细菌性肝脓肿37例诊治体会

目的提高对细菌性肝脓肿的诊治水平。方法回顾分析2005年²013年我院诊治的37例细菌性肝脓肿病例临床资料。结果多数患者以高热、右上腹痛、肝区叩击痛为主要临床表现。B超及CT是首选而有效的影像学检查方法,绝大部分病例血常规检查示白细胞不同程度升高。细菌来源最常见为隐源性(51.4%),其次为胆源性(32.4%)。细菌学检查以肺炎克雷伯杆菌、大肠埃希菌为主。经保守治疗,以及B超或CT引导下经皮肝脓肿穿刺和(或)置管引流是安全有效的治疗措施。结论细菌性肝脓肿以隐源性及胆源性感染多见,主要致病菌为肺炎克雷伯杆菌、大肠埃希菌。细菌性肝脓肿的治疗应采取个体化治疗。     

细菌性肝脓肿33例临床分析

目的 探讨近年来肝脓肿的病因、病原菌及治疗方式的变化.方法 回顾性分析1999年～2006年33例肝脓肿患者的临床资料.结果 肝脓肿多见于老年人,右肝多见(24/33).保守治疗22例,B超定位穿刺引流21例,1例14个月后死于肝癌并肺转移,手术引流11例.隐源性肝脓肿22例,其中合并糖尿病7例,胆道疾患为致病因素11例.结论 细菌性肝脓肿以老年患者为多,糖尿病已成为肝脓肿患者的一个独立的易患因素,胆道疾患为主要的致病因素,致病菌亦有变异;肝脓肿久治不愈应怀疑肝癌.     

32例肝脓肿诊治分析

近年来肝脓肿的发病率呈下降趋势 ,我院从 1992年 3月至 1999年 12月共收治肝脓肿 32例 ,现将治疗情况报告如下。1　临床资料本组 32例 ,男 19例 ,女 13例 ;年龄 14～ 84岁 ,平均 38岁。发病部位 :肝右叶 2 2例 ,肝左叶 4例 ,左右两叶 6例 ,其中多发性肝脓肿 6例。发病时间最短 3天 ,最长半年。其中胆源性肝脓肿 14例 (慢性胆囊炎、胆石症 8例 ,肝内胆管多发性结石 3例 ,胆道蛔虫症 3例 ) ,细菌性肝脓肿 12例 ,隐源性肝脓肿 4例 ,阿米巴肝脓肿 2例。伴其它疾病 :血吸虫性肝病 3例 ,右下肺炎 2例 ,右胸腔积液 3例 ,糖尿病 2例 ,尿毒症 1例。…     

糖尿病合并肝脓肿手术时机及手术方式的选择

目的探讨糖尿病合并肝脓肿患者手术时机及手术方式的选择。方法北京市通州区潞河医院1998年9月～2009年10月收治的36例糖尿病合并肝脓肿患者中,手术治疗21例;B超引导下穿刺引流8例;腹腔镜下引流3例;非手术治疗4例。手术治疗21例中,单纯脓肿引流12例,脓肿引流＋胆囊切除7例,脓肿引流＋胆囊切除＋胆总管探查2例;腹腔镜治疗3例中,单纯脓肿引流2例,脓肿引流＋胆囊切除1例。结果手术死亡2例;非手术治疗死亡1例;B超引流中3例引流不畅,重新手术治疗,其余患者均治愈。结论糖尿病合并肝脓肿病情复杂,要根据患者情况、脓肿位置、大小、数目、有无合并症,合理选择手术时机及手术方式。     

