创伤后迟发性脑肿胀的临床特点与治疗

目的 探讨创伤后迟发性脑肿胀的临床特点、发病机制与治疗。方法 回顾性分析1998年1月～2005年6月年收治的17例迟发性脑肿胀患者的临床特点和救治情况。结果 所有颅脑损伤患者采用保守治疗后均有好转，但于伤后5-10d出现恶化，CT复查有脑肿胀，经加强综合脱水等治疗后16例治愈，1例死亡。结论 迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下薄层血肿及早期CT有脑肿胀者。其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。此类患者病情隐蔽性强，应加强观察、积极行CT复查，如能早期明确诊断，保守治疗多数效果良好。     

Ursachen und Diagnostik der Laterogenie

Zusammenfassung Zur Klärung möglicher Ursachenfaktoren, die zur Entstehung einer Laterogenie beitragen, wurden 22 Patienten nach klinisch funktionellen Kriterien ausgewählt und computertomographisch untersucht. Durch die bessere Vergleichbarkeit überlagerungsfrei abgebildeter morphologischer Strukturen im Computertomogramm konnte eine Einteilung in vier Ursachenbereiche erfolgen, innerhalb derer verschiedene asymmetrische Einzelabweichungen analysiert und diskutiert wurden. Es hat sich gezeigt, daß die computertomographisch strukturelle Analyse bei dieser Problemstellung anderen Untersuchungsmethoden überlegen ist und im Einzelfall neue Anhaltspunkte für eine prognostische Abschätzung weiterer Entwicklungstendenzen bietet.

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Summary To determine the possible reasons, contributing to the formation of laterogenia, 22 patients were investigated by computer tomography. The patients were selected according to clinical and functional criteria. As CT gives a more accurate comparison of structures without superimposition it was possible to subdivide the causative factors into four groups. Within each of them, different asymmetric deviations could be analysed and discussed. It was shown, that structural-CT analysis is superior to other methods of investigation, particularly for this kind of problem. Furthermore it provides new criteria for a prognostic evaluation of development.

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Résumé Pour rechercher les causes qui contribuent à la formation d'une latérogénie, on avait examiné 22 patients, sélectionnés par leur aspect clinique et fonctionnel, à l'aide d'un computer analysant des tomographies. Grâce à ce computer, la meilleure comparaison des structures, représentées sans superposition, donnait la possibilité d'en classifier les causes en quatre catégories, dans lesquelles on analysait et discutait les différentes déviations asymétriques. Il est évident, que dans ces problèmes l'analyse computertomographique-structurelle surpasse d'autres méthodes d'examen et qu'elle offre de nouveaux critères pour prévoir d'autres tendances du développement.

     

Retrorenal colon: implications for percutaneous diskectomy

It has been recommended that computed tomography (CT) with the patient prone be performed in every patient undergoing percutaneous diskectomy; this would enable detection of a retrorenal location of the colon, which could interfere with the percutaneous procedure. In this evaluation of 346 prone CT studies, only one patient (0.29%) was found to have retrorenal or retropsoas bowel that would have been perforated at diskectomy. Because of this extremely low prevalence, the performance of prone CT in every patient undergoing percutaneous lumbar diskectomy is not believed to be necessary.     

Extended HLA profile of an inbred isolate: The Schmiedeleut Hutterites of South Dakota

HLA-A, -B, -C, -DR, and -DQ typings of the Schmiedeleut Hutterites of South Dakota were collected as part of an ongoing genetic-epidemiologic study of HLA and fertility. A total of 1,082 individuals, including 852 married adults representative of the reproductive population of this isolate, were characterized for five-locus HLA haplotypes. HLA-A1, A2, A3, and A24 accounted for 75% of observed HLA-A alleles and HLA-B27, B35, B51, and B62 accounted for 55% of observed HLA-B alleles. S-leut Hutterites are derived from 68 or fewer ancestors. However, only 48 ancestral HLA haplotypes were observed and nine of these accounted for over 52% of the observed haplotypes. Measures of two-locus linkage disequilibrium derived from these haplotypes indicated that one-third to half of the observed HLA-A/B, B/DR, and A/DR allele combinations exhibited highly statistically significant linkage disequilibrium. Allele and haplotype frequencies did not differ between males and females. Recombination rates of 0.004% and 0.005% between HLA-A and -C and between HLA-B and -DR, respectively, were observed. This HLA profile points out a paucity of HLA alleles and haplotypes in this population and marked linkage disequilibrium among the HLA alleles that are present. © Wiley-Liss, Inc.     

肾移植受者血清巨细胞病毒IgE和IgA抗体检测

采用间接ＥＬＩＳＡ检测２３名肾移植受者血清巨细胞病毒（ＣＭＶ）抗体，共检出１８名（７８％）活动性ＣＭＶ感染，其中１０名（４４％）为原发性感染。结果证实ＣＭＶ－ＩｇＥ和－ＩｇＡ具有较好的血清学诊断价值，优于ＣＭＶ－ＩｇＭ。