移植肾自发性破裂超声造影表现1例

患者女,31岁.因慢性肾功能不全尿毒症行同种异体肾移植术,术后1 d无尿.常规超声检查:移植肾大小 10.4 cm×5.7 cm,各级肾动脉流速正常,阻力指数(RI) 0.95~1.0,肾周未见异常回声,考虑移植肾急性排异反应.磁共振检查:移植肾皮质增厚,信号增高,体积增大.给予抗排异治疗仍无尿,后行腹膜透析,尿量约1000 ml/d.术后第5 d切口及右下腹剧痛并肉眼血尿.     

超声诊断移植肾自发性破裂1例

患者女 ,40岁。因慢性肾炎尿毒症行同种异体肾移植术 ,术后第 7ｄ尿量减少 ,肌苷增高。超声检查示移植肾形态饱满 ,大小约 10 .9ｃｍ× 5 .9ｃｍ× 5 .9ｃｍ ,皮质回声增强 ,锥体肿胀 ,大小为 1.8ｃｍ× 1.8ｃｍ ,移植肾内血流信号尚丰富 ,阻力指数增高 ,舒张期血流消失 ,主肾动脉Ｖｍａｘ64ｃｍ/ｓ ,段动脉Ｖｍａｘ3 4ｃｍ/ｓ ,弓形动脉Ｖｍａｘ12ｃｍ/ｓ。超声提示 :移植肾急性排异反应。给予甲基强的松龙抗排异治疗 ,术后 11ｄ患者右下腹移植肾区肿胀、疼痛 ,皮下淤血 ,血压下降 ,引流口可见鲜红色血液流出 ,临床考虑 :移植肾破裂出血。…     

结肠癌术后并发肠管内出血一例

1 病例介绍 患者,男,76岁,主因结肠癌入院,完善各项检查,心、肺、肾、凝血功能无异常,血压130/60 mmHg(1 mmHg=0.133 kPa),脉搏64次/min.在全麻下行结肠癌根治术,手术经历3h,术中应用肠管吻合器[1].患者返回病房时已清醒,血压160/80 mmHg,脉搏86次/min,术中留置腹腔引流管[2],并给予持续胃肠减压. 患者术后1 h血压下降至95/58 mmHg,心率增快至120次/min,经加快输液速度后无效.血压波动在72～96/50～60 mmHg,心率波动在120次/min左右,检查各液路通畅,腹腔引流管、胃管通畅,未见大量血液流出,同时患者诉有便意,未排便.术后2h患者排鲜红色血便20 mL,给予肛门指诊[3],指套带血.考虑肠管内出血.立即给予白眉蛇毒血凝酶2 kU入壶,2 kU肌肉注射[4].查血常规示:血红蛋白109 g/L.及时给予去白悬浮红细胞2U静脉输入并给予大量液体快速输入补充血容量[5].     

心肾联合移植中去甲肾上腺素对移植肾的影响

目的:探讨去甲肾上腺素在心肾联合移植中对移植肾的影响。方法:对1例接受同期心肾联合移植术患者,术中及术后应用小剂量去甲肾上腺素,观察对血压及移植肾的影响。结果:患者在全麻体外循环下行原位心脏移植,待血液动力稳定后,再行肾移植。术中持续应用去甲肾上腺素,浓度0.15～0.2μg/(kg·min),开放循环时血压提高至120/80mmHg,中心静脉压18cmH2O。移植肾充盈良好,红润,立即泌尿。术后持续使用去甲肾上腺素,浓度0.05～0.15μg/(kg·min),血压控制在100～120/60～80mmHg,中心静脉压维持在15～18cmH2O。为了循环稳定,并使用多巴胺及硝普钠或立萁丁等血管活性药物。患者术后第3天肌酐恢复正常。术后第6天停用去甲肾上腺素。经彩色多普勒超声动态检查显示移植肾血流灌注良好,移植心功能正常。结论:小剂量去甲肾上腺素在心肾联合移植中能明显提高血压,增加移植肾血流灌注,对移植肾的恢复是安全、有效的。     

老年女性患者全麻诱导致过敏性休克1例

正1临床资料患者女性73岁。现病史:绝经22年22天前出现阴道间断流血时有时无鲜红色经妇科医生明确诊断为:子宫内膜癌。治疗方式:择期行广泛全子宫切除术。既往史:患者结肠癌术后30年高血压病史10年血压最高160/90mmHg规律口服硝苯地平片控制血压控制在130/70mmHg糖尿病病     

