敷磁治疗耳廓假性囊肿42例体会

Background:Auricularpseudocyst,whichisalsocalledserousperichondritisoftheauricle,isanasepticlocalserousin-flammatorymassintheperichondriumoftheauricle.Thecauseisunknown.Itisdifficulttobecuredwithachroniccourse,andmighttransformintosuppurativeperichondritisbecauseofincorrecttreatmentsuchasrepeatedpuncture,andevennecrosisoccurs,re-sultingindeformationoftheexternalear.Objective:Tostudythetherapeuticeffectofmagneticappli-cation.Unit:JianpingCountyHospital.Subjects:42patientswereincludedinthisst…     

软骨损伤与中耳术后耳廓化脓性软骨膜炎

目的：研究中耳术后耳廓软骨损伤与否与耳廓化脓性软骨膜炎的关系。方法回顾分析1453例行鼓室成型中耳手术患者的临床资料,其中行耳甲腔成型病例1083例（耳甲腔成型组）,非耳甲腔成型病例370例（非耳甲腔成型组）。比较2组并发耳廓化脓性软骨膜炎的发生率。结果耳甲腔成型组并发术后耳廓化脓性软骨膜炎12例,发生率为1.11%;非耳甲腔成型组并发术后耳廓化脓性软骨膜炎0例,发生率0.00%,2组比较差异有统计学意义（P＜0.05）。结论中耳手术中耳廓软骨损伤与耳廓化脓性软骨膜炎有一定的关系。     

18例耳郭巨大血管瘤治疗的临床观察

目的观察耳郭巨大血管瘤手术治疗的疗效。方法回顾性观察2005年至2011年收治的18例耳郭巨大血管瘤患者手术治疗后的疗效。结果 18例患者均治愈,重建耳郭成活,13例患者耳后区血管瘤一次治愈,耳前区血管瘤经多次平阳霉素注射或微波凝灼,基本治愈。术后6个月至1年有5例患者局部复发出现约米粒大小的数个小血管瘤,采用微波热灼治疗,追访1年未见局部复发。结论耳郭血管瘤的治疗手段众多,应依据血管瘤大小、发病部位、以及侵犯的范围选择合理的治疗方案,以最大限度去除血管瘤,保留耳郭形态。     

内剥切并局部注射治疗耳郭瘢痕疙瘩

背景：瘢痕疙瘩是创伤后皮肤异常修复的结果,表现为过度生长且进行性增大、侵犯邻近正常皮肤组织、常扩展到原伤口范围以外,单纯手术切除后极易复发,故需结合其他方法进行综合治疗。目的：探讨耳郭瘢痕疙瘩内核剥除术后及时局部注射的临床疗效。方法：20例耳郭瘢痕疙瘩患者,采用瘢痕疙瘩核心摘除术,并分别于术后逐渐拉长间隔时间,于切口瘢痕组织内注射氟尿嘧啶或曲安奈德加利多卡因混合或单独用药,必要时按瘢痕情况偶加用适量的复方倍他米松,视瘢痕的消退情况及时调节药物的注射剂量,观察治疗12个月到24个月。结果与结论：20例患者36个耳部瘢痕,其中有1个耳部瘢痕为效果有效,35个为耳部瘢痕为治愈。随访12-24个月,均无复发,有效率为100%,其中完全治愈者97%,效果良好者3%。结果表明,瘢痕疙瘩核心切除并利用其上皮瓣覆盖整形,联合氟尿嘧啶与糖皮质激素局部注射治疗耳郭瘢痕疙瘩是安全有效的方法。     

鼻内镜下尖牙窝联合进路治疗霉菌性鼻窦炎

目的 探讨鼻内镜下尖牙窝联合进路治疗霉菌性鼻窦炎的疗效。方法 对该科24例霉菌性鼻窦炎采用双进路手术方法治疗的疗效及随访结果进行分析。结果 24例霉菌性鼻窦炎采用鼻内镜下尖牙窝联合进路手术均获治愈。结论 鼻内镜下尖牙窝联合进路治疗霉菌性鼻窦炎可达到根治和微创的效果。     

颅中窝底硬膜外血肿的早期手术治疗

目的 分析49例外伤性颅中窝底硬膜外血肿的临床及CT表现与手术治疗效果。方法 对49例外伤性颅中窝底硬膜外血肿患者的临床资料进行回顾性分析。结果 49例外伤性颅中窝底硬膜外血肿中，出现脑干周围池形态改变31例，其中手术治疗23例，治愈17例，死亡6例；保守治疗8例，其中死亡6例(4例恶化后转手术)，治愈2例.未出现脑干周围池形态改变18例，均保守治疗，结果 治愈9例;后因病情恶化改手术治疗，治愈7例，死亡2例。结论 外伤性颅中窝底硬膜外血肿不同于一般的幕上硬膜外血肿，容易出现脑干周围池的改变，故应及早、积极地进行手术治疗。     

