经肛门内镜显微手术治疗早期直肠肿瘤

直肠绒毛状腺瘤的体积会逐渐增大,其恶变成有侵袭性肿瘤的可能性也随之增加.因此,切缘阴性的完整切除是治疗直肠绒毛状腺瘤的目标.目前,对于直肠绒毛状腺瘤,有许多治疗方法可供选择,包括内镜下肿瘤电切术、传统的经各种途径的局部切除术及根治性的直肠切除术.内镜下肿瘤电切术虽然是一种微创的方法,但在切除较大的直肠肿瘤时往往难以获得满意的切缘.另一方面,传统的经各种途径的局部切除术虽然大多可以获得满意的切缘,但是只能局限应用于靠近肛缘的直肠肿瘤.直肠切除术也可以获得满意的切缘,但是手术创伤大,而且并发症发生率较高.……     

肛门直肠测压在功能性便秘中的临床应用

目的 观察功能性便秘患者的肛门直肠动力学改变.方法 采用肛门直肠测压方法检测189例功能性便秘患者的肛门直肠静息压、缩榨压、直肠初始感觉阈值、排便阈值、最大耐受容量指标及反常运动情况.结果所有患者均有直肠肛门运动功能的异常,有32.2%的患者出现了排便时的反常运动.结论功能性便秘患者存在肛门直肠动力和感觉异常,肛门直肠测压为便秘的分型和治疗提供了重要依据,值得临床推广.     

直肠阴道前庭瘘不同术式的疗效评价

小儿直肠阴道前庭瘘在临床工作中较常遇到,其发生比例没有明确的流行病学依据,各家报道的情况也不一致.但其发生是直肠重复畸形的一种[1],多在新生儿和幼儿期发生,部分患儿出生后就有瘘口存在,另一部分则是出生后三月之内会阴部及肛周问隙感染导致瘘外口出现.以往有多种手术方法效果各异,多不满意复发率较高.2000年～2007年3月我们采用肛管内直肠粘膜游离修补术15例,采用直肠前壁游离修补瘘5例,结果显示直肠前壁游离于肛管吻合疗效确切,无复发病例,而肛管内直肠粘膜游离修补者复发6例.     

溃疡性结肠炎的诊断治疗

溃疡性结肠炎又称非特异性溃疡性结肠炎,是一种病因未明的直肠和结肠炎性疾病.病变主要限于大肠黏膜与黏膜下层,多累及直肠和远端结肠.临床表现有腹泻、黏液脓血便和腹痛、里急后重.     

卵巢和输卵管

以犯,%卵巢桨液性乳头状囊腺摘致下消化道出血一例/郭铃新…//中华妇产科杂志一l望刃,34(12)一728 患者66岁,因大便出血1年,加重1月人院。B超提示:子宫右侧肿物7.oem x 5.semxs.oem。行剖腹探查术见:右卵巢厚壁囊肿与宫体后壁、宫颈及直肠广泛粘连,直肠被压向左侧。行子宫、双附件及部份直肠切除术。病检发现,相当于粘连处的直肠粘膜面,有一与直肠长轴平行的线状裂隙,长约8~,其中有一针头大小的孔。小孔与肿物的囊腔相通。镜下检查证实为卵巢浆液性乳头状囊腺瘤伴出血、坏死。诊断:卵巢浆液性乳头状囊腺瘤致下消化道出血。(胡寒)仪犯9,7心…     

耻骨直肠肌部分切除治疗耻骨直肠肌综合征1 49例

目的观察耻骨直肠肌部分切除术的治疗效果.方法149例经直肠排粪造影和耻骨直肠肌肌电图确诊为耻骨直肠肌综合征患者,经尾骨下正中切口行耻骨直肠肌部分切除术,术后观察其临床症状改善情况,复查直肠排粪造影了解其影像学变化.结果手术后排便困难均得到完全缓解,肛门坠胀或疼痛有15例未完全消除,但程度明显减轻;直肠排粪造影显示耻骨直肠肌压迹消失.结论耻骨直肠肌部分切除术治疗耻骨直肠肌综合征方法简便,疗效好,并发症少.     

半刺法治疗小儿直肠脱垂36例

直肠脱垂是指肛管、直肠粘膜、直肠全层或部分乙状结肠向下移位的一种疾病.属于中医"脱肛"范畴.临床特征为患儿身体瘦弱,大便后有肿物自肛门脱出,多见于2～4岁的幼儿.我们自1995年8月～1998年12月运用斗刺法治疗36例,疗效满意,现介绍如下.     

