Tension gastrothorax in late-onset congenital diaphragmatic hernia,a rare but life-threatening condition: A case report

Rationale:Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient.Patient concerns:A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath.Diagnosis:Based on radiological findings we diagnosed tension gastrothorax.Interventions:Hernia reduction and diaphragmatic defect repair were performed under thoracotomy.Outcomes:After the operation, the patient''s clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings.Lessons:Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.     

光固化氢氧化钙制剂作为临时冠粘结剂的临床应用

目的 探讨光固化氢氧化钙制剂作为临时冠粘结剂的可行性.方法 纳入242例需行临时冠的患者,根据每月就诊周数顺序随机分为3组,每组患牙制作临时冠并分别采用TempoCemNE(n=78)、Provicol(n=80)、Calcimol LC(n=84)行临时冠粘结,1周后复诊,观察固位效果、牙龈状况以及牙髓状况,比较其临床效果.结果 1周后复诊,3组间总体的固位效果、牙龈状况以及牙髓状况比较,差异无统计学意义(c12=5.553,P1=0.062>0.05;c22=4.783,P2=0.091>0.05;c32=3.290,P3=0.193>0.05).结论 光固化氢氧化钙制剂Calcimol LC和临时冠粘结剂TempoCemNE、Provicol具有相似的粘结效果,牙龈和牙髓保护作用良好,操作简单,可作为一种新型临时冠粘结剂进行临床应用.     

35岁以上护士心理状况的调查分析

目的调查35岁以上护士（以下简称大龄护士）心理状况,为制订改善大龄护士心理状况的干预措施提供理论依据。方法采用自行设计的调查问卷对408名大龄护士的心理状况进行调查。结果 236名（57.84%）大龄护士心理状况为优良水平,128名（31.37%）为中等水平,44名（10.78%）为差水平。排在前4位主要心理问题分别为焦虑（48.29%）,自责（46.08%）,体力不支（43.38%）和强迫心理（30.64%）。结论护理管理者要加强大龄护士心理素质训练,减少职业给其所致的压力源,为其创造良好的工作环境和条件,使大龄护士能克服不良心理情绪,提升积极乐观工作态度,从而提高护理质量。