左侧腹股沟隐睾恶变伴右侧睾丸及左侧腹膜后转移超声表现1例

正患者男,46岁,左侧腹股沟隐睾逐渐增大2年,右侧睾丸明显肿大2个月且伴左侧腹部阵发性疼痛1周就诊。体格检查:腹软,左侧腹部饱满,未触及明显肿块,散在压痛,无反跳痛,肠鸣音不活跃,阴囊壁未见红肿及皮肤破溃,右侧阴囊内及左侧腹股沟内均可见鹅蛋大的肿物,质硬,表面不光滑,压痛,透光试验     

钝性暴力致小肠破裂的超声诊断

例1 患者男18岁,腹部被板车柄碰撞后5小时,曾呕吐两次胃内容物,腹痛剧烈,查体:腹肌紧张,肠鸣音减弱.B超检查:脐上偏右探及两个形态不规则的低回声团块,大小分别为5.3×1.5cm、4.4×1.6cm,检查中腹部未见明显肠蠕动回声,腹腔内未见明显液性暗区.超声提示:小肠穿孔可能性大.X线检查:左侧腹部肠管胀气明显,双膈下未见游离气体 ,腹腔内未见液平面,血常规:白细胞14.2×10~9/L、分叶90%,淋巴10%,血红蛋白130g/L.于伤后24小的行剖腹探查、见空肠上段距Treitz韧带50cm处穿孔、口径约2×1cm,有胆汁样液体溢出.周围网膜包囊,行空肠穿孔修补术.例2 患者男40岁.腹部被人用膝盖猛烈撞击后3小时.患者腹痛难忍,以右上腹更为明显.查体:腹肌紧张,全腹压痛反跳痛明显,肠鸣音减弱.B超检查:中腹部偏右探及一形态不规则、边界不清的低回声团块,大小约7.8×2.9×4.5cm~3,下腹部膀胱直肠窝探及少许液性暗区,深度约1.7cm,检查中未见明显肠蠕动回声.超声意见:小肠穿孔可能性大.X线检查:空、回肠、结肠扩张,但未见液平面,未见隔下游离气体.血常规:白细胞14.2 ×10~9/L分叶94%、淋巴6%、血红蛋白124/L.于伤后8小时手     

慢性肾炎合并重症急性胰腺炎并发横纹肌溶解症一例

患者男, 55岁, 因"左侧腹痛2 d, 加重1 d"入院。入院前2 d, 患者无明显诱因出现左侧腹部疼痛, 伴有恶心呕吐, 呕吐后症状未见明显缓解, 无发热、无咳嗽、无咳痰、无腹泻等伴随症状, 遂至上海市东方医院急诊外科就诊。体格检查:神志清楚, 精神萎靡, 痛苦面容, 问答体格检查尚配合, 呼吸急促, 双肺呼吸音粗, 可闻及湿啰音, 血压101/58 mmHg(1 mmHg=0.133 kPa), 心率128次/分, 腹软, 肠鸣音减弱, 脐周压痛, 无反跳痛, 双肾区叩痛, 双下肢轻度水肿。既往病史:6个月前诊断慢性肾炎, 肾穿刺活检提示:微小病变性肾病。平时口服醋酸泼尼松片, 每日35 mg, 尿量每日1 500～2 000 ml, 否认高血压、糖尿病等慢性疾病史。心电图检查结果示窦性心动过速和T波改变(Ⅰ、Ⅱ、Ⅲ、aVL、aVF低平);腹部CT检查:胃壁轻度增厚、水肿;肝右下叶钙化灶;胰头部显示不清, 周围有疑似液化灶;少量腹腔积液。腹部B超示脂肪肝, 胰腺显示不清, 建议复查;胆囊增大, 轮廓清晰, 内部未见明显实质性异常回声。实验室检查:淀粉酶906 U/L, 白蛋白21...     

