简易立体定位仪定位微创治疗高血压脑出血

目的　探讨高血压脑出血微创治疗的方法和手术时机的选择对该病疗效的影响。方法　对 12例高血压脑出血患者 ,采用脑内血肿定位仪微创血肿穿刺引流术清除血肿 ,观察疗效。结果　ADL1～ 3级 75 % ,病死率 8.3%。结论　颅内血肿定位仪定位微创血肿穿刺引流术 ,具有效果肯定、定位准确、损伤轻微、适应症广的特点 ,超早期治疗是预后的关键     

Bleeding from foveolar hyperplasia developing on a gastrointestinal stromal tumor of the stomach

A 52‐year‐old Japanese woman who presented with gastrointestinal (GI) bleeding underwent a proximal gastrectomy for a gastrointestinal stromal tumor (GIST) with a foveolar hyperplasia at the apex of the tumor, 4.5 cm in size, located in the upper body of the stomach. Although GIST are often asymptomatic and are found only incidentally, clinical symptoms such as bleeding, abdominal pain, or obstruction, occasionally lead to a premorbid diagnosis. When submucosal tumors present GI bleeding, the source of the bleeding usually is an ulceration of the mucosa over the tumor. However, in the present study, it was thought that the bleeding originated from the region of foveolar hyperplasia.     

Measurement of blood loss at childbirth and postpartum.

OBJECTIVE: To accurately measure blood loss during childbirth in a developing country. METHOD: The alkaline hematin technique was used to quantify blood lost during delivery and 24 h postpartum in 158 women in Pemba Island, Zanzibar. RESULT: Women were found to lose less blood during childbirth and 24 h postpartum than previously reported. Compared with laboratory values, nurse-midwives approximated blood loss accurately (mean difference, i.e., mean underestimation by nurse-midwives, 4.90 mL); however, their imprecision was greater for higher laboratory values. CONCLUSION: This study may prompt further investigation, as no comparable data exist for developing countries where maternal mortality is high and severe anemia prevalent.     

Ischemic and hemorrhagic cerebral lesions of the newborn

Neonatal pathology comprises a large array of cerebral lesions due to ischemic and/or hemorrhagic mechanisms. Pathogenesis, neuropathology, clinical settings in the acute stages as well as short and long-term outcome are discussed.     

重症脑出血微创术后下呼吸道感染病原学分析

目的:重症脑出血微创术后气管切开病人痰培养病原菌分布与耐药情况分析,其院内感染发生的原因、探讨防治对策。方法:应用痰培养检出的病原菌及耐药性分析。结果:重症脑出血微创术后气管切开病人下呼吸道感染41例,其中G-杆菌26例占63.4%,G 球菌15例占36.6%,其中金葡菌11例,药敏仍以敏感菌株为主,但耐药菌株有增多趋势。结论:重症脑出血微创术后气管切开病人下呼吸道感染以G-杆菌为主,G 球菌以金葡菌为主,仍以敏感菌珠为主,耐药有增多趋势。万古霉素对G 球菌,氨曲南对G-杆菌敏感性较敏感,故在培养结果未出来之前经验用药是非常重要的。     

利多卡因治疗外伤性蛛网膜下腔出血疗效分析

目的探讨早期静脉注射利多卡因对外伤性蛛网膜下腔出血（tsAH）继发性脑损伤的治疗作用。方法重度颅脑损伤后SAH患者60例（GCS评分≤8分）。随机分为治疗组（早期静脉注射利多卡因组）和对照组。在治疗前后对患者均进行GCS评分、颅内压（ICP）测定以及头部CT、发射计算机体层摄影（ECT）、经颅多普勒（TCD）检查。结果利多卡因治疗7d后即出现颅内压降低、挫伤脑组织血流供应改善、脑水肿减轻，与对照组比较，有明显差异（P〈0．01）；GCS评分在利多卡因治疗7d、14d后较对照组明显增加（P〈0．01）。结论早期静脉注射利多卡因能明显减轻颅脑损伤后SAH继发性脑组织损伤的程度，有利于神经功能的早期恢复。     

CT结合内镜检查诊断胃肠道间质瘤的价值

目的：探讨CT结合内镜检查诊断胃肠道间质瘤(GIST)的价值。方法：回顾分析18例均经手术病理检验证实为GIST病人的CT及内镜检查资料。结果：(1)18例GIST的CT表现为类圆形或分叶状肿瘤，边界清楚，13例平扫及增强密度均匀，强化明显，5例瘤灶内有坏死液化区；肿瘤周围肠管不同程度受压移位或粘连。(2)15例源于胃、十二指肠及结肠的间质瘤均行内镜检查，4例瘤侧胃壁镜下所见黏膜呈外压性改变者未行咬检；11例伴有溃疡形成，溃疡处咬检获取病理组织。(3)18例均行手术后光镜观察及免疫组化检查，18例CD-117均为阳性，13例CD-34阳性，10例Vimentin阳性。结论：CT与内镜相结合检查，能提高胃、十二指肠及结肠GIST定位、定性的准确性。     

TCD观察动脉瘤性SAH后脑血管痉挛的血流动力学改变

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛的血流动力学改变。方法经CT、DSA证实为动脉瘤性SAH患者179例,床旁经颅超声多谱勒(TCD)在术前、术后1~3d、5~7d、9~11d、12~14d记录并分析大脑中动脉(M CA)的血流参数及频谱改变。结果M CA平均血流速度(Vm)于SAH后1~3d开始升高,5~7d、9~11d达到高峰;L I(血管痉挛指数)为3~6时预后良好;>6时可以出现神经系统功能损害,颅内压增高且有脑血管痉挛(CV S)者预后较差。结论TCD能无创、实时评价SAH后CV S的动态变化,可以推断SAH后CV S的严重程度及临床转归。     

Foley尿管气囊压迫治疗骶前静脉丛大出血的评价(附6例报告)

目的:评价直肠癌根治术中用Foley尿管气囊压迫治疗骶前静脉丛大出血(MPVP)的临床价值。方法:分析1995~2005年用Foley尿管气囊压迫治疗骶前静脉丛大出血6例的临床资料。结果:6例骶前大出血中全部用Foley尿管气囊压迫控制出血,术中出血量为800~1700mL,Foley尿管于术后4d拔除3例,5d1例,6d2例,均无再出血,会阴切口均一期愈合。结论:Foley尿管气囊压迫治疗骶前静脉丛大出血是一种简单安全有效的治疗方法。     

血红素氧合酶-1与脑出血的继发性损害

自发性脑出血是指非外伤性脑实质出血,发病率高,死亡率高[1],且脑出血后患者多遗留不同程度的神经功能障碍。因此,探讨脑出血后脑组织损伤的病理生理机制对于改善脑出血病情及预后是十分必要的。大量研究表明自发性脑出血后造成的脑损伤存在多种机制[2]:早期血肿机械占位效应、