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左股骨颈基底部骨折早期漏诊1例
患者,女,20岁,因左髋疼痛,活动不利1周,加重13 h入院。1周前曾因溜冰不慎滑倒,致左髋部疼痛不适,左腿行走不利,查左髋关节正位X线片示:左髋关节未见明显异常。口服活血止痛药对症治疗,症状缓解。昨夜患者坐立起身时突然跌倒,左髋关节疼痛明显,左腿活动障碍,来我院求诊。入院查体:左髋部轻度肿胀,局部压痛,活动障碍;左下肢外旋、短缩畸形,纵向叩击痛(+),浅感觉及肢端血循未见明显异常。行左髋关节正位片X线片示左股骨颈基底部骨折。对比前后两次髋关节正位线片发现,1周前X线片示左侧股骨头基底部有一模糊骨折线,骨折对位良好,故此病例应属早期“左股骨颈基底部骨折”漏诊病例。
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面神经腮腺内走行变异1例报道
1 病例介绍患者女性,28岁.右耳后肿物进行性增大10a余,以"右耳下肿物性质待查、腮腺混合瘤可能"收治入院.入院查体:右耳下触及约3.0 cm×3.5 cm大小肿物,质地硬,表面光滑,活动可,无触痛,边界清.
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放射性肠炎的营养支持(附二例报告)
目的观察2例盆腔肿瘤患者手术后行下腹部放射治疗,引起腹痛、腹泻及下腹部弥漫性化脓性蜂窝组织炎并肠梗阻,由于对食物没有进行科学选择,致腹泻不能控制,腹部切口裂开长18cm、深达腹膜,切口大量渗液患者行营养支持的效果.方法1.坚持TN+EN,对食物进行选择.水样泻期间,限制脂肪及蛋白类食物,配以无油炒面和藕粉,坚持限制脂肪、膳食纤维、乳糖及麦麸蛋白的膳食.2~3天控制了水样泻后,根据病人消化功能恢复情况,逐渐增加食物品种,谨慎地增加蛋白质和脂肪.2.计算每日TN+EN总热量,在腹部切口裂开大量渗液导致低蛋白血症期,每日补充白蛋白20~40克,低蛋白血症纠正后,调整减少用量.3.EN不足部分用百普素补充.2例应用百普素后,补充了EN不足的热量,迅速改善了病人营养状况,其中1例实施营养治疗13天后停TN,裂口渗液减少,新鲜肉芽开始生长.结果实施营养治疗后,2~3天控制水样泻.通过人体测量,体重在一个月内平均增长4kg,上臂肌围、三头肌皮褶厚度也相应增长.腹部切口一个月后渗液减少,肉芽生长,三个月伤口填平结痴.血液总蛋白、白蛋白、前白蛋白、血红蛋白等项化验,均有增长.结论营养支持对放射性肠炎能控制腹泻,改善病人营养状况,加速肠功能恢复,体重增长,提高血浆蛋白,促进裂口愈合,并可减少输血及输液量,疗效较满意.
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AIM To search for a new surgical method which accords with physiologico-anatomical principles, reducethe incidence rate of some postoperative complications in conventional Billroth I (CB1) gastrectomy andraise the life quality of patients after surgery.METHODS Using the blood vessels and innervation of the remaining stomach and duodenum, we designeda new pyloric sphincter reconstruction (PSR) in Billroth I gastrectomy, in which the end of the duodenumremnant is surrounded by the seromuscular valve of 2 cm wide in the end of the greater curvature, thickenedthe muscle of the stoma and reconstructed a similar pylorus with the sphincteric function.RESULTS Eleven patients were treated, 8 males and 3 females, 6 malignant and 5 benign and 1accompanied by mould infection, aged from 33 to 73 years, with 1 to 29 years of gastric disease history(average 7.9 years). The function of gastric emptying was shown to be essentially normal by barium mealstudy with video record one month after the operation. The pyloric-like control effect was present in thereconstructive pylorus. PSR vs CB1 vs NES (P >0.01); PSR vs CB1 (P < 0.01); PSR vs NSE (P >0.05).CONCLUSION The new method of pyloric reconstruction is safer, simpler and more effective thanconventional procedures. This method can be applied to all patients for whom Billroth 1 anastomosis can beperformed regardless of benign or malignant lesion.
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肺癌合并多发血栓患者抗凝治疗1例
Case presentationThe patient,a 60-year-old male,was admitted to the Chinese PLA General Hospital on Jun 1,2009,because of"cough,dyspnea and left chest pain for 2 months".He was diagnosed as poorly differentiated adenocarcinoma of left lung,with pleural and mediastinal lymph nodes,and bony metastasis.Chemotherapy was administered through retained peripherally inserted central catheters(PICC)at left brachiocephalic artery.On June 22,2009,the patient developed left upper limb edema.Ultrasoundexamination displayed venous thrombosis from ulnar vein to subclavian vein.
