经纤支镜气道内膜下注射药物治疗对支气管内膜结核患者并发症的影响

目的探讨纤支镜气道注射药物治疗对支气管内膜结核患者并发症的影响。方法选择2018年1月—2019年1月在湖北省潜江市中心医院治疗的支气管内膜结核患者66例,分为对照组和研究组各33例。对照组给予药物雾化吸入疗法,研究组经过纤支镜气道内膜下注射药物治疗。比较两组治疗效果和症状缓解的影响。结果研究组总有效率为90.91%,对照组总有效率为84.85%,研究组的治疗效果均高于对照组(P<0.05);对照组并发症发生率为39.39%,研究组并发症发生率18.18%,研究组并发症发生率明显低于对照组(P<0.05)。结论经纤支镜气道内膜下注射药物治疗支气管内膜结核患者并发症的发生率较小。     

腮腺切除术中沿面神经总干顺行解剖面神经的效果及安全性

目的探讨腮腺切除术中应用沿面神经总干顺行解剖面神经的治疗效果及安全性。方法选取我院2016年2月至2019年3月收治的60例择期行腮腺切除术的患者,随机分为观察组与对照组各30例。对照组沿面神经总干逆行解剖面神经,观察组沿面神经总干顺行解剖面神经,观察两组患者术后1个月面神经功能及术后并发症发生情况。结果术后1个月,两组患者的面神经功能分级比较无统计学差异(P>0.05);观察组的术后并发症发生率为10.00%,明显低于对照组的33.33%(P <0.05)。结论临床行腮腺切除术中,沿面神经总干顺行解剖面神经可降低术后并发症发生率,值得推广。     

抗原激活红细胞和白细胞免疫反应主干道的实验研究

目的测定抗原对红细胞和白细胞免疫反应主干道的作用。方法癌细胞(5×106/ml)和(或)卡介苗(0·1mg)或酵母菌(5×108/ml)加到全血细胞悬液0·2ml(或白细胞0·2ml)和枸橼酸抗凝的新鲜血浆0·3ml(或生理盐水0·3ml)37℃温育1h,采用免疫酶联法检测IL-8水平。分组:①抗原(癌细胞或酵母菌或卡介苗)0·2ml加入全血细胞悬液0·2ml和血浆0·3ml;②生理盐水0·2ml加入全血细胞悬液0·2ml和血浆0·3ml;③抗原0·2ml加入白细胞悬液0·2ml和血浆0·3ml;④生理盐水0·2ml加入白细胞悬液0·2ml和血浆0·3ml。结果癌细胞、卡介苗和酵母菌能激活血液免疫反应,但没有加血浆组中,这些抗原不能激活血液免疫反应,在这些抗原加入全血细胞和血浆组,IL-8激活指数(2·124±0·860)明显高于这些抗原加入白细胞和血浆组的IL-8激活指数(0·390±0·080),P<0·01。结论结果表明在血液免疫反中存在红细胞和白细胞免疫反应主干道路线图,红细胞和补体在血液免疫反应路线图中具有重要作用。     

Granular cell tumours of the lower respiratory tract

Granular cell tumours rarely involve the lower respiratory tract. We report eight cases surgically resected at our institution. There were four females and four males, aged between 18 to 56 years (mean 40). One tumour associated with a peripheral lung adenocarcinoma was asymptomatic. The other lesions presented with obstructive pneumonitis (3 cases), haemoptysis (2), dyspnea (1) or cough (1). These tumours were tracheal (1) or bronchial (6) and one case was located in the lung parenchyma. Four cases were multicentric with associated lesions located in a bronchus (2), the oesophagus (1) or a mediastinal lymph node (1). All tumours, with the largest diameter ranging from 0.5–4.5 cm, were histologically invasive. The tumours were positive for S-100 protein, neuron specific enolase, KP1 (CD68) and vimentin. No tumour expressed desmin, keratin or p53 oncoprotein. Our study demonstrates that, in spite of marked anatomical and clinical polymorphism, the rare granular cell tumours of the lower respiratory tract have a constant histological appearance. Our observations confirm that large tumours (> 8–10 mm) usually extend beyond the tracheo-bronchial cartilages and, therefore, only surgical treatment may avoid recurrence.     

MRI的选购定位

对MRI若干主要参数进行总结,结合实际应用体会,对我院MRI设备选购进行讨论,以期对MRI设备的选购定位提供参考.     

ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.     

Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections

Summary Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2–3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.     

ABL50血气分析仪电、液路故障维修

本文介绍ABL50型血气分析仪使用过程中遇到的电、液路故障处理方法。     

Mechanical emergency recanalization of the left main coronary artery

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.     

不同病因腹泻病儿肠道主要菌群变化的研究和比较

对８８例不同病因腹泻儿肠道双歧杆菌、乳酸杆菌、大肠杆菌的变化进行研究。对照组２５例。结果：研究组较对照组双歧杆菌、乳酸杆菌有显著下降（Ｐ＜０．０１和Ｐ＜０．０５），大肠杆菌下降不明显（Ｐ＜０．０５）。非感染性腹泻组较感染性腹泻组双歧杆菌、乳酸杆菌下降更显著（Ｐ＜０．０１和Ｐ＜０．０５），大肠杆菌下降不显著（Ｐ＜０．０５）。感染性腹泻组中，双歧杆菌在轮状病毒肠炎组中较急性菌痢下降更显著（Ｐ＜０．０５），而其它两种菌下降程度相差不明显（两者Ｐ＜０．０５）