19例艾滋病合并新型隐球菌性脑膜炎患者临床分析

目的:分析19例艾滋病(AIDS)合并新型隐球菌性脑膜炎(CNM)患者的临床特点及治疗效果。方法:收集2015年1月至2017年7月在我院住院治疗的19例AIDS合并CNM患者,回顾性分析患者的临床特点及治疗效果。结果:19例患者临床特点主要为头痛、呕吐、颅内压增高;实验室检查墨汁染色可见隐球菌或者脑脊液培养可见隐球菌;通过单药使用两性霉素B或两性霉素B联合氟康唑治疗,好转出院无复发仅7例(36.8%),死亡7例(36.8%),因经济困难放弃治疗5例(26.3%),其中死于多脏器功能衰竭2例(10.5%),脑疝3例(15%)。结论:CNM好发于AIDS病人,发病隐匿,但具有一般症状及神经系统症状,可通过查找或培养出隐球菌确诊,药物治疗效果差,死亡率高。     

重症急性胆源性胰腺炎患者的抗感染治疗方案分析

目的对临床药师参与的1例重症急性胆源性胰腺炎患者的抗感染治疗方案进行分析,提高消化内科临床药师的药学服务水平。方法全程药学监护1例重症急性胆源性胰腺炎患者的治疗,并对其抗感染治疗方案进行分析。结果胰腺假性囊肿合并感染时,经积极地清除脓肿、引流及抗感染治疗,患者病情明显好转。结论通过有效的药学监护服务,临床药师在优化患者的药物治疗方案中可以发挥重要作用。     

急性胆源性胰腺炎的内镜治疗

目的 探讨急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的内镜治疗。方法 对我院1998年3月至2003年3月收治的急性胆源性胰腺炎92例首先行内镜下乳头括约肌切开取石(EST),同时置入鼻胆管引流(ENBD);合并胆囊结石者,待胰腺炎恢复后,施行腹腔胆囊切除术(LC)。结果 全组92例中,53例胆管结石行EST取出,所有病人均行ENBD;胰腺炎顺利治愈88例,治愈率95．6％;合并胆囊结石67例,恢复期行LC,均顺利切除胆囊治愈;经非手术治愈23例占25％;行腹腔镜探查手术69例占75％。结论 EST ENBD能有效治疗急性胆源性胰腺炎,伴胆囊结石者联合应用LC,是目前理想的治疗方法。     

超声介入治疗糖尿病肝脓肿的临床疗效及安全性分析

目的:分析超声介入治疗糖尿病肝脓肿的临床效果和安全性。方法:对2017年6月～2020年1月期间在某院治疗的60例糖尿病合并肝脓肿患者进行回顾分析,所有患者均在超声引导下进行介入治疗,根据脓液引流方法分为对照组和观察组各30例,对照组采用穿刺抽吸方式(PA),观察组采用置管引流方式(PCD),观察两组的并发症、临床疗效及治疗前后的血糖控制情况。结果:治疗后,患者血糖均明显改善,与治疗前比较差异有统计学意义(P0.05),但两组血糖控制情况无差异(P0.05);两组患者治疗总有效率均为96.67%,差异无统计学意义(P0.05);两组的体温和白细胞恢复正常时间及并发症比较差异均无统计学意义(P0.05),观察组一次性穿刺治愈率(100%)明显高于对照组(66.67%),对照组脓腔闭合时间(8.24±3.13)d短于观察组(17.11±7.25)d,差异均有统计学意义(P0.05)。结论:糖尿病合并肝脓肿患者在超声引导下行介入治疗,具有操作简单、并发症少、安全性高、疗效显著等优势,具有临床研究价值。     

医院细菌性肝脓肿患者病原菌分布、耐药性及危险因素分析

目的 研究医院细菌性肝脓肿(PLA)患者病原菌分布、耐药性及危险因素.方法 回顾性分析医院从2017年1月～2020年10月收治的672例PLA患者的临床资料以及病原菌分布、耐药性情况.此外,将所有受试者按照病原菌的差异分作A组(肺炎克雷伯菌所致肝脓肿)271例及B组(除肺炎克雷伯菌外其它病原菌所致肝脓肿)401例.分...     

胆源性肝脓肿的介入治疗

本院对10例胆源性肝脓肿患者采用经皮穿刺脓肿引流或同时行胆道支架置入治疗,疗效满意.报告如下.     

