急诊肺切除治疗大咯血85例临床分析

８５例大咯血急诊肺切除，取得并发症少，死亡率低的良好效果。不可逆性肺部慢性病变如空洞、血管瘤破裂所致出血控制困难。急诊肺切除能去除出血来源及挽救病人生命；并能减少出血和感染扩散的危险。严格的术前准备、精确判定出血部位、平稳的麻醉处理、气管或支气管内插管、适当吸痰使下呼吸道通畅、迅速切除病肺是手术成功的关键。术后着重于咳痰、或支气管吸引下呼吸道积血或凝血块的处理；并积极预防感染。     

DSA支气管肺动脉栓塞术治疗大咯血31例临床疗效观察

目的评价支气管动脉栓塞术在治疗大咯血患者中的作用。方法通过对31例大咯血患者行数字减影血管造影术(DSA)支气管动脉栓塞术观察临床疗效。结果术后6个月进行随访,结果显示31例病例中有2例肺癌患者再发咯血,3例因肺癌晚期死亡,2例支气管扩张症再次发生大咯血,其余均无咯血症状复发。结论应用DSA支气管动脉栓塞术对大咯血患者进行治疗,能够在术中对出血点进行有效治疗,效果较好。而且其适应证广泛,对患者痛苦小,微创、安全。     

Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts,indications, and recent advances

Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future.     

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a patient with isolated renotesticular involvement after cure of non-Hodgkin's lymphoma

 Sinus histiocytosis with massive lymphadenopathy (SHML) – Rosai-Dorfman disease – is a rare but well-defined benign histiocytic proliferative disorder. We report an unusual patient, cured of non-Hodgkin's lymphoma, who presented 12 years later with renotesticular SHML associated with IgA monoclonal gammopathy, but without any evidence of relapsed lymphoma. The genitourinary manifestations of this disorder with massive lymphadenopathy and its rare association with malignant lymphoma are reviewed. Received: 4 July 1996 / Accepted: 25 September 1996     

创伤失血性休克患者临床输血的疗效分析

目的探讨意外创伤时临床输血量与疗效的相关性及其在临床治疗中的意义。方法选择2012年1月至2012年6月南京市属15家医院收治的创伤失血性休克患者214例,根据用血量分为3组:4 h内红细胞用量4¹0 U为中等量输血组;4 h内红细胞用量≥10 U、24 h内红细胞用量<20 U为大量输血组;24 h内红细胞用量≥20 U为超大量输血组,分析并比较各组血常规及凝血象变化。结果各组患者血小板计数、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)比较差异均有统计学意义(P<0.05)。输血小板组APTT和PT均低于未输血小板组,差异有统计学意义(P<0.05)。结论机体损伤越严重,失血量越大,凝血象异常也越明显。若早期使用新鲜冰冻血浆(冷沉淀)及血小板治疗,有助于改善凝血状况。     

经尿道前列腺电切术治疗大体积良性前列腺增生疗效分析

目的探讨经尿道前列腺电切术（TURP）治疗大体积（〉80g）良性前列腺增生（BPH）的疗效。方法选取大体积BPH患者47例,均采用硬膜外麻醉行经尿道前列腺电切术。观察术中出血情况、手术时间、术后尿管留置时间、排尿情况、最大尿流率及住院时间等。结果47例均顺利完成前列腺电切术。手术时间75～150（101±15）min,无输血病例。术后留置导尿管3～5d,均排尿通畅,无尿失禁,术后住院时间5～7d。术后3个月时,平均最大尿流率由术前（4．3±0．5）ml／s增至（17．2±1．5）ml／S,国际前列腺症状评分及生活质量评分由术前的28．0±5．5和5．04-0．5分别降至8．5±2．3和2．5±0．4,手术前后比较差异均有统计学意义（均P〈0．01）。术后无继发出血。结论TURP治疗大体积BPH是一种安全、有效的微创治疗方法,可显著提高手术效率。     

Pseudosarcoma - massive localized lymphoedema in morbidly obese - a rare entity: Case report

INTRODUCTIONMassive localized lymphoedema (MLL) first described in 1998 by Farshid and Weiss. Usually MLL present like huge pedunculated mass and appear like sarcoma hence called Pseudosarcoma. Morbid obesity is a growing epidemic in our society. Morbid obesity is usually associated with hypertension, Diabetes mellitus, dermatological complications like Acanthosis nigricans, skin tags, leg ulcers, edema, lymphoedema, plantar hyperkeratosis and massive localized lymphoedema (MLL) is one of the complications of morbid obesity.Pseudosarcoma is due to derangement of lymphatic channels secondary to excessive deposition of adipose tissue.PRESENTATION OF CASEWe report a patient afflicted with this unique disorder presented with huge mass arising from monspubis in morbidly obese individual with body mass index (BMI) 55.DISCUSSIONMassive localized lymphedema presenting like pseudosarcoma in morbidly obese individuals is rare. Awareness of this disease is essential to avoid misdiagnosis as soft tissue neoplasm. It is a term used to describe a benign over growth of lymhoproliferative tissue in morbidly obese patients. Because of its size patients have difficult to do daily activities. Histopathologically characterized by dilated lymphatic channels with fibrotic and edematous tissue, without evidence of malignancy. Patient seeks treatment only if there is huge swelling causing discomfort, complications like excoriation, wound break down occur. The treatment of choice is complete excision.CONCLUSIONSurgical treatment is effective if done along with bariatric surgery. Functional rehabilitation was achieved. No recurrence was observed within the follow up period of twenty months and BMI was reduced to 28.     

