Helical computed tomography of liver injuries: A trial of dual phase imaging

This study was performed to evaluate whether consecutive arterial phase and portal venous phase scans of the upper abdomen are contributory in the evaluation of the liver in patients with blunt abdominal trauma. The purpose of the study was to determine whether such dual acquisition using helical computed tomography (HCT) provides improved definition of injuries and significant information about the dynamics of posttraumatic hemorrhage.During a 10-month period, all patients referred for evaluation of blunt abdominal trauma were scanned using a dual phase imaging technique. Two consecutive and comparable scan clusters were programmed to study the upper abdomen, with a slice collimation of 10 mm and a 11 pitch. Intravenous contrast medium was delivered at a rate of 2 ml/sec for a total of 125 ml, with scan delays of 30 and 70 seconds (arterial and venous phases of hepatic enhancement).Thirty-two patients with hepatic lacerations were encountered, and the images from both acquisitions were compared and graded according to lesion conspicuity. The presence of contrast medium extravasation associated with parenchymal injuries was also recorded.In 23 (72%) of the 32 patients, the liver injuries were better defined in the portal venous phase, and in eight (25%) patients, the lesions were equally shown in both phases. In only one case, the lesion was better demonstrated in the arterial phase. Contrast medium extravasation was noted in two patients at the site of liver laceration. In three additional cases, contrast medium extravasation was also noted in associated splenic injuries. In all of these patients, the extravasation (bleeding laceration) was seen only in the images corresponding to the portal venous phase.Dual phase HCT of the upper abdomen does not provide significant additional information in the evaluation of patients with liver injuries resulting from blunt abdominal trauma. With a single scan cluster through the upper abdomen after a 70-second injection-scan delay, lesion definition is optimal, and vascular opacification remains adequate.     

Partial Artificial Heart (ALVAD) Use with Subsequent Cardiac and Renal Allografting in a Patient with Stone Heart Syndrome

The abdominal left ventricular assist device (ALVAD) is an order of magnitude more effective than conventional intra-aortic balloon pumping (IABP) in unloading and providing circulatory support to the failing left ventricle. This is a report of a unique case which demonstrates that in the absence of pulmonary vascular obstruction or constriction, the ALVAD can substitute for both left and right heart function. A 21-year-old patient with a congenital bicuspid aortic valve developed acute valvular endocarditis which rapidly progressed to congestive heart failure. An operation was undertaken, the mitral and aortic valves were excised and replaced by porcine heterografts, and a fistula from the right sinus of Valsalva to the right ventricle was closed. When coronary circulation was restored, irreversible ischemic contracture of the left ventricle, or "stone heart" syndrome, developed and emergency ALVAD or partial artificial heart implantation was effected. This device functioned as a total artificial heart for nearly six days, while a donor heart was sought. The patient then underwent removal of the ALVAD and cardiac and renal allografting. The transplanted heart functioned well, but the patient expired fifteen days later from gram-negative sepsis.     

Synovial sarcoma of abdominal wall: a case report and study of tumor fine structure

A case of synovial sarcoma in the abdominal wall of a 50-year-old Iraqi woman is reported. The ultrastructure of the tumor has been studied. Eight other cases of synovial sarcoma in the abdominal wall reported in the English literature up to 1978 have been reviewed. Synovial sarcomas in the abdominal wall tend to occur with a much greater frequency in women, whereas such tumors occurring in the extremities or the neck are more common in men than woman. No ultrastructural studies of abdominal wall synovial sarcomas could be found in the English literature. The ultrastructural characters of this tumor are similar to those of such tumors arising in the usual sites and the neck. However, the present study has indicated that the light and dark cells reported by earlier workers are not limited solely to the epitheloid areas but are also present in the spindle cell zones.     

小儿急腹症的临床探讨

目的：总结小儿急腹症的临床诊断和外科治疗。方法：回顾性分析我院1990——2001年收治的96例小儿急腹症病例，在检查、诊断及本组各类疾病的治疗方法之特点。结果：本组病例行阑尾切除术48例，嵌顿疝高位结扎8例，肠套叠复位加固定术3例，肠切除吻合术3例，脾修补和脾部分切除术2例，胰腺囊肿外引流术1例，其余给予保守治疗，均治愈出院，仅6例阑尾炎术后切口感染，1例合并腹壁坏死性筋膜炎，无手术死亡。结论：小儿急腹症在检查、诊断及各类疾病的治疗方面均有着与成人不同的特点，注意掌握手术时机。     

