目的 探讨原发性肝癌自发性破裂腹腔内出血的临床特点和手术治疗方法。方法 回顾性分析我院1998～2007年收治的53例经手术证实的原发性肝癌自发性破裂腹腔内出血患者的临床资料，结合文献复习进行讨论。结果 53例患者均以突发性腹痛为首发症状，有前期症状者33例，无症状者20例； 有外伤史者(左上腹或季肋区)6例； 有腹膜炎体征46例，腹腔穿刺抽出不凝血41例，合并休克29例。术前误诊16例。行急诊手术48例，施行肝切除33例。术后肝功能不全34例，其中3例死于肝功能衰竭。术后生存3 d～78个月，平均34.6个月。结论 原发性肝癌自发性破裂腹腔内出血多以腹痛为首发，常以血性腹膜炎表现为特点，术前误诊率较高； 手术方式根据病变位置、大小，肿瘤是否局限、转移和肝硬变程度决定。术后近期死亡原因主要是肝功能衰竭，远期死亡原因主要是复发转移。
目的:探讨使用院前指数(Prehospital Index, PHI)及格拉斯哥昏迷评分(Glasgow Coma Score, GCS)两种创伤评分法对院前急救中急性酒精中毒合并外伤性颅内出血患者的评估价值。方法: 纳入68例院前急救中酒精中毒合并头外伤患者,院前均进行PHI及GCS两种创伤评分,随访至出院,以头部CT扫描及随访结果作为标准以判断患者是否伴有颅内出血。计算两种创伤评分的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及Youden指数,并作出受试者工作特征曲线(ROC曲线),以正态离差值Z检验两种评分法ROC曲线下面积的差异。 结果: 院前指数以6分作为诊断界值,敏感度为94.7%,特异度为71.4%;格拉斯哥昏迷评分以9分作为诊断界值,敏感度为98.8%,特异度为30.6%,PHI及GCS的ROC曲线下面积分别是0.881和0.678,其差异有统计学意义。结论: 在对急性酒精中毒合并头外伤患者是否伴有颅内出血的院前评估中,院前指数较格拉斯哥昏迷评分更有价值。
目的:通过CT影像资料评价新生儿缺氧缺血性脑病与颅内出血量的关系及其预后。方法:收集1998~2006年临床诊断为缺氧缺血性脑病70例新生儿患者的CT资料,观察CT图像显示的脑出血量,分析不同程度的缺氧缺血性脑病和出血部位与颅内出血量和预后的关系。结果:新生儿缺氧后轻、中度出血在1~2周内均可完全吸收,发生在基底节或大脑白质区域的重度出血预后较差。结论:颅内出血量与窒息缺氧程度呈正相关;发生在不同部位的出血,其预后不同。
ObjectiveTo discuss the effect of glucosamine-hydrochloride (Glu/Ch) in protecting and repairing the cartilage in blood-induced joint damage (BJD) in vivo. MethodsThirty-two adult New Zealand rabbits were randomly divided into 4 groups (n=8):high-dose Glu/Ch treated group (group A), low-dose Glu/Ch treated group (group B), positive control group (group C), and negative control group (group D). A joint bleeding model was established by blood injection into articular cavity in groups A, B, and C. Glu/Ch was given by gavage in groups A (250 mg/kg) and B (21.5 mg/kg) once a day for 8 weeks, and the same dosage of saline was given in groups C and D. The serum cartilage oligomeric matrix protein (COMP), serum chondroitin sulfate 846(CS846), and urinary C-terminal telopepide of type II collagen (CTX-II) were measured at 3 days, 7 days, 2 weeks, and 8 weeks after modeling. The expressions of cytokines such as interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) in synovial fluid were analyzed by ELISA at 8 weeks after modeling. The expression of matrix metalloproteinase 13(MMP-13) was detected by immunohistochemistry. Alcian blue staining and Safranin-O staining were performed to calculate the percentage of the positive staining areas. The proteoglycan content was detected by semi-quantitative analysis in the articular cartilage. ResultsThe COMP concentration was significantly higher in groups A, B, and C than group D, and in groups B and C than group A at 3 days after modeling (P<0.05); no significant difference was found among groups A, B, and D at 7 days (P>0.05), and it was significantly lower in groups A, B, and D than group C (P<0.05); there was no significant difference among 4 groups after 2 and 8 weeks (P>0.05). Difference in CS846 concentration had no significance among 4 groups at each time point (P>0.05). The CTX-II concentration of groups A, B, and C was significantly higher than that of group D at each time point (P<0.05); it was significantly lower in group A than groups B and C at 7 days, 2 weeks, and 8 weeks (P<0.05). The TNF-α concentration of groups A and B was significantly higher than group D, and was significantly lower than group C at 8 weeks (P<0.05), but no significant difference was observed between groups A and B (P>0.05). The IL-1β concentration was significantly higher in group C than the other groups (P<0.05), and in group B than groups A and D (P<0.05), but there was no significant difference between groups A and D (P>0.05). The MMP-13 expression was significantly higher in group C than groups A, B, and D (P<0.05), in groups A and B than group D (P<0.05). A significant decrease in the area stained with Alcian blue and Safranin-O was observed in group C. There were significant differences in the percentage of the positive stained areas of Alcian blue and Safranin-O among 4 groups (P<0.05). The relative quantities of proteoglycan from small to large in order was groups C, B, A, and D, respectively, showing significant differences (P<0.05). ConclusionThe metabolism disorder of cartilage matrix and synovium inflammatory reaction can be observed in rat joint bleeding model. Glu/Ch has certain protective effect on the cartilage after BJD by down-regulating IL-1β, TNF-α, and MMP-13, as well as increasing proteoglycan content in the cartilage.
Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
ObjectiveTo explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. MethodsWe retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. ResultsA total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. ConclusionPercutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.