Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.
ObjectiveTo explore the epidemiological characteristics, clinical manifestations, laboratory examination and imaging findings of patients with coronavirus disease 2019 (COVID-19) outside Hubei Province in 2019.MethodsFrom January 21, 2020 to February 18, 2020, 17 patients with COVID-19 diagnosed by SARS-CoV-2 nucleic acid test in Xianyang Central Hospital of Shaanxi Province and 23 patients in Liaocheng Infectious Disease Hospital of Shandong Province were collected. The information of epidemiology, age, time of onset, first symptom, white blood cell, lymphocyte count, procalcitonin (PCT), serum amyloid protein A (SAA), C-reactive protein (CRP) and chest CT were collected and analyzed.Results40.0% of the 40 patients had a clear history of contact with Wuhan or other areas of Hubei, 60.0% had no clear exposure history, 60.0% were aggregative diseases, 40.0% were imported patients; the average visit time was (4.9±3.5) d, 35% of the patients had underlying diseases; 75.0% of the patients had fever, 7.5% of the initial symptoms were cough, 5.0% pharyngitis, 2.5% headache, and 10.0% were asymptomatic. In the laboratory examination, 77.5% of the patients' white blood cells were normal, 45.0% of the patients' lymphocyte count could be decreased, 72.5% and 55.0% of the patients' SAA and CRP increased respectively, 92.5% of the patients' PCT was normal, 92.5% of the patients were positive for the first nucleic acid test, and 72.5% of the patients' chest CT showed multiple ground glass lesions in one or both lungs, and the positive coincidence rate between the initial nucleic acid test and the chest CT test was 92.5%. 90% of the patients in the group were common type, and all patients were treated with aerosol inhalation of α-interferon combined with lopinavir/ritonavir tablets, 62.5% were treated with antibiotics and 15.0% were treated with glucocorticoid. All patients were improved and 14 patients were cured and discharged from hospital.ConclusionsSARS-COV-2 is highly contagious, family aggregation infection and asymptomatic infection may be the main mode of transmission outside Hubei Province, mild and common types are common, there are no specific changes in laboratory examination, and the condition is stable after treatment.
摘要:目的:总结胸心血管外科慢性伤口换药的经验。方法：2008年11月2009年4月我科共发生12例手术切口裂开病例，使用贝复济喷洒创面，藻酸钙敷料填塞创面，外用二层敷料固定，根据渗液情况决定更换敷料的频率，高渗出时每天更换，中等渗出时每2天更换，少量渗出时每3天更换。结果：本组12例患者，11例患者伤口均达到二期愈合，平均愈合时间为（12±2）天，另外1例转烧伤科行植皮术，后愈合。结论：通过联合使用贝复济和藻酸钙敷料，使本组病例的渗出减少，创面肉芽生长迅速，伤口疼痛减轻或消失，伤口周围皮肤免受浸渍，伤口快速愈合。Abstract: Objective: To introduce the methods of using streptogenin spray and the alginate dressing on Cardiac wound disruption. Methods: Our department had 12 cases of wound disruption from the November 2008 to the April 2009, We sprinkled the streptogenin spray to wound, then filled wound with the alginate dressing, finally fix wound with gauze and adhesive tape.According to the volume of the exudation, we decided how often to change the dressings. When the exudation volume was high ,We changed the dressing every day; While medium, We changed every two days ; When low ,We changed every three days. Results:Eleven 11 of 12 wounds got second phase of healing, the average healing time was (12±2) days. Conclusion: Using of the Streptogenin spray and the alginate dressing on disruption wound can reduce the exudation volume and wound pain, meanwhile it can progress the growth of granulation , so the wounds healed quickly.
目的 探讨双源CT低剂量扫描技术在胸部普通检查中的应用价值。 方法 将2011年8月－2012年12月收治的875例患者依次分为7组，分别采用常规管电流量110 mAs和低管电流量105、100、95、90、85、80 mAs测量，计算并评估7组患者纵隔窗图像的胸骨前空气CT值标准差（SD空气）、肺动脉分叉平面肺动脉信噪比、降主动脉信噪比、肺动脉-竖脊肌对比噪声比、降主动脉-竖脊肌对比噪声比；纵隔窗图像和肺窗图像主观质量评分以及射线剂量指标：CT剂量指数（CTDI）、剂量长度乘积（DLP）、有效剂量（ED）。 结果 7组患者纵隔窗图像肺动脉信噪比、降主动脉信噪比、图像主观质量评分和射线剂量CTDI、DLP、ED之间差异均有统计学意义（P＜0.05）；肺动脉-竖脊肌对比噪声比、降主动脉-竖脊肌对比噪声比之间差异无统计学意义（P＞0.05）；其中第7组图像信噪比、射线剂量和主观质量评分均为最低，部分图像肩背部出现横条状伪影，影响肺尖部病变的显示，难以提供足够的诊断信息。 结论 胸部普通CT检查，通过阶段性降低管电流量使诊断医生逐渐适应低剂量图像质量，从而普及现有设备的低剂量扫描的方法是可行的。双源CT采用85 mAs的参考管电流量，既能获得满足临床诊断的合格图像，又能明显降低患者群体接受的辐射剂量。
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.