肱骨髁上骨折合并血管神经损伤治疗体会（附12例报告）

肱骨髁上骨折合并血管神经损伤治疗体会（附１２例报告）湖北中医学院附属医院（武汉４３００６１）邹季主题词肱骨髁上骨折／并发症，血管损伤／治疗，神经损伤／治疗肱骨踝上骨折合并血管、神经损伤的发生率虽然不高，但其后果严重、致残率高。所以，对血管、神经损伤的...

多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值

目的探讨多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值。方法 9例颅底肿瘤术前均行DynaCTA检查及MRI薄层(2 mm)增强扫描检查,将多组影像数据输入工作站,采用"双容积重建"技术进行脑血管及MRI的影像融合,通过静态及动态融合影像观察肿瘤与脑结构、血管及颅骨的毗邻关系,并对肿瘤的诊断、手术治疗及预防血管并发症进行分析。结果 9例均获得满意的影像融合、具有很好的空间一致性,在一张影像上可以清晰显示病变及其周围脑结构、血管及颅骨解剖关系,提高精准性诊断,并应用于指导治疗策略、设计手术划及预防并发症。9例均恢复满意出院。结论多模态影像融合对提高颅底肿瘤的诊断精准性、提高肿瘤全切除率、降低病死率和残疾率效果肯定,对血管损伤并发症治疗疗效肯定。

Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.

Major comorbid disease processes associated with increased incidence of acute kidney injury

Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.

Emergency intervention therapy for renal vascular injury

Objective： To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury. Methods： A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles （PVA） in 9, and gelfoam particles in 6 cases. Results： Renal angiogram revealed arterlovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months （mean, 48 months）. Six patients died of primary diseases （5 cases of renal failure and multiple organ failure and l case of malignant tumor）. Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range. Conclusion： Transcatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.

Surgical treatment of infected arterial injuries of the major limb

To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department. Methods： After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient＇s condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases. Results ： 1 case （ 4.8 % ） died during the treatment. 5 cases （ 5/21, 23.8 % ） underwent amputations. Blood supply reconstruction was successful in 15 cases （15/21, 71.4%）. 93.3% （14/15） of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case （ 1/15, 6.7 % ） and a sound result was obtained after a second operation. Conclusions： Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.

First rib fractures： not always a hallmark of severe trauma a report of three cases

According to medical literature, fracture of the first rib is quite rare and the bilateral condition is especially rare. This type of fracture is usually associated with severe intrathoracic trauma and other bony or neurovascular injuries, thus can be considered as a harbinger of major trauma. However here we present three cases of low velocity first rib fractures without any major trauma or multisystem injuries. All the three patients were treated conservatively and did well on simple analgesics and rest and had no early or late complications. It can be seen that not all the first rib fractures are associated with major trauma or multisystem injuries. There is a variant of first rib fracture with low velocity injuries which is not associated with any major complications in contrast to majority of first rib fractures associated with high velocity injuries. Causative factor of such injuries may be violent muscular contraction of scalenus anterior or serratus anterior, but not direct trauma.