穿刺抽吸与切开排脓治疗扁桃体周脓肿的对比

扁桃体周围脓肿为扁桃体周围间隙的化脓性炎症 ,多为急性化脓性扁桃体炎或急性扁桃体炎的并发症 ,多见于急性扁桃体炎反复发作的患者。脓肿位于扁桃体被膜与咽上缩肌之间。扁桃体周围脓肿的治疗原则是在应用足量抗生素的同时 ,反复穿刺抽吸脓液或切开排脓。 1990年 1月至 1996年 1月我们收治了扁桃体周围脓肿 (PTA ) 6 4例 ,比较了反复穿刺抽吸与切开排脓的治疗效果。1　资料与方法1.1　临床资料　 PTA 6 4例 ,男 46例 ,女 18例 ,2 0～ 35岁 ,平均 2 7.5岁 ,随机分为穿刺抽吸组 (1组 ) 33例 ,切开排脓液(2组 ) 31例。 1组 6 8%、2组 6 0 …     

穿刺抽脓治疗扁桃体周围脓肿38例

1999年 3月至 2 0 0 2年 12月我们采用局部穿刺抽脓并全身应用抗生素治疗扁桃体周围脓肿 38例 ,其中男 2 9例 ,女 9例 ,16～ 5 5岁。 38例脓肿均为单侧 ,左侧 2 6例 ,右侧 12例。在无麻下 ,用 12号长穿刺针头 ,接 5ml注射器 ,于脓肿隆起处 ,穿刺抽脓 ,直至抽不出脓液为止。然后静脉滴注青霉素、氟美松、甲硝唑 ,每天 1次 ,治疗 5～ 7d。次日复诊 ,35例症状明显减轻 ,除继续应用抗生素外 ,未再行穿刺和其他治疗。 3例局部仍肿胀疼痛 ,再次穿刺抽脓。 5～ 6d后复发 2例 ,第 3次穿刺抽脓治愈。 1次穿刺治愈率 86 .8%,随访 6～ 12个月 ,仅 1例复…     

经皮穿刺抽脓术与保守治疗细菌性肝脓肿对比分析

目的:观察超声引导下中心静脉导管经皮穿刺抽脓术与保守治疗细菌性肝脓肿(PLA)各自的优缺点,探讨经皮穿刺抽脓术治疗PLA的临床意义.方法:回顾性分析61例PLA患者的临床资料,其中26例(42.6%)经超声引导下中心静脉导管经皮穿刺抽脓术治疗,35例(57.4%)完全经内科保守治疗.结果:经皮穿刺抽脓术治疗的26例PLA患者比完全经内科保守治疗的35例PLA患者退热、住院时间短,治疗治愈率高.结论:超声引导下中心静脉导管经皮穿刺抽脓术治疗PLA临床意义较大,值得在临床推广.     

扁桃体周围脓肿141例分析

<正>扁桃体周围脓肿是扁桃体周围间隙的一种化脓性感染。好发于青壮年。现就我院十年来收治的141例进行分析,报告如下。 1.临床资料 本组141例,男99例,女42例,发病年龄12～73岁,30岁以下80例(45.7％);病程3～30天,其中3～9天97例,10～30天44例;前上型134例,后上型7例。 治疗 全身给予抗生素及皮质类固醇激素;局部处理:单纯穿刺抽脓1～3次8例,脓肿自行破溃2例;切开排脓81例;扁桃体切除50例,其中脓肿时切除29例,切开排脓3～4天后切除14例,切开排脓2周后切除7例。 结果 扁桃体切除50例,均痊愈;单纯穿刺抽脓或自行破溃10例,2例复发,1例25天复发,1例3年后复     

温通法治疗急性乳腺炎348例

目的:观察温通法治疗急性乳腺炎的疗效。方法:选择285例急性乳腺炎患者组成观察组,采用温通法治疗,成脓者配合穿刺抽脓;同期63例急性乳腺炎患者组成对照组,采用青霉素治疗,成脓者配合穿刺抽脓,观察两组疗效。结果:未成脓期病例中,观察组治愈率96.90%,对照组为60.41%;观察组有效率为100%,对照组为81.25%。成脓期病例中,观察组治愈率为79.66%,对照组为66.67%;观察组有效率为100%,对照组为80%。结论:温通法可有效治疗各期急性乳腺炎,避免手术。     

