Leukocyte Esterase From Synovial Fluid Aspirate : A Technical Note

Accurate and efficient diagnosis of periprosthetic joint infection remains one of the most challenging tasks for orthopedic surgeons. Currently, no widely used diagnostic test allows for quick and efficient performance, low cost, and high sensitivity and specificity. Aspiration of synovial fluid from a patient's joint can be done in the clinic both quickly and easily; oftentimes, the aspirate obtained is bloody, thus rendering the use of colorimetric strip testing impractical. We describe a simple, inexpensive, and effective protocol using centrifugation to allow for leukocyte esterase (LE) testing after bloody joint aspirations. In all cases, both septic and aseptic, there was a 100% concordance in LE enzyme test results. Although further validation may be necessary, these initial results demonstrate that accuracy of LE testing is not affected by centrifugation.     

乳腺肿块细针吸取物的细胞学诊断价值

目的 探讨细针吸取对乳腺肿块的细胞学诊断价值.方法 分析术后病理学诊断对照的333例乳腺肿块细针吸取物的细胞学诊断资料.结果 127例乳腺恶性肿块细针吸取的细胞学诊断为恶性102例,可疑10例,良性15例;206例乳腺良性肿块细针吸取物的细胞学诊断为良性201例,可疑5例;采用国际通用细胞学诊断准确性统计方法 (Frabl,1989)统计,本组敏感性80.3%,特异性97.6%,假阴性率11.8%,准确率91%,且部分乳腺肿块细胞学与病理学诊断完全一致.结论 细针吸取的细胞学诊断可以结合临床确诊绝大多数乳腺肿块的良恶性,而且可以作为确诊部分乳腺良性肿块的组织学类型的一种方法 .     

Do medullary thyroid carcinoma patients with high calcitonin require bilateral neck lymph node clearance? A case report

BACKGROUNDIn clinical work, 85%-90% of malignant thyroid diseases are papillary thyroid cancer (PTC); thus, clinicians neglect other types of thyroid cancer, such as medullary thyroid carcinoma (MTC).CASE SUMMARYWe report a 53-year-old female patient with a preoperative calcitonin level of 345 pg/mL. There was no definitive diagnosis of MTC by preoperative fine-needle aspiration cytology or intraoperative frozen pathology, but the presence of PTC and MTC was confirmed by postoperative paraffin pathology. The patient underwent total thyroidectomy and bilateral central lymph node dissection. Close follow-up at 1.5 years after surgery revealed no signs of recurrence or metastasis.CONCLUSIONThe issue in clinical work-up regarding types of thyroid cancer provides a novel and challenging idea for the surgical treatment of MTC. In the absence of central lymph node metastasis, it is worth addressing whether patients with high calcitonin can undergo total thyroidectomy and bilateral central lymph node dissection without bilateral lateral neck lymph node dissection.     

血栓碎吸术与系统静脉溶栓治疗中央型下肢深静脉血栓的疗效对比研究

目的：比较血栓碎吸术与系统静脉溶栓治疗中央型下肢深静脉血栓形成（LEDVT）的疗效。方法：2009年10月-2012年8月收治的173例急性中央型LEDVT患者随机分为实验组（行血栓碎吸术,97例）和对照组（t5单纯静脉溶栓,96例）。测量2组治疗前、后患肢腿围,比较2种治疗方法的临床疗效及其预后。结果：实验组出院日寸患肢膝上、下15cm处周径差与入院比较差异有统计学意义（P〈0．05）;出院时造影静脉通畅率100％。对照组出院时患肢膝上、下15cm处周径差与入院比较亦差异有统计学意义（P〈0．05）;出院时静脉造影通畅率91．67％（88／96）。实验组入、出院患肢膝上、下15cm处周径差的差值较对照组更大（P〈0．05）,住院时间较对照组减少（P〈O．05）,出院时静脉造影通畅率较对照组高（P〈0.05）。由于实验组中18例合并髂静脉狭窄或闭塞患者行支架植入,实验组住院费用较对照组高（P〈0．05）。结论：对于急性LEDVT患者,与系统静脉溶栓治疗相比,血栓碎吸术治疗疗效显著,能够缩短住院时间,提高静脉通畅率,远期疗效有待进～步研究。     