外科治疗老年人胆囊炎胆石症安全因素分析

目的 总结分析外科治疗老年人胆囊炎胆石症的安全因素及经验。方法 对41例胆囊炎胆石症老年患者的围手术期处理、手术时机、手术方式(方法)、术后并发症的处理和预防等进行总结分析,寻找外科治疗老年人胆囊炎胆石症的安全方案。结果 全组治愈39例占95．12％,死亡1例(死因为感染性休克并多器官功能衰竭),术后自动出院1例。术后发生并发症11例占26．83％,多为肺部感染、切口裂开或感染、心衰、泌尿系感染等。结论 要重视老年人胆tt炎胆石症的外科治疗,尤其是围手术期的处理、手术时间、手术方式、术后并发症的处理和预防,均是提高治疗老年人胆囊炎胆石症的安全措施因素。     

Contribution of bee venom phospholipase A2 contamination in melittin fractions to presumed activation of tissue phospholipase A2

Melittin from bee venom has been suggested to activate tissue phospholipase A2 (PLA2) activity, and subsequently has been used as a specific PLA2 probe. The melittin in most cases was obtained commercially and used without further purification or treatment. To test the hypothesis that commercially obtained melittin specifically activates tissue PLA2, we radiolabeled the lipids of immortalized epithelial cells by incubating the cells for 22 hr with 14C-linoleic acid. The cells were then incubated with 2 microM melittin, 2nM bee venom PLA2, 2 microM melittin treated with p-bromophenacyl bromide (p-BPB) or PLA2 plus p-BPB-treated melittin. Lipids were extracted and separated by thin-layer chromatography. The radioactivity in each lipid fraction was then quantitated. The melittin-stimulated PLA2 activity observed in cells was primarily associated with phosphatidylcholine. Fatty acid release was decreased by 75% when the melittin fraction was pretreated with p-BPB to reduce contaminating venom PLA2 activity. Adding PLA2 to the p-BPB-treated melittin at an amount about equal to the original contamination (0.1%) resulted in the same PLA2 activity in cell as observed with the untreated melittin fraction. These findings suggest that bee venom PLA2 contamination, even at very low levels, can account for approximately 75% of the PLA2 activity in cells treated with commercial melittin fractions.     

Polymyositis-dermatomyositis:25 years of follow-up of 50 patients disease course, treatment, prognostic factors

Therapeutic results were analysed in 50 patients, including 17 with polymyositis (PM) and 30 with dermatomyositis (DM). All patients were treated with prednisone (Encorton, Polfa) and 47% of patients with PM and 73% with DM required combined treatment with prednisone and cytostatic agents, mostly with cyclophosphamide (Endoxan G.D.R.). Long-term treatment monitored with the clinical status led to remissions persisting after treatment discontinuation in 17.6% of PM patients and 24.2% of DM patients. In 64.7% of PM patients and 57.6% of DM patients regression of the clinical signs of the disease was achieved but these patients required further treatment. No information was obtained on 5 cases. Four DM patients died. The cumulative 17-year survival rate of PM patients was 100%, and that of DM patients was 78.8% . In 45 follow-up cases, the mortality was 8.9%. Side effects of the combined treatment included most frequently mucosal candidiasis (22.2%), transient leucopenia (14.8%) and recurrent respiratory tract infections (11.1%). In 5 cases liver biopsy was done and histological examination disclosed moderate fatty, glycogen and vacuolar degeneration of the hepatocytes. The statistical analysis of prognostic factors such as the diagnosis of PM or DM, sex, age at disease onset, disease duration till diagnosis establishing and beginning of treatment, fever, dysphagia, circulatory and respiratory changes, leucocytosis nad ESR at the beginning of the disease showed that sex (female), older age at disease onset and respiratory system changes may be accepted as poor prognosis factors.     

