Objective
To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience.
Methods
We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years).
Results
Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia.
Conclusion
ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.
Objective To reinforce the recognization of deltoid contracture inchildren and probe its causes, pathomechanism,diagnosis and treatments. Methods The Clinical data were summarized and analysed, including etiological factors, clinical situations, examinations and treatments from 9 child patients with deltoid contracture from 1992 to2004. The 9 child patients were followed up to evaluate therapeutic efficacy. Results Nine child patients with deltoid contractureincluded 4 boys and 5 girls, who aged from 5 to 14 years. The main clinical features were presented as abductive deformity,limitation of adduction of the shoulder, winging of the scapula, and dimpling of the skin with a palpable fibrous hard band in deltoid muscle. Four cases had a history of intramuscular injections in deltoid and 1 case was accompanied with bilateral gluteul contracture.Among the 9 patients, 8 cases were misdiagnosed before correct diagnosis and treatment. The misdiagnosis rate was up to 90%. All the cases received the operative treatments to release fibrous bands and were followed up for 8 months to 12 years. Abductive deformity disappeared and functions of the shoulders recovered inall patients, except 1 patient who had a lightly winged scapula. Conclusion Deltoid contracture may be caused by multiple factors,but its clinical features are conductive to correct diagnosis and excellent therapautic efficacy can be acquired by operation early.
Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive pulmonary fungal infection( IPFI) . Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases( 62. 2% ) , Cryptococcus in 18 cases( 20. 0% ) , Mucormycosis in 6 cases( 6. 7% ) , and Histoplasma in 6 cases( 6. 7% ) , etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients ( 54. 4% ) received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases( 27. 8%) , nodule lesions type in 15 cases( 16. 7% ) , lung consolidation type in 22 cases( 24. 4% ) , cavity type in 22 cases( 24. 4% ) , aspergilloma type in 6 cases( 6. 7% ) . 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2% . 31 cases ( 34. 4% ) underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases ( 62. 2% ) received systemic anti-fugal therapy, and 43 cases( 76. 8% ) were cured or significantly improved. 3 cases ( 3. 3% ) refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-termand broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.
摘要:目的: 探討如何提高早產兒存活率和生存質量。 方法 :對我院新生兒病房收治的228例早產兒的臨床資料進行了回顧分析。 結果 :引起早產的母親因素以胎膜早破、妊娠期膽汁淤積綜合征及妊娠合并高血壓綜合征為早產的重要因素,而引起早產兒常見疾病的是新生兒肺炎,高膽紅素血癥及新生兒窒息等。而呼吸衰竭、新生兒休克、多器官衰竭則是引起早產兒預后不良的重要因素。 結論 :早產原因以母體因素為主,故加強孕期保健,積極防治母親的有關并發癥,同時提高新生兒急救水平,早期干預,以提高早產兒的生存質量。Abstract: Objective: To exploere the ways of promoting the survival rate and the quality of life in premature infants. Methods :The clinical data on 228 cases of premature infants treated by neonatal wards were analyzed retrospectivelly. Results : The important factors of premature are cholestasis of pregnancy syndrome, premature rupture of membbranes, and hypertemsion in prefnancy. The commom diseases in premature infants are neonatal pnecemonia, hyperbilirubinemia and asphxia, the major factors in poor prognasis are caused by neonatal shock, multiple organ failure in premature infants. Conclusion :The main reasons of premature is maternal factors. It is important to strengthen the health care during pregnancy, control the complications of mothers actively, at the same time, improve the level of neonatal first aid, intervent early, so as to imprive the quality of life in preterm infants.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy.
MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence.
ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
ObjectiveTo explore the clinical features of myasthenia gravis (MG) harboring both acetylcholine receptor antibody (AChRAb) and muscle-specific tyrosine kinase antibody (MuSKAb) positivity.MethodsWe searched PubMed, Web of Science, Embase and China National Knowledge Infrastructure databases (from inception to November 2016), to collect the case reports of MG with both AChRAb and MuSKAb positivity. Along with one case discovered in Department of Neurology, West China Hospital, the clinical data of the cases were retrospectively analyzed.ResultsA total of 13 double-seropositive MG patients were enrolled in this study, demonstrating a marked female predominance (including 1 male and 12 females) and a younger age at onset [(31.07±24.77) years]. During the disease course, 10 of the included patients presented severe bulbar involvement, dyspnea and neck weakness, with myasthenic crisis in 6 individuals. Among the 11 patients with detailed records, abnormal thymus glands comprised 4 thymus hyperplasia and one thymoma. While the response to oral pyridostigmine was unsatisfactory in 11 double-seropositive MG patients, ranging from mild benefit to overt intolerance; the patients treated with plasma exchange (3/3), rituximab (1/1) or corticosteroid (7/12) improved dramatically, with other immumosuppressants and intravenous immunoglobulin partially responsive. Moreover, 5 patients undergoing thymectomy improved markedly or partially.ConclusionsCompared with MG patients with MuSKAb positivity merely, the condition of the double-seropositive MG patients seem to be more severe and further inclined to myasthenic crisis. The incidence of abnormal thymus, such as thymus hyperplasia, is higher. Thymectomy may be an effective treatment for such patients.
