Extradural hematomas: Measurement of size by volume summation on CT scanning

Summary The method of volume summation (V = T(A₁ + A₂...A_n ) was used to measure the size of extradural hematomas. The accuracy was tested on six different artificial silicone hematomas and the mean difference was-2.7 ml, SD 3.7 ml. The reproducibility was tested on CT scans of clinical hematomas, SD was 2.1 ml. An empirical formula for volume estimation then found: 0.5xheightxlengthxdepth was moderately reliable, while midline shift and vesselfree space were poor indicators of size. In conclusion, the volume summation with manual outlining was found to be highly accurate, but the problems of CT smoothing, spectral shift artifact, partial volume effect and separation of the hematoma from other structures must be considered.     

Spinal Pencil-shaped Softening: Report of an Autopsy Case Studied Using a Three-dimensional Model

The pathologic features of a case of spinal pencil-shaped softening (PS) were studied by detailed step-sectioning and reconstruction using a three-dimensional (3D) model. The spinal cord was obtained at autopsy from a patient who had developed paraplegia due to extradural involvement of lung cancer. Above and below the area of transverse necrosis were PSs containing necrotic debris. They compressed the surrounding tissue and extended longitudinally over several segments. The PS was continuous with the area of transverse necrosis. These findings support the hypothesis that PS is formed by penetration of necrotic debris. The 3D model revealed that the PS was cylindrical to spindle-shaped. It showed a remarkable change in width along its course, with an unusual expanding shape. The PS was mainly located in the ventral part of the posterior column but was also observed in other locations in the segment near the transverse necrosis. Detailed stepsectioning showed that the PS changed in width mainly in response to intrapial pressure, and that it occurred where the parenchymal tissue was fragile. The expansion produced by penetration of necrotic debris may thus play an important role in the morphogenesis of this unusual lesion. Furthermore, the condition of the surrounding tissue may also be an important factor influencing the width and location of PS.     

术后持续硬膜外镇痛对肠功能恢复的影响

目的:观察术后持续硬膜外布比卡因混合吗啡镇痛对肠功能恢复的影响。方法:选择6 0例胃肠手术患者随机均分为两组:对照组为传统哌替啶肌注镇痛;实验组为布比卡因复合吗啡术后持续硬膜外镇痛。记录患者术后镇痛效果、肠鸣音恢复情况、肛门排气时间、恶心、呕吐等。结果:实验组镇痛效果明显优于对照组(P <0 .0 1) ;术后肠鸣音恢复、排气时间两组基本相同(P >0 . 0 5 )。结论:持续硬膜外低浓度布比卡因混合吗啡用于胃肠手术后镇痛效果良好,对术后肠功能恢复无明显影响。     

穿破硬脊膜后头痛的防治

硬膜外麻醉穿刺操作中,穿破硬脊膜,脑积液外漏可致术后头痛。我们用硬膜外腔填充的方法,对硬脊膜穿破后头痛患者进行预防和治疗,报告如下。1资料与方法1.1一般资料1992年至2005年,硬膜外麻醉中共穿破硬脊膜38例。其中男14例,女24例,年龄18岁~80岁,穿破位置最高T7~8,最低L2~3,ASA均为Ⅰ级~Ⅱ级。穿破原因分析见表1。表1穿破硬脊膜原因分析原因例数(例)百分比(%)操作技术因素821.1穿刺工具因素1231.6生理因素(脊柱畸形,体位,韧带钙化)1539.5其他37.91.2穿破后麻醉处理硬膜外注药前发现36例(硬膜外穿刺时发现32例,置管后发现4例),10例上腹部…     

建设基层卫生队伍是发展基层卫生事业的当务之急——基层卫生工作系列谈之三

人才是事业之本。卫生人力资源是卫生资源中最重要的资源。卫生工作是专业性、技术性很强的工作，对卫生人员有着特殊的要求。所谓卫生人力资源，主要包括各个层次的卫生技术人员，在我国，约占卫生人员总数的80％以上。此外，还包括卫生管理人员，约占6％左右；工勤人员，约占9％左右。所谓卫生队伍建设，主要是指卫生技术队伍建设，其次是指卫生管理队伍建设。     

新生化冲剂的主要药效学研究

目的研究新生化冲剂的主要药效作用.方法采用灌胃给药,以生理盐水作为阴性对照组,生化汤丸作为阳性对照组,观察新生化冲剂高剂量、中剂量、低剂量对雌激素引起的小鼠子宫增重的作用、对醋酸引起扭体反应的作用及对小鼠单核吞噬细胞吞噬功能的影响.结果新生化冲剂高,中剂量与生理盐水组比较具有显著抑制己烯雌酚促进性成熟小鼠子宫增重作用(P＜0.01)、提高小鼠单核吞噬细胞吞噬功能(P＜0.01),新生化冲剂高剂量与生理盐水组比较具有抑制醋酸引起扭体反应的次数(P＜0.05).结论新生化冲剂能抑制己烯雌酚增重子宫的作用,并具有镇痛及提高机体免疫功能的作用.     