定量罂粟碱不同给药途径对移植皮瓣血管阻力的影响

目的:临床上常用罂粟碱等血管舒张药预防和解除带血管蒂游离皮瓣移植吻合口及其附近血管痉挛,减少血管阻力,提高皮瓣成活率.观察在带血管蒂皮瓣移植中,定量罂粟碱(1.5 mg/kg)的不同给药途径对皮瓣移植后血管阻力的影响.方法:①实验于2007-03/05在广州市第一人民医院动物实验中心完成.②选用雄性新西兰兔24只,实验方法符合动物伦理学要求.采用随机区组设计,按给药途径把24只兔分成4组(n=6),即皮瓣蒂部皮下注射组、皮瓣中央皮下注射组、臀部肌肉注射组及对照组(静脉推注).建立下腹部腹壁浅动脉皮瓣模型,术后1 h～7 d每组定量注射罂粟碱,剂量为1.5 mg/kg,1次/d.③利用彩色多普勒超声测量术前、术后1周内每天注药后1 h的皮瓣血流阻力指数.结果:24只兔全部进入结果分析.①术后各组移植皮瓣的血流阻力指数均高于术前(P < 0.05).②术后第1天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于臀部肌肉注射组(P < 0.01),与其他两组差异无显著性意义(P > 0.05).术后第4天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于其他3 组(P < 0.05).术后第5天注药后1 h除臀部肌肉注射组血流阻力指数略高于手术前外,其他各组的血流阻力指数均略低于手术前,3组之间差异无显著性意义(P > 0.05).结论:皮瓣移植术后经皮瓣中央皮下注射罂粟碱扩血管效果最好,能改善皮瓣的成活能力;静脉注射与皮瓣蒂部皮下注射效果相近;臀部肌肉注射效果最差.     

彩色多普勒诊断肝假性动脉瘤1例

患者男,74岁,入院1个月前因胆囊多发性结石行胆囊切除术,术中见胆囊内有鲜红色血液喷出,缝扎止血.术后10天出现呕血、黑便,消炎、止血治疗后缓解.术后14天再次呕血.     

腹膜后腹腔镜手术治疗肾囊肿

目的:评价腹膜后腹腔镜下治疗肾囊肿的疗效.方法:回顾分析接受腹膜后腹腔镜手术治疗的15例肾囊肿患者的临床资料.结果:15例肾囊肿均顺利切除去顶.手术时间40～100 min,平均55 min,术中出血量10～50mL,平均30mL.术后1例出现尿瘘,腹膜后引流管引出尿液达120mL/d,经膀胱镜逆行内置双J管,引流管持续引流5周后尿瘘治愈.余14例平均住院时间6 d.15例病理报告均为良性病变.15例随访1～18个月,B超复查均未见囊肿复发.结论:腹膜后腹腔镜肾囊肿去顶术是治疗肾囊肿安全、有效的方法.     

腹膜后异位甲状腺1例

患者女,60岁,因“体检发现腹膜后肿物20天”入院,既往有高血压、糖尿病史。查体:重度肥胖(体质量指数38.8 kg/m 2),血压190/110 mmHg。MRI:腹膜后胰头下方4.6 cm×4.4 cm不规则团块状混杂信号肿块,与胰头分界不清(图1A),增强扫描示肿块明显不均匀持续强化,内见2.5 cm×1.6 cm无强化囊变区(图1B),肝门区、胃小弯侧及腹主动脉周围见多发肿大淋巴结(图1C);提示:腹主动脉旁占位,考虑副神经节细胞瘤,侵犯胰头可能,并周围多发淋巴结转移,考虑恶性可能大。甲状腺超声:甲状腺双侧叶多发实性及囊实性结节,考虑结节性甲状腺肿。结合病史,临床考虑嗜铬细胞瘤,行腹膜后肿物切除术。术中见肿物位于胰头沟突背侧,直径约3.0 cm,质硬。术后病理:送检物为甲状腺组织,伴囊性变及钙化(图2),考虑异位甲状腺;(腹主动脉旁)淋巴结未见肿瘤性病变。免疫组织化学:CK19(少数+),CD56(+),TTF-1(+)。     

桡动脉入路冠状动脉造影后迟发肱动脉假性动脉瘤1例

患者女,65岁,主因"劳累后心前区疼痛2年,加重1周"入院。既往高血压病史10年,最高血压200/100mmHg,口服氨氯地平控制血压在150/90mmHg左右。入院诊断:冠心病,不稳定型心绞痛,阵发性心房颤动,高血压病3级。入院后给予抗血小板、抗凝、降脂等治疗,入院第3天(2012年2月16日)行经右桡动脉入路冠状动脉造影检查。穿刺顺利,导丝前行通畅、无阻力(术后追问患者曾有一过性疼痛),造影显示:三支病变,前降支弥     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.