经内科胸腔镜滑石粉粘连治疗难治性气胸

目的 观察内科胸腔镜介入下医用滑石粉治疗难治性气胸的临床价值.方法 自2003年4月～2009年3月,16例难治性气胸患者,局部麻醉下经内科胸腔镜松解胸腔粘连带,注洒滑石粉混悬液.结果 胸腔镜观察可见患者胸腔多发粘连带伴或不伴有肺大泡；术后胸腔闭式引流持续时间为3～13 d.13例患者治愈,3例患者好转.疼痛是术中、术后主要并发症.结论 局部麻醉下胸腔镜直视下滑石粉粘连治疗难治性气胸,具有吸尽胸腔积液,松解胸膜腔内粘连带,胸膜暴露充分,滑石粉分布均匀,安全有效等优点,值得临床推广应用.     

内镜下自体血加凝血酶治疗难治性气胸8例分析

1997年3月以来,我们共收治自发性气胸患者46例,其中经持续胸腔闭式引流等治疗2周,肺仍未复胀的难治性气胸R例。我们应用纤维支气管镜(纤支镜)代替胸腔镜,对此8例患者进行了胸腔检查,并经纤支镜对胸膜漏气处喷射自体静脉血和凝血酶治疗,效果满意。1 资料和方法1.1 一般资料 男6例,女2例,年龄16～68岁,其中右侧气胸5例,左侧气胸3例。     

胸腔镜临床检查应用

目的：探讨内科胸腔镜检查对疑难胸膜疾病的诊断检查和胸腔镜检操作关键。方法：回顾性分析91例内科胸腔镜检查诊断胸膜疾病的病例资料，总结病因组成和并发症。结果91例胸膜疾病患者，男性73例，女性18例，胸腔积液71例，自发性气胸20例。胸腔积液病因：恶性肿瘤39例，结核15例，慢性炎症14例；气胸病因：肺大疱6例；胸膜粘连3例；肺破裂1例；无原因者8例。并发症以发热多见，无与胸腔镜检查相关的死亡。结论：该院胸腔镜诊断的胸腔积液以恶性肿瘤最常见，其次为结核。难治性气胸首要病因为肺大疱。对胸液分析、细胞学检查和闭式胸膜活检不能确诊的胸膜疾病有必要考虑内科胸腔镜检查。     

顽固性自发性气胸的胸膜固定术的治疗与护理

我院于1989年5月～1996年2月，对7例经胸腔置管闭式引流等治疗效果欠佳的自发性气胸患者，采用局麻下胸腔镜探查术，在查明病因后，于直视下松解及离断胸膜粘连带而关闭胜胸膜裂口，并向裂口及肺大危表面喷洒滑石粉混悬液行胸膜固定术治疗，收到显著效果。全部患者均在1周内治愈，随访观察无1例复发，现将治疗方法与护理要点报道如下。1临床资料本组7例，男5例，女2例，年龄22～47岁；左侧4例，右侧3例；5例为交通性气胸，2例为张力性气胸；基础肺部病变肺结核6例，支气管扩张症1例，其中2例为复发性气胸。X线检查：肺体积压缩均＞50％，3…     

持续负压引流治疗老年自发性气胸43例疗效观察与护理

目的:探讨持续负压引流治疗老年自发性气胸患者的疗效与护理方法。方法:对43例老年自发性气胸患者进行胸腔闭式引流术,以中心吸引装置持续低负压吸引治疗和护理。结果:肺复张时间为4～20(6.5±3.1)d,38例治愈,3例转胸外科手术治疗,2例胸膜粘连治疗。结论:加强闭式引流术后及低负压吸引护理,加快了气体的排出及吸收,缩短了肺复张时间,无胸腔内感染,无脱管发生。     

胸腔镜在结核性胸膜炎治疗中的价值

目的探讨胸腔镜对难治性结核性胸膜炎的治疗价值。方法局麻下用硬质胸腔镜钳除脏、壁层胸膜面的结核结节、剥离胸膜粘连带、抽尽残余积液后放置闭式引流管,配合有效的抗结核治疗并每周2～3次胸腔内注药。结果镜下见胸膜充血、水肿,单发或多发白色结节,胸膜弥散分布的粟粒样改变,亦可见大量的粘连带形成及胸膜肥厚。经胸腔镜治疗后3～7天胸水消失,拔管后未再复发,随访1年,治愈率100%。结论胸腔镜是一种治疗难治性结核性胸膜炎有效、安全、并发症少的方法,可避免开胸手术。     

胸腔内注药治疗顽固性自发性气胸2例报告

自发性气胸是常见急症之一,其中少数病人虽经胸腔闭式引流等处理,仍不能使患肺复张。这种顽固性自发性气胸的长期存在危害较大,容易继发胸腔感染,并能造成肺功能损害。对于这类病人采用胸腔内注药使胸膜粘连,往往能取得满意疗效。我们采用氨苄青霉素治疗2例,现报告如下。一、病例介绍:例1:男,25岁。肺结核病史8年。因右侧自发性气胸在某医院经胸穿、胸腔闭式引流,治疗40天无效急诊入我院。患者呼吸急促,不能平卧,气管     

