可吸收螺钉治疗股骨头骨折临床分析

目的观察可吸收螺钉治疗股骨头骨折的疗效。方法2004年4月-2006年11月对12例股骨头骨折患者采用切开复位可吸收螺钉内固定。结果12例获得6～37个月随访，采用Charnley分数分级评定疗效，总体优良率83．3％。结论可吸收螺钉治疗股骨头骨折固定可靠，减少了二次手术的再损伤，最大限度恢复了髋关节功能。     

折断螺钉内固定治疗股骨转子间骨折

目的探讨高龄患者股骨转子间骨折内固定方法。方法对３０例高龄患者骨转子间骨折采用折断螺钉内固定进行临床观察。结果３０例全部愈合，平均愈合时间４３个月，无并发症发生。结论该法创伤小，尤为适宜高龄患者，手术安全，术后护理简单，恢复快。     

Xeroderma pigmentosum variant associated with multiple cancers

A 62-year-old Japanese man with xeroderma pigmentosum (XP) variant is reported. The patient had developed at least 6 basal cell carcinomas, a squamous cell carcinoma, and a malignant melanoma on sun-exposed areas, and an atypical carcinoid on the right lung. In vivo phototesting showed a normal response. The minimal erythema dose of ultraviolet B (UVB) was not lowered and no delayed peaking of the erythema reaction was observed. His skin fibroblasts exhibited higher sensitivity to UV irradiation, but a normal level of unscheduled DNA and RNA synthesis. Cell fusions with XP group A, C, D, E, F, and G cells after UV irradiation were all complemented. Previous reports together with this case suggest that older XP variant patients have a high frequency of not only skin cancers, but also internal malignancies.     

脊柱钉棒系统治疗骨盆后环损伤

目的探索脊柱钉棒系统应用于骨盆后环损伤治疗的效果。方法对36例骨盆后环损伤，按照Denis分型，Ⅰ型20例，Ⅱ型12例，Ⅲ型4例。按照Tile分型，B3型16例，C1型10例，C2型6例，C3型4例。应用脊柱钉棒系统固定治疗，将万向椎弓根钉从双侧髂后上棘处开槽置入髂骨后部内外板间，钉尾沉于骨质内，连接棒通过双侧骶棘肌隧道放置固定后，在骨盆后环处形成一个强有力的“内支架”有效固定。结果30例获得6～18个月随访，平均11个月，患者均无螺钉松动、断棒、骶髂关节再次脱位及内固定物引起的血管、神经损伤并发症。按刘利民等功能评定标准，优15例，良13例，中2例。结论脊柱钉棒系统治疗骨盆后环损伤，固定有效牢靠，操作简便，无需复杂定位，创伤小，恢复快，无透视条件的基层单位也可行手术，极有推广价值。     

Transpharyngeal Echocardiographic Imaging of the Right and Left Carotid Arteries

We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.     

Cyclic Nucleotides Increase During Neuronally Induced Relaxation of Sphincteric and Nonsphincteric Gastrointestinal Smooth Muscle

Neuronal stimulation of most isolated precontracted gastrointestinal smooth muscle results in relaxation. This study examined the changes in cyclic nucleotide content associated with neuronally induced relaxation in sphincteric and nonsphincteric smooth muscle of the gut. Electrical field stimulation produced a frequency-dependent relaxation of the guinea pig proximal colon (EF₅₀= 1.6 Hz) and taenia coli (EF₅₀= 2.4 HZ), and the canine proximal colon (EF₅₀= 3.1 Hz) and internal anal sphincter (EF₅₀= 3.0 Hz). Changes in cyclic nucleotide content occurred during EFS-induced relaxation. Cyclic AMP levels were significantly increased in the guinea pig poximal colon and taenia coli and in the canine proximal colon. No change in cyclic GMP occurred in these smooth muscles. Conversely, in the canine internal anal sphincter the cyclic GMP content increased significantly with no change in cyclic AMP. These effects in this sphincter are similar to those identified previously in the lower esophageal sphincter of opossum, dog, and man. Tetrodotoxin blocked the EFS-induced relaxation and the associated accumulation of cyclic nucleotides of all tissues. Therefore, EFS-induced relaxation is mediated by the activation of neurons and the release of inhibitory neurotransmitter(s). Also, EFS-induced relaxation is closely associated with increases in smooth muscle cyclic nucleotide content. Most importantly, the change in cyclic nucleotide accumulation that occurs during EFS-induced relaxation is different for sphincteric and nonsphincteric smooth muscle, (i.e., different cyclic nucleotides are generated in sphincteric and nonsphincteric smooth muscle in response to stimulation of nonadrenergic, nonchohnergic, inhibitory enteric neurons).     

