颈、纵隔型囊性淋巴管瘤患者一例的护理

淋巴管瘤是淋巴管发育畸形所形成的一种良性肿瘤,是由扩张的内皮细胞增生的淋巴管和结缔组织所共同构成的良性肿瘤,内含淋巴液、淋巴细胞或混有血液。淋巴管瘤有3种类型:毛细淋巴管瘤、海绵状淋巴管瘤和囊性淋巴管瘤。囊性淋巴管瘤也称为囊状水瘤,大多数起源于儿童或年青人的原始     

1例大网膜巨大海绵状淋巴管瘤术后护理

海绵状淋巴管瘤由Fink在1885年首先报道,属淋巴管瘤的一种类型。淋巴管瘤是由扩张的内皮细胞增生的淋巴管和结缔组织所共同构成的先天性良性肿瘤,内含淋巴液、淋巴细胞或混有血液。海绵状淋巴管瘤可发生于体表,也可发生于深部组织或内部脏器,好发于颈部、腋下、纵隔内,本例位于大网膜属罕见。肿瘤大小44cm×34cm×22cm,手术难度和风险较     

四黄液在淋巴管炎病人护理中的应用

多数淋巴管炎是由于溶血性链球菌通过皮肤破损处或其他感染源蔓延到邻近淋巴管所引起.     

肺淋巴管平滑肌瘤病临床分析

目的 探讨肺淋巴管平滑肌瘤病的临床特征,提高对肺淋巴管平滑肌瘤病的认识.方法 对2例肺淋巴管平滑肌瘤病患者的临床资料进行分析,并结合文献进行复习.结果 肺淋巴管平滑肌瘤病临床表现为呼吸困难,气胸,乳糜胸,肺功能呈阻塞性或限制性通气功能障碍,弥散功能障碍.高分辨CT示两肺广泛弥漫性分布的薄壁小囊状病变.病理特点为肺淋巴管、小血管、小气道的管壁平滑肌细胞弥漫增生.结论 育龄期妇女如反复出现气促或乳糜胸,胸部CT示两肺弥漫性囊状改变,即应考虑肺淋巴管平滑肌瘤病可能.肺淋巴管平滑肌瘤病预后差,目前无有效治疗方法.     

淋巴水肿的外科治疗进展

淋巴水肿是由于先天性淋巴管发育不良或继发性淋巴液回流障碍造成的肢体浅层软组织内淋巴液积聚引起的组织水肿，淋巴水肿分为原发性和继发性两大类。原发性又根据淋巴管发育程度分为淋巴管发育不全，淋巴管发育不良和淋巴管扩张扭曲三种类型。继发性淋巴水肿常由丝虫病感染、局部感染、外伤、肿瘤切除、放疗等引起。     

逆向腋淋巴显影技术在乳腺癌患者腋窝淋巴结清扫中的应用

目的 探讨逆向腋淋巴显影技术在乳腺癌患者腋窝淋巴结清扫中的应用价值。方法 对拟行腋窝淋巴结清扫的70例乳腺癌患者采用亚甲蓝注射液行逆向腋淋巴显影技术检查,通过病理分析确诊有无淋巴结转移,并采用单因素分析及多元Logistics回归分析探讨逆向腋淋巴显影技术识别淋巴结或淋巴管的影响因素。结果 本组70例乳腺癌患者检出淋巴结或淋巴管61例(87.14%),检出淋巴结38个,平均淋巴结数量为1.5个,且大多数位于A区。逆向腋淋巴显影技术淋巴结或淋巴管未识别患者接受新辅助化疗、放疗的比例显著高于淋巴结或淋巴管识别患者(P<0.05),T分期、N分期显著高于淋巴结或淋巴管识别患者(P<0.05),雌激素受体、孕激素受体和人表皮生长因子状态与淋巴结或淋巴管识别情况无明显相关性(P>0.05)。多元Logistics回归分析显示,新辅助化疗和N分期是引起逆向腋淋巴显影技术未识别淋巴结或淋巴管的危险因素(P<0.05或0.01),新辅助化疗和N分期是引起未识别的重要危险因素(P<0.05)。结论 逆向腋淋巴显影技术可为乳腺癌患者腋窝淋巴结清扫提供参考,但对接受新辅助化疗、...     

