Objective To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with l imited open repair of medial collateral ligament (MCL) in recovering the stabil ity and the function of the knee. Methods Between April 2003 and October 2010, 14 patients (14 knees) with multi ple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21- 71 years). Injury was caused by traffic accident in 11 cases and fall ing in 3 cases. The average time from injury to admissionwas 2 days (range, 1-4 days). Lysholm score was 17.00 ± 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 ± 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. Results All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120° and extension was 0° at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 ± 6.26 and 88.93 ± 4.82, respectively, showing significant differences when compared with preoperative scores (P lt; 0.01). Conclusion For multi ple injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.
目的:总结汶川大地震期间合并有多发伤的脊柱骨折的临床特点和治疗经验。方法:回顾分析汶川大地震期间四川大学华西医院收治的281例脊柱骨折,其中223例合并有多发伤,分析其临床特点和治疗方式。结果:223例合并多发伤的脊柱骨折中单纯椎体骨折138例,单纯附件损伤37例,椎体+附件骨折48例;平均年龄43.45±14.05岁;椎体分布以下胸段和腰段为主,胸腰段占60%左右;致伤原因中砸伤占82.1%;脊柱手术治疗35例,占需手术治疗的27.8%;合并伤共267例次;严重并发症127例次;合并脊髓或马尾神经损伤101例,占45.3%,有15例在搬运中发生脊髓损伤。结论:汶川大地震发生在山区,地震烈度高,伤员多为复合伤,存在严重的并发症,受累椎体多,治疗的重点首先放在处理开放伤、感染、并发症上,影响了脊柱骨折的治疗;早期救援时正确施救才能有效防范继发性脊髓损伤。
多发性硬化临床表现多样,其中大脑半球型多表现为精神症状、癫痫、偏瘫或感觉异常等,而以截瘫及排尿障碍为表现者少见。本文对表现为“脑性截瘫”的3 例MS患者的临床和MRI特点进行回顾分析,以此提高对于MS的认识水平。
ObjectiveTo evaluate the magnetic resonance imaging (MRI) manifestations, pathological and clinical characteristics, and treatment outcomes of multiple sclerosis (MS) patients with new lesion in medulla oblongata (MO).MethodsPubMed, EBSCO, and Springer databases between January 1st, 2000 and May 1st, 2018 were searched with the combined keywords of " multiple sclerosis” and " medulla oblongata”. Furthermore, the MS patients’ MRI manifestations, pathological and clinical characteristics, and treatment outcomes were summarized.ResultsA total of 18 papers were involved, in which 26 patients were included. The lesions in MO were mainly showed by wedge-shape (9/20), and round or oval-shape (9/20) in axial head MRI. Inflammatory cells infiltration and acute demyelination in the new lesions of MO had been displayed by autopsy reports of two MS patients. The new lesions in MO mainly referred to various types of nystagmus (9/26), left ventricular apical ballooning syndrome (LVABS) (8/26), neurogenic pulmonary edema (NPE) (6/26), and acute heart failure (6/26). Nucleus tracts solitaries (NTS), along with dorsal motor nucleus of the vagus nerve and medial reticular formation (MRF), was related to LVABS and NPE. Intercalatus nucleus, Roller nucleus and/or autonomic nerve structure were related to various types of nystagmus.ConclusionsIn axial head MRI, the new MS lesions in MO were mainly wedge-shape and round or oval-shape. Beyond that, the new MS lesions in MO could involve NTS, dorsal motor nucleus of the vagus nerve, MRF, intercalatus nucleus, Roller nucleus and/or autonomic nerve structure, resulting in special clinical features, such as, nystagmus, LVABS, NPE, and acute heart failure. Corticosteroid is still the main treatment to relieve the clinical manifestations caused by new MS lesions in MO.