回肠重复畸形并憩室及扭转一例

男,12岁,因突发上腹部持续性痛阵发性加剧两天入院。次晨起痛转移至中下腹部,以左中腹为甚,呕吐两次为食物及水,低热,食欲不振,肛门一天未排便排气,尿痛。体查:体温38.4℃,脉搏112次,轻度失水征。心肺(一)。腹平,腹式呼吸减弱,未见肠型及蠕动波,中下腹部腹肌紧张,明显压痛、反跳痛,以左侧为甚。肝浊音界存在,肠鸣音减弱。下腹穿刺抽出少量黄红色微混液,抹片白细胞 ,红细胞 ,Gram染色未发现细菌。血红蛋白9.5g。白细胞16,000,中性82％,淋巴18％。腹部透     

霍奇金淋巴瘤误诊为结核性胸膜炎

【病例】男,79岁。因左下胸疼痛2个月入院。平素身体健康,有60年吸烟史。患者2个月来无明显诱因出现左下胸部阵发性烧灼样疼痛,无发热、咳嗽、咳痰、咯血、呼吸困难等症状。查体:一般状况好,浅表淋巴结不大,左下肺叩诊呈浊音,呼吸音减弱,心脏及腹部检查未见异常。查血白细胞4.0×109/L,中性粒细胞0.68,淋巴细胞0.26;红细胞沉降率55 mm/h。行胸部X线平片及CT扫描示左侧胸腔少量积液伴胸膜粘连、肥厚,双肺未见肿块,纵隔内未见明显增大淋巴结。结核菌素试验(2+)。行胸腔穿刺抽出深黄色微浑浊液体,实验室检查提示为渗出液,3次行胸腔积液及胸膜…     

左肝内胆管破裂误诊

【病例】　女 ,72岁。因左腹股沟区肿块伴持续性腹痛 3天入院。 33年前曾行胆囊切除术 ,有胆总管结石史 10年 ,左侧股疝 6年。查体 :痛苦貌 ,意识清 ,生命体征平稳。皮肤、巩膜轻度黄染 ,浅表淋巴结未触及。心肺未见异常。腹部平坦 ,右上腹切口瘢痕 ,全腹肌紧张 ,压痛 (3+) ,反跳痛 (+)。肝脾肋下未触及 ,肝区叩痛(+)。移动性浊音 (± ) ,肠鸣音减弱。左腹股沟区触及鸡蛋大小肿块 ,质硬 ,压痛 (2 +) ,平卧位不能回纳 ,屏气后未见明显增大 ,未闻及肠鸣音。辅助检查 :X线腹透示肠管广泛积气 ,中腹部可见少量中小液气平面 ,膈下未见游离气体。…     

超短波治愈多脏器复合伤术后重症胸腔积液一例

患者1例,男,6岁.腹部撞伤30 min后就诊.全麻下急行肝脾破裂及右肾挫伤修补术、腹腔引流术.10 d后伤口拆线愈合良好,无感染,常规检查均正常,出院.15 d患儿出现发热、咳嗽、右侧胸痛;查体:神志清楚,精神尚可,胸廓未见畸形,右侧稍饱满,双肺闻及肺泡呼吸音,右侧减弱,听觉语音右侧较左侧减弱,心音有力;胸片示右侧膈肌抬高,外高内低,约平第8肋,右侧胸腔积液.     

腹股沟斜疝致肠坏死1例

男，56岁。于2d前无明显诱因出现下腹疼痛，在当地卫生所已抗炎解痉治疗无好转。既往有左腹股沟可复性包块6a，近2a未出现包块，无外伤史及手术史。查体：T36．8℃，P72次／min，R22次／min，BP110／70mmHg。下腹压痛，尤以左下腹为甚，腹部未及明显包块，反跳痛存在。无移动性浊音，右侧肠鸣音亢进，左侧肠鸣音减弱，左腹股沟未见明显包块及疝内容物，腹部X线检查：可见多个液平面：血常规：WBC14．8×10^9／L，拟定肠梗阻手术。     

胸膜腔粘连带挛缩致膈肌抬高误诊膈疝一例报告

胸膜腔粘连带挛缩致膈肌抬高误诊膈疝一例报告山东省郯城县第一人民医院［２７６１００］梁岿然，付现敏［病例］男，６０岁，因食欲不振，反酸，上腹部饱胀感伴左侧胸部隐痛６年入院。查体：消瘦，左胸部扁平，呼吸动度明显减弱，左肺呼吸音消失，左胸部闻及肠鸣音。腹部...     