近心端结扎瘢痕固定术加芍倍注射液注射治疗直肠脱垂28例

直肠脱垂临床较常见,是肛管、直肠粘膜、直肠全层和部分乙状结肠向下移位脱出肛门外的一种疾病.可发生于任何年龄.小儿多为直肠粘膜脱垂,成人多为完全直肠脱垂.发生直肠脱垂的病因比较复杂,关于直肠脱垂的治疗方法也很多,但效果均不理想,自我们应用安氏疗法起,采用近心端结扎瘢痕固定加芍倍注射液注射治疗直肠脱垂28例,疗效满意,总结如下.     

溃疡性结肠炎的临床护理体会

溃疡性结肠炎又称非特异性溃疡性结肠炎,是一种病因未明的直肠和结肠慢性炎症性疾病.病变主要位于直肠和结肠,可延伸到降结肠,甚至整个结肠.主要症状有腹泻、脓血便、里急后重.病程漫长,病情轻重不一,常反复发作.我国发病率较国外低,但近年有增高趋势.     

肛管直肠功能测定在直肠癌中的应用

目的:肛管直肠功能测定在低位直肠癌消化道重建中有明确的指导意义.方法:通过肛管直肠功能测定也可以判断直肠癌系膜切除术后吻合口瘘对肛管直肠功能的影响.结果:直肠癌放化疗对肛管直肠功能是有一定影响的,无论术前或术后应用放化疗,患者的肠管功能均明显受到损害.但肛管直肠功能损害的程度却不会随放射剂量的大小发生变化.结论:相关问题正处于进一步的探讨中.     

Diabetes and infarcted papillary thyroid cancer

A young black Jordanian lady who has type one diabetes, chronic diabetic complication and ischemic heart disease, presented with a picture of diabetic keto-acidosis, precipitated by an acute neck swelling. This was suggestive of acute suppurative thyroiditis with abscess formation causing compressive symptoms. This unfortunate patient had an eventful course despite aggressive treatment by antibiotics and surgery and then succumbed of an acute cardiac event. The operative tissue biopsy revealed an abscess in an infarcted papillary thyroid cancer. We believe this is a rare presentation of such an association with a fatal outcome.     

和谐医患关系在和谐社会建设中的作用

和谐医患关系是和谐社会建设中的一个重要组成部分。医患关系紧张折射出社会深层原因;构建和谐的医患关系对社会稳定有着举足轻重的影响;医患关系影响医院文化的建设;医患关系在廉政文化建设中发挥着重要的作用。     

An audit of echocardiograms in acute left ventricular failure.

All patients with heart failure should have an echocardiogram to establish a diagnosis, both to aid treatment as well as for prognostic reasons. An audit of 100 case notes of patients admitted with acute left ventricular failure over a 12-month period found that 26 patients had not had an echocardiogram. Of the 74 who did have an echocardiogram 68 patients had reduced systolic function (mean ejection fraction 42%). Almost all (93%) were commenced on an angiotension-converting enzyme (ACE) inhibitor. Those who did not receive an ACE inhibitor had no contraindications to these drugs. Seventeen patients had a confirmed myocardial infarction. Of these, 11 had an echocardiogram and 10 were discharged home on an ACE inhibitor. Despite appropriate indications some patients are deprived of echocardiography as well as the benefits of ACE inhibitors.     

An omental abscess mimicking an intra-abdominal tumor

Here, we report the case of a 12-year-old boy who presented with intermittent lower abdominal pain; subsequently, an intra-abdominal mass found by abdominal ultrasound. Initially, an intra-abdominal tumor was suspected according to the results of the physical examinations, laboratory data, and imaging studies. A surgical excision was performed, and pathological examination revealed an omental abscess without evidence of intestinal perforation or a residual foreign body. The patient’s history consisted solely of receiving an open appendectomy for a ruptured appendicitis 2 years prior. This is an extremely rare case of a post-appendectomy omental abscess forming after such a long interval, but no evidence of residual appendiceal tissue or foreign bodies could be identified.     

