术后早期炎性肠梗阻23例诊治分析

目的 探讨术后早期爽性肠梗阻的临床特点、诊断、治疗和预防。方法 对23例早期炎性肠梗阻的治疗结果进行回顾性分析。结果 23例患者经胃肠减压、应用生长抑素、肠外营养、肾上腺皮质激素等疗法治愈，平均95d，无一例2次手术。结论 术后早期炎性肠梗阻常发生于术后4～11d，有典型的临床特点，保守治疗可治愈。     

术后早期炎性肠梗阻64例诊治分析

目的 探讨术后早期炎性肠梗阻的临床特点及处理方法。方法 分析64例术后早期炎性肠梗阻的病例资料。结果 64例均行禁食、胃肠减压、应用生长抑素、肠外营养等支持治疗，平均治愈时间13.5d，无一例再手术。结论 术后早期炎性肠梗阻多发性于术后5-15d，可表现为典型的肠梗阻征象，多由小肠无菌性炎症致广泛肠粘连所致，多数病例采用保守疗法可治愈。     

术后早期炎性肠梗阻13例诊治体会

目的总结术后早期炎性肠梗阻的诊治经验。方法回顾13例炎性肠梗阻病人的治疗方法，包括禁食，胃肠减压，全肠外营养，生长抑素和糖皮质激素的应用，中医治疗。结果13例病人中12例治愈，平均治疗时间28d，一例治疗三周后转入上级医院。结论采用非手术治疗术后早期炎性肠梗阻效果满意，并发症少，安全。     

术后早期炎性肠梗阻18例诊治分析

目的 探讨术后早期炎性肠梗阻的临床特点及处理方法.方法 分析18例术后早期炎性肠梗阻的临床特点及治疗结果.结果 18例均胃肠减压,应用生长抑素、肠外营养等支持疗法,平均治愈时间为17 d,1例因"切口裂开"再手术并发小肠瘘.结论 术后炎性肠梗阻多发生在术后5～7 d,可表现为典型的肠梗阻体征,多由小肠无菌性炎症致广泛肠粘连引起,多数病例采用保守疗法可治愈.     

胃肠穿孔术后早期炎性肠梗阻诊治体会

目的探讨胃肠穿孔术后早期炎性肠梗阻的诊断、预防和治疗措施。方法回顾性分析我院2004年1月至2009年1月收治的25例胃肠穿孔术后早期炎性肠梗阻患者病例,全部患者予以持续胃肠减压、营养支持、中药外敷等保守治疗措施,观察治疗效果和病员愈后回访结果。结果25例患者中,22例经保守治疗,痊愈出院;另外3例行剖腹探查术,手术治疗后痊愈。结论胃肠穿孔术后早期炎性肠梗阻患者通过综合治疗能够明显改善术后早期炎性肠梗阻的临床症状、维持患者的营养状况及内环境稳定,促进肠道功能恢复,从而有效地治疗术后早期炎性肠梗阻,避免患者再次手术。     

术后早期炎性肠梗阻32例临床分析

目的 探讨术后早期炎性肠梗阻的诊断和治疗方法.方法 对32例术后早期炎性肠梗阻的临床特点和治疗方法进行回顾性分析.结果 32例患者均经胃肠减压、应用生长抑素、肾上腺皮质激素、肠外营养、抗生素等方法治愈,平均住院时间15d,无一例肠坏死.结论 术后早期炎性肠梗阻的特点①发生于腹部手术后早期.②症状以腹胀为主,疼痛相对轻,部分患者排便、排气,体征典型,但较少发生绞窄.③保守治疗大多有效,过程中应严密观察,如出现肠坏死、腹膜炎时及时中转手术.     

