上下泪小管同时断裂35例手术分析

目的探讨上、下泪小管同时断裂的手术治疗方法。方法上、下泪小管同时断裂共35例,按手术方式分为两组。A组:27例同时行上、下泪小管吻合术;B组:8例仅行下泪小管吻合术。结果A组27例较少发生内眦角变形、睑外翻,上下泪点复位良好。结论为求上、下泪小管断裂术后能达到解剖复位及功能复位,同时行上、下泪小管断裂吻合效果较好。     

改良泪道探通术治疗新生儿泪囊炎

新牛儿泪囊是婴幼儿常见病，作者应用自制的泪道探通冲洗针对28例新生儿泪囊炎进行了泪道探通冲洗治疗观察．疗效满意．报告如下。     

面斜裂整形修复中泪道重建术的探讨

为了解决面斜裂整形修复中泪道重建的难题，１９８９年３月～１９９５年１月，对４例患者治疗中设计了三种手术方法：泪小管鼻腔吻合术；静脉血管或口腔粘膜移植重建泪道术；改良的泪囊鼻腔吻合术。术后重建的泪道置入导管３～６个月。经术后６个月～１年的观察，面部畸形整复，溢泪消失，红汞试验及泪道检查均通畅，效果满意。认为，应根据泪道畸形程度的不同，选择合适的手术方法，以取得最佳疗效。     

改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床观察

目的 :探讨改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床效果。方法 :用 7～ 9号腰脊穿刺针针头去尖 ,磨光后制成改良空管式泪道探针。为慢性泪囊炎 98例、10 2眼探通泪道后沿空管注入素高捷疗眼膏 ,使之布满泪道内壁 ,尽快修复探通的泪道内皮 ,达到扩张疏通的目的。以同一疾病 84例、85眼为对照组 ,以 1～ 3号银质泪道扩张针扩通泪道 ,留针 15min ,隔日 1次 ,共扩张 2～ 3次 ,扩张后用 0 .2 5 %氯氟液冲洗。结果 :术后随访 3个月 ,观察组治愈率为 97.0 5 %,对照组治愈率为 9.4 1%,差异有高度显著性 (P<0 .0 1)。 结论 :用改良的泪道探针探通泪道后注入素高捷疗眼膏 ,促使泪道修复 ,是治疗泪道阻塞或狭窄的有效方法。     

Value of spiral CT in hemodynamically stable patients following blunt chest trauma

Introduction: Features of spiral CT (SCT) — fast scanning, dynamic injection of contrast allowing optimal vessel opacification, and supplemental multiplanar imaging — promises to provide increased accuracy in the diagnosis of acute and non acute thoracic vascular disease. Recent work demonstrating the cost effective triage of hemodynamically stable patients after blunt chest trauma for angiography based on dynamic CT findings has prompted an investigation into the accuracy of SCT in this clinical setting. Methods: A retrospective review of all patients seen in the emergency department over the period of one year for aortic, thoracic, or blunt chest trauma evaluation was performed (74 patients) and all SCT scans available were reviewed and data reformatted for optimal delineation of pathology using maximum intensity projection and multiplanar reformation. The accuracy and predictive positive and negative values of SCT were calculated with respect to angiography, surgical, and/or clinical follow up evaluation. Results: Twenty three (31%) patients went directly to angiography owing to mediastinal widening on chest film and hemodynamic instability, of which four were positive and required emergent surgery. Seven hemodynamically stable patients (9%) had noncontrast SCT owing to mediastinal widening on chest film, all of which had angiography with none having great vessel trauma. Fourty four hemodynamically stable patients (60%) had contrast enhanced SCT (ceSCT), of which five (11%) were abnormal and underwent angiography, four of these were positive for aortic damage, one for a subclavian artery laceration. Of the remaining 39 patients who had normal ceSCT; five had angiography, all of which were normal. Of the remaining 34 patients that had normal ceSCT none had adverse outcome on clinical follow-up, minimum of 12 months. Conclusion: The predictive positive value for aortic trauma of ceSCT in blunt trauma is 80%, with a predictive negative value of 100%, indicating that it is feasible for SCT to be a first line exam in blunt chest trauma in the future.     

脑挫裂伤水肿转归时间的探讨

目的总结脑挫裂伤后脑水肿发展与消退的时间,为临床治疗提供依据。方法我院4年来收治的脑挫裂伤的患者174例,至少每3d复查一次CT,根据CT影像表现作为观察脑水肿的指标,记录脑水肿随时间演变的过程。结果所有病例脑水肿在3d内达到高峰,但水肿高峰持续时间存在差异,病程中脑水肿的高峰持续时间3～5d7例,6～8d34例,9～11d112例,12d以上21例。脑水肿高峰持续时间与脑水肿严重程度和挫裂伤的严重程度有显著关系。结论大部分脑挫裂伤脑水肿高峰时间比过去我们认识的要长,故使用控制脑水肿药物的时间应适当延长,特别是严重颅脑损伤患者,并应根据不同情况选择脱水剂。     

Acute pseudotumor of the orbit

A case is presented of a 22-year-old man with a history of bilateral eye injection, lacrimation, and rhinorrhea. The right orbit was inflamed and its globe proptotic, with medial and lateral gaze deficits. Tomography revealed swelling about the right lacrimal gland. He was admitted and treated with high-dose steroids, which caused regression of his symptoms. This presentation and response to steroids is pathognomonic for acute pseudotumor of the orbit, a condition rarely described in the emergency medicine literature. If left untreated, treudotumor of the orbit may progress to blindness and ophthalmoplegia.     

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: Report of a case

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.     

亚低温冬眠疗法治疗重度脑挫伤的临床研究

目的探讨亚低温冬眠疗法对重度脑挫伤病人的脑保护机理及临床疗效。方法46例重度脑挫伤患者(GCS≤8分)随机分为亚低温冬眠治疗组和常温治疗组。其中亚低温冬眠组22例,入院后4￣12h内行亚低温冬眠治疗,输液泵持续静脉点滴冬眠合剂,将肛温控制在32￣35℃,亚低温冬眠治疗4￣7d,同时检测颈动脉和颈静脉血气、电解质变化、血糖及生命体征等指标。常温组24例除未行亚低温冬眠治疗外,其余综合治疗及监测方法同亚低温冬眠组。两组病人均于伤后3个月根据GOS预后评分判定疗效。结果与常温组比较,亚低温冬眠治疗组脑氧耗明显降低,高血糖情况显著下降,生命体征及电解质等无明显差异,无严重并发症,死残率明显降低,预后显著改善。结论亚低温冬眠疗法具有显著的脑保护作用,临床应用于重度脑挫伤救治安全有效,无严重并发症。