猪尾导管心包引流治疗浆膜腔炎患者改善生存质量的观察

Severelymultipleserouscavityinflammationdefyinterventioninclinic．Mostpatientswithseverelymultipleserouscavityin－flammationdiedofcardiactampondate，whichaffectsprognosis．Inrecentyears，itwasreportedthateffectsofdrainageonma－lignantcardiaceffusionweresatisfying．Whetherdrainageisef－fectiveintreatingmultipleandsevereserouscavityinflammationremainsunknownandnorelatedreportsisavailable．Incombina－tionwithintracardiacdepartment，wesuccessfullytreatseverelymultipleserouscavityinflammationafterc…     

胎儿第四脑室发育在产前超声鉴别颅后窝异常的临床应用

目的研究中孕期胎儿第四脑室形态与大小在鉴别颅后窝异常诊断中的临床应用价值。 方法根据笔者既往建立并报道的第四脑室正常值测量数据作为第四脑室大小的评价指标,结合胎儿颅脑异常的超声图像、第四脑室形态与大小测值,对2013年1月至2017年12月四川省妇幼保健院产前超声诊断为颅后窝异常58例单胎胎儿的临床资料进行分组研究。第1组,第四脑室增大24例;第2组,第四脑室缩小或消失7例;第3组,第四脑室形态与测值正常27例。总结3组颅后窝异常胎儿临床结局。 结果第1组24例胎儿中Dandy-Walker畸形15例,超声形态与测值：以第4脑室横径增大为主,横径测值均位于同孕周两倍标准差之上;交通性脑积水9例;超声形态与测值：第四脑室横径、前后径、周长及面积均位于同孕周胎儿两倍标准差之上。第2组7例胎儿中Arnold-ChiariⅡ畸形3例,菱脑融合3例,Joubert综合征1例;超声形态与测值：第四脑室横径、前后径、周长、面积均位于同孕周两倍标准差之下。第3组27例胎儿中后颅窝池增宽10例,颅后窝蛛网膜囊肿3例,第四脑室以上部位梗阻导致脑积水8例,永存Blake陷窝囊肿6例;超声形态与测值：第四脑室横径、前后径、周长及面积均在正常范围内。临床结局：3组58例产前诊断颅后窝异常的胎儿超声或（和）磁共振检查后29例孕妇选择终止妊娠在外院引产,19例孕妇继续妊娠至胎儿正常出生。产后磁共振成像,引产后尸检证实产前超声诊断与产后检查结果均符合。 结论第四脑室形态与大小测值在产前超声评价颅后窝异常中有重要价值。第四脑室增大、减小甚至消失是颅后窝严重畸形的线索,是预后不良的指标之一。更大样本量,更广孕周范围的研究有可能进一步证实本研究得出的结论。     

50例胎儿颅后窝异常的超声诊断及预后分析

目的分析胎儿颅后窝异常超声诊断准确性及预后表现。 方法对2015年8月至2018年3月于首都医科大学附属北京妇产医院超声检查提示颅后窝异常50例胎儿的二维和三维超声图像进行分析,总结不同种类颅后窝异常胎儿产前超声声像图特点,与胎儿颅脑磁共振检查、出生后检查及随访结果对照,分析超声诊断胎儿颅后窝异常的准确性。 结果50例颅后窝异常胎儿经三维超声检查最终提示Dandy-Walker畸形8例,小脑蚓部发育不良8例,Blake′s陷窝囊肿6例,小脑发育不良5例,颅后窝蛛网膜囊肿9例,单纯小脑延髓池增宽13例,小脑蚓部形态异常1例。其中26例胎儿颅脑磁共振检查证实23例与产前三维超声提示诊断相符合,2例与产前三维超声提示诊断不符合,1例胎儿颅脑磁共振检查对超声诊断进行了补充。妊娠结局：50例胎儿经超声及颅脑磁共振检查后,24例孕妇选择终止妊娠（5例失访）;26例孕妇继续妊娠（小脑蚓部发育不良和小脑发育不良各1例,Blake′s陷窝囊肿4例,颅后窝蛛网膜囊肿7例,单纯性小脑延髓池增宽13例）。其中1例小脑蚓部发育不良胎儿出生后诊断为Joubert综合征,余25例胎儿预后良好。诊断准确性：与胎儿颅脑磁共振及出生后检查随访结果相比,产前二维超声诊断准确率为62.2%（28/45）,产前三维诊断准确率为88.9%（40/45）。 结论不同种类颅后窝异常（Dandy-Walker畸形、小脑蚓部发育不良、Blake′s陷窝囊肿）产前二维超声图像上表现相似,产前三维超声对颅后窝异常疾病分类及诊断有重要意义。     

