【摘要】 目的 评价低场MRI对膝关节半月板撕裂的诊断准确性。 方法 2009年9月-2010年4月经关节镜检或手术确诊的膝关节损伤患者69例，其中35例41个半月板撕裂，回顾性分析、整理其临床、关节镜及MRI表现，以传统Reicher诊断的改良分级标准确定半月板撕裂的级别、形态并记录，同时对关节内其它伴随征象作统计。 结果 35例41个撕裂半月板中，17个为盘状半月板，MRI显示Ⅲa级撕裂信号24个，Ⅲb级撕裂信号5个，Ⅲc级撕裂信号4个，Ⅳ级撕裂信号1个，桶柄状撕裂信号7个。本组低场MRI诊断半月板撕裂的敏感度、特异度、准确度分别为93.18%、92.11%、92.68%。 结论 低场MRI诊断膝关节半月板撕裂与关节镜结果差异不大，是一种诊断半月板撕裂的可靠、无创性检查方法。【Abstract】 Objective To evaluate the accuracy of low-field MRI in the diagnosis of meniscus tears. Methods We collected the clinical data of 69 patients with knee joint injuries confirmed by surgical operation or arthroscopy from Septembe 2009 to April 2010. Among them, 35 patients had 41 cases of meniscus tears. We retrospectively analyzed their clinical symptoms, and their manifestations on low-field MRI and arthroscopy. According to the modified diagnostic criteria based on Reicher’s diagnosis, the grade and the shape of meniscus tears were determined and recorded, and other accompanying signs inside the joint were also analyzed statistically. Results Among the 41 cases of meniscus tears of 35 patients, 17 were discoid meniscus. MRI showed that there were 24 signals of Ⅲa tears, 5 of Ⅲb tears, 4 of Ⅲc tears, 1 of Ⅳ tears and 7 of bucket-handle tears. The sensitivity, specificity and accuracy of low-field MRI in the diagnosis of meniscus tears were 93.18%, 92.11%, and 92.68%, respectively. Conclusions There is no significant difference between the results of arthroscopy and low-field MRI in diagnosing meniscus tears. Consequently, MRI is a reliable and non-invasive method in the diagnosis of meniscus tears.
目的 总结风险评估和预警措施在中毒患者洗胃救治中的作用，以减少洗胃并发症发生，保证救治安全。方法 抽取2009年1月－2010年12月在急诊科实施强制洗胃患者90例，2009年中毒洗胃患者45例为对照组，2010年中毒洗胃患者45例为观察组。对照组实施常规护理，观察组在常规护理的基础上实施风险评估，比较两组患者洗胃并发症发生情况。结果 观察组洗胃并发症较对照组明显减少，两组比较差异有统计学意义（χ2=10.601，P＜0.01）。结论 风险评估可提高护理人员对洗胃风险的预见性，有效减少并发症的发生。
Objective To establish and modify a rat model of arterialized small-for-size orthotopic liver transplantation and investigate the histopathologic changes of the grafts after transplantation. Methods Modified two-cuff technique was applied to establish a rat model of 40% small-for-size orthotopic liver transplantation with a modified microvascular “sleeve” anastomosis between the celiac trunk of donors and the stump of right kidney artery of recipients. Seven days survival rate was observed, main indices of liver function, histopathologic changes of the grafts were detected on the 1st, 2nd, 4th and 7th day after transplantation, respectively. Results The successful rate of operation was 93.3%. Seven days survival rate was 60.0%. The mean time of nonhepatic time was (12.0±2.5) min. Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate on the first day and peaked on the second day after operation. Histological findings indicated that hepatic sinusoidal and central vein dilation, monocytes infiltration in partial area were found on the 1st day after operation, more diploid and polyploid hepatocytes could be observed on the 4th day after operation. Conclusion The model is easily available and highly reproducible, and the stability of the model is improved by modifying the technique. The histological changes of the grafts are mainly caused by ischemia-reperfusion injury.
