上腔静脉肉瘤1例报告并文献复习

目的：总结原发性上腔静脉肿瘤的临床特点和手术治疗方案。方法：分析我院近年收治的1例上腔静脉肉瘤患者临床特点、鉴别诊断、手术治疗经过及随访结果。结果：患者行上腔静脉肉瘤切除＋上腔静脉-右房人工血管旁路术,术后患者生活质量良好,无任何临床症状,术后8个月人工血管血栓形成,再行人工血管及残余上腔静脉切除并无名静脉-右房人工血管旁路术,术后随诊3a,患者无复发。结论：提高上腔静脉肉瘤治愈率的关键是早期诊断和积极的外科治疗。     

31例巨大纵隔肿瘤的围术期护理

探讨巨大纵隔肿瘤切除术后围术期护理的方法。31例均完成手术切除,除纵隔肿瘤切除外,包括心包部分切除6例,上腔静脉人工血管置换5例,左无名静脉人工血管置换1例,上腔静脉及双侧无名静脉“Y”型血管置换2例,肺楔形或肺叶切除12例,全肺切除5例。本组患者1例死于心力衰竭,1例患者死于低血容量休克,余患者均治愈出院。31例患者经过合理的围术期护理,死亡率6％,预防和减低了术后并发症。     

上腔静脉综合征人工血管置换术中"Y"型旁路的应用

目的:探讨上腔静脉综合征(superior venacava syndrime,SVCS)行人工血管王换术中"Y"型旁路方法的应用效果.方法:对6例经上腔静脉造影检查证实的SVCS行人工血管置换术,术中先游离阻断上腔静脉近心端及远心端,用三通管连接3根腔静脉插管,在左、右无名静脉及右心耳之间建立"Y"旁路,无需放血措施降低上腔静脉压.结果:6例上腔静脉阻断时间最长3小时,术中均未输血,术后亦无脑损害观察发生.随访半年～5年,无复发及并发症.结论:在SVCS行人工血管置换术中应用"Y"型旁路,可有效预防颅内静脉系统高压所致的脑损害,增加了手术安全性.     

纵隔肿瘤的外科治疗体会

目的 总结纵隔肿瘤的诊断和外科治疗体会。方法 回顾分析139例纵隔肿瘤的手术方法及术后并发症的处理，手术方法包括单纯肿瘤切除，胸腺肿瘤切除合并纵隔脂肪扩大清除术，肿瘤侵犯肺叶楔形切除或肺叶切除术，上腔静脉置换术及无名静脉和上腔静脉成形术。结果 全组无死亡病例，术后复张性肺水肿3例，乳糜胸1例，肌无力危象5例，胆碱能危象1例，左无名静脉成形术后栓塞1例。结论 正确的围术期处理和手术方式的选择，可以提高纵隔纵隔肿瘤的治疗效果。     

1例颈内静脉、上腔静脉人工血管转流术患者的术后护理

胸部肿瘤侵犯上腔静脉、无名静脉时,过去曾经被认为是外科手术禁忌症[1].随着血管外科技术在胸部肿瘤外科手术中的应用,使部分肿瘤侵犯上腔静脉和/或无名静脉的患者得到根治性治疗[2].2010年5月,我院胸科成功完成了1例左右无名静脉切除,左侧颈内静脉、上腔静脉人工血管转流术,住院71d后痊愈出院,现报道如下.     

一例恶性胸腺瘤术后并发左侧颈内及无名静脉血栓形成的护理

胸腺瘤是上前纵隔最多见的纵隔肿瘤。按其细胞组织学结构可分为上皮细胞型、淋巴细胞型、混合型、上皮细胞癌和淋巴肉瘤。前3者中部分病例细胞组织形态上属于良性,但有恶性行为,手术时可见肿瘤侵蚀心包膜、胸膜或大血管表面〔1〕。我科于2007年3月收治了1例恶性上皮细胞型胸腺瘤患者,术中发现肿瘤侵蚀到左侧无名静脉,对其实施了“胸腺瘤切除、左侧无名静脉修补术”,术后第3天发现左侧颈内及无名静脉血栓形成,立即进行了抗凝、溶栓治疗,辅以有效的护理措施,获得了良好的效果,现将护理体会报告如下。1病例简介患者女,43岁,2007年2月体检时胸部…     

外科手术治疗侵袭性胸腺瘤侵犯大血管患者疗效

胸腺瘤从临床x线表现难以判断肿瘤的良恶性,侵袭性胸腺瘤是恶性胸腺瘤的一种类型,常侵入相邻软组织、肺部、大动脉、心包及心脏,左右无名静脉,上腔静脉、膈神经。目前倾向于用手术切除为主的综合治疗方案。作者自2000年12月至2009年12月对本院对收治的12例侵袭性胸腺瘤侵犯大血管患者行手术治疗,取得良好的效果。现报告如下。     

胸腺肿瘤的临床

胸腺(Thymus)为纵隔器官,上与颈部甲状腺相邻,于上纵隔内位于心脏、无名静脉、上腔静脉、主动脉弓前侧,双侧界于纵隔胸膜之间,可深入肺门区。胸腺在人体早年的生长发育期发挥重要生理功能,认为是与人体免疫有关的器官。本文主要介绍有关胸腺肿瘤的临床诊断与治疗。症状及诊断1.症状:胸腺肿瘤由于多数有侵蚀特征,所以早期呈压迫症状。较小的胸膜肿瘤可无临床症状,但多数有胸疼、胸闷和咳嗽。个别特别小的胸腺瘤只有手术时方能发     

1例肺恶性肿瘤合并上腔静脉人工血管置换术的护理

正肺部肿瘤直接侵犯上腔静脉和无名静脉表明原发肿瘤已属晚期,远期预后极差,手术根治切除难度大,技术要求高,以往曾被认为是外科手术的禁忌证~[1]。随着医疗技术的发展,部分肿瘤侵犯上腔静脉和无名静脉的病人能够得到根治性手术治疗。2016年10月本院普胸外科对1例肺恶性肿瘤侵犯上腔静脉病人行肿瘤切除合并上腔静脉人工血管置换手术治疗。现     

13例肺肿瘤切除并人工血管再造术患者的围手术期护理

目的探讨晚期肺部肿瘤切除并人工血管再造术后完善护理措施的临床意义。方法总结13例晚期肺部肿瘤侵犯上腔静脉和无名静脉患者行肺部肿瘤切除并人工血管再造术的围手术期护理,术前做好患者的心理护理,密切观察上腔静脉综合征的进展和血压的变化,注意低盐饮食,加强社会支持;术后密切监测呼吸血流动力学和中心静脉压,注意置换后上腔静脉回流及神经系统症状观察,做好抗凝护理,预防感染,明确出院指导等。结果13例均安全渡过手术期,术后2周内出院。结论术后采取准确有效的护理措施,有利于肺功能及早恢复和减少并发症的发生,是患者早日康复的保证。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.