原发性骨横纹肌肉瘤(附8例报告及29例文献分析)

目的：探讨原发性骨横纹肌肉瘤的临床与Ｘ线特点，材料与方法；对本组８例及文献中２９例共３７例临床和Ｘ线资料进行了分析。结果：３７例中男２８例，女９例，年龄９～６１岁，平均３７．４岁，病程２～１４个月，平均７．５个月，病变位于胫骨１３例，占３５．１％，股骨１０例，占２７％，肱骨５例，占１３．５％；胸椎２例，占５．４％，骶骨２例，占５．４％，颅骨２例，占５．４％，腓骨１例，占２．７％，腰椎１例，占２．７     

不同海拔高度新生儿染色体畸变观察比较研究

目的：了解高原低氧分压对新生儿染色体畸变的影响；方法：常规培养新生儿脐带血，制片、分带、计数观察；结果：（１）高原组新生儿中，发生结核改变的染色体１０例，占６２．５％，明显高于喀什组３０．０％及西安组６．６６％，喀什组又高于西安组；（２）高原新生儿染色体计数观察１５９４个，发生畸变８３个，占５．２０７％，明显高于喀什组２．４０１％及西安组１．５３２％；（３）高原新生儿当构本结构异常３４个，占２．１     

86例新生儿肺炎临床X线分析

本文分析８６例新生儿肺炎的临床和Ｘ线表现，探讨二者的特点和相互关系。本组病例包括支气管肺炎５８例（６７．４％），大病灶肺炎１８例（２０％），大叶或节段性肺炎２例（２．３％）。间质性肺炎５例（５．８％）。临床表现典型而Ｘ线表现阳性３例（３．５％）。通过肺部体征和Ｘ线表现的对照分析，提出提高本病诊断率的注意事项。     

青年人在高原适宜负重的实验研究

探讨不同海拔高度和不同步速条件下的适宜负重，对于确定高原作业人员合理负重有指导意义。本工作通过高原模拟负重步行试验（跑台）提出适宜负重。在海拔３７００ｍ，步行速度分为４．０、４．５和５．０ｋｍ／ｈ；负重分别为体重的０、１４％、２１％、２８％、３５％和４２％。在海拔４３００ｍ，步行速度分别为３．０、３．５和４．０ｋｍ／ｈ；负重分别为体重的Ｏ、１４％、２１％、２８％、３５％。在海拔５２００ｍ，步行速度分别为２．０、２．５和３．０ｋｍ／ｈ；负重分别为体重的０、７％、１４％、２１％、２８％和３５％。在每个海拔高度上选择移居半年以上的青年学生１２人作为受试对象。每人参加不同速度与不同负重步行试验。根据很累感发生率、ＶＥ、ＨＲ、恢复ＨＲ和Ｅ的改变确定适宜负重。结果表明，在海拔３７００ｍ，速度为４．０、４．５和５．０ｋｍ／ｈ时的适宜负重分别为２０．８、１７．４和１４．１ｋｇ。在海拔４３００ｍ，速度为３．０、３．５和４．０ｋｍ／ｈ时的适宜负重分别为１８．４、１４．３和１０．２ｋｇ。在海拔５２００ｍ，速度为２．０、２．５和３．０ｋｍ／ｈ时的适宜负重分别１７．３、１４．２和１１．４ｋｇ。     

FAO对发展反刍家畜展望

ＦＡＯ对发展反刍家畜展望Ｖ．Ｍ．Ｔｉｍｏｎ在过去４０年中，联合国粮农组织，世界银行在发展中国家投资了不少畜牧生产项目，仅在１９８６—１９９０年间就达３５．４亿美元，其中肉牛与奶牛业占６３％，绵羊、猪与禽各占１０％，山羊占５％，其他占２％。１９９１年世...     

创伤性胃肠道破裂48例诊治

临床资料男４２例，女６例，年龄３５～７０岁，１４～６０岁４２例，占全组８７．５％。闭合伤４３例，开放伤５例。破裂部位：胃２例，胃十二指肠２例（１例合并结肠破裂），十二指肠３例，空肠１３例，回肠１９例，空回肠４例，结肠５例。伴其它脏器伤１７例（占３５％...     