微创腋下小切口治疗自发性气胸32例

目的 :探讨微创腋下小切口治疗肺大疱致自发性气胸的可行性和优缺点。方法 :采用腋下小切口长 (7.0± 2 .5cm) ,手术治疗肺大疱致自发性气胸患者 32例 ,其中行肺粘连松解 2 0例 ,肺大疱切除缝扎 34例。结果 :34次手术平均耗时 4 0min ,失血量均小于 5 0ml,术后平均胸腔闭式引流量 15 0± 5 0ml,平均拔管时间 2 .5d ,无并发症发生 ,术后平均住院时间 9± 3d ,术后随访 4～ 18个月无复发。结论 :腋下小切口损伤小 ,恢复时间短 ,治疗肺大疱手术有实用性和普遍推广的意义。     

胸膜固定术治疗难治性气胸的护理

总结了22例难治性气胸患者行胸膜固定术治疗的护理方法,主要包括术前患者准备、物品准备、术中配合以及术后对患者的观察、胸腔闭式引流的护理、饮食护理等,认为对难治性气胸患者应用胸腔闭式引流联合滑石粉混悬液经胸腔引流管作胸膜固定术,取得满意的效果,该方法简便、快捷、安全、有效。     

电视胸腔镜手术治疗自发性气胸 --附42例报告

目的探讨电视胸腔镜手术(VATS)治疗自发性气胸的适应证、手术方法和疗效.方法对1999～2003年我科用VATS治疗42例自发性气胸的临床资料进行回顾性分析,其中单纯性气胸38例,血气胸4例;右侧23例,左侧18例,双侧1例;首次发作的2例,2次发作12例,3次以上发作8例;手术方式均为松解胸膜粘连+切除或闭合大疱+胸膜固定术.结果所有患者手术均顺利,平均手术时间110 min,术中出血30～120ml,术后胸腔引流量267±96ml,均未输血,平均住院时间6.7 d,各例均能早期起床活动,术后X线胸片显示肺部无气胸征象.随访10～24个月无复发.结论电视胸腔镜手术治疗自发性气胸具有创伤小、恢复快、住院时间短、疗效确切、复发率低,及符合美学要求等优点.手术成功的关键是严格掌握其适应证,彻底处理肺大疱和胸膜固定术.     

ON THE PHYSICOCHEMICAL REGULATION OF THE GROWTH OF TISSUES : THE EFFECTS OF THE DILUTION OF THE MEDIUM ON THE GROWTH OF THE SPLEEN.

It may be concluded that the degree of dilution of the culture medium has a marked influence on the rate of growth of splenic tissue. The maximum acceleration was obtained in a medium composed of three volumes of normal plasma and two volumes of distilled water. The growth in this hypotonic plasma was very much larger than in normal plasma. On the contrary, the growth of the spleen in hypertonic plasma was always less than in normal plasma. In other experiments, we found that in diluted plasma there was also an acceleration of the growth of the skin, the heart, and the liver of chickens. The skin of adult frogs also grew more actively in this plasma. The optimum degree of dilution varied according to the nature of the tissues and to the species of the animals. While the plasma containing two fifths distilled water produced the largest growth of splenic tissue, a slightly less diluted medium was more favorable for the liver and the heart, and generally for the skin also. The action of hypertonic plasma varied also in a large measure. While the spleen did not grow at all in the medium containing 0.0124 and 0.0144 sodium chlorid, the skin, on the other hand, could stand a high concentration of the sodium chlorid. Even its growth was activated in media containing 0.0094 and 0.0124 sodium chlorid and was greater than with normal plasma. The spleen of kittens was very easily affected by the changes of the dilution of the plasma, while the skin of the frog presented its best growth in plasma containing one half distilled water. Marked variations in the sensitiveness of tissues to hypertonic and hypotonic media will probably be observed in animals of different species. From these experiments, three conclusions can be drawn: namely, that certain laws of growth, discovered by Loeb, in lower organisms are true also for higher organisms; that normal plasma is not the optimum medium for the growth of tissue; and that each tissue has probably its optimum medium. The growth of the spleen is, without doubt, considerably modified by the variations of the dilution and perhaps of the osmotic tension of the plasma. It is possible then that the influence of osmotic tension, discovered by Loeb, in the growth of certain organisms, is a general law applicable as well to higher forms of life— frogs, cats, and chickens—as to lower organisms—tubularia and sea-urchins. In placing tubularia in different dilutions of sea-water and distilled water, Loeb found that the greatest rate of regeneration was observed when two volumes of distilled water were added to three volumes of sea-water. But fertilized eggs of sea-urchins were more sensitive to the action of hypertonic plasma, and they all died in a dilution of sea-water with two fifths distilled water. If only one fifth distilled water was added to the sea-water they developed normally. We found that the cells of certain tissues of the chicken follow a similar rule, since the maximal growth of the spleen is obtained in plasma containing two fifths distilled water, while other tissues grow better in a less hypotonic medium. Normal plasma is certainly not the ideal medium for the growth of tissues, since slight modifications of the tension, the alkalinity, or the addition of certain inorganic salts to normal plasma, increase the rate of the growth of tissues.     

