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本文报道了1例食管主动脉瘘患者的诊治情况,详细记录了患者的内镜及CT表现,并对患者食管主动脉瘘病变的内镜超声特征做了详细的描述。  相似文献   
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[摘要]?卟啉病是一种与血红素生物合成途径中酶活性缺乏有关的遗传代谢性疾病,其中以肝功能损害为表现的卟啉病较为罕见,易造成误诊、漏诊。我中心在2014年11月—2019年12月共收治6例伴有肝功能损害卟啉病患者,现对其临床表现、肝脏损伤指标、肝脏病理特征、基因检测结果、治疗及转归进行总结分析,以期提高临床医生对伴有肝功能损害卟啉病的认识。  相似文献   
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ObjectiveNursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia.DesignA multiple case study.Setting and ParticipantsStaff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial.MethodsQuestions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic.ResultsHigh management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents’ racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation.Conclusion and ImplicationsNHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness.  相似文献   
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Rationale:Nonconvulsive status epilepticus (NCSE) is a heterogeneous disease with multiple subtypes. NCSE poses great diagnostic and therapeutic challenges due to the lack of typical symptoms. Here, we report a case of NCSE manifesting as rapidly progressive dementia (RPD) and infarction in the splenium of the corpus callosum. Additionally, the relevant literature was reviewed.Patient concerns:A 63-year-old man presented with RPD. Electroencephalogram (EEG) revealed NCSE, and brain magnetic resonance imaging (MRI) showed an isolated infarction in the splenium of the corpus callosum. Mini-mental state examination showed moderate cognitive impairment (14/30 points).Diagnosis:A diagnosis of NCSE with RPD and infarction in the splenium of the corpus callosum was made.Interventions:The patient was treated with intravenous diazepam (10 mg), oral levetiracetam (1.0g twice daily), oral sodium valproate (0.2g twice daily), and intramuscular phenobarbital sodium (0.2g once daily).Outcomes:After the treatment, the symptoms were improved. The patient could answer questions. Repeated EEG showed that the background a rhythm was slightly overdeveloped, and no clinical or electrical seizures were observed. After discharge, the patient was treated with oral levetiracetam (1.0g twice daily) and oral sodium valproate (0.2g twice daily) for 6 months. At the last follow-up, the patient had clear consciousness, sensitive response, and fluent answering ability. Repeated mini-mental state examination showed that his cognitive function was significantly improved (28/30 points); nevertheless, the lesion in the splenium of corpus callosum remained unchanged on MRI.Lessons:NCSE manifesting as RPD and infarction in the splenium of the corpus callosum is extremely rare. Epileptic events and focal infarction are usually overlooked in patients with dementia, and the diagnostic value of MRI and EEG should be highlighted  相似文献   
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李士荣  朱晓峰 《全科护理》2021,19(13):1797-1799
目的:探究分析SBAR沟通模式联合情景案例教学在低年资护士急救能力培训中的应用效果。方法:纳入2018年1月—2019年6月医院护理人员进入急诊科规范化培训N 0~N 1级护士39人设为观察组,2016年4月—2017年12月进入急诊科规范化培训N 0~N 1级护士39人设为对照组。对照组实施传统急救理论及技能培训方式,观察组实施SBAR沟通模式联合情景案例教学方式。比较分析两组规范化培训护士不同情景应急能力评分以及急救能力综合评分情况。结果:干预后观察组低年资护士应对猝死、窒息、急性脑梗死、脑疝、跌倒、坠床/摔伤、火灾以及停电等情景应急能力评分明显高于对照组(P<0.001);急救理论知识、急救技术操作、抢救配合能力、应变能力以及应急流程执行能力评分均明显高于对照组(P<0.05)。结论:SBAR沟通模式联合情景案例教学有利于提高低年资护士不同情景应急能力及急救综合能力。  相似文献   
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复发性口腔溃疡(Recurrent oral ulcer,ROU)是以口腔黏膜出现孤立的圆形或椭圆形浅表溃疡,表现为烧灼样疼痛并且反复发作为特征的一类疾病。本病患者病情日久不愈,迁延多年,发作时疼痛难耐,严重影响生活质量。中医学基于五脏整体观的经典理论,在临床诊治中发挥整体辨治的优势,对于复发性口腔溃疡的缓解和愈后具有良好的临床效果。  相似文献   
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The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.  相似文献   
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