Early and late outcomes in patients with severe extracranial internal carotid stenosis undergoing carotid endarterectomy

Ｃａｒｏｔｉｄｅｎｄａｒｔｅｒｅｃｔｏｍｙ (ＣＥＡ )ｈａｓｂｅｅｎｓｈｏｗｎｔｏｂｅｓｕｐｅｒｉｏｒｔｏｍｅｄｉｃａｌｔｒｅａｔｍｅｎｔｉｎｐａｔｉｅｎｔｓｗｉｔｈｓｙｍｐｔｏｍａｔｉｃｏｒａｓｙｍｐｔｏｍａｔｉｃｈｉｇｈ ｇｒａｄｅｃａｒｏｔｉｄｓｔｅｎｏｓｉｓ ＡｌｔｈｏｕｇｈＣＥＡｒｅｍａｉｎｓｔｈｅｍｏｓｔｃｏｍｍｏｎｌｙｐｅｒｆｏｒｍｅｄｏｐｅｒａｔｉｏｎｆｏｒｐｅｒｉｐｈｅｒａｌａｒｔｅｒｉａｌｄｉｓｅａｓｅｓｉｎｔｈｅＷｅｓｔ,ｉｔｉｓｎｏｔａｓｐｏｐｕｌａｒｉｎＣｈｉｎａ Ｔｈｉｓｐ…     

钢板内固定治疗锁骨骨折

我们采用切开复位钢板内固定治疗不稳定型锁骨骨折65例 ,取得满意疗效 ,现报告如下。1　临床资料本组 65例 ,男 41例 ,女 2 4例 ;年龄 1 2～ 54岁 ,平均 35岁。受伤至手术时间 1～ 6天 ,平均 4天。骨折类型包括 :短斜形 1 2例 ,长斜形 34例 ,粉碎性 1 9例。骨折部位 :中段 31例 ,外段 2 2例 ,内段 1 2例。选用钢板 :4孔钢板 34例 ,6孔钢板 2 1例 ,重建钢板 1 0例。2　治疗方法　　仰卧位 ,患侧肩胛部垫一薄垫 ,采用高位臂丛麻醉。以骨折为中心沿锁骨上缘做一约 3～ 5ｃｍ长之横切口 ,显露断端。沿纵轴切开骨膜 ,少许剥离后 ,撬拨并牵引使骨…     

经皮骶髂关节螺钉治疗骶骨纵形骨折

目的应用经皮骶髂关节螺钉固定术治疗骶骨纵形骨折及疗效评价。方法牵引复位后，C形臂X线机透视下经皮骶髂关节螺钉固定骶骨纵形骨折19例，男11例，女8例；年龄18～57岁，平均30．2岁。其中17例行骨盆前环固定，闭合复位耻骨支经皮空心拉力螺钉固定9例，耻骨联合分离经皮拉力螺钉固定2例，耻骨支骨折合并耻骨联合分离经皮拉力螺钉固定1例，耻骨支切开复位钢板螺钉固定5例。结果手术时间30～65min，平均42．5min。术后住院时问3～12d，平均6．5d。19例均获得随访，时间6～34个月，平均18．5个月。无骶髂部疼痛16例，轻度疼痛3例；18例均恢复原工作，1例术后再移位行切开复位内固定术而发生医源性S1神经损伤。结论经皮骶髂关节螺钉固定骶骨纵形骨折是一种安全、有效的治疗方法，手术创伤小，并发症少，手术时问短，康复快。     

心内科护理的安全问题探讨

我院于对2008年1月-2010年5月对心内科2858例患者从患者因素方面进行安全隐患分析，现将相应安全风险防范对策总结报告如下。