THE EXTENT OF THE CAPILLARY BED OF THE HEART

By means of injections made into the coronary arteries of beating hearts it has been possible to determine the number of capillaries in the normal heart muscle. This study has shown a very rich blood supply with an average of approximately one capillary for each muscle fibre in the ventricular walls and papillary muscles, and a less abundant supply in the auricular muscle and Purkinje system. The number of capillaries per sq. mm. of ventricular wall or papillary muscle is about twice that found by Krogh in skeletal muscle. Capillaries were not found constantly in the valves of hearts in which there was apparently a complete injection of the capillary bed. The method described for injecting the capillaries of the heart also provides a means of studying the blood supply to the muscle, valves and aortic wall in pathological hearts.     

THE STRUCTURE AND DIFFERENTIATION OF THE SPECIFIC CELLULAR ELEMENTS OF THE PARS INTERMEDIA OF THE HYPOPHYSIS OF THE DOMESTIC PIG

The bearing of these results on the Herring-Cushing theory of pituitary secretion is apparent. For the first time a true secretion antecedent has been demonstrated in the cells of the pars intermedia, an antecedent which appears in the cells at the same period of development at which active pressor effects may be obtained from the gland extracts. The route of export of this material from the gland to its point of utilization, however, is unknown; it may go by way of the blood or, as required by the Herring theory, by the transneural route to the third ventricle. The objections to the latter conclusion have been amply expanded in the introduction to this paper, but here may be emphasized the fact that the fetal pig hypophysis contains no hyaline bodies. Indeed they are rare in the adult, though there may be seen in the cells of the pars nervosa in the processes of its intrinsic cells, granular deposits which we believe to be the antecedents of the hyaline bodies but which in the pig rarely are discharged and aggregated into discrete masses as in other mammals. The fact that some observers have obtained positive pressor effects from the nervous part of the posterior lobe, exclusive of the pars intermedia, need not weigh very heavily in attempting to trace the course of the secretion, when we reflect that the difficulties of making such a mechanical separation are almost insuperable, and that the chemical product of the pars intermedia is so soluble and vanishes from the cells so rapidly that it may well be diffusible through the thin membranes which intervene and penetrate post mortem into adjacent parts. We are inclined, therefore, to the view that the secretion leaves the gland by the vascular route rather than by way of the interfibrillar spaces of the pars nervosa.     

THE INFLUENCE UPON THE SPLEEN AND THE THYROID OF THE COMPLETE REMOVAL OF THE EXTERNAL FUNCTION OF THE PANCREAS

The complete removal of the function of the pancreas concerned in digestion is followed by marked changes in the spleen and in the thyroid apparatus. Second, the spleen shows an extreme simple atrophy. Third, the thyroid apparatus exhibits a constant change shown by the macroscopic transparency of the gland, by the microscopic increase in the amount of colloid, by the chemical increase of the iodine content of the gland, and by the functional test of the delayed appearance of tetany after the complete removal of the thyroid apparatus.     

THE VISCOSITY OF THE BLOOD OF THE DOG AFTER OBSTRUCTION OF THE UPPER GASTROINTESTINAL TRACT

Estimations of the viscosity of the whole blood and plasma of the dog after experimental upper gastrointestinal tract obstruction are reported. With cardiac obstruction there is a rapid and marked rise in the viscosity of the whole blood and some increase in the viscosity of the plasma. The changes after pyloric obstruction are similar to those observed after cardiac obstruction. After obstruction of the upper jejunum only slight changes are observed. The increase in viscosity parallels quite closely the degree of the toxemia. It is unaccompanied by any marked concentration of the blood.     

THE INFLUENCE OF THE ANTERIOR LOBE OF THE PITUITARY BODY UPON THE GROWTH OF CARCINOMATA

1. The administration of emulsions of the anterior lobe of the ox pituitary increases very markedly the rate of growth of the primary tumor in rats inoculated with carcinoma. The growth of small tumors is accelerated relatively more than that of large tumors. 2. This acceleration is only evidenced, however, at a certain stage in the growth of the tumor, subsequent to the twentieth day succeeding inoculation. The administrations do not enhance the tendency of the tumors to metastasize. 3. Liver emulsion does not cause an acceleration of the growth of carcinomata in rats.