超声在小儿颈部淋巴管瘤中的诊断及血流特征分析

目的探讨超声在诊断小儿颈部淋巴管瘤中的应用价值。方法对本院既往诊断及治疗的72例颈部囊性病变患儿的灰阶超声、彩超诊断结果进行回顾性分析,以穿刺活检或手术后病理诊断作为金标准,对灰阶超声、彩超诊断颈部淋巴管瘤的诊断学效能进行评价,同时分析不同类型颈部淋巴管瘤彩色多普勒血流特征。结果穿刺活检或术后病理诊断颈部淋巴管瘤48例、甲状腺管囊肿18例、鳃裂囊肿6例;其中囊状淋巴管瘤34例(70.83%),海绵状淋巴管瘤8例(16.67%),单纯型淋巴管瘤6例(12.50%)。灰阶超声正确诊断颈部淋巴管瘤患儿34例,诊断颈部淋巴管瘤的灵敏度为70.83%、特异度为60.25%、漏诊率为29.17%、误诊率为37.50%;彩超正确诊断颈部淋巴管瘤患儿46例,诊断颈部淋巴管瘤的灵敏度为95.83%、特异度为95.83%、漏诊率为4.17%、误诊率为4.17%;囊状淋巴管瘤、海绵状淋巴管瘤、单纯型淋巴管瘤的收缩期峰值血流速度、静脉血流速度及阻力指数差异均具有统计学意义(P0.05)。结论超声在诊断小儿颈部淋巴管瘤具有较高的灵敏度和特异度,为临床诊治可提供早期诊断依据。     

读片窗答案

本病影像学诊断为:前上纵隔多囊性病变,考虑为胸腺囊肿或淋巴管瘤可能性大.病理诊断:淋巴管瘤.     

胰腺血管淋巴管瘤的CT表现及文献复习

<正>血管淋巴管瘤属于淋巴管和微静脉的混合畸形,最常见于头颈部[1],少见于胰腺、脾、小肠及阑尾等部位。胰腺血管淋巴管瘤发生率较低,迄今,仅见9例血管淋巴管瘤累及胰腺的个案报道[2-3]。胰腺血管淋巴管瘤的临床症状多不典型,易与胰腺其他囊实性或囊性肿瘤相混淆,术前确诊较为困难。笔者通过分析1例胰腺血管淋巴管瘤的CT及临床特征,并回顾性总结相关文献,旨在提高该病CT诊断的准确性。     

肺淋巴管癌病8例尸检临床病理学观察

目的探讨肺淋巴管癌病(PLC)的临床病理学特征、诊断及预后。方法运用光镜、特殊染色及免疫组化染色,观察8例肺淋巴管癌病的尸检病理学材料,结合并整理临床资料,复习以往文献。结果8例肺淋巴管癌病均表现为进行性呼吸困难,平均生存期约为6个月。病理学改变为肺内淋巴管高度扩张,腔内淤积单个或成团的肿瘤栓子。在原发肿瘤为肺癌、胃癌、食管癌和乳腺癌的PLC病例中,肿瘤仅仅在肺内的淋巴管中扩散,不伴或极少有血管内瘤栓形成;原发肿瘤为肝癌和胰腺癌的病例中,肿瘤沿淋巴道和血道同时扩散。免疫组化标记可见淋巴管及血管内皮细胞CD34、FⅧ呈( ),淋巴管和血管内的癌栓与原发癌表达相同的免疫标记物。结论肺淋巴管癌病是晚期恶性肿瘤在肺内淋巴管弥漫转移的一种淋巴道播散的特殊形式,因原发癌的不同,可同时伴有肺内血管内癌栓形成,具有进行性呼吸困难和预后凶险的临床特征。     

Snake venoms and hemostasis

Snake venoms are complex mixtures of biologically active proteins and peptides. Many of them affect hemostasis by activating or inhibiting coagulant factors or platelets, or by disrupting endothelium. Based on sequence, these snake venom components have been classified into various families, such as serine proteases, metalloproteinases, C-type lectins, disintegrins and phospholipases. The various members of a particular family act selectively on different blood coagulation factors, blood cells or tissues. For almost every factor involved in coagulation or fibrinolysis there is a venom protein that can activate or inactivate it. Venom proteins affect platelet function by binding or degrading vWF or platelet receptors, activating protease-activated receptors or modulating ADP release and thromboxane A2 formation. Some venom enzymes cleave key basement membrane components and directly affect capillary blood vessels to cause hemorrhaging. L-Amino acid oxidases activate platelets via H2O2 production.     

