亚急性放射病的临床特点

本文以我国牡丹江事故的临床资料为主要依据, 结合文献对亚急性放射病的临床特点、诊断与鉴别诊断进行了分析讨论。认为该病是人体在较长时间内受电离辐射连续或间断较大剂量外照射所引起的一组全身性疾病。通常起病隐袭, 分期不明显, 不伴无力型神经衰弱综合征, 临床上以造血功能再生障碍为主, 可见全血细胞减少及与之有关均症状, 染色体畸变率增高, 其中稳定性与非稳定性畸变各占一定比例, 可伴微循环。凝血机制障碍及T淋巴细胞功能及生殖功能低下, 一般抗贫血药物治疗无效。临床上主要需与急性。慢性放射病及原发性再生障碍性贫血相鉴别。     

外照射慢性放射病诊断进展

一、背景外照射慢性放射病（简称慢放）,是指机体在较长时间内连续或间断受到超剂量限值外照射作用所发生以造血组织为主,并伴有其他系统改变的一种全身性疾病,是放射病诊断标准中讨论较多的国标之一。本期人的慢性放射病专栏中的各文已从不同侧面做了阐述,本文作者仅...     

外照射慢性放射病的诊断历史回顾

外照射慢性放射病（ｃｈｒｏｎｉｃｒａｄｉａｔｉｏｎｓｉｃｋｎｅｓ,ＣＲＳ）,是指机体在较长时间内连续或间断受到超剂量限值外照射作用所发生的以造血组织为主,并伴有其他系统改变的一种全身性疾病。１慢性放射病的国外情况目前对慢性放射病（简称慢放）存在不同...     

两例外照射慢性放射病继发缺铁性贫血

两例外照射慢性放射病继发缺铁性贫血杨秀梅姜恩海陈子齐王晓琳本文作者主要结合已确诊的两例慢性放射病继发缺铁性贫血的诊断进行讨论。１临床病例例１，女，４９岁，放射科主管技师，放射工龄２６年。因头昏、乏力、睡眠障碍、白细胞减少２０年，于１９９１年６月２５日...     

外照射慢性放射病的胸腺肽治疗及追踪观察

目的本文观察１１例慢性放射病的胸腺肽治疗结果及病程转归。方法以临床症状变化、造血系统造血功能、Ｔ淋巴细胞百分率、染色体畸变率变化作为慢放病恢复的综合判断标准进行分析。结果胸腺肽能促使患者的无力型神经衰弱征候群明显好转；能显著提高Ｔ淋巴细胞百分率，进而增强机体免疫力，治愈口腔粘膜溃疡。追踪观察表明，慢放病恢复时间依次为细胞免疫功能（２年），无力型神经衰弱综合症（３．５年），造血组织造血功能（５～８年），染色体畸变率（１０年）。结论按照我们拟定的慢放病恢复综合判断标准，慢放病是一种可以恢复的职业性疾病。胸腺肽有助于慢放病的治疗，且方法简单，值得临床试用     

忻州60Co源放射事故主要8例受照者临床报告

目的通过对诊断不明病人“芳”的诊断和治疗,探索在放射源不明情况下,如何进行放射病的诊断;探索采用简易隔离和ＧＭ－ＣＳＦ治疗效果;同时回顾性介绍同组其他病人发病经过。方法通过详细询问病史,排除传染病和中毒,在高度怀疑放射病时,经对外周血淋巴细胞染色体畸变分析,确诊急性放射病;复习文献,提出放射源不明、放射病诊断线索。结果经作淋巴细胞染色体畸变分析,估算受照剂量为２．３０（２．０７～２．５０）Ｇｙ,确诊为骨髓型急性（中度）放射病,同时推断家中死亡３例也为放射病。结论如遇到难以解析的皮肤烧伤病变（红斑,水疱）,排除热或化学烧伤后,应考虑放射烧伤,对有恶心,呕吐,脱发,口腔溃疡,外周血细胞减少者,更支持诊断;如家中成员中相继发生上述同类症状者更应高度怀疑,并作相关检查确诊;简易隔离可为一般医院所采用;细胞因子可促进造血功能恢复,缩短病程     

细胞遗传学指标在慢性放射损伤诊断中的意义

用染色体畸变估算全身一次比较均匀的Ｘ、γ射线和中子的过量照射时的生物剂量比较准确 ,对不均匀和局部照射可给出相当于均匀照射的等效剂量当量。淋巴细胞微核也已被用作估算受照射剂量的指标 ,并取得了较为满意的结果。但在慢性放射损伤时 ,染色体畸变和微核的变化特点及其在慢性放射病诊断中的作用 ,是值得探讨和深入研究的问题。在《外照射慢性放射病诊断标准及处理原则》(ＧＢ82 81 87) [1] 中将“外周血淋巴细胞染色体畸变率显著增加和 /或外周血淋巴细胞微核率显著增加” ,作为慢性放射病诊断的参考指标。到目前为止 ,还不能用染色…     

山东济宁60Co辐射事故受照人员的临床救治

目的总结和探索肠型放射病和极重度骨髓型放射病临床诊治经验。方法中国山东济宁^60Co辐射事故中2例病人受到意外照射。综合估算，病例A受照剂量20～25Gy，诊断为“肠型放射病”；病例B受照剂量9～15Gy，诊断为“极重度骨髓型放射病”。经联合预处理，2例分别行单倍体和HLA相合外周血造血干细胞移植。结果2例患者均移植成功，供体完全植活，三系血细胞和骨髓造血重建成功，均无移植排斥和移植物抗宿主病。病例A于照后33d（d33）死于败血症和多脏器功能衰竭，病例B于d75死于心衰为主的多脏器功能衰竭。结论骨髓和外周血染色体及牙齿ESR检查等对超大剂量放射病诊断有重要价值。HLA相合及半相合外周造血干细胞移植救治急性放射病是完全可能和可行的。感染和多脏器功能衰竭仍然是病人的主要死亡原因。应加强对促进辐射损伤修复和多脏器功能衰竭的救治研究。     

中度急性放射病的诊断

本文报道了40例中、晚期恶性淋巴瘤病人采用⁶⁰Coγ线一次全淋巴区照射6,8Gy的临床表现。若按病人外周血淋巴细胞染色体畸变估算这一剂量, 则相当于一次全身均匀照射条件下血液平均受照剂量分别为2.73～4.30Gy(平均3.55Gy)和3.48～5.58Gy(平均4.25Gy).按红骨髓千细胞法估算等效剂量为1.85～2.37Gy.可以见到中度急性放射病的临床经过, 表现为消化道反应和造血免疫功能受损, 骨髓受到抑制。白细胞, 血小板迅速减少, 淋巴细胞在早期就有质和量的变化。所有这些均是有意义的诊断指标。此外, 唇肌刺激反应、C反应蛋白、皮质醇, 尿中核苷和碱基, 照射前后皆有显着改变。因此利用肿瘤病人进行6～8Gy全淋巴区照射可以作出中度急性放射病的早期诊断。     

T淋巴细胞亚群和淋巴细胞转化率在急性放射病的观察

Ｔ淋巴细胞亚群和淋巴细胞转化率在急性放射病的观察张东华，张瑶珍，李美颖，汪道文，鲜于志群，路武受电离辐射所致的急性放射病病人，淋巴细胞的功能必然受到不同程度的影响，以Ｔ淋巴细胞为中心的免疫网络在机体辐射损伤后的变化日益受到重视。我们观察了４例受６０Ｃ...     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.