Beneficial effects of preventive cholecystectomy in patients with hepatic cancer

There is no conclusive answer to the question whether excising gall bladder is helpful to the patient with hepatic cancer. The survival rate of patients with hepatic cancer for more than two years has been increased, and the incidence of complications of cholecystitis and gall stone are relatively higher among these patients, which may seriously complicate treatment of advanced hepatic cancer and decrease quality of life. The researchers conducted a prospective clinical investigation from 2002 to 2006 to assess the clinical significance of preventive cholecystectomy in patients with hepatic cancer. One hundred and eighteen cases of postoperative patients with hepatic cancer, who survived for more than two years, were followed up. Based on whether cholecystectomy was performed, the patients were divided into two groups including 48 cases with cholecystectomy and 70 cases with cholecyst reserved. The two-year morbidity of gall stone and morbidity of pain in the right upper abdomen of cholecyst reservation group were 54.29% and 68.57%, respectively, obviously higher than 0.00% and 20.83% of cholecystectomy group. Mainly for those treated with transcatheter arterial chemo-embolization, the morbidity of gall stone was 86.67% (P < 0.01). Therefore, preventive cholecystectomy is strongly recommended during hepatectomy to decrease the incidence of chronic cholecystitis and gall stone, especially for those whose chemotherapy and embolization will be carried out through hepatic artery and portal vein.     

儿童气管支气管异物120例诊治分析

目的 总结儿童气管、支气管异物的临床诊断与治疗方法.方法 回顾性分析经直达喉镜、硬质气管镜确诊的120例儿童气管支气管异物的临床表现、影像学改变及异物取出方法.结果 120例气管支气管异物中,109例患儿有异物吸入史;120例患儿有侵入综合征;气管拍击音在气管异物中的出现率为66.7%(26/39);59例患儿X线胸部透视下呼气时可见纵隔向健侧摆动,均被气管镜确诊有异物;经CT诊断的气管支气管异物准确率为86.2%(25/29);均行喉镜、支气管镜检查加异物取出术而得以确诊和治疗,119例异物被成功取出,1例转胸外科治疗.结论 异物吸入史、侵入综合征、气管拍击音和X线检查中的纵隔摆动是诊断气管支气管异物的重要证据,胸部CT诊断气管支气管异物准确率较高,直达喉镜气管镜检查是确诊气管支气管异物重要方法;直达喉镜、硬质气管镜下气管异物取出术是治疗气管支气管异物的有效方法.     

Successful treatment of gallbladder neuroendocrine carcinoma with combined chemo-radiotherapy: a case report and literature review

Neuroendocrine tumors (NETs) occur in the bronchopulmonary system. Extrapulmonary NETs are rare and are considered to ac count for 2.5 - 5% of all NETs, with more than 60% of these tumors occurring along the gastro intestinal tract, including primary NET of the gall bladder. Pri mary NETs of the gall bladder have been classified as carcinoid, neuroendocrine carcinoma or heterogeneous carcinoma. Currently, the main treatment of neuroendocrine car ci noma re mains surgery. The role of radiotherapy and chemotherapy is undefined be cause of the paucity of data. In advanced cases, chemotherapy has been prescribed with such effective agents as cisplatin, carboplatin, etoposide and paclitaxel. Here we re port a case of a 64-year-old Taiwanese male patient with neuroendocrine carcinoma of the gall bladder who received combined chemoradiotherapy (CCRT) with cisplatin, 5- fluorouracil and leucovorin (PFL) from June 2009 un til now, and whose disease is stable. CCRT with PFL may be a possible reg i men for high-grade neuroendocrine carcinoma of the gall bladder.     