中西医结合治疗肝脓疡15例疗效观察

我院内科自1978年以来以肝脓疡汤(中药组)为主治疗阿米巴性肝脓疡及细菌性肝脓疡共15例,全部治愈出院,无一例复发。并选1974年以来用传统西药或灭滴灵治疗肝脓疡,其中病历记载较完整的32例为对照组(西药组),进行疗效比较。一、临床资料(一) 病例选择:两组病例均为内科收治,且确诊为肝脓疡,其配合治疗措施大致相同,如采用肝穿抽脓法或肝插管抽脓法。     

治疗扁桃体周围脓肿41例报告

本文总结了切开排脓和穿刺抽脓治疗扁桃体周围脓肿４１例，分析患者的治愈率和复发率，探讨治疗扁桃体周围脓肿的首选方法。结果表明：两组患者的一次治愈率和复发率均有显著差异性（Ｐ＜０．０５）。提示切开排脓应作为治疗扁桃体周围脓肿的首选方法     

双腔套管引流加抗生素冲洗治疗肾及肾周脓肿

<正> 我院自1990年1月以来,对8例较大肾皮质脓肿(RCA)及3例肾周脓肿(PA)行脓肿切开,置双腔套管引流,并以抗生素持续冲洗脓腔,取得满意效果,报告如下。1 资料与方法1.1 临床资料 本组11例,其中RCA8例,PA3例,均经手术证实。均有发热史,腰疼9例,均行B超检查,CT检查10例。脓肿最大8.6cm×7.8cm,最小4.5cm×5.0cm。B超引导下穿刺抽脓3例,均未愈或复发而改用本法治疗。     

扁桃体周围脓肿的细菌学培养及治疗

目的：探讨扁桃体周围脓肿的致病菌种类及临床治疗。方法，对1992—2000年共观察的86例PTA患，其中49例做细菌培养．在治疗上60例采取针吸排脓治愈，26例行扁桃体切除治愈．结果，49例RA穿刺脓掖培养结果，23例阳性(46．9％)，其中金黄色葡萄球菌10株(43．5％)，溶血性链球菌6株(26．1％)，草绿色链球菌及表皮葡萄球菌等其它菌7株(30．4％)．86例中60例经针吸排脓近期治愈2年内随访有中12例(20％)PTA复发，26例行扁桃体切除术随访未见复发．结论，RTA应用青霉素效果较好，疗程术少于2周．对初发PTA病人应采取针吸排脓治疗为主，只有少数在穿刺排脓治疗失败或有扁桃体切除适应证才行扁桃体切除术．     

扁桃体周围脓肿急诊手术30例治疗体会

对于扁桃体周围脓肿的治疗,通常采用全身应用抗生素,穿刺抽脓或切开排脓,择期手术的治疗原则,自1994年以来,我科采用急诊(脓肿期)行扁桃体剥离摘除术的方式,同时应用抗生素治疗,达到一次性根除脓肿,临床观察30例,均取得较好疗效,未见任何并发症,现将治疗体会报道如下。1临床资料1.1 一般资料 1994年以来我院耳鼻咽喉科接诊的扁挑体周围脓肿患者60例,随机分为两组,择期手术组30例,其中男25例,女5例,平均年龄18-40岁;急诊手术组30例,其中男21例,女9例,平均年龄18-40岁.急诊查体,两组病人均有低热、头痛、咽痛、畏寒、张口受限、扁桃体脓肿症状…     

计算机X线断层扫描引导细针穿刺活检诊断肺部小病灶

目的探讨计算机X线断层扫描(CT)引导下经皮细针穿刺活检诊断肺部周边小病灶的准确度和安全性。方法2000年6月至2003年11月共45例患者行CT引导下经皮肺部周边小病灶穿刺,男34例,女11例,年龄31～81岁,平均为(61.8±13.7)岁。病灶直径7～20mm,平均为(16.3±4.5)mm。孤立病灶39例,多发病灶6例。结果恶性病变19例(42.2%);良性病变17例(37.8%);组织学检查阴性6例,其中1例为假阴性;无诊断价值3例。其准确度为91.1%(41/45例),灵敏度为95%(19/20例)。并发气胸4例(8.9%)。2例(4.4%)患者合并病灶周围少量出血。讨论CT引导下细针穿刺肺部良、恶性病灶是相当安全和准确的诊断方法,其准确度和安全性与病灶大小和进针深度有关,小病灶准确度低于大病灶。该方法除气胸外无其他严重并发症,值得临床广泛推广。     

