Relative risks of ventriculostomy infection and morbidity

Summary Ventricular catheter placement is a common procedure for the management of increased intracranial pressure. Hypotheses regarding the etiology of infection of catheters center on two alternative assumptions: 1) contamination leading to infection occurs at the time of catheter insertion, implying that catheter duration has minimal effect on infection risk; and 2) infection of catheters derives from catheter contamination after insertion, suggesting that duration of catheter use may significantly affect infection risk.We have studied the relative complication rate of ventricular catheter insertions using a retrospective approach (n=161 patients and 253 catheter insertion procedures). The overall infection rate was 4.1%, but the daily infection hazard increased exponentially with time, to a maximum daily rate of 10.3% by day 6 of catheter insertion. This increasing risk appears most consistent with the second hypothesis. The risk of non-infectious complications was 5.6%, including hemorrhagic occurrences and misplacement severe enough to require a new catheter insertion. The daily hazard of infection approximately equalled the non-infectious risk of routine catheter replacement by day 5.Additional prospective data on the daily risk of CSF infection and the appropriateness of antibiotic prophylaxis either at the time of ventricular catheter insertion or continued through the catheter's-presence may be required to both definitively identify which hypothesis of infection risk is correct and whether antibiotics can significantly ameliorate this risk.     

Diffuse Axonal Injury (DAI) is not Associated with Elevated Intracranial Pressure (ICP)

Summary Objective. Traditionally, intracranial pressure (ICP) monitoring has been utilized in all patients with severe head injury (Glasgow coma score of 3–8). Ventriculostomy placement, however, does carry a 4 to 10 percent complication rate consisting mostly of hematoma and infection. The authors propose that a subgroup of patients presenting with severe head trauma and diffuse axonal injury without associated mass lesion, do not need ICP monitoring. Additionally, the monitoring data from ICP, MAP, and CPP for a comparison severe head injury group, and subgroups of DAI would be presented. Materials and methods. Thirty-six patients sustaining blunt head trauma and fitting our strict clinical and radiographic diagnosis of DAI were enrolled in our study. Inclusion criteria were severe head injury patients who did not regain consciousness after the initial impact, and whose CT scan demonstrated characteristic punctate hemorrhages of <10 mm diameter at the greywhite junction, basal ganglia, corpus callosum, upper brainstem, or a combination of the above. Patients with significant mass lesions and documented anoxia were excluded. Their intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were compared to a control group of 36 consecutive patients with severe non-penetrating non-operative head injury, using the Analysis for Variance method. Results. Eighteen (50.0%), six (16.7%), and twelve (33.3%) patients had types I, II, and III DAI, respectively. The admission Glasgow Coma Score (GCS) was higher for types I and II than for type III DAI. ICP was monitored from 23 to 165 hours, with a mean ICP for 36 patients of 11.70 mmHg (SEM=75) and a range from 4.3 to 17.3 mmHg. Of all ICP recordings, of which 89.7% (2421/2698) were ≤20 mmHg. Average mean arterial pressure (MAP) was 96.08 mmHg (SEM=1.69), and 94.6% (2038/2154) of all MAP readings were greater than 80 mmHg. Average cerebral perfusion pressure (CPP) was 85.16 mmHg (SEM=1.68), and 90.1% (1941/2154) of all CPP readings were greater than 70 mmHg. This is compared to the control group mean ICP, MAP, and CPP of 16.84 mmHg (p=0.000021), 92.80 mmHg (p=0.18), and 76.49 mmHg (p=0.0012). No treatment for sustained elevated ICP>20 mmHg was needed for DAI patients except in two; one with extensive intraventricular and subarachnoid hemorrhage who developed communicating hydrocephalus, and another with ventriculitis requiring intrathecal and intravenous antibiotic treatments. Two complications, one from a catheter tract hematoma, and another with Staph epidermidis ventriculitis, were encountered. All patients, except type III DAI, generally demonstrated marked clinical improvement with time. The outcome, as measured by Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) was similarly better with types I and II than type III DAI. Conclusion. The authors conclude that ICP elevation in DAI patients without associated mass lesions is not as prevalent as other severe head injured patients, therefore ICP monitoring may not be as critical. The presence of an ICP monitoring device may contribute to increased morbidity. Of key importance, however, is an accurate clinical history and interpretation of the CT scan.     