结肠癌致肠梗阻的外科治疗（附64例报告）

目的：探讨结肠癌致肠梗阻的外科治疗方法及效果。方法：外科手术治疗结肠癌致肠梗阻64例，其中右半结肠癌并梗阻43例，左半结肠癌并梗阻21例。肿瘤切除一期行肠吻合52例（81．2％）；行肿瘤切除、一期肠吻合、同时行近端结肠预防性造口8例（12．5％），其中4例（6．25％）分别于术后8～12周行造口关闭；4例（6．25％）肿瘤无法切除仅行乙状结肠或横结肠造口。结果：本组64例均治愈。术后出现并发症6例（9．3％），1例为切口感染，3例切口裂开，2例肺部感染，分别采用换药、减张缝合、抗感染等方法治愈。无围手术期死亡。结论：重视结肠癌致肠梗阻的围手术期处理，选择合理的手术方式是提高疗效，减少并发症的重要保证。     

奥曲肽对炎症性肠梗阻患者血浆CRP和IL-6浓度的影响及疗效观察

肠梗阻是指各种原因引起的肠内容物不能顺利通过肠管，从而引起一系列病理生理改变的临床综合征。术后炎症性肠梗阻为发生在腹部手术后早期因腹内创伤或炎症，导致肠管壁炎性水肿、增生、渗出、黏连而形成的机械性与动力性并存的肠梗阻，为腹部术后常见并发症。     

奥曲肽联合乌司他丁治疗术后早期炎性肠梗阻疗效观察

术后早期炎性肠梗阻(early postoperative inflammatory ileus)是腹部手术后较常见的一种并发症,目前认为,内毒素(LPS)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)在术后早期炎性肠梗阻的疾病进程中发挥了重要作用[1-3]。本文采用奥曲肽和乌司他丁联合治疗术后早期炎性肠梗阻,通过观察治疗后患者体内LPS、IL-6、TNF-α、hs-CRP及临床症状的变化,探讨奥曲肽和乌司他丁联合治疗术后早期炎性肠梗阻的临床疗效及可能机制,现报道如下。     

腹部手术后早期炎性肠梗阻21例的临床分析

2005年3月至2009年12月,笔者收治手术后早期炎性肠梗阻21例,经保守或手术治疗后,效果满意,现报道如下. 1 资料与方法 1.1一般资料 本组21例,其中男13例,女8例;年龄12～71岁,平均(41.5+3.5)岁;急性阑尾炎切除手术6例,肠修补术3例,胃穿孔行胃大部分切除术3例,十二指肠穿孔行胃大部分切除术2例,胃癌根治术3例,结肠癌根治术2例,胆石症胆囊切除术1例,子宫切除术1例;肠梗阻发生术后5～14d17例,15～28d4例.     

新生儿甲基丙二酸血症10例临床分析

目的探讨新生儿期发病的甲基丙二酸血症（MMA）的临床特征、早期诊断方法及治疗方案,以提高早期诊断的能力。方法对2008年1月至2014年3月湖南省儿童医院新生儿期起病的10例甲基丙二酸血症患儿临床特点进行回顾性分析。结果男8例,女2例。生后1w内起病6例,1-2w内起病1例,超过2w3例。10例中均有黄疸及肌张力异常（其中肌张力低下6例,增高4例）,反应差7例,体重不增或下降6例,呼吸道症状8例。严重酸中毒8例,高血糖3例,低血糖2例,高氨血症8例,酮尿5例,高乳酸血症5例。6例行颅脑MRI检查,5例异常,颅脑彩超5例异常。放弃治疗后72h内死亡或死亡病例4例,好转出院6例,随访3例存活超过1年,其中2例有智力发育落后,l例合并有CMV感染。结论新生儿期起病的MMA其临床表现无特异性,病情进展快,病死率高,预后不良,提示需加强早期识别,旱期诊断能力,指导家属优生优育,提高生存率。     

千兆架构的设想与实现

随着医院信息化的加快,医院传统的工作方式,已逐渐暴露出诸多落后因素,如:效率低、耗资大、不方便病人等等。如果停滞不前,必将使医院失去竞争和存在能力。医生工作站、PACS(医学影像系统)、LIS(检验信息系统)逐渐成为医院信息管理系统中不可缺少的组成部分。我院最近正在进行系统网络升级。升级之前我院的千兆网极不完善,仅有一条千兆链路,这种情况已经日益成为影响医院信息化发展的瓶颈。以太网络技术已经成为企事业组织建设局域、园区网络的主流技术,并开始应用于城域网络和宽带接入网络等市场。而其中千兆以太网络技术已经作为建设网络骨干和高速服务器组群连接的主流技术。     

Nodular fasciitis: Spontaneous resolution following diagnosis by fine-needle aspiration