Prevalence of sleep disordered breathing symptoms among Malay school children in a primary school in Malaysia

Sleep disordered breathing (SDB) is increasingly being diagnosed in children. However, there is no prevalence study done in Malaysia. The study objective was to evaluate the prevalence of SDB symptoms based on parental reports and associated risk factors among Malay school children aged 6 to 10 years old in a primary school using a translated University Michigan Paediatric Sleep Questionnaire (Malay UM-PSQ). The children whose parents responded to the questionnaire and consented were examined, documenting height, weight, skin fold thickness, neck and abdominal circumference, tonsillar size, nostril examination and presence of micrognathia or retrognathia. There were 550 respondents. The prevalence of parental report of SDB symptoms was 14.9 % (95 % CI 11.9, 17.9). Two hundred and eighty-five (51.8%) school children were males with mean age of 8.5 years (SD 1.1). The associated risk factors for SDB symptoms are male, obesity, large neck and waist circumference, positive history of asthma, history of recurrent tonsillitis, enlarged tonsil (> 4+) and enlarged nasal turbinate. Multivariate analysis showed that male gender is the only significant independent risk factor of SDB symptoms     

Laser tonsillotomy in children with tonsillar hyperplasia

Tonsillectomy in children is performed on a regular basis in ENT. The indications are chronic tonsillitis, sleep apnea to deeper structures. The natural history of tonsillar hyperplasia is regression when a child is six years beyond. In children with bilateral tonsillar hyperplasia we studied the use of laser as an alternative procedure to reduce the bulk of the tonsillar mass. Children with symptoms of bilateral tonsillar hyperplasia underwent laser tonsillotomy. The tonsils were dissected using carbon dioxide (CO2) laser. The tonsillar bed was left untouched. Intraoperative and postoperative conditions were noted.     

食管鳞状细胞癌高/低发区肿瘤家族史流行病学病例对照分析

目的探讨高/低发区肿瘤家族史与食管鳞状细胞癌患病风险、性别和发病年龄的关系。方法采用大规模人群流行病学病例-对照研究方法,对住院患者或胃镜受检者面对面调查,病例及对照资料来自全国食管癌高/低发区45家单位,病例组39 833例、对照组9 242例进入最终分析。结果高发区和低发区病例组家族史阳性率均高于对照组(分别为34%,23%,P<0.05;21%,5%,P<0.05);高发区男性患者家族史阳性率高于女性(34%,33%,P<0.05);高发区和低发区肿瘤家族史阳性食管鳞癌患者平均发病年龄均低于家族史阴性患者(分别为57.6岁±9岁,58.4岁±10岁,P<0.05;58.7岁±9岁,59.7岁±9岁,P<0.05);高发区和低发区病例组小年龄组(≤45岁)家族史阳性率均高于大年龄组(≥66岁)(分别为35%,31%,P<0.05;22%,18%,P<0.05)。结论肿瘤家族史阳性者ESCC发病风险明显高于肿瘤家族史阴性者,尤以高发区男性为甚,且发病年龄偏低;遗传因素在ESCC发生中起重要作用,食管鳞癌的发生是遗传因素、环境因素交互作用的结果。     

65岁及以上2型糖尿病患者的低血糖特征

目的分析内分泌代谢专科住院老年2型糖尿病患者低血糖特征。方法提取2014年1月~2015年12月内分泌科住院2型 糖尿病1187 例次患者共58 565 次床边血糖监测系统（BGMS）数据,按患者年龄分为<45 岁（128 例次）、45~64 岁（594 例次） 和≥65岁（465例次）3组,通过3组对比,分析老年患者住院期间低血糖发生率及时段分布特征。结果随年龄增加,低血糖发生 风险逐渐增加,≥65 岁组低血糖密度、患者占比和患者-住院日占比分别是<45 岁组的2.38、2.57、2.54 倍（0.95% vs 0.40%, 28.17% vs 10.94%,4.48% vs 1.76%,P<0.001）;凌晨是老年组低血糖高发时段,相比<45岁和45~64岁组,≥65岁组凌晨的低血糖 密度分别是其2.44和1.40倍（2.66% vs 1.09% vs 1.90%,P<0.05）,患者占比分别是其3.86和1.55倍（14.57% vs 3.77% vs 9.42%, P<0.02）;≥65岁组反复低血糖（≥2次）患者占比是其他两组的5.70倍和1.41倍（13.33% vs 2.34% vs 9.43%,P<0.05）。结论65 岁及以上2型糖尿病患者低血糖风险显著高于非老年组,凌晨和反复低血糖情况最为突出。应针对老年糖尿病患者制订差异 化血糖监测和管理策略,以提高医疗安全。     