The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache

The administration of nitroderivatives in cluster headache (CH) sufferers is the most reproducible experimental paradigm to induce spontaneous-like pain attacks. Previous uncontrolled studies have reported that the local use of anaesthetic agents in the area of the sphenopalatine fossa is able to extinguish nitroglycerin (NTG)-induced pain in CH. The present study, carried out according to a double-blind placebo-controlled design, included 15 CH patients, six with episodic CH (mean +/- SD age of 36.8+/-5.6 years), and nine with chronic CH (37.8+/-10.4 years). Patients had undergone a standard NTG test (0.9 mg sublingually), during which the intensity of pain was scored using a visuoanalogic scale (VAS, range 0-10). Nine patients (two with the episodic form, seven with the chronic form) experienced a typical, spontaneous-like attack on the usual side, occurring in all cases within 45 min. In these patients, the test was repeated with an interval of 2 days, and once pain intensity reached 5 on the VAS, a 10% solution of cocaine hydrochloride (1 ml, mean amount per application 40-50 mg), or 10% lidocaine (1 ml), or saline was applied using a cotton swab in the area corresponding to the sphenopalatine fossa, under anterior rhinoscopy. This was done in both the symptomatic and the non-symptomatic side, for 5 min. Treatments were always performed randomly, in separate sessions. All patients responded promptly to both anaesthetic agents, with complete cessation of induced pain occurring after 31.3+/-13.1 min for cocaine and 37.0+/-7.8 min for lidocaine (M+/-SD). In the case of saline application, pain severity increased thereafter, and extinction of the provoked attacks occurred with a latency of 59.3+/-12.3 min (P<0.01 and P<0.01 vs. cocaine and lidocaine, respectively, Mann-Whitney U-test). While further suggesting that the sphenopalatine ganglion participates in the mechanisms of pain, these findings indicate that the local administration of the anaesthetic agents cocaine and lidocaine is effective on NTG-induced CH attacks, and may be used in the symptomatic treatment of this disorder.     

烧伤后膝关节的运动功能维护与康复护理

目的研究运动功能维护与康复护理在烧伤后膝关节功能恢复中的应用。方法对68例膝关节深度烧伤(包括月国窝周围皮肤烧伤)患者进行运动功能维护及康复护理。结果 68例患者中,治愈56例,占82.4%;显效9例,占13.2%;有效2例,占2.9%。结论对膝关节深度烧伤(包括月国窝周围皮肤烧伤)患者进行运动功能维护及康复护理可有效防治膝关节僵硬、肌肉萎缩、挛缩畸形,提高患者的生存质量。     

CO_2激光治疗肛管-直肠下端尖锐湿疣疗效观察

目的观察2点麻醉法下CO2激光治疗肛管-直肠下端尖锐湿疣的效果。方法对286例肛管-直肠下端尖锐湿疣患者进行肛门2点法麻醉下的CO2激光治疗,并进行末次治疗后6个月的随访。结果 1次治疗痊愈55例占19.2%,2次治疗痊愈75例占26.2%,3次治疗痊愈97例占33.9%,3次以上治疗痊愈53例占18.5%,6例伴HIV感染者失访,无并发症。结论 2点麻醉法CO2激光治疗肛管-直肠下端尖锐湿疣简单、安全、方便,患者痛苦小。     

得宝松局部治疗耳廓囊肿的疗效观察及护理

目的探讨治疗耳廓假性囊肿既有效又能被病人接受的一种方法。方法将患耳廓假性囊肿的60例病人随机分为治疗组和对照组,每组30例。治疗组采用囊肿穿刺抽液后局部注射得宝松的方法,对照组采用囊肿穿刺抽液后石膏固定法,同时做好相应的护理;比较2种方法的治疗效果。结果2种方法有效率均为100%(差异无显著性),但治疗组因避免了对照组外观上(石膏的颜色)的不足及耳部不适,病人容易接受。结论得宝松局部注射治疗耳廓假性囊肿操作简单,做好相应的护理能取得满意的疗效,且方便、快捷,值得临床推广。     

Unusual imaging appearances of pancreatic serous cystadenoma: correlation with surgery and pathologic analysis