碘造影剂过敏反应的观察与抢救

我院自１９９３年２月使用全身ＣＴ，使用国产和造影剂。方法是：静脉加压滴注和静脉快速推注两种。增强病人２８８０例，发生过敏反应５０例，占１．７％。中度反应１６例，占０．５％，重度反应２例，占０．０６％。５０例反应病人中均有全身咽喉部灼热感。其中皮肤刺痒、荨麻疹占６０％，恶心呕吐占３４％，打喷嚏咳嗽占３０％，喉头阻塞感，呼吸困难占８％，过敏性休克占４％，由于抢救及时，处理恰当，无一例死亡。静脉注射碘剂     

高原不同民族新生儿染色体畸变观察比较研究

目的：了解高原不同民族、不同地区新生儿染色体畸变情况;方法：收集高原塔汉及平原维汉不同民族新生儿脐血进行常规培养、制片、分带、计数观察;结果：①高原新生儿染色体发生结构改变的汉族为８３．３３％（５／６）,高于塔族５０％（５／１０）,喀什汉族为３３％（４／１２）,高于维族２５％（２／８）;②高原汉族新生儿染色体计数观察,发生畸变率５．８９２％（３５／５９４）,塔族为０．４８％（４８／１００００）,喀     

550例大肠息肉的临床病理分析、内镜下治疗及随访

本文报道５５０ 例大肠息肉的临床及病理特点、内镜下治疗及１～２０ 年随访结果。大肠息肉的检出率为１４．０％ ，５０ 岁以上患者占 ４９．１％ ，单发性息肉 ４２０ 例，多发性息肉 １３０ 例，好发部位为乙状结肠和直肠（５０．５％ ）。病理诊断以腺瘤性息肉（４２．２％ ）和炎性息肉（４０．０４％ ）最多，息肉的异型增生发生率为１４．２％ ，腺瘤性息肉的癌变率为 １２．１％ ，结肠癌伴息肉的发生率为 ２．９％ 。对５４４ 例患者进行了内镜下息肉治疗，息肉的复发及再发率为５５．４％ ，平均复发时间为 ３２ 个月。随访检出４ 例息肉癌变，分别在术后第 ３、５、１０、２０ 年。     

飞行人员胆囊结石特点（4218名飞行人员临床调查）

为了了解飞行人员胆囊结石发病、诊治情况、临床特点以及对飞行安全影响等，我们于１９９５年５ 月至 １９９７ 年５ 月随机对４２１８ 名飞行人员进行了临床调查。结果：４２１８ 名中发现胆囊结石患者１８９例，患病率为 ４．５％ 。临床特点：男性多（１８５ 例占 ９７．８％ ）；４０ 岁以上者多（１４３ 例占７５．７％ ）；单纯胆囊结石多（１６８ 例占８８．８％ ）；胆囊多发结石多（１４４ 例占 ７６．２％ ）；有症状胆囊结石多（１１０ 例占 ５８．２％ ）；带石飞行多（１０４ 例占５５．０２％ ）；手术治疗少（７０ 例占３７．０３％ ）。临床调查证实：胆囊切除术是治疗飞行人员胆囊结石安全、可靠、有效的方法，术后能够达到飞行合格标准。结论：对空军飞行人员和民航驾驶员的胆囊结石不论有无症状，在恢复飞行之前必须施行航空医学性胆囊切除术以保障飞行安全     

Evidence for exercise-induced bone formation in premature infants

We assessed the effect of a four weeks exercise training intervention on bone turnover markers in premature infants. Twenty-four very low birth weight premature infants were matched for gestational age, birth weight, gender, as well as for corrected age and weight at initiation of the study. Then the subjects were randomly divided into an exercise (n = 12) and a control group (n = 12). Exercise consisted of passive range of motion exercise with gentle compression of both the upper and lower extremities lasting 5 - 10 minutes each day, 5 days per week for 4 weeks. This protocol has been shown to increase bone mineral density in premature infants. Bone formation was assessed by measurements of circulating bone specific alkaline phosphatase (BSAP) and the C-terminal procollagen peptide (PICP). Bone resorption was determined by serum measurements of C- terminal cross-links telopeptide of type-I collagen (ICTP). Training led to a significant (P < 0.05) increase in weight gain (767 +/- 49 versus 586 +/- 24 gr in trained and control premature infants, respectively); and to a significant increase in BSAP (37.2 +/- 14.6 versus 4.1 +/- 8.4 % in trained and control premature infants, respectively). PICP increased also following exercise (34.6 +/- 18.9 versus 5.4 +/- 9.1 % in trained and control subjects, respectively), however, this increase was not statistically significant. Exercise led to a significant decrease in ICTP (-24.7 +/- 3.1 versus -5.5 +/- 5.4 % in trained and control subjects, respectively). A relatively brief exercise intervention was associated with a biochemical evidence of bone formation in very low birth weight premature infants.     