胰腺癌的临床表现

胰腺的临床表现因病变而异。腹痛、黄疸及体重减轻是胰腺癌的主要临床表现。部分病人同时可表现为发热、焦虑、抑郁、胆囊肿大及血栓性静脉炎等。     

雌激素干预影响腹腔脂肪积聚的实验研究

目的研究雌激素干预对雌性C57BL/6J小鼠腹腔脂肪代谢的影响.方法采用卵巢切除法造成雌激素缺乏模型,以及在动情周期正常和围绝经期的小鼠中,给以雌激素干预,观察腹腔脂肪重量的变化.3 mon 龄小鼠随机分为正常组,卵巢切除组,给雌激素 15 d 组和给雌激素 60 d 组,每组10只.小鼠摘除卵巢后饲养至 7 mon 龄处死.5和 10 mon 龄小鼠分为正常组,动情周期正常+雌激素 60 d组,围绝经期组和围绝经期+雌激素 60 d 组,每组10只,分别饲养至7和 12 mon 龄处死,检测腹腔脂肪重量.各组小鼠于处死前15和 60 d 分别皮下埋植控释雌激素(17β-雌二醇)药丸(0.18 mg/丸).结果卵巢切除组腹腔脂肪重量明显增加(P<0.05);给雌激素 15 d 组腹腔脂肪重量减轻(P＜0.05);给雌激素 60 d 组腹腔脂肪重量有明显减轻,与正常组比较无显著性差别(P>0.05).动情周期正常+雌激素组和围绝经期+雌激素组的小鼠,其腹腔脂肪重量的变化无差别.结论卵巢切除明显影响小鼠的脂肪代谢导致腹腔脂肪积聚,而雌激素干预,特别是长期应用,可以明显减少小鼠的腹腔脂肪积聚.外源性雌激素干预在动情周期正常和围绝经期对小鼠腹腔脂肪没有明显的影响.     

抚触对低出生体重儿早期生长发育的影响

目的　了解抚触对低出生体重儿早期生长发育的影响。方法　选择 4 2天儿保健卡筛出低出生体重儿136例 ,对其中 6 0例未查出疾病的低出生体重儿随机分为抚触组和对照组 ,抚触 10、 30天后分别观察其体重、身长 ,并做组间比较。结果　接受抚触治疗后 10天的低出生体重儿的体重、身长增长与对照组差别无显著性 (P>0 .0 5 ) ,30天后抚触组的体重、身长增长显著优于对照组 (P<0 .0 5 )。结论　抚触对低出生体重儿的早期生长具有促进作用 ,值得推广。     

循经穴位推拿治疗肩周炎临床观察

根据肩周炎局部压痛点的经络所属,运用循经推拿治疗肩周炎88例(治疗组),并与常规推拿治疗肩周炎102例(对照组)比较,疗程为3周.结果两组的总有效率分别为100%、89.2%(P＜0.05);复发率分别为12.5%、26.4%(P＜0.05).     

推拿、针刺对急性脑梗死大鼠细胞凋亡相关基因蛋白表达的影响

从细胞凋亡及其相关基因蛋白表达方面探讨推拿、针剌治疗急性脑缺血的作用机理。用线栓法制成SD大鼠大脑中动脉阻塞再灌注模型，在阻塞2小时再灌注24小时后，应用TUNEL法和免疫组织化学法检测针刺、推拿治疗后大鼠脑组织细胞凋亡及Bel-2、Bax蛋白表达。结果：推拿、针刺均可减少缺血所致TUNEL阳性表达，提高梗死周边区皮层Bcl-2／Bax的比值。提示推拿、针刺对急性脑缺血的治疗作用可能与其可抑制细胞凋亡有关，从而保护脑神经细胞。     

大黄与芒硝对高腹内压危重患者脏器功能的保护作用

目的　观察大黄、芒硝对高腹内压危重患者脏器功能的保护作用。方法　将 6 2例高腹内压危重患者分为治疗组 (30例 )和对照组 (32例 ) ,在综合治疗的基础上 ,治疗组予鼻饲大黄、芒硝或大黄灌肠复加芒硝腹部热敷 ,每日 2次 ;对照组予吗丁啉鼻饲 ,72h后观察相关指标。结果　治疗组患者肛门排气、排便明显提前 ,血pH ,HCO3 -增高 (P <0 .0 1) ,尿量增加 ,膀胱内压下降 ,血 p(CO2 )下降、p(O2 ) /Fi(O2 )增高 (P <0 .0 5 ) ,能较早改善胃、肠、肾、肺功能。结论　及时合理应用大黄、芒硝能减低腹腔内压 ,改善脏器灌注及心、肺、肾功能 ,减少多器官功能不全的发生