Background We describe imaging and pathologic features of serous cystadenoma of the pancreas on multislice helical computed tomography CT (MS-CT) and surgical resection. Methods Radiologic and pathologic features were analyzed in five patients. All patients underwent MS-CT and digital subtraction angiography (DSA), and four patients underwent magnetic resonance (MR) imaging. Preoperatively, three cases showed radiologic evidence of mainly solid appearance on MS-CT, and the suspected diagnoses were solid pancreatic tumors (patients 1–3). The other two cases showed radiologic evidence of macrocystic tumor of the pancreas, and the suspected diagnoses were mucinous cystic tumors (cases 4 and 5). All patients underwent surgery, and the diagnosis of serous cystadenoma was confirmed on pathologic examination. Results In three cases that showed a solid appearance on MS-CT, a microcystic appearance was identified on microscopic examination, and the tumors were found to be hypervascular lesions on multiphasic contrast-enhanced CT and DSA. In cases 1 and 2, the lesions showed high intensity with internal septation on T2-weighted MR images. In two cases, the tumors were classified as a macrocystic variant of serous cystadenoma, and no mural nodules, papillary projections, or calcifications were seen in the tumors. Conclusion Imaging appearance of serous cystadenoma on MS-CT is various and sometimes indistinguishable from that of solid tumor or mucinous cystic tumors of the pancreas. Imaging findings of hypervascularity and a well-marginated high-intensity lesion with internal septation on T2-weighted MR imaging may be crucial to identify serous cystadenoma that contains no visible cystic compartments on MS-CT.     

176例外伤性脑脊液漏的临床分析

【目的】了解颅底骨折部位及其与脑脊液漏发生之间的关系，探求有效的治疗方法。【方法】分析近9年来本院收治的716例颅底骨折患者脑脊液漏的发生率、发生部位、治疗方法及效果。【结果】脑脊液漏共176例，发生率为24．6％。发生于前颅窝者112例，中颅窝者46例，前中颅窝者18例。150例经保守治疗痊愈，26例手术治疗，其中20例经一次手术痊愈，6例经二次手术痊愈。26例手术病人中，有10例和五官科医师合作在鼻内窥镜下结合腔内摄像系统经鼻行脑脊液漏修补一次成功，其中包括经颅内修补失败后4例经鼻内窥镜手术成功。【结论】颅底骨折部位，脑脊液漏口大小。决定了治疗方案的选择。鼻内窥镜下手术具有副损伤小。瘘孔定位准确．可作为脑脊液漏治疗的一种补充手段。     

支气管哮喘急性发作并发气胸的临床特点分析

目的：探讨支气管哮喘急性发作并发气胸的临床特点。方法：对２４例支气管哮喘并发气胸的患者，从哮喘程度与病程、诱发因素、临床表现、Ｘ线胸片检查、气胸类型、治疗及转归等方面进行综合分析。结果：本组并发气胸者以中或重度哮喘、病程超过１２年且有明显发病诱因（剧咳、呕吐、用力）者为多，所占百分比分别为３３．２％、４５．９％、６３．０％和６６．７％；气胸临床症状不典型，９５．８％经Ｘ线胸片确诊，４５．８％为张力性气胸。２４例均治愈出院。结论：支气管哮喘急性发作应高度警惕并发气胸的可能。一经确诊，迅速有效地排气减压是抢救患者生命的关键。     

晚期肝硬化患者输液渗漏的原因分析及对策

目的探讨更适合晚期肝硬化患者输液渗漏的应对措施。方法对96例晚期肝硬化患者输液渗漏进行有目的的护理观察、评估、处理、评价。结果66例水肿在24h内完全恢复，17例在48h内水肿消散吸收；9例在72h内消散吸收；3例局部出现水泡，经抗菌对症处理后治愈，无疤痕形成；仅1例局部发生坏死，渗漏2d后患者死亡，死亡前恢复不明显。结论早期发现、及时处理、积极预防能有效减少晚期肝硬化患者输液渗漏及并发症的发生。     

