巴龙霉素单剂治疗绦虫病

巴龙霉素是从2株不同的链丝菌菌株培养物中分离出的氨甙抗生素。该药尚具有强大的抗细菌和抗阿米巴作用,口服后肠道不吸收,仅在肠腔内发生作用。本文对该药治疗绦虫病的疗效进行了观察。 观察对象为104例牛带绦虫病病例,其中男性75例,女性29例,年龄15～72岁。均根据粪便内孕节的大体观察和虫卵的显微镜观察进行诊断。104例中约半数病例有腹痛、恶心、流涎和腹胀,其余病例无症状。病例于本次治疗前至少4周内未接受过绦虫病治疗。采用巴龙霉素6.0～70mg/kg治疗,最大剂量不超过4g;治疗包括间隔15～30分钟的4     

人体猪带绦虫病的治疗与临床护理

人体猪带绦虫也叫有钩绦虫、链状带绦虫或猪肉绦虫,其成虫寄生于人体小肠,所致的疾病称为猪带绦虫病,是一种人畜共患的寄生虫病.当人误食生的或者未煮熟的含有活囊尾蚴的猪肉后,经2～3个月发育成虫,从而患猪带绦虫病.本病广泛分布于世界各地,国内散发于吉林、辽宁、黑龙江等25个省市区.本文统计的资料,系近24年(1973～1996年)来我单位收治的绦虫病2427例,患者来自山东省94个县市区.全部患者经治疗取得满意疗效,现报道如下.     

18例单中心误食枣核致小肠穿孔经验总结

目的:总结我院误食枣核导致小肠穿孔患者的诊治经验，为临床急腹症的诊疗提供临床经验，以便为该种少见急腹症的早期诊断和治疗提供参考。方法:回顾性收集2019年2月—2022年6月期间陕西省人民医院普外科和急诊外科收治的18例误食枣核致小肠穿孔患者行手术治疗的临床资料并对患者数据行总结分析。结果:18例患者中，男4例，女14例；平均年龄为62.3岁；10例患者有明确的术前误食枣核的病史；患者主要临床表现为腹痛，其中3例患者伴体温升高。8例患者行肠穿孔修补术，10例患者行肠切除+吻合术；3例患者在手术后入住重症监护室。18例患者的术后住院时间为3～27 d,平均为11.3 d。结论:老年患者为误食枣核的高危人群，术前CT及相关病史是误食枣核致小肠穿孔的重要诊治方法；患者保守治疗效果不佳，出现弥漫性腹膜炎、脓毒血症等严重并发症时，应及时手术。     

急腹症的临床诊断和治疗

目的探讨急腹症的临床诊断及治疗方法。方法回顾性分析我院2001年3月至2007年9月以腹痛为主要临床症状就诊的患者，后经相关检查确诊或住院手术证实的各种有腹痛疾患患者100例的临床资料。结果各种有腹痛疾患患者均能通过患者临床症状及结合实验室检查、超声，CT等辅助检查确诊。结论随着现代医学技术进步，尤其是影像学技术和腹腔镜技术的发展，急腹症的诊治水平得到极大的提高。明确诊断急腹症，对于患者转危为安，减少医患纠纷，搞好医疗安全防范，都有十分积极和重要的意义。     

以突发意识丧失为首发表现的急腹症1例

<正>急腹症是指腹腔内、盆腔和腹膜后组织和脏器发生了急剧的病理变化,从而产生以腹部症状和体征为主,同时伴有全身反应的临床综合征[1-2]。腹痛是其最常见的临床表现,以意识丧失为首发表现的急腹症十分罕见[3-5]。沈阳军区总医院于2014年6月21日收治1例以突发意识丧失为首发表现的急腹症患者,经检查诊断为腹腔出血致失血性休克,濒临死亡。采用"救命手术—ICU复苏—确定性再手术"的损伤控制理念,患者得以挽救。现将该     

人体猪带绦虫病的治疗与临床护理

人体猪带绦虫也叫有钩绦虫、链状带绦虫或猪肉绦虫,其成虫寄生于人体小肠,所致的疾病称为猪带绦虫病,是一种人畜共患的奇生虫病。当人误食生的或者未煮熟的含有活囊尾蚴的猪肉后,经２~３个月发育成虫,从而患猪带绦虫病。本病广泛分布于世界各地,国内散发于吉林、辽宁、黑龙江等２５     

肠结核实验室检查的临床应用进展

正随着人类免疫缺陷病病毒感染和免疫抑制剂的使用,结核感染的范围日趋扩大,肠结核(ITB)也日趋频繁,ITB是重要的肺外结核病之一,占结核病的1%~3%[1]。它是由结核分枝杆菌侵袭肠道引起的慢性特异性感染,主要影响回肠和结肠,回肠末端病变最为常见,导致胃肠道症状如腹痛、腹泻、便秘等临床表现。ITB的诊断依据为肠道病变组织中发现结核分枝杆菌、典型的干酪样坏死表现及抗结核治疗有效。由于内镜下     

粪常规镜检发现牛带绦虫病1例

寄生虫病是由寄生虫感染宿主引起的常见病,是一个重要的公共卫生问题,绦虫病是其组成部分之一.随着社会经济的发展和人们生活水平的提高,食品卫生质量并没有得到真正意义上的提高,喜食生牛肉及烤肉导致的绦虫病已见诸多报道.本文应用粪常规镜检方法,发现1例牛带绦虫病患者,现报道如下.     