浅谈医学生的医患沟通教育

具备良好的沟通水平是由实习医生转变为合格医生不可或缺的因素之一。而临床实习重在培养专业知识与技能以及解决临床切实问题的水平,同时也有利于实习医生加强处理医患关系的能力,并尽快成长为一名合格的临床医生。在临床实习期间要重点加强关于医患沟通技巧的培养以及树立医患沟通的意识。     

Development of a testicular tumour during cisclomiphene therapy

Enlargement of an atrophic testis occurred in an oligospermic patient during long-term therapy with a low dosage of cisclomiphene. Orchidectomy revealed an adult teratoma combined with an atypical seminoma. The development of a germinal-cell neoplasm during pituitary-gonadal stimulation therapy raises the question of a possible cause-effect relationship. Available evidence does not support this possibility. However, it is less clear whether hormonal influences may promote the growth of a germ-cell tumour focus. Therefore, prolonged treatment with such agents demands close supervision, particularly in patients with a predisposition to gonadal carcinogenesis.     

Significance of idiopathic deep venous thrombosis

The risk of developing an overt malignancy after an isolated deep venous thrombosis (DVT) is poorly documented. We therefore reviewed a series of patients in whom a solitary idiopathic DVT had been proven by venography at least 12 months earlier. No patient had developed a malignancy at follow-up. However, decreased fibrinolytic activity was observed in five out of the six patients aged less than 45 years. Patients with an idiopathic DVT should not be subjected to an exhaustive search for malignancy.     

浅谈实验动物饲养管理和使用计划中 “灾难计划”的制定与实施

作为一个健全的实验动物饲养管理和使用计划的必须组成部分,"灾难计划(disaster plan)"的制定对任何研究机构均是非常重要的。目前,国内多数实验动物饲养和使用机构均会制定一份突发事件下的紧急预案(emergency operation plan,EOP),但多数机构均没有制定完善的运营连续性计划(business continuity plan,BCP)。本文将就"灾难计划"中"灾难"的定义、如何制定和实施完善的"紧急预案"、如何制定和实施完善的"运营连续性计划"等内容分别进行浅述,以期呈现一个完整并专业的实验动物饲养管理和使用计划中的"灾难计划"。     

The use of angiotensin-converting enzyme inhibitors in the treatment of heart failure in hospital practice.

Several well-controlled trials in patients with heart failure have shown that the use of angiotensin-converting enzyme (ACE) inhibitors, in combination with a diuretic, causes a reduction in mortality and morbidity, which seems to be mainly due to a reduction in fatal and nonfatal cardiovascular events. Our aim was to determine whether 249 consecutive patients discharged from hospital with a primary diagnosis of heart failure were routinely being treated with an ACE inhibitor at an appropriate dose. At the time of admission to hospital, 91 (36.5%) were receiving a combination of a diuretic and an ACE inhibitor, 129 (51.8%) were receiving a diuretic alone, and 29 (11.6%) had not previously received either a diuretic or an ACE inhibitor. At the time of discharge from hospital all patients were on a diuretic and 144 (57.8%) were also receiving an ACE inhibitor. Although 41 patients (16.5%) had a relative or absolute contraindication for the use of an ACE inhibitor, 64 patients (25.7%) with no contraindication were not receiving an ACE inhibitor. Many of the patients who were prescribed an ACE inhibitor were given it at an inappropriate dose; only 24 patients (16.7%) were on the dose that was used in the clinical trials showing a reduction in mortality. These results show that in one in four patients admitted to hospital with heart failure who should be receiving an ACE inhibitor by the time of discharge, are not. The average age of these patients was 76 years. Whilst it has been shown that the benefit of ACE inhibitors does not appear to be age-related, most published studies have not included many patients over the age of 80. Specific studies looking at the effect of ACE inhibitors in elderly patients would be helpful, as well as studies to determine the optimum treatment regimen for this age group.     

Metastatic cervical lymph nodes: general practitioner referral patterns.

Premature excision biopsy of a cervical lymph node infiltrated by metastatic carcinoma may compromise patient survival since it is associated with an increased incidence of local wound recurrence and distant metastases. Seventy per cent of such patients have an identifiable head and neck primary, obviating the need for an excision biopsy. It is important therefore that they are examined by surgeons who are experienced in inspecting the upper aerodigestive tract and who are competent in performing definitive head and neck surgery. A questionnaire sent to all general practitioners of an Inner London and a District Health Authority revealed that only 18% and 33% respectively referred patients who they suspected of having a metastatic neck node to a department with an experienced head and neck surgeon. We conclude that greater emphasis on the correct management of these patients at both an undergraduate and postgraduate level may encourage subsequent generations of general practitioners to review their referral patterns.