老年性蛛网膜下腔出血非典型症状30例分析

CLINICAL DATA Subjects came from 30 patients with senile subarachnoid hemrrhagetreated in our hospital from January 1999 to December 2001 in-cluding 12 males and 18 females aged 60-78(mean: 65) yearsold. 24 patients presented with onset in action, 6 patients at rest; 26cases presented with acute onset and 4 cases subacute onset. Acuteheadache as first symptom was in 13 cases; pain at neck, waist,sacral as first symptom in 7 cases. 3 patients searched medical ser-vice for headache within 1 week; 2 patients for severe pain of bothlimbs and unable to walk; 2 patients for headache and vomiting at 2week. 7 patients were once treated out of our hospital and sciaticawas diagnosed in 4 cases, cold in 3 cases. Pain at shoulder, back,upper limb in action occurred in 2 cases as first symptom, consciousdisturbance was the first symptom in 4 cases, grand mal of epilepsyas first symptom in 3 cases. 1 patient searched medical service forright head pain, auricle pain for 20 days. Stiff neck ( + ) appeared in25 patients at hospitalization and (-) in 5 patients. 24 patientspresented with positive Kernig' s sign. 21 patients were complicatedwith hypertension, 1 patient was complicated with peripheral facialparalysis and left hemihypoesthesia, 3 patients with transient hemi-paresis of both lower limhs, 2 cases with bilateral ptosis, 1 case withexotropia of bilateral eyeball, pupil dilation, 6 cases with consciousdisturbance. Auxilliary examination: (1) Skull CT scanning: Sub-arachnoid hemorrhage was found in 20 cases, no abnormality in 7cases and 3 cases didn't undergo CT scanning. (2) Examination ofspinal fluid: patients with positive CT findings didn' t undergo lumbarpuncture, even hemic spinal fluid was found in 6 patients and yellowspinal fluid and shrinking red blood cell in 4 cases. Prognosis: Allcases were treated according to subarachnoid hemorrhage, 6 patientsdied and other 24 patients were cured after 6 - 8 weeks of treatment.     

基于TCGA数据库分析GADD45B基因在卵巢浆液性囊腺癌中的表达及其临床价值

目的:利用TCGA数据库探讨生长停滞和DNA损伤诱导基因β(growth arrest and DNA damage-inducible geneβ,GADD45B)的基因表达与卵巢浆液性囊腺癌临床特征的相关性及其在卵巢浆液性囊腺癌预后分析中的价值。方法:下载TCGA数据库中604例卵巢浆液性囊腺癌患者的临床信息及307例卵巢浆液性囊腺癌患者的RNA测序数据,利用卡方检验和t检验分析GADD45B表达与卵巢浆液性囊腺癌临床病理特征的相关性,利用Kaplan-Meier法分析GADD45B表达与卵巢浆液性囊腺癌总生存时间的相关性,利用单因素和多因素COX回归分析GADD45B是否可以作为卵巢浆液性囊腺癌预后分析的独立分子标志物,利用qRT-PCR检测GADD45B在多药耐药卵巢癌细胞及对照卵巢癌细胞中的表达。结果:GADD45B表达与卵巢浆液性囊腺癌的国际妇产科联合会(International Federation of Gynecology and Obstetrics,FIGO)分期、肿瘤大小、肿瘤在卵巢的浸润情况、初次化学药物治疗效果及生存情况均显著相关,且与卵巢浆液性囊腺癌的总生存时间显著负相关;多因素COX回归分析示:只有年龄和初次化疗效果可以作为卵巢浆液性囊腺癌的独立分子标记,同时qRT-PCR发现GADD45B在多药耐药卵巢癌细胞中显著升高。结论:GADD45B在耐药卵巢癌细胞中显著升高,其高表达与卵巢浆液性囊腺癌预后不良及化疗耐药明显相关,可作为分析卵巢浆液性囊腺癌预后的有效分子标志物。     

血液透析与肾移植患者肾性骨病的转归

背景慢性肾功能衰竭患者肾性骨病的防治直接关系到患者的长期存活,因此,对比血液透析与肾移植治疗肾性骨病差异的研究十分有意义.目的观察维持性血液透析(maintenance hemodialysis,MHD)及肾移植患者治疗前后血磷及甲状旁腺激素(parathyroid hormone,PTH)的变化,探讨肾性骨病的治疗和转归.地点、对象和方法选取解放军第四军医大学西京医院血液透析中心符合肾性骨病l临床诊断标准均有高磷血症及高PTH血症的慢性肾功能衰竭患者,分为MHD组、肾移植组,每组20例.另选20例健康人作对照.MHD组行MHD,肾移植组行同种异体肾移植且术后肾功能恢复良好.主要观察指标两组患者透析及移植前后血磷及PTH水平比较.结果两组患者透析或移植后,血磷和PTH浓度均显著下降,与透析及移植前比较,差异有非常显著性意义(t=3.5l,P＜0.001),但MHD组透析后血PTH浓度[(278.20±95.84)ng/L]仍高于正常对照组[(21.60±16.60)ng/L],而且下次透析前血磷和PTH浓度又恢复至高水平.结论MHD组患者透析后血磷和PTH水平仍高于健康人,肾移植后患者血磷和PTH浓度与健康差异不大,肾移植是治疗肾性骨病最有效的方法.