胸腔巨大孤立性纤维性肿瘤的超声表现1例

患者女,40岁.1年前无明显诱因出现胸闷,活动后加重.外院诊为左侧胸腔大量积液,于左侧胸腔穿刺未抽出液体,始来我院.查体:胸廓对称无畸形,左侧呼吸运动明显减弱,呼吸音微弱.常规化验未见异常,血沉不快,C-反应蛋白不高,结核菌素实验为阴性.行胸部增强CT示左侧胸腔见不规则软组织密度肿块,纵隔中度右移.气管镜检查未见新生物.     

Clinical Trial Updates and Hotline Sessions presented at the Scientific Session 2007 of the American heart association

This article provides information and commentaries on trials which were presented at Clinical Trial Updates and Hotline Sessions presented at the Scientific Sessions 2007 of the American Heart Association in Orlando, Florida. The comprehensive summaries have been generated from the oral presentations and the webcasts of the American Heart Association. Most reports have not been published as full papers and therefore have to be considered as preliminary data, as the analysis may change in the final publications. The following papers are discussed: TRITON TIMI-38, EVA-AMI, BRIEF-PCI, RACE, MASS Stent, HF-ART, STITCH, CORONA, ILLUMINATE, CORE-64, OAT Substudy, AFCHF, MASCOT, RETHINQ, MASTER I, POISE, COUMA-GEN, HIJ-CREATE, PROVIDENCE I, CAUSMIC, IC-BMC, IC/IM BMCs.     

Caring as a slave morality: Nietzschean themes in nursing ethics

BACKGROUND: Sceptical arguments about 'caring' can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self-deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing. AIM: This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the 'caring paradigm'. METHODS: The paper adopts a genealogical approach, borrowed directly from Nietzsche's Genealogy of Morality. That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident). Caring represents an inversion, a sort of 'fantasy revenge', in which the nobles can be portrayed as 'evil', while the slaves portray their own weakness as 'good'. Taking its cue from Nietzsche, the paper shows that the Genealogy narrative can be transposed into a modern health care context, with nurses as the 'slaves' and the medical profession as the 'nobles'. CONCLUSIONS: The ideology of caring is, in the Genealogy's terms, a slave morality. It represents an attack on the 'medical-scientific model', motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a 'noble' (that is, a properly scientific) discipline.     

Recent advances in plant hepatoprotectives: a chemical and biological profile of some important leads

Medicinal plants have been traditionally used for treating liver diseases since centuries. Several leads from plant sources have been found as potential hepatoprotective agents with diverse chemical structures. Although, a big list of hepatoprotective phytomolecules was reported in the scientific literature, only a few were potent against various types of liver damages. Of which, silymarin, andrographolide, neoandrographolide, curcumin, picroside, kutkoside, phyllanthin, hypophyllanthin, and glycyrrhizin have largely attracted the scientific community. This review focuses discussion on the chemistry, biological activity, mode of action, toxicity, and future prospects of these leads.     

吞咽障碍患者服药管理的最佳证据总结

目的检索、评价和总结吞咽障碍患者服药管理的最佳证据。方法运用循证护理的方法,针对吞咽障碍患者服药管理提出问题,系统检索UpToDate、BMJ、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)图书馆、Cochrane Library、加拿大安大略注册护士协会网站、英国国家临床医学研究所指南库、苏格兰学院间指南网、美国国立指南网、国际网络指南网、加拿大医学会临床实践指南、美国心脏/脑卒中协会网站、PubMed、CINAHL、英国NEWT网站、中国生物医学文献数据库、医脉通、中国知网等数据库或网站,检索时限为建库至2021年1月,文献类型涵盖临床决策、临床实践指南、证据总结、系统评价、专家共识。由3名研究者对检索到的文献进行评价和证据提取。结果共纳入12篇文献,其中临床决策2篇、指南2篇、证据总结6篇、专家共识2篇。总结了8个方面的最佳证据,包括医护人员教育和培训、用药前筛查和评估、多学科合作、代偿性方法、口服固体剂型的选择、碾碎药物的管理、胃肠营养管用药、用药效果监测和记录。结论该研究针对吞咽障碍患者服药管理进行证据总结,为建立吞咽障碍患者服药规范流程、实践...     