护理干预剖宫产及硬膜外吗啡术后镇痛对产妇泌乳的影响

目的观察剖宫产、硬膜外吗啡术后镇痛产妇的泌乳状况及血清泌乳素（PRL）变化。方法足月产妇240例均分为四组：Ⅰ组术毕行硬膜外吗啡镇痛；Ⅱ组术毕行硬膜外吗啡镇痛，24h后追加一次；Ⅲ组未行术后镇痛；阴道自然分娩60例为Ⅳ组。240例产妇产前、产后均进行护理干预、科学宣传，实行母婴同室和纯母乳喂养。结果产后5min、24h及48h内开始泌乳及72h泌乳分泌不足发生率与剖宫产组相比无差异。结论由于护理干预，剖宫产及硬膜外吗啡术后镇痛不影响产妇母乳喂养的成功率。     

Intraspinal extradural teratoma mimicking neural sheath tumor in infant

Introduction An intraspinal teratoma that is located entirely extradurally is unusual both in children and in adults.Case history The authors present a case of an 8-month-old male infant with an extradurally arising intraspinal mature teratoma located from T-2 to T-4, who had suffered from progressive paraparesis (grade 1). The patient did not have any stigmata or anomalies suggesting spinal dysraphism. Spinal MRI showed a cystic extradural mass markedly compressing the dural sac. On operation, the only way of getting sufficient space for exposure of the whole tumor was to perform hemilaminectomies with preservation of facetal areas to prevent postoperative instability. The tumor was well encapsulated and located entirely extradurally, and the cystic portion was occupied with yellowish fluid. The site of tumor occurrence was the spinal root sheath, mimicking a neural sheath tumor. Paraparesis had improved markedly to grade 4 by the time of the neurological examination 3 months after operation.     

消纤痛颗粒镇痛与抗炎作用的实验研究

目的：研究消纤痛颗粒的镇痛和抗炎作用。方法：观察对小鼠热板法、扭体法致疼痛模型的影响,大鼠角叉菜胶致炎症模型的影响。结果：消纤痛能明显延缓小鼠因热板法和注射冰醋酸引起的疼痛,减轻大鼠因注射角叉菜胶引起的足肿胀程度,抑制PGE2的释放。结论：消纤痛颗粒有良好的镇痛、抗炎作用。其镇痛的机制主要在于改善机体对疼痛刺激的耐受性,降低痛觉感受器的敏感性从而提高痛阈。抗炎的作用的机制可能与其能减少PGE2等多种炎症递质的合成和释放,降低毛细血管通透性有关。     

Nonoperative management of acute epidural hematomas: a "no-brainer"

BACKGROUND: Acute epidural hematomas are generally considered to require urgent operation for clot evacuation and bleeding control. It has become increasingly apparent, however, that many epidural hematomas will resolve with nonoperative management. The purpose of the current study was to review our experience with nonoperative management of acute epidural hematomas. METHODS: Patients admitted to our busy urban level I trauma center with an epidural hematoma were identified using our trauma registry. Patients were excluded if they suffered other significant intracranial injury mandating operative intervention. Patient records were reviewed and relevant data collected. Patients who required subsequent craniotomy were compared to those who did not in order to identify risk factors for failure of nonoperative treatment. RESULTS: Between January 1995 and June 2004, 84 patients were identified. The mean age was 27 +/- 1.6 years and 68 (81%) were male. Mean Glasgow Coma Scale in the emergency department was 13.7 +/- 0.3. The most common mechanism of injury was a fall. Fifty-four (64%) patients were initially managed nonoperatively and 30 (36%) were taken directly to the operating room for craniotomy. Nonoperative management was successful in 47/54 (87%) patients. Failure of initial nonoperative management was not associated with adverse outcome. There were no deaths in patients managed operatively or nonoperatively. Seventy-two (86%) patients were discharged to home with excellent neurologic outcome. CONCLUSIONS: Epidural hematomas can be successfully managed nonoperatively in an appropriately selected group of patients. Moreover, failure of initial nonoperative management has no adverse effect on outcome.