Children and violence

In this “information ear” it can no longer be said that children are being raised in Eden or in a gentle environment of kindness and love. However rural their home, children will undoubtedly see depictions of violence on television, in the movies, or in newspapers, or hear about it on the radio or while at school or on classroom computers. All children require safety education in order to learn how to protect themselves from harm at home, at school, or in the neighborhood. This article outlines how violence may impact today's children who seek medical care. The author has stated that she does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The author does not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Diagnosis and management of pathological laughter and crying

Patients with various neurologic disorders exhibit exaggerated or inappropriate episodes of laughter, crying, or both without an apparent motivating stimulus or in response to stimuli that would not have elicited such an emotional response before the onset of the underlying disease. During these episodes, patients have difficulty controlling their emotional expression according to the contextual information. In contrast, patients with mood disorders have a pervasive and sustained change in their emotional experience and thus exhibit spells of laughter or crying because of an underlying mania or depression. This article focuses on the clinical presentation, diagnosis, prevalence, and proposed pathophysiological mechanisms of and available treatment options for this clinical phenomenon.     

Strain and force transducers used in human and veterinary tendon and ligament biomechanical studies

Biomechanical studies often aim at determining the contribution (in terms of load or strain) of a tendon or ligament in posture, gesture or locomotion. To this end, many transducers have been developed since 30 years. These devices implanted within or attached to the inside of the tendon or ligament must be compliant enough to measure in vivo the tissue load or strain without interfering with the movement of man or animals. They can be transducers with variation of electrical resistance (liquid metal strain gauge, buckle transducer, implantable force transducer and pressure transducer), variation of magnetic field (Hall effect transducer) and variation of light flow (optic fibre). Their use requires surgery in order to implant them and it is limited in time because of their invasive character and the development of fibrous healing reactions. Besides, the transducer dimensions and its position in the tendon can influence the transducer output signal. Moreover, the latter may not reflect the behaviour of the tendon as a whole but only locally. In addition, a calibration is required in order to convert the output signal into a strain or a force. In animals, this calibration is generally made by a post-mortem procedure on dissected anatomical specimens; in man, an indirect calibration procedure using inverse dynamic calculations is generally performed. However, the calibration conditions cannot reproduce exactly the in vivo conditions. So far, only invasive transducers have allowed to measure strain or force in tendons with all constraints and limits mentioned above.     

Exercise and smoking habits in patients with and without low back and leg pain

The exercise and smoking habits of low back or leg pain sufferers vs. persons not having low back or leg pain are compared. The type, frequency and length of exercise is determined from a study of 576 low back or leg pain sufferers compared to 50 persons who state they are symptomatic. The same was done for smoking habits. Thirty-three percent of low back or leg pain sufferers smoked as compared to 14% of those without pain. Forty-seven percent of low back or leg pain sufferers as compared to 86% of non-sufferers exercised regularly. The level of physical activity and general exercise have been found to improve strength, mobility and endurance; this might prevent future back injury. Our study is to determine differences in the exercise habits of persons with low back and/or leg pain vs. those who do not have pain, with the intention being to see if pain sufferers exercise less.     