慢性病和功能障碍老年人身体活动的健康效果：系统综述的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建身体活动对慢性病和功能障碍老年人健康及健康相关状况的干预效果范畴及架构。方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)对老年人的健康及健康状况进行系统分析。检索PubMed、CBM、Scopus、Web of Science、Embase、中国知网、维普、万方等数据库,收集建库至2022年8月8日关于身体活动干预对慢性病和功能障碍老年人健康及健康相关状况康复效果的系统综述进行综述。结果 最终纳入系统综述11篇,来自6个国家,共涉及316项相关随机对照试验和28 169名参与者,主要包括老龄化、公共健康、康复、身体锻炼等领域。与老年人健康状况相关的疾病主要集中于痴呆、帕金森病、精神分裂症、抑郁症、认知障碍,骨质疏松症、关节炎、肌少症,慢性心力衰竭、冠心病、高血压、脑卒中,2型糖尿病,慢性肺病。干预方案中,活动形式有平衡、功能和耐力训练、灵活性训练,步行、伸展、上下肢训练、瑜伽、气功、太极拳等,活动频率每周1～7次,活动强度为中度,活动持续时间4周～10年。健康结局涉及降低疾病风险,...     

Integrative Medicine in the Oncology Setting,What Does the Research Show?

Most oncology patients are using some form of complementary alternative medicine (CAM). These can include acupuncture, massage, yoga, homeopathy, energy work, spiritual healers, vitamins and supplements, mind-body interventions, diets, and many other modalities. Although many of these interventions are safe and beneficial, some of them can be harmful. Unfortunately, because of time constraints, knowledge deficits, and the acuity of our patients, assessment of the use of CAM is often overlooked. As nurse practitioners, we must educate ourselves about the evidence for safety and efficacy of these interventions.     

四维面积应变评价不同左心室构型高血压患者的左心室功能

目的评价四维应变成像技术面积应变（4D-area strain）检测高血压不同左心室构型患者左心室收缩功能的价值。 方法收集2015年2月至8月浙江省杭州市余杭中医院确诊的原发性高血压患者125例,根据Ganan分类法分为：正常构型组45例（A组）、向心性重构组25例（B组）、向心性肥厚组25例（C组）及离心性肥厚组30例（D组）。另选取本院体检中心40名健康人作为健康对照组（N组）。采用4D-area strain检测各组与健康对照组常规左心室收缩功能指标与整体面积应变（GAS）、节段面积应变（RAS）值,进行相互比较。组间整体面积应变与对应的节段面积应变比较采用多样本均数方差分析,多个均数间的两两比较采用LSD-t检验。 结果（1）常规心功能：A、B、C、D及N组左心室舒张末期容积（EDV）、心搏量（SV）及心输出量（CO）测值比较,差异均无统计学意义（F =0.679、3.829、0.600,P均>0.05）,收缩末期容积（ESV）、射血分数（EF）、球形指数（Spl）、舒张末期重量（EDMass）测值比较,差异均有统计学意义（F=3.829、6.596、2.653、2.604,P均<0.05）;D组ESV测值与N、A、B、C组比较,差异有统计学意义（t =2.011、2.244、3.685、2.278,P均<0.05）;B组ESV测值与N组比较,差异有统计学意义（t=2.170,P<0.05）;B组EF测值与N、A、D组比较,差异有统计学意义（t =2.452、3.514、4.949,P均<0.05）;D组EF测值与N、C组比较,差异有统计学意义（t=2.849、3.486,P均<0.05）;D组SpI测值与N、A、B、C组比较,差异有统计学意义（t =2.854、2.941、3.200、2.979,P均<0.05）;C组EDMass测值与N、A组比较,差异有统计学意义（t=2.170、2.087,P均<0.05）;D组EDMass测值与A、B、N组比较,差异有统计学意义（t=2.668、2.081、3.762,P均<0.05）。（2）GAS：A、B、C、D各组与N组GAS测值比较,差异均有统计学意义（t=7.950、7.361、8.959、11.277,P均<0.01）,且随左心室重构程度加重差异更为明显;A、B组GAS测值分别与D组比较,差异均有统计学意义（t =3.332、2.102,P均<0.05）,A组GAS测值与C组比较,差异有统计学意义（t=3.134,P<0.05）。（3）RAS：D组所有节段与N组比较,差异均有统计学意义（第1~17节段,t分别为2.967、3.793、4.896、4.001、2.375、4.169、4.077、2.137、4.652、4.016、5.230、6.267、5.735、2.143、2.353、5.429、4.128,P均<0.05）;A、B、C 3组与N组比较,基底段的前间隔壁、后间隔壁、前侧壁,中间段的前侧壁,心尖段的前壁、侧壁、心尖帽,差异均有统计学意义（A-N：t=2.667、3.084、3.574、4.771、3.182、4.806、3.567,P均<0.05;B-N：t=2.702、2.868、2.179、3.130、3.302、3.203、3.093,P均<0.05;C-N：t=4.927、5.600、4.276、6.577、6.198、5.190、5.441,P均<0.05）;A、B、C 3组与N组心尖间隔段比较,差异均无统计学意义（t=0.934、1.562、1.879,P均>0.05）。 结论4D-area strain为不同左心室构型高血压患者左心室收缩功能的检测提供一种新方法,尤其是对早期收缩功能的检测更为敏感。     

Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts

Lymphedema has historically been underrated in clinical practice, education, and scholarship to the detriment of many patients with this chronic, debilitating condition. The mechanical insufficiency of the lymphatic system causes the abnormal accumulation of protein-rich fluid in the interstitium, which triggers a cascade of adverse consequences such as fat deposition and fibrosis. As the condition progresses, patients present with extremity heaviness, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, acanthosis, and other trophic skin changes. Correspondingly, lymphedema results in psychological morbidity, including anxiety, depression, social avoidance, and a decreased quality of life, encompassing emotional, functional, physical, and social domains. For this review, we conducted a literature search using PubMed and EMBASE and herein summarize the evidence related to the fundamental concepts of lymphedema. This article aims to raise awareness of this serious condition and outline and review the fundamental concepts of lymphedema.     

Sitting biomechanics part I: review of the literature

OBJECTIVE: To develop a new sitting spinal model and an optimal driver's seat by using review of the literature of seated positions of the head. spine, pelvis, and lower extremities. DATA SELECTION: Searches included MEDLINE for scientific journals, engineering standards, and textbooks. Key terms included sitting ergonomics, sitting posture, spine model, seat design, sitting lordosis, sitting electromyography, seated vibration, and sitting and biomechanics. DATA SYNTHESIS: In part I, papers were selected if (1) they contained a first occurrence of a sitting topic, (2) were reviews of the literature, (3) corrected errors in previous studies, or (4) had improved study designs compared with previous papers. In part II, we separated information pertaining to sitting dynamics and drivers of automobiles from part 1. RESULTS: Sitting causes the pelvis to rotate backward and causes reduction in lumbar lordosis, trunk-thigh angle, and knee angle and an increase in muscle effort and disc pressure. Seated posture is affected by seat-back angle, seat-bottom angle and foam density, height above floor, and presence of armrests. CONCLUSION: The configuration of the spine, postural position, and weight transfer is different in the 3 types of sitting: anterior, middle, and posterior. Lumbar lordosis is affected by the trunk-thigh angle and the knee angle. Subjects in seats with backrest inclinations of 110 to 130 degrees, with concomitant lumbar support, have the lowest disc pressures and lowest electromyography recordings from spinal muscles. A seat-bottom posterior inclination of 5 degrees and armrests can further reduce lumbar disc pressures and electromyography readings while seated. To reduce forward translated head postures, a seat-back inclination of 110 degrees is preferable over higher inclinations. Work objects, such as video monitors, are optimum at eye level. Forward-tilting, seat-bottom inclines can increase lordosis, but subjects give high comfort ratings to adjustable chairs, which allow changes in position.     

Hospital Management of Acute Iron Ingestion

Abstract

This overview summarizes the major and minor side effects and drug interactions of fluoxetine. The adverse reactions include the “serotonin syndrome”, cardiovascular complications, extrapyramidal side effects such as akathisia, dyskinesias, and parkinsonian-like syndromes and an apparently increased risk of suicidality. Fluoxetine-induced mania and hypomania, seizures and sexual disorders are evaluated along with minor symptoms of allergic reactions, stuttering, hematological changes, psoriasis, and inappropriate secretion of the antidiuretic hormone. The major fluoxetine-drug interactions involve the amino acids L-dopa and L-tryptophan, anorexiants, anticonvulsants, antidepressants, anxiolytics, calcium channel blockers, cyproheptadine, lithium salts, and drugs of abuse. The underlying mechanism and the paradoxical effects of fluoxetine are addressed.