The diagnostic frequency of multiple pulmonary tumor nodules has increased significantly in clinical practice. Among patients with multiple pulmonary nodules, distinguishing between separate primary lung carcinomas and intrapulmonary metastases is critical for accurate tumor staging, therapeutic decision-making, and prognostic evaluation. The consensus document "Differentiating separate primary lung adenocarcinomas from intrapulmonary metastases with emphasis on pathological and molecular considerations: Recommendations from the International Association for the Study of Lung Cancer Pathology Committee" highlights the pivotal role of integrated pathological and molecular analyses in diagnosing and differentiating primary lung adenocarcinomas from intrapulmonary metastatic lesions. It further proposes a combined four-step histologic and molecular classification algorithm for addressing multiple pulmonary tumor nodules of adenocarcinoma histology, providing clinicians with enhanced diagnostic tools to refine staging accuracy, guide therapeutic strategies, and improve prognostic predictions for lung adenocarcinoma. Building on current advancements in global research, this article offers a comprehensive interpretation of the consensus recommendations.
目的 测定多发性骨髓瘤（MM）患者血清胱抑素C （Cys-C） 的水平，探讨Cys-C与国际分期体系（ISS）、血β2-微球蛋白、溶骨性损害等指标的关系。 方法 收集2008年1月－2010年9月32例初治和8例复发的MM患者作为研究对象，同时收集40例健康体检者的检查资料作为对照组，测定血清Cys-C、血肌酐（Scr）、血β2-微球蛋白。采用核素全身骨显像（ECT）观察患者的溶骨性病变部位数。 结果 患者血清Cys-C水平（1.40 mg/L）明显高于健康对照组（0.90 mg/L）（P＜0.01）；在MM患者中Cys-C比Scr更敏感，能反映肾小球滤过率；血清Cys-C水平与ISS分期晚，血β2-微球蛋白升高以及溶骨性病变进展密切相关。 结论 MM患者的Cys-C水平高于健康者。Cys-C是骨髓瘤肾损害的早期敏感标志物，与肿瘤负荷及溶骨性损害密切相关，可作为评价肿瘤负荷的潜在指标。Objective To evaluate the serum levels of cystatin-C in patients with multiple myeloma (MM), and to explore its possible correlations with clinical data, including ISS stage, serum β2-microglobulin, and advanced lytic lesions. Methods From January 2008 to September 2010, serum cystatin-C, creatinine (Scr), and β2-microglobulin in 32 patients with MM, 8 patients with relapsed disease, and in 40 healthy controls were detected by automatic biochemistry analyzer detection. According to skeleton ECT, grading of osteolytic lesion was observed. Results The levels of serum cystatin-C of patients with MM were significantly higher than those of the controls. Serum cystatin-C could reflect the glomerular filtration rate , and was more sensitive than Scr in patients with renal lesion. Serum cystatin-C had ber correlations with advanced ISS stages, high levels of serum β2-microglobulin, and extensive bone diseases. Conclusion Serum cystatin-C is a sensitive marker of renal lesion in patients with MM, it could be a potential indicator to assess the tumor burden.
目的 观察乌司他丁对多发伤患者的治疗作用和对肝、肾功能的保护作用。方法 46例多发伤患者随机分为治疗组（23例）和对照组（23例）。治疗组从入院第1天开始，每天静脉点滴乌司他丁10万单位+生理盐水100 ml，每8 h 1次，连续用药6 d，观察患者的临床指标判断疗效，并在入院时以及术后第1、3、5、7天检测谷丙转氨酶（ALT）、谷草转氨酶（AST）、血尿素氮（BUN）、血肌酐（Scr）、血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）以及白细胞介素-8（IL-8）含量的变化。结果 多发伤患者治疗组平均住院时间及平均住ICU时间均低于对照组，差异有显著性意义（P＜0.05）； 治疗组术后血浆ALT、AST、BUN及Scr浓度均明显低于对照组（P＜0.05）； 治疗组术后血浆TNF-α水平逐渐降低，对照组维持在较高水平； IL-2、IL-6及IL-8水平低于对照组（P＜0.05）。结论 乌司他丁对多发伤有治疗作用，并能减轻机体的全身炎症反应程度，有保护和改善肝、肾功能的作用。