Blood shortages and changes to massive transfusion protocols: Survey of hospital practices during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has resulted in severe ongoing blood shortages across the US, despite employment of numerous blood-conservation measures. Massive transfusion protocols (MTP) are one resource-intensive practice that utilize significant amounts of blood products. Alterations to the composition of MTP parameters to conserve scarce biologic resources have hitherto not been examined during the pandemic.MethodsAn anonymous 18-question survey was administered to 115 hospitals with valid email contact information. Survey questions addressed whether institutions have altered their MTPs due to the COVID-19 pandemic and blood shortages, and if so, what adjustments they have made. Additional details concerning potential differences in the number and cycles of MTPs and blood product wastage during the COVID-19 pandemic compared to the year prior were assessed.Results50 responses were received (43 % response rate). 10 % (5/50) of institutions altered their MTPs utilizing a variety of approaches in attempt to conserve blood during the COVID-19 pandemic. Four additional institutions intend to alter them if it becomes necessary. Following onset of the COVID-19 pandemic, 24 % of institutions (12/50) reported an increase in monthly MTP activations, while 16 % (8/50) reported decreased activations compared to prior to the pandemic. 22 % (11/50) of institutions experienced increased blood wastage, whereas 16 % (8/50) reported decreased waste compared to pre-pandemic.DiscussionThe results of this survey highlight a variety of mechanisms by which institutions have attempted to conserve blood via altering MTPs. Whether an institution adjusted their MTP does not correlate with changes in blood product wastage compared to pre-pandemic.     

大面积脑梗死患者血管内低温治疗的寒战与抗寒战分析

目的探讨大脑半球大面积脑梗死患者血管内低温治疗期间,寒战出现规律与抗寒战措施,以保障血管内低温治疗的顺利实施。方法采用前瞻性队列研究,将22例接受血管内低温治疗并经抗寒战处理的患者,根据寒战程度,分为无寒战或轻度寒战(0～1级)组(5例)和中重度寒战(2～3级)组(17例)。分析寒战与低温的相关性、寒战与抗寒战药物的相关性、抗寒战药物不良反应以及寒战与预后的相关性。结果①22例患者中,低温全程伴有寒战19例(86.4%),其中轻度(1级)2例(10.5%)、中度(2级)12例(63.2%);重度(3级)5例(26.3%)。各低温阶段中,诱导低温期寒战发生率最高,为68.2%(15/22),0～1级寒战患者平均降温速度[(0.92±0.59)℃/h]快于2～3级寒战患者[(0.51±0.15)℃/h],但差异无统计学意义(t=1.941,P=0.090)。②应用哌替啶、咪达唑仑和肌松药的患者,寒战发生率分别为89.5%、83.3%和85.7%,差异无统计学意义;0～1级寒战组与2～3级寒战组比较,抗寒战药物负荷剂量和维持剂量差异均无统计学意义(P>0.05)。③抗寒战药物不良反应发生率依次为胃肠动力抑制(95.5%,21/22)、肝功能异常(77.3%,17/22)和循环抑制(40.9%,9/22)。④无寒战和轻度寒战患者与中重度寒战患者相比,不良预后差异无统计学意义(P>0.05)。结论低温过程中,诱导低温期间寒战发生率最高,并以中度寒战为主;中重度寒战可减慢诱导低温期间的降温速度,需采取更加积极的抗寒战措施;抗寒战药物不良反应出现率高,但可以控制,对预后影响不大。     

体外高频热疗对大容量肺灌洗患者肺功能影响的研究

目的探讨体外高频热疗对大容量肺灌洗患者短期肺功能恢复的影响。方法将48例接受大容量肺灌洗的煤工尘肺I期男性患者随机分为治疗组和对照组,治疗组给予体外高频热疗,热疗温度为39～43℃,时间为40min／次,隔日1次,连续3次。对照组不接受体外高频热疗。比较两组患者灌洗前后TLC、FVC、MVV、DLCO、FEVl．0％肺功能指标的变化。结果两组患者灌洗前后肺功能比较差异无统计学意义（P〉0．05）。结论就本研究结果而言体外高频热疗对于肺灌洗患者术后肺功能的恢复无明显影响,其对肺灌洗患者或对尘肺病患者的疗效还有待进一步观察。