微型经食管超声探头在低体重先天性心脏病患儿外科手术中的应用

目的研究微型经食管超声探头(micro-TEE)在低体重婴幼儿先天性心脏病外科手术中的应用价值,评估其诊断准确性及图像质量。资料与方法收集行先天性心脏病外科手术的68例患儿,术中行micro-TEE监测,与术后经胸超声心动图(TTE)结果比较,评估其诊断准确性。根据体重将患儿分为A组(<3.5 kg)、B组(3.5~7.0 kg)和C组(>7.0 kg)。对术中图像进行评分,比较3组图像质量的差异。结果术中micro-TEE监测68例,发现残余问题13例,2例立即再处理;发现心功能减低3例,其中1例协助决定延迟关胸。术后TTE发现残余分流18例,心功能减低5例,均无需再次手术。术中micro-TEE与术后TTE诊断结果差异无统计学意义(P<0.01)。图像质量评分显示,3组间图像质量差异有统计学意义(P<0.05)。结论micro-TEE术中监测可获得准确、满意的图像,在低体重先天性心脏病患儿外科手术中有重要的应用价值。     

低体重婴幼儿先天性心脏病手术麻醉中血糖的管理

 目的 比较两组低体重婴幼儿行先天性心脏病(先心病)手术麻醉中血糖管理的效果.方法 选择我院2007-06至2010-06择期行先天性心脏病手术的低体重患儿60例,随机分为A组和B组,每组30例.A组患儿麻醉前2～3 h给予饮1次糖水,B组患儿麻醉前5～6 h给予饮1次糖水;两组患儿入手术室麻醉诱导前均给予肌肉注射氯胺酮8～10mg/kg,入室后行心电、脉搏氧监护及吸氧,麻醉诱导用咪唑安定0.05～0.1 mg/kg,芬太尼3～5μg/kg,维库溴铵0.08～0.1mg/kg,诱导后经口行气管内插管.以芬太尼20～30μg/kg,异丙酚、复合吸入异氟醚维持麻醉.于诱导前5 min(T1)、诱导后5 min(T2)、体外循环开始前5 min(T3)、体外循环结束后5 min(T4),监测以上各时点的血流动力学指标:心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),同时监测各时点血糖变化.结果 两组患儿T1、T2、T3时点血流动力学指标及血糖变化差异具有统计学意义(P＜0.05).T4时点血流动力学指标及血糖变化无明显差异(P＞0.05).结论 低体重婴幼儿先心病手术麻醉做好术前评估、术中监测,术前血容量及血糖的维持是稳定围术期血流动力学的关键.     

低体重婴儿先天性心脏病的体外循环策略及外科疗效

 目的 探讨低体重先天性心脏病患儿的体外循环管理方法和外科预后。方法 回顾性分析我院2008-2012年共297例月龄≤12个月且体重≤10 kg的先天性心脏病患儿行心内直视术的体外循环方法,总结围术期并发症及死亡情况。结果 体外循环时间16~122(57.4±13.9) min,主动脉阻断时间6~95 (35. 1±11.3) min,均采用改良超滤+平衡超滤,围术期低心排综合征26例,急性呼吸窘迫综合征33例,重症肺部感染9例,肾衰竭5例,延迟关胸5例,围术期死亡5例。结论 合理的预充和灌注,采用超滤并重视脏器的保护,是低体重先天性心脏病患儿体外循环管理的合理策略,可以有效改善手术预后。     

不同治疗时机对妊娠梅毒的预后影响研究

目的 探讨不同时机妊娠梅毒治疗对患儿预后的影响.方法 选取2008年1月～2010年4月于我院进行生产治疗的妊娠梅毒患者80例为研究对象,将其随机分为A组（≤12周治疗组）20例、B组（13～28周治疗组）20例、C组（≥29周治疗组）20例和D组（未治疗组）20例,将四组患者的足月分娩率、早产率、死胎率及低体重儿发生率、畸形率、Apgar评分及母婴RPR滴度进行检测及比较.结果 经研究比较发现,A组的足月分娩率高于B、C及D组,以D组最低,A组的早产率、死胎率及低体重儿发生率、畸形率均低于B、C及D组,以D组最高,A组1min及5minApgar评分均优于B、C及D组,母婴RPR滴度A组也最佳,其中A组中治疗2个疗程者母婴RPR滴度优于1个疗程者,P均〈0.05,均有显著性差异.结论 早期的治疗对改善妊娠梅毒的预后有着积极的意义,因此主张早期的治疗.     

高危新生儿头颅CT表现（附41例分析）

目的：提高对高危新生儿头颅CT异常表现的认识。方法：41例均为高危新生儿,出生后1．5h-12天内行CT检查,扫描前半小时肌注鲁米那钠或10％水合氯醛口服或灌肠,使其安睡。结果：单纯蛛网膜下腔出血13例,脑实质出血5例,脑室内出血3例,室管膜下出血4例,硬膜下出血5例,单纯脑缺氧缺血性损害9例,正常CT表现2例。结论：高危新生儿大部分存在颅内出血或脑缺氧缺血性损害,CT检查对这些病变有极高的诊断价值。     

New-born infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory versus conventional ventilation

Objective: The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants. Materials and methods: New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration. Results: At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO₂ 0.38 vs. 0.64). Conclusion: In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.     