Stereochemistry and drug efficacy and development: relevance of chirality to antidepressant and antipsychotic drugs

Many drugs contain a chiral center or a center of unsaturation, or such centers result during metabolism of these drugs. Often such drugs are marketed as a mixture of the resultant enantiomers (racemates) or of geometric isomers, respectively. These enantiomers (molecules that are not superimposible on their mirror image) or geometric isomers may differ markedly from each other with regard to their pharmacodynamic and/or pharmacokinetic properties. This review deals primarily with drugs with chiral centers, and possible complications arising from the use of racemates are discussed. Recent developments in resolution of enantiomers, increased knowledge of the molecular structure of specific drug targets and a heightened awareness of several possible advantages of using single enantiomers rather than racemic mixtures of drugs have led to an increased emphasis on understanding the role of chirality in drug development. This has resulted in increased investigation of individual enantiomers early on in the development of drugs and in 'chiral switching', i.e. the replacement of a racemate of a drug which has already been approved or marketed by a single enantiomer. Although stereochemistry is an important matter to consider in drugs of virtually all classes, this review focuses on the relevance of chirality to antidepressant and antipsychotic drugs. Examples of the effects of chiral centers on the properties of antidepressants (tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, viloxazine, bupropion, mianserin, venlafaxine, mirtazapine and reboxetine), antipsychotics and/or some of their metabolites are discussed.     

Synergy between cephalosporin and aminoglycoside antibiotics against Providencia and Proteus

Clinical isolates of Providencia and Proteus with relative aminoglycoside resistance were tested for susceptibility to combinations of gentamicin or tobramycin with cephalothin or cefazolin. The minimal bactericidal concentration of aminoglycoside for one-third of the strains was reduced by fourfold or more in the presence of one-fourth of the minimal bactericidal concentration of either cephalosporin. This effect was achieved by clinically attainable concentrations of cephalothin or cefazolin.     

Rationale, design, and methods for the risk evaluation and communication health outcomes and utilization trial (REACH OUT)

OBJECTIVE: To test the primary study hypothesis that a physician-delivered coronary heart disease risk evaluation and communication program can lower patients' predicted 10-year risk of myocardial infarction or death due to coronary heart disease by 10% within 6 months compared to usual care. DESIGN: Prospective, parallel group, open-label, controlled, cluster-randomized multinational trial; the study site is the unit of randomization. SETTING: Patients were recruited from 106 general practices located in nine European countries. PATIENTS: Men and women aged 45 to 64 (N=1500) with a documented history of hypertension (treated or untreated), systolic blood pressure > or =140 mmHg (or > or =130 mmHg in the presence of renal or kidney disease), no history of cardiovascular disease, and a predicted 10-year risk of myocardial infarction or death due to coronary heart disease > or =10%. INTERVENTION: Sites were randomized to deliver a physician-directed coronary heart disease risk communication and education program or usual care. The intervention program included informing patients of their 10-year risk of myocardial infarction or death due to coronary heart disease, educating patients about modifiable risk factors and their control, and three follow-up phone calls by a physician or study nurse. MAIN OUTCOME MEASURE: Predicted 10-year risk of myocardial infarction or death due to coronary heart disease at 6 months. CONCLUSIONS: REACH OUT will evaluate a novel, patient-focused, physician-implemented application of coronary heart disease risk equations. Results of the study will be of practical relevance to physicians, health care organizations, and those who issue clinical guidelines for the reduction of cardiovascular risk.     

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Stingers

Standaert CJ, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: stingers.Stingers are a common injury in contact sports and are characterized by acute lancinating pain in 1 upper extremity with or without associated weakness and neck pain. Appropriate on-field evaluation is necessary to identify the extent of injury and rule out structural injuries to the head, spine, or shoulder girdle. Although athletes can often return to play after a single acute event that resolves rapidly, those who have recurrent events, persisting pain, or strength deficits require a thorough diagnostic evaluation before return-to-play decisions can be made. In some circumstances, players sustaining a single stinger or multiple recurrent stingers may be permanently removed from participation in collision or contact sports.     

Asperger's syndrome and medical care

Asperger's syndrome has been recognized recently. Diagnosis is done by DSM-IV-TR, ICD-10 or Autistic Spectrum Diagnosis. Medical care is performed by adjustment of environmental atmosphere, educational treatment and/or medication. Patients are cured by parents or teachers who can understand their thinking or behavior pattern. Educational treatment is important to compensate the lack of "mind of theory", of integration of central nervous system and of executive functioning. Medication is applied only secondary symptoms, such as hallucinated or delusional complaints or change of mood or compulsive behavior. Some of this syndrome's patients have excellent abilities and will accomplish great achievement in adult. We need protect them from bullying or secondary social withdrawal in adolescent age.