Objective To investigate the significance of hepatic arterial reconstruction on the model of 40% small-for-size orthotopic liver transplantation in rats. Methods Modified two-cuff technique was applied to establish a rat model of 40% orthotopic liver transplantation. A total of 240 Sprague Dawley (SD) rats were randomly divided into 2 groups: reconstructive artery group and non-reconstructive artery group. One week survival rate was observed. Main indexes of liver function, histology and the expression of proliferative cell nuclear antigen (PCNA) of liver graft （by immunohistochemical method） were detected on day 1, 2, 4 and 7 after transplantation, respectively. Results One week survival rates of reconstructive artery group and non-reconstructive artery group were 65.0% (13/20) and 50.0% (10/20) respectively (Pgt;0.05). Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate from day 1 and peaked on day 2 after surgery in two groups. ALT in non-reconstructive artery group on day 2 and 4 were significantly higher than that in reconstructive artery group (P＜0.05). TB in non-reconstructive artery group on day 2 and 7 were significantly higher than that in reconstructive artery group (P＜0.05). Histological findings indicated that more diploid and polyploid hepatocytes and more gently dilation of central veins and hepatic sinusoids could be seen postoperatively in reconstructive artery group. The expression of PCNA of liver graft peaked on day 2 after surgery. The expression of PCNA of reconstructive artery group was higher on day 1 (P＜0.01) and lower on day 7 than that of non-reconstructive artery group after operation (P＜0.05). Conclusions Arterial reconstruction can improve liver function of liver grafts after small-for-size orthotopic liver transplantation, alleviate the histological changes and promote the regeneration of liver grafts quickly.
Objective To compare the clinical effects of one-stage anastomosis on patients with middle and lower rectum carcinoma and intestinal obstruction and the ones without intestinal obstruction, and to evaluate the safety and feasibility of patients with middle and lower rectum carcinoma and intestinal obstruction undergoing one-stage anastomosis. Methods The data of patients diagnosed definitely by pathology as middle and lower rectum carcinoma underwent one-stage anastomosis in West China Hospital of Sichuan University between January 2007 and December 2008 was retrospectively analyzed. The clinical effects were compared between intestinal obstruction group and non-intestinal obstruction group. Results During this period, 525 patients were included into intestinal obstruction group (n=87) and non-intestinal obstruction group (n=438). Among the patients included, there were 307 males and 218 females. Ages were from 25 to 85 years, and the average age was 60 years old. According to tumor histology, there were 487 cases of adenocarcinoma, 29 of mucinous adenocarcinoma and 9 of other types. According to the degree of tumor differentiation, there were 140 cases of low differentiation, 372 of middle differentiation and 13 of high differentiation. According to TNM stage, there were 4 cases of stage 0, 93 of stageⅠ, 189 of stage Ⅱ, 202 of stage Ⅲ and 37 of stage Ⅳ. Constituent ratio of gender, distributions of distances from tumor to anus, TNM stages and differentiation degrees of tumor were significantly different between intestinal obstruction group and non-intestinal obstruction group (Plt;0.05); and there was no statistical difference in the age, pathological types， significant internal medical complications and operative types between the two groups (Pgt;0.05). There was no statistical diffe rence in operative duration and intraoperative blood loss between the two groups (Pgt;0.05). There was no statistical difference in postoperative time of first defecation, first out-of-bed activity and first oral feeding, and postoperative hospital stay between the two groups (Pgt;0.05); while time of first aerofluxus was earlier in intestinal obstruction group than that in non-intestinal obstruction group (Plt;0.05). There was no statistical significance in the disease incidence of postoperative complications between the two groups (Pgt;0.05). Conclusions Comparing with patients with non-intestinal obstruction, there is no significant evidence shows that one-stage anastomosis will affect the rehabilitation and increase the risk of complications in patients with middle and lower rectum carcinoma and intestinal obstruction. It is considered that it would be safe and feasible for patients with middle and lower rectum carcinoma and intestinal obstruction to have one-stage anastomosis; however, it is necessary for us to have more researches to evaluate the long-term clinical effect.