Percutaneous thoracic drainage in neonates: catheter drainage versus treatment with aspiration alone

PURPOSE: To retrospectively compare thoracic drainage in neonates by using catheter and aspiration techniques. MATERIALS AND METHODS: Approval was obtained from the institutional research ethics board; informed consent from parents was waived. Retrospective review of 21 neonates (19 boys, two girls; mean gestational age, 39.3 weeks) who underwent percutaneous thoracic drainage during a 9-year period was performed. Data such as indication for drainage, type of drainage, age and weight at birth, corrected age and weight at the time of drainage, use of mechanical ventilation at the time of drainage, and outcomes were collected. Drainage was considered successful if the collection was treated without additional surgical or radiologic intervention. Fisher exact test and two-tailed unpaired student t test with a confidence level of 95% (unequal variances assumed) were used to compare neonates treated with a catheter and those treated with aspiration. RESULTS: Image-guided therapy was used to treat pleural effusion (29%, n = 6), chylothorax (24%, n = 5), empyema (19%, n = 4), pneumothorax (14%, n = 3), mediastinal seroma (10%, n = 3), and congenital cystic adenomatoid malformation (5%, n = 1). Sixteen (76%) infants were treated with catheter placement, with a success rate of 81% (13 of 16). Five (24%) infants were treated with simple aspiration with no success. The difference in success rates was significant (P = .003). There was no significant difference between the catheter placement and aspiration groups in terms of average age, average weight, and percentage dependent on mechanical ventilation. One complication (cellulitis) was directly related to catheter drainage. In cases where treatment was successful, the mean length of the chest tube placement was 13.5 days, and there were no deaths at follow-up. In cases where treatment failed, the long-term mortality rate was 50% (four of eight). CONCLUSION: Image-guided percutaneous thoracic drainage success rates are improved if drainage catheters are placed rather than if aspiration alone is performed.     

Patterns of complications of neonatal and infant meningitis on MRI by organism: a 10 year review

Introduction

Imaging of meningitis in neonates and infants is not routine, but is frequent for complications. Aside from tuberculosis and herpesvirus, imaging findings related to most responsible pathogens are thought to be nonspecific, but few studies exist. We reviewed the imaging features of complicated meningitis in infants and neonates at our hospital in the past decade, hypothesizing that patterns of complications might be more specific than previously recognized.

Methods

10 yr retrospective review of magnetic resonance imaging (MRI) and microbiology data for all neonates (age <30 d) and infants (age <1 yr) imaged for possible complications of meningitis at a tertiary children's hospital.

Results

We had 63 patients (25 neonates, 38 infants). The 3 most common pathogens were streptococcal species (n = 32, mean age 4.7 mo), E. coli (n = 9, mean 1.2 mo), and herpes simplex virus (n = 4). The most common findings were meningeal enhancement (78% of those given IV contrast), infarct (52%), subdural collection (35%), and ventriculomegaly (32%). E. coli presented much more frequently with ventriculomegaly (64% vs. 22%) than streptococcal species. Extensive infarcts were typical of streptococcal meningitis (13/32, 41%) and rarely seen with other organisms (2/31, 6%, p = 0.001). All 3 cases of Serratia meningitis had large parenchymal abscesses, and 2/4 cases of meningococcus had occipital cortical necrosis.

Conclusion

Although overlap was present, each organism responsible for neonatal/infant meningitis produced an identifiable pattern of complications on MRI. Recognising these patterns can help the radiologist suggest possible diagnosis and influence early management.     

纵隔低密度肿块病变的CT诊断

目的：提高纵隔低密度肿块病变的CT诊断水平。方法：回顾性分析52例经临床、手术及病理确诊的纵隔低密度肿块病例资料。结果：52例中皮样囊肿4例，畸胎瘤6例，胸腺囊肿3例，支气管囊肿5例，心包囊肿4例，脂肪瘤1例，胸内甲状腺肿囊变4例，胸腺瘤囊变5例，淋巴结肿囊变7例(淋巴瘤2例，淋巴结结核5例)，神经源性肿瘤囊变4例(神经节细胞瘤1例，神经鞘瘤2例，恶性神经纤维瘤1例)，纵隔血肿2例，纵隔脓肿6例。CT诊断正功率92．3％(48／52)。结论：纵隔低密度病变种类较多。CT检查可清楚显示病变的部位与特点，结合临床表现一般能作出准确的术前诊断。