Nodular fasciitis can be histologically mistaken for a sarcoma. Typical cases are less than 5 cm and enlarge rapidly over days or weeks before diagnosis. The natural history of nodular fasciitis is unknown, since the diagnosis is usually based on excised lesions. Fine-needle aspiration of nodular fasciitis has been described, and features benign-appearing spindle cells (singly and in groups), collagen, and myxoid material. We describe 11 cases in which nonsurgical observation led spontaneously to complete resolution. Our study includes 7 males and 4 females (24 to 73 years of age; median = 42). Lesions were located in the arm (4), thigh (3), temporal area (2), breast (1) and the parotid (1) and ranged from 0.5 to 5.0 cm. (median = 1.5). They had been present for from less than 1 to 4 weeks (median = 2). In 9 cases, spontaneous resolution occurred in from 3 to 8 weeks (median = 4). Two other patients were lost to follow-up for up to 11 months, after which resolution was noted. Small palpable masses in the subcutaneous soft tissues which evolve over a short period of time and show the cytologic features of nodular fasciitis should be managed nonsurgically. If resolution does not occur within a few weeks, surgery can then be performed. Diagn Cytopathol 1993;9:322-324.     

肘关节“恐怖三联征”的治疗――附10例报告

目的探讨肘关节"恐怖三联征"的治疗方法和疗效。方法 10例患者手术治疗9例,其中1例行人工桡骨头置换,并修复肘关节前关节囊及肘内、外侧副韧带;8例内固定,术后予长臂石膏或铰链式支架外固定制动2～3周,早期开始屈伸康复训练。闭合复位保守治疗1例。结果 10例患者均获随访,随访时间3～40月,平均22.5个月。手术组切口均一期愈合。术后8～12周骨折达临床愈合,平均9.2周。肘关节平均屈伸范围为110°±28°,前臂平均旋转活动范围为109°±25°,1例有创伤性关节炎。按照肘关节HHS评分标准评定标准进行评价:优5例、良2例、可1例、差2例(含保守治疗1例),总优良率为70%。结论对于肘关节"恐怖三联征",应积极手术治疗,重建或恢复骨的结构,坚强内固定,修复关节周围支持结构,早期功能锻炼,能有效恢复关节功能,减少骨折并发症。     

Xanthogranulomatous Pyelonephritis in Korean Children

Purpose

Xanthogranulomatous pyelonephritis (XGP) is rare among children. In most cases, XGP is diffusely or focally enlarged, mimicking the neoplastic process. The aim of this study was to examine clinical characteristics and outcomes of Korean children with XGP.

Materials and Methods

Fourteen children (9 boys, 5 girls) with XGP were reviewed retrospectively. The cohort included 2 children managed at our institution and 12 children reported in the Korean literature. The patients'' records were reviewed with respect to age at diagnosis, clinical presentation, management method, and other characteristic features.

Results

The mean age was 79.4±66.5 months (range 1-168 months). Common clinical presentations included fever (85.7%), abdominal pain (57.1%), and palpable mass (28.6%). Laboratory abnormalities included leukocytosis (57.1%), anemia (57.1%), and pyuria (57.1%). The types of XGP that were diagnosed based on preoperative radiologic studies included the focal form in 9 children and the diffuse form in 5. Thirteen children underwent nephrectomy, and 1 child received conservative medical therapy.

Conclusion

The possibility of XGP should be considered if a child is diagnosed with a renal mass, especially if it is a small renal mass associated with fever, leukocytosis, or stone. Nephrectomy is the treatment of choice for the diffuse form, whereas partial nephrectomy or conservative medical therapy may be indicated to manage focal XGP.     

人工髋关节置换术后并发有症状下肢深静脉血栓临床分析

目的：探讨有症状下肢深静脉血栓（DVT）的发生率、临床特点及药物预防DVT的可行性。方法：2006年1月～2009年12月行人工髋关节置换术232例,术后连续腹壁脐周皮下注射低分子肝素钙4000U／d×10d,口服阿司匹林1片／d×30d。其中13例分别于术后第3～9天先后出现术侧下肢循环障碍临床表现,结合下肢深静脉彩超或下肢深静脉造影检查,均确诊为有症状下肢DVT,并立即行取栓术治疗。结果：13例患者行取栓术后,临床症状消失,Homans征和Neuhof征转为阴性。2例患者术后伤口渗出增加,细菌培养阴性,停用低分子肝素钙后伤口渗出减少,至术后2周伤口完全愈合。出院后随访1．5个月,再次行下肢深静脉彩超或下肢深静脉造影,未发现有血栓形成。结论：术前和术后患肢发生不明原因的肿痛时,应警惕下肢DVT的存在。早期诊断DVT,早期手术,并规范应用抗凝剂,联合早期功能锻炼,可以有效的防治下肢DVT。     