Possible role of Helicobacter pylori serology in reducing endoscopy workload.

We validated a commercial enzyme-linked immunosorbent assay (ELISA), Helico-G, in diagnosing H. pylori in 129 patients (mean age 50 years, range 15-86). We analysed the results of endoscopy against serology to see whether there was a possibility of adopting the strategy of not endoscoping dyspeptic subjects under the age of 45. H. pylori infection was considered present if either histology and/or culture were positive. The ELISA had a sensitivity of 88%, specificity of 72%, positive predictive value of 85%, negative predictive value of 77% and accuracy of 82% in detecting H. pylori. In a subgroup of 52 subjects aged 45 or less (mean age 35 years, range 15-45), 17 out of 25 patients with positive endoscopic findings were H. pylori seropositive while 16 out of 27 patients had normal endoscopic findings. Eighteen out of the 52 patients (35%) were H. pylori seronegative and normal endoscopically except for five patients (10%) who had mild to moderate oesophagitis and two who had non-erosive gastritis (4%). All patients with duodenal ulcer disease (7) were seropositive giving predictive values of positive and negative serology for a diagnosis of duodenal ulcer disease as 28% and 100%, respectively. Therefore adopting a strategy of endoscoping subjects under the age of 45 only if they were H. pylori seropositive would have saved 35% of endoscopies in this age group but missed oesophagitis in 10%. Negative serology would tend to exclude duodenal ulcer disease while positive serology discriminates poorly for it. Serology may be a useful adjunct in screening to reduce endoscopy workload provided that patients with gastro-oesophageal reflux symptoms are excluded.     

Extrapulmonary Tuberculosis in Human Immunodificiency Virus Infection

Background

In view of increase in incidence of exptrapulmonary tuberculosis after the epidemic of human immunodeficiency virus infection, the clinical profile of extrapulmonary tuberculosis in patients with HIV infection was studied.

Method

The study population comprised patients of HIV infection with extrapulmonary tuberculosis. Work up included history, clinical examination, sputum for acid fast bacilli, chext X-ray, ultrasonography (USG) abdomen, fine needle aspiration cytology(FNAC), transbronchial needle aspiration (TBNA) and computed tomography of chest.

Results

There were 50 cases, all males with mean age of 35 years. 24(48%) were without pulmonary tuberculosis and 26(52%) had pulmonary tuberculosis. 41(82%) had disseminated disease and 9(18%) involve one site. Fever and weight loss were the most frequent symptoms (79% and 58% respectively) in cases without pulmonary tuberculosis. The most frequent extrapulmonary site was lymph node in 46(92%), followed by spleen in 13(26%), pleura 9(18%), miliary 7(14%) and hepatic 1(2%). The diagnosis was confirmed by invasive methods in 30 out of 50(60%) cases [FNAC in 23(88%), TBNA in 2(25%) and pleural biopsy in 5(55%)].

Conclusion

In HIV infected patients, the most common extrapulmonary site is lymph mode followed by spleen.Key Words: Extrapulmonary TB, HIV Infection     

咽旁间隙肿瘤（附89例临床分析）

目的：总结诊治咽旁间隙肿瘤的经验。方法：回顾分析咽旁间隙肿瘤89例。术前为32例患者行针吸活检术,50例行CT检查;全部患者均行手术治疗,经腮腺入路29例,经颈入路45例,经颈－下颌骨外旋入路15例,术后全部标本作病理检查。结果：针吸活检32例中27例诊断正确,CT检查50例中46例可准确判断肿瘤的位置;组织学检查良性肿瘤72例（81例）,以恶性肿瘤、混合瘤多见37（42％）。良性肿瘤术后10例复发（14％）,恶良肿瘤12例复发或转移（74％）。结论：术前针吸活检和CT检查对诊断咽旁肿瘤有意义,经腮腺和经颈部入路是最常用手术进路。     