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射频导管消融术中异丙肾上腺素滴注时出现窦性停搏一例
患者男性,48岁.因反复发作性心悸20年,加重半年于2004年6月16日入院,心悸发作时心电图示阵发性室上性心动过速,心率200次/min,未见明显逆行P波,入院时血压120/80 mm Hg(1 mm Hg=0.133 kPa),心电图示窦性心律70次/min,肝肾功能、X线胸片、超声心动图未见异常.拟行射频导管消融术.
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POEMS综合征相关性肺动脉高压一例
患者男性,59岁,2007年6月开始出现双下肢乏力,活动后明显,伴纳差,体重下降.2008年6月开始出现双下肢浮肿,晨轻暮重,伴腹泻;乏力、纳差加重、体重减轻明显.到某医院就诊检查心脏超声提示:重度肺动脉高压伴重度三尖瓣反流,右心房、右心室增大,少量心包积液.
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A 34-year-old man with no history of any abdominal pain or fatigue was admitted to our hospital in June 2008 due to the cirrhosis found incidentally during a physical examination. Laboratory examination, electrocardiograph, abdominal ultrasonography and magnetic resonance imaging were carried out during his hospitalization. However, according to the results of the above measures, the diagnosis of nodular regenerative hyperplasia of the liver (NRHL) could not be made. The result of electrocardiograph showed there was no sinus bradycardia. The abdominal ultrasonography showed evidence of hepatosplenomegaly, and magnetic resonance imaging showed multiple non-enhancing hepatic nodules. Histologic conifrmation was available by means of liver biopsy and the deifnitive diagnosis of NRHL was conifrmed histologically by liver biopsy. NRHL always presents with signs of portal hypertension with little evidence of obvious liver disease, NRHL may mimick the cirrhosis of liver and be easily confused with cirrhosis of the liver nodules, so liver biopsy should be recommended for correct diagnosis. The clinical, radiological and pathologic features of this case with NRHL was reported in order to familiarize the physicians with its clinical manifestations.
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骨的原发性恶性淋巴瘤误诊1例报告
患者男性,11岁,因左大腿肿痛、无力20天入院.该患者于2001年5月因高热伴颈部肿块在儿科住院治疗,骨髓穿刺显示感染性骨髓象,诊断为1、颈部淋巴结炎;2、颈部蜂窝织炎;3、败血症.住院二个月后好转出院,出院时淋巴结消失,但仍有低热.一周后因上呼吸道感染而出现发热,达38~38.5℃,数天后热退,但出现左下肢无力、疼痛.门诊以左股骨上端骨髓炎收入院,查体见贫血貌,全身浅表淋巴结无肿大,左大腿中上段肿痛,皮温高于健侧,局部压痛,局部皮肤完好,无潮红.体温37.6℃.实验室检查显示:WBC12.3×109/L,N0.718,L 0.23,Hb108g/L,血沉105mm/h;X光片显示:左股骨上段粗隆部可见7×3.5cm的破坏区,呈溶骨样,边缘较模糊,内无死骨,无明显硬化,考虑为左股骨上端化脓性骨髓炎(图1).ECT显示:左股骨上端有浓集.
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Due to their relative abundance, stable biological properties and excellent reproductive activity,umbilical cord mesenchymal stem cells have previously been utilized for the treatment of Duchenne muscular dystrophy, which is a muscular atrophy disease. Three patients who were clinically and pathologically diagnosed with Duchenne muscular dystrophy were transplanted with umbilical cord mesenchymal stem cells by intravenous infusion, in combination with multi-point intramuscular injection. They were followed up for 12 months after cell transplantation. Results showed that clinical symptoms significantly improved, daily living activity and muscle strength were enhanced,the sero-enzyme, electromyogram, and MRI scans showed improvement, and dystrophin was expressed in the muscle cell membrane. Hematoxylin-eosin staining of a muscle biopsy revealed that muscle fibers were well arranged, fibrous degeneration was alleviated, and fat infiltration was improved. These pieces of evidence suggest that umbilical cord mesenchymal stem cell transplantation can be considered as a new regimen for Duchenne muscular dystrophy.
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大脑中动脉支架内血栓形成1例报告
支架内血栓形成是支架置入术后的一种常见并发症.术后血管内皮损伤、胶原组织暴露和作为异物的支架均为引发血栓形成的可能机制.不能及时识别处理则成为再狭窄的重要原因.
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A case of a fibrous histiocytoma (FH) of the larynx in a 54-year-old male is reported. Laryngeal fibrous histiocytoma is uncommon. The case recurred several times over 4-year period. Its pathology is described including arguments on potential malignancy and the way of management.
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上颌窦郎格罕细胞组织细胞增生症一例
患儿男,5个月.近10 d来发现右面颊部进行性膨隆,伴右眼睑肿,无明显鼻塞、流涕及发热史.体检:一般情况好,体温36.7℃,呼吸28次/min,脉搏120次/min.