机械性血栓抽吸术治疗髂股静脉血栓形成

目的:探讨机械性血栓抽吸治疗髂股静脉血栓形成的临床疗效。方法:回顾性分析236例急性髂股深静脉血栓(DVT)患者的临床资料。均经健侧股静脉预防性放置下腔静脉滤器,在数字减影血管造影(DSA)透视下患侧股静脉插入12～14 F大腔鞘管,50 mL注射器负压抽吸髂股静脉血栓。112例合并髂静脉狭窄或闭塞患者,行经皮血管成形术(PTA)和支架植入;术后给予肝素抗凝。结果:出院时膝上、下15 cm处健、患侧周径差分别降为(1.34±0.57)cm和(0.93±0.42)cm,与入院时比较差异有统计学意义(t=19.37、23.99,P均<0.05);随访36个月,随访率97.88%(231/236)。术后水肿、色素沉着和溃疡等后遗症发生率12.99%(30/231)、8.23%(19/231)和0;随访疗效优92.21%(213/231)。支架植入患者随访均通畅。结论:机械性血栓抽吸治疗髂股DVT疗效显著,并发症少,住院周期短,能够明显降低后遗症的发生率。     

Gallbladder aspiration for acute cholecystitis in average-surgical-risk patients

We conducted a retrospective case note review to assess whether or not gallbladder aspiration can be applied as a temporary measure for the treatment of acute cholecystitis in average-surgical-risk patients. Gallbladder aspiration was performed in 79 consecutive average-surgical-risk patients with acute cholecystitis, who had no indications of emergent surgery and who complained of severe colicky pain. Elective surgery became possible in 92% of patients by gallbladder aspiration. The percentage reached 97 when percutaneous cholecystostomy was added (four patients). Emergent surgery was needed in one patient suffering bile leakage following gallbladder aspiration. Colicky pain was controlled soon after the procedure in most cases. Neither major complications nor mortalities were observed in the following surgical therapies. It is suggested that gallbladder aspiration might be applied as a temporary measure for acute cholecystitis in average-surgical-risk patients, although early surgery should remain the primary choice of therapy in such patients.     

胎粪吸入综合征患儿脑组织氧饱和度的监测及护理

目的探讨胎粪吸入综合征(MAS)患儿脑组织氧饱和度监测情况及相应的护理方法。方法将73例MAS患儿按病情分为两组,轻型38例为MASⅠ组,中、重型35例为MASⅡ组,应用无创组织氧监测仪对生后1、3、5、7 d的MAS患儿进行脑组织氧合状态的监测,并与正常新生儿进行比较。结果生后的1、3、5、7 d,正常新生儿与MASⅠ组和MASⅡ组患儿脑组织氧饱和度比较,MAS患儿的脑组织氧饱和度均有不同程度的降低。MASⅠ组患儿临床虽无明显缺氧症状及体征、肺部病变较轻,但与正常新生儿比较,出生后第3天的脑组织氧饱和度(rSO2)有显著性差异(P<0.01);MASⅡ组患儿生后的第1、第3、第5、第7天脑组织rSO2明显降低,与正常新生儿比较,各时相rSO2均有显著性差异(P<0.01)。结论MAS患儿脑组织rSO2受到不同程度的影响,缺氧的加重和持续时间增加可进一步加剧脑损伤,对MAS患儿应积极行呼吸道管理及加强护理,避免缺氧加重。采用近红外光谱测定技术对MAS的患儿进行动态监测,早期了解脑组织氧合状态,结合全身氧供需的变化,及时调整氧疗措施,对减轻缺氧脑损伤发生有重要的临床指导意义。