Ultrasound in the assessment of the palpable breast mass

The aim of the study was: to obtain the profile of patients (with regards to age and family history of breast cancer) with a palpable breast mass. To determine the validity of ultrasound in the assessment of the palpable breast mass by determining the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound in distinguishing a malignant mass. To determine the most discriminating ultrasound characteristics for differentiating benign and malignant masses. Seventy patients who had fine needle aspiration cytology of a palpable breast mass were subjected to an ultrasound assessment of the mass. The ultrasound findings were classified as benign, indeterminate or malignant. These findings were then compared with either the cytology or histology results in cases that eventually had surgical excision. The age of the patients ranged from 15 to 66 years old The majority was in the third and fourth decades with an average age of 25 years. The 8 patients with a proven malignant breast mass were aged between 39 and 66 years old. They did not have any family history of breast cancer. Only 4 patients had a family history of breast carcinoma and all proved to have a benign breast lesion. Ultrasound had a sensitivity of 100%, specificity of 85.7%, positive predictive value of 50%, negative predictive value of 100% and accuracy of 87.5% for distinguishing a malignant mass. For benign masses: 93.7% had well-defined margins, 81.3% had homogenous internal echoes, 91.7% had depth-width ratio of less than 1.0 and 89% were compressible. For malignant masses: 87.5% had either ill-defined or irregular margins, 87.5% had inhomogenous internal echoes and mixed posterior echoes, and 100% were incompressible. The majority of patients with a palpable breast mass were aged below 40 years old. Most of the patients with a malignant breast mass were aged 40 years and older. Neither a positive nor a negative family history of breast cancer had any significance on outcome. Ultrasound had high sensitivity, specificity and accuracy in distinguishing a malignant mass. The most discriminating benign ultrasound characteristic was compressibility. The most discriminating malignant ultrasound characteristic was ill-defined and irregular margins.     

类风湿关节炎患者风湿病家族史特征及临床意义

目的 分析类风湿关节炎(rheumatoid arthritis, RA)患者的风湿病家族史特征及其临床意义。方法 采用现场问卷调查方法,共调查890例RA患者,其中资料完整者803例,内容包括患者的性别、年龄、吸烟史、饮酒史、身高、体重、风湿病家族史、临床及血清学特征、疼痛和疾病总体评价、多维健康评估问卷等,并根据RA患者有无家族史进行分组比较。结果 本研究中,RA患者发病年龄为(45.09 ±14.50)岁,男女比例1 ∶3.5。有风湿病(包括RA、脊柱关节炎、干燥综合征、系统性红斑狼疮、系统性硬化症)家族史的患者123例(123/803, 15.32%), 其中一级亲属患病者占有家族史者73.98%(91/123),二级亲属患病者占有家族史者17.89%(22/123),一级+二级亲属均患病10例(8.13%)。家族史疾病种类以RA为主,为70.73%(87/123),其他风湿性疾病为21.95%(27/123),RA合并其他风湿病占7.32%(9/123)。根据有无家族史,对两组RA患者的人口学特征和临床指标进行比较,结果显示:在有家族史患者中,发病年龄提前6.04年[(39.97±13.68)岁 vs.(46.01 ±14.46)岁],类风湿因子阳性率高(78.48% vs. 66.67%), 差异具有统计学意义(P<0.05)。校正性别、体重指数及抗环瓜氨酸肽抗体等混杂因素后,有家族史患者的发病年龄提前4.54年(β = -4.54;95%CI:-8.70, -0.38;P < 0.05)。进一步分层分析发现,在吸烟RA患者中,有家族史者发病年龄提前10.02年,差异具有统计学意义(β = -10.02;95%CI:-17.60, -2.43;P = 0.01);而在不吸烟RA患者中,有家族史者发病年龄提前3.27年,差异无统计学意义(β = -3.27;95%CI:-8.37, 1.82;P= 0.21)。结论 风湿病家族史是RA发病提前的危险因素,与吸烟可能具有协同作用。