ObjectiveTo analyze the contact allergens of melanosis.
MethodsFifty-six patients confirmed with melanosis between June 2010 and October 2013 received patch test and BICOM test, and the results were analyzed statistically and clinical data of the included patients were retrospectively analyzed.
ResultsOf the 56 patients, 50 patch tests and 40 BICOM tests were positive. The top three chemical allergic resources in patch test of these patients were nickel sulfate (33.9%), aluminum (21.4%), and potassium dichromate (16.1%). The positive rates of male patients with aluminum, rubber compounds and cobalt chloride were significantly higher than those of females. The positive rate of female patients with nickel sulfate was significantly higher than that of males. The differences were all significant (P＜0.05) .
ConclusionNickel sulfate, aluminum and potassium dichromate may be the main allergens of melanosis.
ObjectiveTo explore the epidemiological and clinical features of hepatic hemangioma.
MethodsThe clinical data of patients with hepatic hemangioma who were diagnosed in the First Affiliated Hospital of Guangxi Medical University from 2003 to 2011 were retrospectively analyzed, and then analyzed the epidemiological and clinical characteristics of hepatic hemangioma.
ResultsEight hundreds and eighteen patients with hepatic hemangioma were included in the study.Among them, 398 cases (48.7%) were male, 420 cases (51.3%) were female, and there were no significant differences in constitute of gender for each year (χ2=9.912, P=0.271), but there were significant differences in constitute of gender between different age groups (χ2=18.791, P=0.000 1), male patients were more than female in the group of aged over 60 years old.There was no special clinical manifestations of hepatic hemangioma.There were 75 patients (9.2%) combined autoimmune diseases in this group.The size of hepatic hemangioma ranged from 0.5-39.0 cm, the median diameter was 3.0 cm.There were significant differences between different gender, the tumor size of female patients were larger than male's (P < 0.05).The tumor happened mostly in the right hepatic lobe (57.2%), and there were no significant differences of the tumor location in different gender (P > 0.05).Hepatic hemangioma with a single lesion was most common (70.0%), and the right lobe lesions were more common than the left lobe lesions in single lesion group, multiple lesions in double lobes were most common in multiple lesion group.
ConclusionsHepatic hemangioma has a certain distribution pattern in gender, age, size, position, and so on, further research in prevention and controlled strategy need to be carried out in the future.At the same time, more in-depth research in the related factors participated in occurrence and development of hepatic hemangioma also need to be carried out, especially for the relationship between gender, age, autoimmune diseases, and hepatic hemangioma, which is worthy to be discussed.
ObjectiveTo explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration.
MethodsThe clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation.
ResultsThree-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography.
Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.
ObjectiveTo analyze the clinical characteristics of acquired immune deficiency syndrome (AIDS) complicated with intracranial infection and to explore the nursing countermeasures.
MethodsWe retrospectively analyzed the clinical features, laboratory examination indexes, and nursing methods of 12 AIDS patients complicated with intracranial infection between January and December 2010.
ResultsIn the 12 patients, 8 were male, 4 were female; 11 were married and 1 was unmarried. The first symptom of headache occurred in 8 patients, and feverin 4 patients. Detection of HIV-1P24 antigen in all the 12 patients with HIV was positive for nucleic acid analysis. After treatment and symptomatic care, 3 cases were cured, 3 quit the treatment voluntarily, 2 improved patients were transferred to a higher-level hospital, 3 patients were readmitted to our hospital after improvement of the situation, and 1 patient died.
ConclusionThe most common symptom of AIDS was neural disease. The diagnosis should be based on clinical manifestations, and the epidemiological data should be used as reference. At the same time, attention should be paid to the admission assessment and good occupation protection, health education promotion, improvement of patients' quality of life, and reduction of the incidence of complications and mortality rate.
