 0mg kg。每天 1次 ,每周 5天 ,共计 40天。结果　MTBE染毒各组小鼠体重轻度降低 ,染毒组全血及肝组织匀浆中GSH在低剂量染毒时增高 ,而高剂量时表现为降低 ,与对照组比较差异有显著性 (P <0 .0 5 ) ;GSH -Px活性明显减低 ,染毒高剂量组与对照组比较差异有高度显著性 (P <0 .0 1 ) ;骨髓嗜多染红细胞微核及精子畸变率增高 ,与对照组比较明显增高 ,差异有显著性 (P <0 .0 5 )。结论　MTBE对昆明小鼠具有一定毒性 ,可降低全血及肝脏组织中GSH -Px活性 ,低剂量时可增加全血及肝脏组织中GSH含量 ,而高剂量可降低其含量。MTBE能使骨髓微核率、精子畸形率明显增高 ,提示MTBE具有潜在的遗传毒性。