以急腹症表现的克罗恩病21例临床诊治分析

目的：探讨表现为急腹症的克罗恩病的术前诊断和外科治疗措施。方法：回顾性分析1996～2006年临床表现为急腹症后经急诊手术术后病理证实为克罗恩病患者21例。结果：21例以急腹症入院时分别表现为急性肠梗阻、肠穿孔和消化道出血,仅有2例术前诊断怀疑克罗恩病,误诊率达90.1%。分别行肠部分切除、肠造瘘、小肠旷置术。结论：克罗恩病临床表现缺乏特异性,术前十分诊断困难。一旦出现急腹症,应及时采用正确的手术方法治疗,术式包括肠部分切除、肠造瘘和肠旷置等。术后应继续药物为主的综合治疗以防止复发。     

重视脑囊虫病的诊断和治疗

重视脑囊虫病的诊断和治疗中山医科大学传染病学教研室（５１０６３０）杨绍基１姚集鲁２目前，脑囊虫病在我国仍是一种常见的寄生虫病，２７个省、市、自治区有本病病例报告，患者多为青壮年。脑囊虫病是猪肉绦虫（链状带绦虫）的幼虫（囊尾蚴）寄生于人体脑组织所致的疾...     

Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty: A case report and review of literature

BACKGROUNDCompared with open mesh repair, transabdominal preperitoneal (TAPP) hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery. However, it may still lead to rare but serious complications. Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom, which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARYA 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged.CONCLUSIONThe possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.     

Unnecessary surgery for acute abdomen secondary to angiotensin-converting enzyme inhibitor use

Acute abdominal pain is the reason for 5% to 10% of all emergency department visits. In 1 in every 9 patients, operated on for an acute abdomen, laparotomy is negative. In a minority of patients, the acute abdomen is caused by side effects of medication. We present a case of unnecessary abdominal surgery in a patient with acute abdominal pain caused by intestinal angioedema (AE), which was eventually due to angiotensin-converting enzyme inhibitor (ACE-i) use. We hope that this case report increases awareness of this underdiagnosed side effect. Emergency department physicians, surgeons, internists, and family physicians should always consider ACE-i in the differential diagnosis of unexplained abdominal pain. Since early withdrawal of the medication causing intestinal AE can prevent further complications and, in some cases, needless surgery, we propose an altered version of the known diagnostic algorithm, in which ACE-i and nonsteroidal anti-inflammatory drugs–induced AE is excluded at an early stage.     

Unusual presentation of dissecting aortic aneurysm

Dissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.     

Intestinal anisakiasis as a rare cause of small bowel obstruction

Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.     

It is not always appendicitis

BACKGROUND: Patients who are suspected of having acute appendicitis usually undergo surgery in order to avoid life-threatening complications such as perforation and peritonitis. However, acute appendicitis is difficult to distinguish from other sources of right-sided abdominal pain. The clinical picture is almost indistinguishable from appendiceal diverticulitis, which is a rare entity and remains a difficult diagnostic problem. PATIENTS AND METHODS: We describe the case of a 39-year-old male with perforated appendiceal diverticulitis. The patient was admitted to our surgical unit with acute appendicitis-like symptoms and underwent surgery with a diagnosis of suspected acute appendicitis. RESULTS: The patient was found to have perforated appendiceal diverticulitis and standard appendectomy with abdominal lavage was carried out. DISCUSSION: Most patients presenting with acute right-sided peritonitic pain are diagnosed and managed as cases of acute appendicitis. Acute pain in the lower right side of the abdomen caused by appendiceal diverticulitis is very rare and clinically indistinguishable from acute appendicitis. Inflammatory complications of appendiceal diverticula mimic acute appendicitis. CONCLUSION: Every surgeon should be aware of the possibility of diverticulitis of the appendix in the operating room, even if this does not change the operative management. As diverticula of the cecum can be found as solitary lesions, as multiple lesions confined to the right colon, or as part of a generalized disease of the entire colon, postoperative barium enema examination may be useful.     