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黑泥鳅导丝被前壁针切割落入肺动脉一例
患者 女,28岁,发现双下肢深静脉血栓形成,原因不明,行下腔静脉滤器置放术.术者采用SDN-18-7.0前壁针(Cook)穿刺右股静脉成功后,以RS A50K10SQ血管造影用鞘组内的0.035 in(1 in=2.54 cm)黑泥鳅短导丝(Terumo)引导上行,前进10 cm后受阻,在穿刺针位置未变情况下,退出导丝,发现导丝前段黑色塑料涂层被切割云一长条,中央金属丝清晰可见,判定被切割段已经下腔静脉回流入肺动脉,X线胸片证实被切割段在右下肺内带(图1).
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介入治疗舌癌粒子植入治疗后动脉大出血1例报告
1 临床资料患者耿某某,女性,71岁.2010年5月份因吞咽困难,经活检检查确诊为舌根腺癌.2010年9月于北京某医院行粒子植入术,术后口腔局部放射至头部疼痛,口服盐酸吗啡片以止痛.2010年11月12日于我院住院,主要症状为疼痛及口腔内有少量出血,予以静脉药物止血治疗.2010年11月16日患者出现口腔内大量出血,呈喷射状,血色鲜红,出血不止,出血量大,约400毫升.
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经导管动脉栓塞治疗良性前列腺增生症一例报道
经导管动脉栓塞治疗良性前列腺增生症(benign prostatic hyperplasi,BPH),文献报道较少,省内未见报道.兹报告我院栓塞治疗的良性前列腺增生症1例如下. 临床资料:患者男性,80岁.因不能自主排尿2年入院.患者2年前出现不能自主排尿、尿潴留;经直肠彩超显示前列腺明显增生、增大;CDFI血流丰富,诊断为前列腺增生症;因患者有脑梗塞病史(左侧肢体肌力0级),未能行外科手术治疗,经保守治疗,留置导尿管并定期更换,但患者反复出现尿道感染、疼痛现象;为缓解患者上述痛楚而行经导管动脉栓塞治疗.
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急性髓系白血病合并慢性淋巴细胞白血病一例报道及文献复习
急性髓系白血病(AML)合并慢性淋巴细胞白血病(CLL)在临床上很少见,其中绝大多数AML的发生与CLL治疗相关.AML合并未治疗的CLL更加少见,Michael等总结1970年~2000年的文献,共报道A M L或骨髓增生异常综合征(MDS)合并未治疗CLL26例.
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运动疗法配合穴位注射治疗肘关节挛缩一例
肘关节挛缩多因外伤或陈旧性损伤引发,关节周围软组织长期反复的炎症反应,术后瘢痕增生,形成组织粘连、挛缩,从而使关节活动受限.1 病例患者,女,68岁,当地农民,右肘关节有外伤史,9个月前右肘关节疼痛,日常生活能力受限,随后进入我院进行康复治疗.经检查,患者右肘关节红肿,触诊有压痛,肘关节呈70°屈曲位,前臂旋前,肱二头肌张力增强,肱二头肌反射亢进,被动伸展肘关节有肩关节代偿.
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用美罗华治疗恶性淋巴瘤发现亚急性肝坏死1例报告
患者,男,50岁,半年前因恶性淋巴瘤(非何杰金氏病)行右半结肠切除术.病故前用美国产美罗华(Mabthera)--利妥普单抗注射液进行化疗,每周1次,连续7周,剂量为100 mg/10 ml×2瓶、500 mg/50 ml×1瓶美罗华加入500 ml 0.9%生理盐水中,静脉滴注.利妥普单抗是一种联合鼠/人的单克隆抗体,适用于复发或化疗抵抗B淋巴细胞型的非何杰金氏淋巴瘤病人,其副作用仅观察到肝功能参数的轻微、暂时上升.
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急性敌敌畏中毒迟发周围神经病1例报告
敌敌畏为常用的有机磷农药之一,具有较高毒性,急性中毒后,可致迟发性神经病,现报道1例.患者,女性,30岁,工人.1996年10月14日患者因和家人争吵,服敌敌畏150 ml,意识丧失10 min,来院就诊.当时检查有瞳孔缩小、多汗、肺水肿、肌颤、昏迷等毒蕈碱样及烟碱样和中枢神经系统临床表现,并一度呼吸停止15min,确诊为急性重度敌敌畏中毒.经洗胃,应用阿托品、胆碱酯酶复能剂及对症抢救措施,得以获救.历时一周,中毒症状消失,患者述双手有轻度麻木感.住院18 d,因经济原因,应患者要求出院.随后患者出现四肢无力,痛觉过敏、精细动作发生困难,手不能持筷、系扣,以致四肢运动障碍,下肢较重,行走需人搀扶,遂于1996年11月8日再次入院.追问病史,既往体健,近期无发热或服药史.