骶尾骨正常变异1例报告

患者女32岁。发现臀部欠对称，左侧较右侧略突出来诊。 X线表现 骶椎自骶髂关节下缘水平以下左右分成两部分，右侧呈“《”状，向右外下方走行，其远端为一节尾骨；左侧呈矛头状向左前外下方走行，其远端几乎达左侧坐骨结节；骶椎示隐裂。诊断：骶尾骨正常变异。     

博罗县孕产妇死亡原因分析

目的了解博罗县孕产妇死亡原因及影响因素。方法根据《博罗县孕产妇、围产儿死亡评审制度和要求》，对该县近5年来11例孕产妇死亡病例按世界卫生组织的“十二表格”进行评审分析。结果1．例死亡孕产妇均为低文化、低收入人群，在医疗保健机构分娩4例，在家分娩7例，在医疗保健机构死亡10例，在家死亡1例；可以避免死亡1例，占9.09％；创造条件可以避免死亡8例，占72.73％；不可避免死亡2例，占18.18％。结论今后妇幼保健工作重点应放在低收入、低文化的广大农村及流动人口中；健全三级妇幼保健网，严格妇产科医务人员准入制；提高各级医务人员助产技术和急救水平；加大执法力度，严厉打击非法接生；加强各部门之间协调．支持、保护母婴安全。     

黄连治疗癫痫的协同作用及对P-糖蛋白介导的抗癫痫药脑转运的调节作用

目的 考察黄连协同抗癫痫药治疗癫痫的疗效及黄连对P-糖蛋白介导的抗癫痫药透过血脑屏障的影响,评价黄连对癫痫的防治作用。方法 选用P-糖蛋白抑制剂维拉帕米和常用抗癫痫药卡马西平,使用戊四唑和士的宁制备小鼠癫痫模型,观察并对比卡马西平单用与联用低、中、高剂量黄连的小鼠潜伏期、惊厥率和死亡率的差异。小鼠分组并灌胃卡马西平、卡马西平加黄连及卡马西平加维拉帕米后,测定脑组织卡马西平浓度并比较。结果 黄连可显著增强卡马西平对抗戊四唑、士的宁所引起的癫痫作用,延长潜伏期和降低惊厥率(P<0.05),明显提高卡马西平的脑浓度(P<0.05)。结论 黄连对癫痫的治疗有良好的增效作用。     

32例膝关节侧副韧带损伤X线诊断

1．临床资料 本组32例，其中男性22例，女性10例，年龄23—55岁，平均年龄47岁，26例为内侧副韧带损伤。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

高血压脑出血的手术治疗

目的探讨高血压脑出血手术方式的选择。方法对我科2004～2009年住院患者289例高血压脑出血病例进行分析。手术方式：开颅清除血肿加去骨瓣减压143例,单纯开颅清除血肿56例,小骨窗微创开颅术51例,额角钻孔行脑室外引流术39例。结果恢复正常生活35例,可独立生活98例,需人帮助扶拐行走89例,卧床43例,死亡24例。结论根据高血压脑出血患者入院时情况进行综合分析,采用适宜患者的手术方法治疗,可有效降低死亡率及致残率,缩短住院日及提高临床治疗效果。     

MR增强参数预测乳腺癌新辅助化疗疗效的前瞻性研究

目的:探讨乳腺癌新辅助化疗(NAC)后MR多期动态增强参数用于预测NAC疗效的价值。方法:应用3.0T MR对90例经NAC治疗后的浸润性乳腺癌患者行乳腺扫描。采用病灶兴趣区(ROI)高值法和手绘ROI法绘制病灶时间-信号强度曲线(TIC),记录TIC各相关参数值。采用t检验比较组织学显著反应(MHR)组和组织学非显著反应(NMHR)组NAC后乳腺癌病灶各参数的差异。以术后病理MHR者为阳性,绘制受试者工作特征(ROC)曲线,探讨MR多期动态增强参数预测MHR的最佳临界值。结果:乳腺癌NAC后不同MP术后评级组,两种ROI测量方法测得的病灶第二期强化程度(SI2%)、峰值强化程度(SIpeak%)、最大线性斜率(Smax)参数均有显著差异,MHR组参数值低于NMHR组(P<0.001)。由ROC曲线下面积可得ROI高值法对乳腺癌NAC后手术病理分级的预测能力略优于ROI手绘法。ROI高值法预测MHR的最佳临界值分别为SI2%=83%、SIpeak%=229.45%、Smax=404.995。结论:NAC后乳腺癌病灶采用ROI高值法和手绘法测得的MR多期动态增强参数,均可预测新辅助化疗疗效,ROI高值法优于ROI手绘法。     

鲍曼不动杆菌耐药性分析及治疗建议

目的 分析我院鲍曼不动杆菌的耐药情况,指导临床合理使用抗菌药物.方法 回顾性对我院2009年1月～2009年12月243株鲍曼不动杆菌药敏结果采用WHONET5.4进行统计、分析.结果 鲍曼不动杆菌检出率最高的标本类型是痰,临床科室是ICU.在常用的抗菌药物中,头孢哌酮舒巴坦钠耐药率最低为7%,米诺环素次之为20%.结论 鲍曼不动杆菌耐药现象严重,临床应合理选用抗菌药物,减少耐药菌株的产生.     

重型颅脑损伤患者术中急性脑膨出的临床分析

目的 探讨颅脑损伤开颅术中急性脑膨出的原因及防治措施.方法 回顾性分析31例颅脑损伤患者手术中出现脑膨出的原因及采取的相应防治措施.结果 迟发性血肿、急性弥漫性脑肿胀、严重脑挫裂伤是术中急性脑膨出的主要原因.早期行气管插管保持呼吸道通畅.正确的手术处理,缓慢的降低颅内压、清除颅内血肿、适当控制血压能有效防止术中脑膨出.结论 针对不同病因采取相应措施能有效防治开颅术中急性脑膨出,提高治疗效果,降低重残率和死亡率.     

由1例遗传性球形红细胞增多症确诊引发的思索

<正>一例16岁的男性患者,因全身乏力伴尿色深3年,近3d前无明显诱因出现全身乏力,精神不能集中,偶有反酸,呃气,无呕吐,胃脘部稍有不适,为求诊治来到我院。既往脾大及胆结石。门诊查血常规示:WBC 6.0×10~9/L,RBC 2.74×10~(12)/L,HB 90g/L, PLT 204×10~9/L,总胆红素126.7μmol/L,直接胆红素11.8μ