药物中微量元素的测定

目的：检测营养制剂善存片中各种微量元素的含量,并就样品前处理及测定进行方法学探讨。方法：采用３ 种不同方法处理善存片样品,然后用电感耦合等离子体发射光谱仪优化测试条件后,测定铁、镁、锌、锰、铬、钼、钙等１１ 种微量元素的含量。结果：各种微量元素的含量与药盒所标数据基本一致。结论：确定了先用硝酸消化,再用石墨炉灰化为最佳样品处理方法。测定时选４ 点作标准工作曲线,既不会使操作太复杂,又能保证测定的精密度     

中华大蟾蜍皮无机元素初步分析

目的：对中华大蟾蜍皮中的无机元素进行分析研究并对其中6种元素进行含量测量。方法：采用原子发射光谱法进行定性，并用等离子体发射光谱法对其中6种金属元素进行定量。结果：钙是中华大蟾蜍皮中含量最高的无机元素。     

抗流感滴鼻剂不同除杂工艺微量元素的含量分析

目的：探讨不同除杂方法对微量元素含量的影响。方法：采用原子荧光法和电感耦合等离子体发射光谱法测定不同除杂方法所得澄清液中As，Hg，Pb，Fe，Mn，Zn，Cu的含量。结果：与原液比较，絮凝澄清液中As，Hg，Pb的去除率分别为57．1％，50．0％，39．6％，并分别为醇沉澄清液去除率的2．00，1．50，1．12倍；絮凝澄清液中的Fe，Mn，Zn，Cu保留率分别为90．6％，95．6％，91．7％，93．9％，并分别为醇沉澄清液保留率的1．09，1．29，1．15，1．28倍。结论：从有害元素的去除率及有益元素的保留率来看，絮沉工艺优于醇沉工艺。     

颅脑损伤颅内多发血肿的治疗

目的总结颅脑损伤颅内多发血肿的治疗经验,提高此类患者的疗效.方法回顾我科近10年425例颅脑伤后颅内双侧多发血肿的临床资料.按照主要血肿的分布,将病员分为硬膜外血肿组(EDH)、硬膜下血肿脑挫裂伤组(SDH BCL)和脑挫裂伤脑内血肿组(BCL ICH).对于不同类型血肿在合适的时机采取合适的手术方法,及时实行ICP监测,不行双侧大块脑组织切除,术中或术后立即复查头颅CT.结果 121例未经手术治疗,其中死亡4例(3.3%);手术304例,死亡17例(5.6%).EDH组127例,全经手术治疗,无死亡;SDH BCL组143例,手术116例,11例死亡(7.7%);ICH组155例,手术61例,10例死亡(6.4%).结论颅脑损伤颅内双侧多发血肿应采取综合治疗,选择合适的手术时机和方法治疗可提高治愈率,改善预后.     

ICP-MS测定香芍软胶囊中砷 汞 铅 镉 铜的含量

目的：采用电感耦合等离子体质谱（ICP-MS）法测定香芍软胶囊（XSSC）囊心物中砷、汞、铅、镉、铜的含量。方法：样品经微波消解，以Re为内标，以茶叶、圆白菜标准物质为质控，采用ICP-MS测定上述5种元素。结果：对于所测5种元素，标准曲线的相关系数r〉0．9996，回收率为95．8-101．6％，RSD〈5．8％。结论：本测定方法快捷、准确、灵敏度高，适用于XSSC囊心物中上述5种元素的同时测定。     

降低围生儿死亡的措施(附89例分析)

目的 :探讨围生儿死亡的主要原因 ,降低围生儿病死率。方法 :统计自 1994～1998在我院分娩的围生儿数 ,根据临床实验室检查、B超及其他检查结果将围生儿死亡病例进行归类。结果 :围生儿总数 42 86例 ,围生儿死亡 89例 ,围生儿死亡率 2 0 17‰ ,其中新生儿死亡率 9 91‰ ,围生儿死亡原因依次为妊娠期肝内胆汁瘀积症 (ICP)、早产脐带因素、畸形、新生儿窒息及其他。结论 :围生儿死亡与围生期保健 ,产程监测处理 ,接受技巧有密切关系 ,提高对ICP的认识 ,提高产前诊断技术 ,预防早产 ,产程各环节的合理处理和提高对新生儿窒息复苏的效果 ,是降低围生儿死亡的重要措施。     

雌激素代谢酶CYP17、COMT基因多态性与妊娠期肝内胆汁淤积症易感性的关系

目的探讨参与雌激素合成和代谢的CYP17和COMT基因多态性与成都地区妊娠期肝内胆汁淤积症（ICP）发病的关系。方法应用聚合酶链反应．限制性片段长度多态性（PCR—RFLP）技术,对100例ICP患者和100名正常对照孕妇CYPl7基因启动予区（T．C）多态和COMT基因外显子4密码子158（G—A）多态性进行分析。结果①两组均存在CYP17基因T．c多态,但两组基因型TF、TC、CC频率和等位基因T、c频率的比较差异均无统计学意义（P〉0．05）;②两组均存在COMT基因G．A多态,但两组基因型GG、GA、AA频率和等位基因G、A频率的比较差异均无统计学意义（P〉0．05）。结论CYP17和COMT基因单核苷酸多态性与成都地区ICP发病风险无相关性。     

中医药辨治妊娠期肝内胆汁淤积症概况

通过妊娠期肝内胆汁淤积症病因病机的讨论及临床辨治的分析,认为其发病主要与湿邪、七情内伤、饮食、劳逸、体质因素等因素有关,气血失调,湿邪蕴脾为其主要病机.在临床上应以"未病先防,既病防变"为原则,及早防治,辨证用药,力图治病与安胎并举,改善有利于围产儿预后.