溃疡性结肠炎并发中毒性巨结肠误诊原因分析

目的提高对溃疡性结肠炎(ulcerative colitis,UC)及其严重并发症中毒性巨结肠的认识,减少误诊误治。方法回顾性分析1例UC并中毒性巨结肠的临床资料。结果患者因腹痛、腹泻、便血入院,在院外及我院按肠道感染处理效果不佳,经全腹CT、结肠镜、腹部立位X线平片等检查确诊UC并中毒性巨结肠、肠梗阻。患者最终因脓毒症性休克、多器官功能衰竭而死亡。结论 UC并中毒性巨结肠患者病情凶险,病死率高,应早期识别,择机手术,改善预后。     

Mesenteric inflammatory veno-occlusive disease – A rare cause of intestinal ischemia

Mesenteric inflammatory veno-occlusive disease (MIVOD) is a relatively recently known and not very often diagnosed form of ischemic bowel disease of low incidence und unknown etiology. We present the case of a patient who after presentation of inconclusive signs of epigastric pain and rectal bleeding suddenly developed right abdominal pain with local peritonism. Suspecting intestinal ischemia or perforated appendicitis we first performed laparoscopy, which showed an inflammable tumor of cecum, ascending colon and appendix with massive adhesions to the abdominal wall. We performed an open right hemicolectomy with primary anastomosis. The patient developed a deep vein thrombosis of the vena tibialis post. and vena saphena parva. After 12 months our patient is free of complaints and recurrence. Investigations carried out showed no evidence of hypercoagulopathy. The presentation of MIVOD can range from chronic inflammatory bowel disease with recurrent abdominal pain in combination with nausea, emesis and bloody diarrhea to acute abdomen. Therefore diagnostic misinterpretation and mistherapy as well as underdiagnosis is common. Histologic investigation shows a variable inflammatory infiltration of multiple veins of the intestinal wall and the mesentery as well as thrombotic vessel occlusion in different stages without involvement of the arteries. All forms of hypercoagulopathy, parasitic disease, sepsis and malignancy have to be excluded. Therapeutic success can only be achieved with surgical resection of the affected bowel, whereon in general no recurrence will occur.     

婴儿隐匿性原发性小肠淋巴管扩张症一例

为提高对婴儿隐匿性原发性小肠淋巴管扩张症的临床、内镜及病理特点的认识,减少漏诊及误诊,我们对厦门市儿童医院收治的1例原发性小肠淋巴管扩张婴儿的临床表现和诊疗相关资料进行了回顾性分析。该例患儿以支气管肺炎收住入院,轻度腹泻和水肿,未见外周血淋巴细胞数减少,呈现低蛋白血症。输注白蛋白未能缓解低蛋白血症,随后胃镜检查显示十二指肠段可见大小不等密集的白色粟粒样颗粒状隆起,黏膜呈广泛白斑样病变,病理检查显示明显的小肠淋巴管扩张,进而确诊小肠淋巴管扩张症。确诊后每两日输注白蛋白,连续输注两个疗程并予portagen中链脂肪酸奶粉喂养。经处理后血浆中总蛋白和白蛋白基本升至正常水平,腹部及胸部彩超显示双胸腔及双肺积液均已被吸收。对该病例的回顾性分析结果表明对于有血浆白蛋白及球蛋白下降而导致浮肿的婴儿,排除肝肾疾患及肿瘤、结核等慢性疾病所致蛋白消耗过多的可能性,均应考虑小肠淋巴扩张症,需尽可能尽早行胃镜检查,进一步完善病理活检,实现早日确诊、尽早进行对症治疗及饮食干预治疗,避免处理不及时导致的严重后果。     

Toxicologic causes of acute abdominal disorders

A variety of drugs and toxins can produce severe abdominal pain and, in some cases, a surgical abdomen. Toxins can be classified according to mechanisms of injury: 1. Corrosives often produce severe gastroenteritis and may result in gastric or esophageal perforations. Examples of corrosive substances include aspirin, iron, mercury, acids and alkali. 2. Drugs may cause intestinal ileus or obstruction by pharmacologic actions (i.e., anticholinergic drugs and narcotics) or by mechanical obstruction (charcoal and drug bezoars). 3. Abdominal pain simulating an acute abdomen may result from systemic effects of black widow spider envenomation or intoxication with heavy metals such as lead and arsenic. 4. Ischemic bowel disease may occur from use of vasoconstrictor drugs, such as ergotamines, amphetamines and cocaine, or may follow treatment with catecholamines or digitalis in critically ill patients. Small bowel ischemia is life-threatening and may require bowel resection. 5. Many drugs cause abdominal pain by directly injuring abdominal organs, such as the liver and pancreas. Antibiotic-associated colitis may present with abdominal pain and inflammatory diarrhea. Consideration of drugs and toxins plays an important role in the differential diagnosis of the acute abdomen.     

术后早期肠梗阻的诊断和治疗

目的：探讨术后早期肠梗阻的特点。诊断和治疗方法，提高对本病的认识。方法：分析近2年来经治的38例术后早期肠梗阻。结果：32例经保守治疗治愈。平均治愈时间为16.5d。6例经手术治愈。平均治愈时间为19d。无肠坏死。结论：术后早期肠梗阻的特点（1）近期有腹部手术史，多于术后3-8d开始出现梗阻症状。（2）以炎性肠梗阻多见。腹胀为主，腹痛较轻，较少发生绞窄，为腹腔炎症引起黏连所致，大多经保守治疗有效。（3）少数病例由于内疝，肠扭转，肠套叠，吻合口狭窄等机械性因素造成梗阻，多需手术解除梗阻。