Clinical Characteristics and Management of Benign Transient Non-Organic Ileus of Neonates: A Single-Center Experience

Purpose

The term benign transient non-organic ileus of neonates (BTNIN) is applied to neonates who present symptoms and plain radiographic findings of Hirschsprung''s disease, but do not have aganglionic bowel and are managed well by conservative treatment. It can often be difficult to diagnose BTNIN because its initial symptoms are similar to those of Hirschsprung''s disease. The aim of this study is to evaluate the clinical characteristics and proper treatment of BTNIN.

Materials and Methods

A retrospective review was made on the clinical data of 19 neonates who were treated for BTNIN between January 2008 and December 2011 at a single facility.

Results

Abdominal distension occurred in every patient (19/19). Other common symptoms included emesis (5/19), explosive defecation (5/19), and constipation (4/19). The vast majority of patients (15/19) experienced the onset of symptoms between 2 and 4 weeks of age. Radiograph findings from all of the patients were similar to Hirschsprung''s disease. A barium study showed a transition zone in 33.4% (6/18) of the patients. However, rectal biopsy revealed ganglion cells in the distal rectum in 88.2% (15/17) of the patients, and anorectal manometry showed a normal rectoanal inhibitory reflex in 90% (9/10). All patients responded well to conservative treatment. Symptoms disappeared at the mean age of 4.9±1.0 months, and the abdominal radiographs normalized.

Conclusion

BTNIN had an excellent outcome with conservative treatment, and must be differentiated from Hirschsprung''s disease. A rectal biopsy and anorectal manometry were useful diagnostic tools in the differential diagnosis.     

The changed clinical spectrum of malaria due to drug resistance

The clinical spectrum of 14 cases of Plasmodium falciparum malaria (PF) who received empirical treatment and suffered from initial prolonged mild illness culminating into severe complicated malaria are presented. The empirical treatment (ET) consisted of adequate doses of chloroquine in 9, chloroquine with pyrimethamine-sulphadoxine combination in 3 and pyrimethamine-sulphadoxine alone in 2 cases. Moderate fever and weakness persisted for 7 to 28 days leading to anaemia and progressive hepatosplenomegaly in all patients. Other clinical features noticed included jaundice in 5, sudden shock with pulmonary oedema in 4, cerebral malaria and renal failure in 3 each and multiorgan in 4 cases. Subsequent investigations revealed PF rings in 9 cases, mixed PF and vivax infection in 3 and PF gametocytaemia only in 2 patients. Seven patients received quinine, 4 quinine with doxycycline and 3 were given quinine followed by injection artemether. Exchange transfusion was carried out in two cases. Four patients died. The empirical treatment with first line antimalarials alters the clinical profile of resistant PF, makes it milder temporarily, delays in confirming the diagnosis and leads to high mortality. There is urgent need for more diligent early workup for these patients who linger on with moderate pyrexia, progressive hepatosplenomegaly, anaemia and jaundice after ET till better diagnostic methods are available to avoid the prolonged illness and high mortality.     

Treatment of Pathological Synovial Plicae of the Knee

OBJECTIVE:

To analyze the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee.

MATERIAL AND METHODS:

Between 2002 and 2006, 63 patients with pathological synovial plicae of the knee were studied. Of those 63 patients, 21 had the diagnosis confirmed by previously performed magnetic resonance imaging. All of the patients initially underwent conservative treatment for 90 days that involved strengthening and improving the flexibility of the muscles surrounding the knee as well as modification of their sports activities.

RESULTS:

A total of 55 patients improved after conservative treatment. Six of these patients eventually experienced a recurrence of symptoms, but the symptoms were not incapacitating in any of these patients. The other eight patients underwent arthroscopic removal of the synovial plica. Of these eight patients, six returned to their pretreatment physical activities, and two had persistent symptoms during physical activity.

CONCLUSION:

The presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Conservative treatment is effective in most cases, and surgical treatment should be reserved for exceptional cases that do not improve with conservative treatment.