气管,支气管,隆突成形术的体会

作者报告自１９８８年至１９９６年用气管、支气管隆、突成形术治疗原发中央型肺癌１９例。其中病变位于右上肺１５４例（含侵犯右总支气管及隆突２例），左上肺４例，气管隆突部肿瘤１例。本组地右上叶抽状切除术１２例，左肺上叶袖状切除术４例，右全肺隆突切除＋隆突成形术２例，气管隆突部肿瘤切除＋隆民形术１例，病理类型：鳞癌细胞１５例，腺癌细胞２例，粘液表皮样癌１例，小细胞肺癌１例。我们认为此手术安全，符合肺癌“二     

纵隔精原细胞瘤2例

1临床资料例1男，15岁，胸闷、胸痛2月伴痰血。常规体检及化验检查均未发现异常，X线脑部正侧位片：左前上纵隔有一巨大阴影，约20cm×18cm大小，分叶状，密度均匀，边缘尚清晰。拟“恶性胸腺癌”行剖胸探查见肿瘤位于左前上纵隔内，约20cm×17cm×16cm，心包、隔神经及胸主动脉均受侵犯，左肺上叶不张。肿瘤质地硬，表面不平。因无法完整切除肿瘤，活检组织一块，术后病理：纵隔精原细胞瘤。1个月后放疗，肿瘤经X线复查已逐渐缩小。3个月后，肿瘤已明显缩小，左肺上叶复张。随访13年，病人现在生活、工作同正常人。无胸闷、咳嗽及胸痛，X…     

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

Objective

To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.

Methods

A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency.

Results

Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson’s disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities.

Conclusion

Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.     

鼠疫媒介蚤簇鬃客蚤Xenopsylla skrjabini的生活史及叮人吸血实验

本项实验的目的是观察鼠疫媒介蚤簇鬃客蚤Xenopsylla skrjabini Ioff, 1928的生活史并证实该蚤是否能叮人吸血.标本采自新疆克拉玛依市艾里克湖畔的大沙鼠Rhombomys opimus体上.在26±0.5℃,RH 80%±5% 条件下,以小白鼠为供血动物,在实验室进行人工饲养繁殖.用刚羽化2～3天的子1代成虫在4人的前臂和踝部皮肤上做叮人吸血试验.结果显示,幼虫期11天,蛹期12天（10～15天）,卵期（包括孕卵期）6天,完成一个生活史周期平均需29天.60只受试蚤（22♂♂,38♀♀）中,能叮人吸血者29只（10♂♂,19♀♀）,吸血率为48.3%.簇鬃客蚤在上述实验条件下,完成一个生活史周期平均历经29天.该蚤两性均能叮人吸血,吸血率为48.3%.     

耳廓断离再植成功1例

患者,男,38岁。左耳廓大部分离断2 h收治入院。检查:一般状况好,心肺及腹部未见异常,生命体征正常。专科检查:左耳廓上起自耳轮脚上方垂直向下,通过耳甲腔到耳垂完全断离,大部分耳垂保留,创缘整齐,耳廓近端创缘有颞浅动脉的耳前支和耳后动脉呈喷射状出血,离体部分约占耳廓的4/5     

电视胸腔镜手术治疗自发性气胸(肺大疱)32例报告

我院自 1996年 5月至 1999年 8月共收治自发性气胸 (肺大疱 )患者 32例 ,现报告如下。1　临床资料本组男 2 6例 ,女 6例 ;年龄 17～ 70岁 ,平均 34岁。右侧气胸 (肺大疱 ) 2 0例 ,左侧 11例 ,双侧 1例 ,合并血胸 4例 ,其中单发肺大疱 10例 ,多发性肺大疱 2 2例。全组病例术前均无严重肺功能不全病史 ,其中 2 0例有吸烟史。2　手术方法与结果全组均采用双腔支气管插管静吸复合麻醉 ,术中行单肺通气 ,患侧肺萎陷。全部手术均在电视胸腔镜 (VATS)下完成 ,方法是患者取健侧卧位 ,于腋中线第 6或 7肋间做 1cm切口置入 0°10 mm直镜探查 ,腋前线…     

清热解毒汤治疗智齿冠周炎的临床分析

智齿冠周炎是指发生于智齿周围的软组织炎症。临床上尤以下颌智齿冠周炎多见。本病主要发生在18—25周岁的青年。     

硬膜外麻醉用于分娩镇痛效果的临床观察

目的观察硬膜外麻醉用于分娩镇痛的临床效果。方法选取2010年1月至2011年12月自然分娩的产妇共60例,随机分为观察组和对照组,观察组采用硬膜外阻滞术进行分娩镇痛,对照组通过非药物性分娩镇痛,对比分析两组临床效果。结果观察组产妇分娩期疼痛在0～III度各个水平上均低于对照组(P<0.05)。观察组在宫口扩张速度要快于对照组,硬膜外麻醉分娩镇痛可以延长第二产程,缩短活跃期时间、第三产程。结论硬膜外麻醉用于分娩镇痛是较为理想的方法,值得推广。     

冰生理盐水口腔护理治疗急性脑梗塞后吞咽障碍的疗效观察

目的:观察使用冰生理盐水进行口腔护理治疗急性脑梗塞后吞咽障碍的临床疗效。方法:选择急性脑梗塞患者61例,随机分为观察组30例、对照组31例。对照组只进行常规药物治疗,观察组除上述治疗外,还采用冰生理盐水进行口腔护理。疗程1周,治疗前后采用洼田氏饮水试验进行评定。结果:经1周治疗,观察组总有效率93.33%;对照组73.33%。两组比较有显著差异(P0.05)。结论:用冰生理盐水进行口腔护理治疗急性脑梗塞后吞咽障碍,方法简单,对吞咽症状的改善有较好的促进作用。     

全麻复合硬膜外阻滞用于腹腔镜胆囊切除术的疗效观察

腹腔镜胆囊切除术(LC)具有手术创伤小,恢复快等优点,已被临床广泛使用。本观察拟将异丙酚静脉全麻与异丙酚静脉全麻复合硬膜外阻滞用于腹腔镜胆囊切除术对血液动力学、术后苏醒的影响作比较观察,以供临床参考。