桥本病28例诊治体会

目的总结桥本病的临床诊治经验。方法分析2002年1月至2008年12月间株洲市二医院普外科收治的28例桥本病的临床资料。结果28例患者中通过细针穿刺抽吸细胞学检查确诊桥本病12例,占42.86%,药物保守治疗有效的8例,占28.57%,手术冰冻确诊6例,占21.43%,切除后常规石蜡切片确诊2例,占7.14%。结论术前可疑病例细针穿刺抽吸细胞学检查及术中冰冻是获得正确诊断的有效方法,有利于避免误诊或漏诊。     

金纳多注射液对2型糖尿病血浆纤溶酶原激活物抑制剂活性的影响

目的观察金纳多注射液对2型糖尿病血浆纤溶酶原激活物抑制剂活性是否有影响。方法 45例2型糖尿病患者,随机分为23例治疗组,22例对照组。治疗前后分别测定血浆纤溶酶原激活物抑制剂活性（PAI-1）、纤维蛋白原（Fg）。结果治疗前两组纤溶指标没有区别,治疗后治疗组PAI-1活性、纤维蛋白原明显降低（P〈0.05）,与对照组相比有意义。结论金纳多注射液可以改善2型糖尿病纤溶活性。     

Pharmacodynamic effects of orally administered dexlipotam on endothelial function in type 2-diabetic patients

OBJECTIVE: Diabetic endotheliopathy is the result of hyperglycemia and the production of oxygen-free radicals. In vitro and in vivo data have shown beneficial effects of dexlipotam (DEX), a tromethamine salt of R(+)-alpha-lipoic acid, on oxidative stress in hyperglycemic states, but no data are available on the effects of this agent on endothelial function. The purpose of this pilot study was to evaluate the impact of DEX on endothelial function in patients with type 2 diabetes (DM2) and to estimate the safety and tolerability of DEX. MATERIAL AND METHODS: DEX 960 mg and DEX 1,920 mg were investigated in DM2 patients over a period of 4 weeks using a randomized, placebo- (PLA) controlled, double-blinded study with 3 parallel groups. The marker of arterial function after 4-week therapy with DEX was the maximum percentage change versus baseline in the flow-mediated dilation of the brachial artery (FMD) after reperfusion. RESULTS: A total of 114 diabetic patients were randomized to the three study groups. DEX was safe and well tolerated. Dyspepsia appeared to be the most relevant side effect of DEX treatment. Systolic (p = 0.078) and diastolic blood pressure (p = 0.059) tended to be lower in patients treated with DEX at a dose of 1,920 mg. There were no significant differences in FMD between the placebo- and the DEX-treated groups. In patients with poorer glucose control (HbA1c > 6.5% Hb), FMD increased significantly after 4-week treatment with DEX: PLA -1.51 +/- 2.98%, DEX 960 mg +1.22 +/- 3.22, p = 0.027, DEX 1,920 mg +1.47 +/- 3.78, p= 0.012. The magnitude of the mean change compared to placebo was 2.73% (DEX 920) and 2.98% (DEX 1,920) in patients with HbAlc > 7.5% Hb (DEX 960, p = 0.007, DEX 1,920, p = 0.032). The effects of treatment were usually statistically significant in subgroups with more severe vascular stress (longer duration of disease, pretreatment history, higher LDL-C, higher blood pressure). CONCLUSION: DEX therapy appears to reduce endothelial dysfunction in DM2, especially in men with long history of DM2 and having poor glucose control. These findings will be useful in patient selection in future prospective clinical trials with drugs to treat vascular stress.     

超声引导下胸腔内置管对老年患者肺底积液的治疗作用

目的 探讨超声引导下胸腔内置管对肺底积液的治疗作用.方法 对我院2007至2009年120例中-少量肺底积液老年患者采用随机对照的方法分为治疗组和对照组,各60例.治疗组采用在超声引导下行胸腔内置管术进行胸腔积液的引流,对照组患者进行常规胸腔穿刺,比较2组肺底积液患者穿刺成功率、胸腔粘连、引流量、并发症等各项指标.结果 治疗组穿刺成功率100%,对照组穿刺成功率86.7%,治疗组胸腔积液引流量（1200±86）ml,对照组胸腔积液引流量（800±59）ml,治疗组胸膜粘连12例,对照组2l例,治疗组发生气胸3例,对照组发生气胸8例,以上各组指标均具有统计学意义（P＜0.05）.结论 B型超声引导下胸腔内置管引流术对中-少量肺底积液治疗具有穿刺简单、引流彻底、疗效确切、并发症少等优点.