腹腔石胎30年致肠梗阻1例

患者60岁,住院号063425.腹部肿物30年,时有腹痛、腹胀,近4天症状加重伴恶心、呕吐,无排气、排便,于1986年1月24月入院.患者于1956年2月曾有停经50多天病史,伴有恶心、呕吐,食欲不振等早孕反应.孕4个月自觉胎动,时有腹痛不适,尤以胎动时腹痛明显.孕7个月时,劳动中突然剧烈腹痛,伴少量阴道出血,次日自觉胎动消失.曾在当地医院诊断为“腹腔肿瘤”建议手术治疗,但本人拒     

儿童肺炎支原体感染临床及实验室结果分析

目的:探讨探索小儿支原体肺炎感染病例临床及实验室指标特征。方法:收集50例肺炎支原体感染住院患儿的临床资料并对其临床特点及实验室指标特征进行回顾性分析。结果:小儿肺炎支原体感染50例中,咳嗽者48例(94.0%)及发热29例(58.3%)为主要症状,出现肺部体征者(84%);实验室检查肺炎支原体均阳性,血常规白细胞>10×109/L共计32例(64.0%);中性粒细胞>70%为27例(54.0%),C反应蛋白升高30例(60%),超敏C反应蛋白升高42例(84%)。结论:肺炎支原体感染为儿童呼吸道感染常见疾病,以肺部表现明显。联合检测肺炎支原体抗体、白细胞及hs-CRP,可为临床儿童呼吸道感染MP的早期诊断及治疗提供依据。     

高铁血红蛋白在早期识别早产儿消化道症状相关性感染的临床价值

目的 探讨高铁血红蛋白(MetHb)在消化道症状起病早产儿中,早期识别新生儿感染的价值。方法 选取2021年9月至2022年8月上海交通大学医学院附属上海儿童医学中心新生儿科就诊的住院期间以消化道症状起病的早产儿为研究对象,所有受试者均在起病的24 h内就诊,并在应用抗生素治疗前测定其C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、MetHb等相关指标。MaxMetHb定义为疾病活动期监测到的MetHb最高水平与血红蛋白的比值(%)。比较感染及非感染患儿的CRP、SAA、MaxMetHb等指标水平,采用受试者工作特性(ROC)曲线评价MaxMetHb及相关炎症指标早期识别新生儿感染的效能。结果 53例以消化道症状为首发表现的早产儿中,感染组29例,非感染组24例,两组患儿的相关消化道症状未见显著差异,提示早产儿感染的消化道症状缺乏特异性。辅助检查方面,感染组患儿的CRP、SAA、中性粒细胞百分比及MaxMetHb较非感染组显著升高,而嗜酸性粒细胞百分比显著降低,差异有统计学意义(P<0.05)。同时,感染组患儿的禁食时间、抗生素使用时间及特殊抗生素使用比例均明显高于非感染组,差...     

发热小儿白细胞和C反应蛋白检测结果的对比分析

目的:探讨发热小儿C反应蛋白与白细胞计数的临床应用价值。方法:将我院2010年1月～2011年7月收治的217例发热患儿进行C反应蛋白和白细胞计数的测定,并将两者结果进行统计分析.其中C反应蛋白使用散射比浊法,白细胞使用血球分析仪检测。结果:217例患儿中,白细胞与C反应蛋白均为阴性者105例,白细胞阳性C反应蛋白阳性21例,白细胞阴性C反应蛋白阳性49例,白细胞阳性C反应蛋白阴性42例。总体分析,C反应蛋白阳性者70例,白细胞63例,C反应蛋白的阳性率明显高于白细胞。结论;C反应蛋白在对发热患儿诊断中具有较大的临床价值,可作为早期诊断的敏感指标。     

淋巴管平滑肌瘤病

淋巴管平滑肌瘤病(lymphangioleiomyomatosis,LAM)是几乎仅见于育龄妇女的进行性疾病。病因不明。病理学特点为肺、纵膈和/或腹部淋巴管及淋巴结的未成熟平滑肌增生。此症主要见于肺部,表现腹部症状者迄今仅3例。本例有可能是首例孕妇LAM的报道,且腹部及肺部症状并存,值得注意。 患者30岁白人初孕妇,孕10周出现腹痛、疲劳、全身不适、体重下降及发热。既往病史无特殊。腹部超声发现一肿物,中心透明,类似于脓肿或中心坏死的肿瘤。MRI确定为大血管右枝处肿物,疑为     

凝血酶原时间和C反应蛋白联合检测在早期儿童脓毒症中的应用

目的探讨凝血酶原时间和C反应蛋白联合检测对早期儿童脓毒症的诊断价值。方法 2015年3月至2016年5月湖南省儿童医院急诊综合内科收治的脓毒症患儿30例,为观察组。同期选取普通发热患儿30例为对照组。分别检测和记录两组患儿发病24h内外周静脉血的凝血酶原时间和C反应蛋白浓度,并对早期脓毒症的诊断准确度进行比较。结果观察组凝血酶原时间和C反应蛋白高于对照组,差异有统计学意义(P0.05)。凝血酶原时间和C反应蛋白联合检测较单独检测两种指标中任一指标的特异性明显增高,假阳性降低,灵敏性亦有所降低。结论凝血酶原时间和C反应蛋白联合检测可以提高早期儿童脓毒症诊断的特异性,降低诊断的假阳性,有助于用于临床中对该病的早期诊断。     

超敏C反应蛋白联合血常规检测的临床应用

目的：探讨超敏C反应蛋白联合血常规检测的临床应用意义。方法：选取2013年1月至2013年5月间我院同时检测超敏c反应蛋白与血常规的患者500例作为研究对象,并将血常规、超敏C反应蛋白与患者目前病情联合分析。结果：细菌感染性组患者的中性粒细胞百分比及超敏C反应蛋白水平较非细菌感染性组患者明显升高,差异显著（P〈0．05）,具有统计学意义。结论：血常规联合超敏C反应蛋白的检测对细菌感染性患者的临床诊治有重要的指导意义,值得在临床上推广应用。     

30例急腹症剖腹探查阴性原因分析

目的：探讨30例急腹症剖腹探查结果为阴性的原因，并提出相应对策。方法：回顾性分析2012年1月至2014年1月我院300例急腹症剖腹探查患者的病史记录，并对探查结果阴性的原因进行分析，同时对比分析阴性、阳性探查患者的术前白细胞计数、c反应蛋白及D-二聚体水平。结果：急腹症剖腹探查阴性的主要原因为患者病史询问不详，未对患者全身进行详细检查，未仔细分析、探究、核实检查结果；探查结果阳性与阴性患者的白细胞计数、c反应蛋白及D-二聚体水平间差异具有统计学意义（P〈O．05）。结论：对于急腹症患者应当仔细询问病史、进行详细的全身检查并且认真进行检查分析，及时进行会诊讨论，术前尽可能对白细胞计数、c反应蛋白及D-二聚体水平进行测定，为急腹症剖腹提供理论依据。     

一例十二指肠乳头腺癌患者的观察及护理

十二指肠乳头腺癌是一种比较隐匿、临床较难检出的小肠恶性肿瘤疾病。其临床表现无特异性,早期可无症状或甚轻微,主要表现为腹痛、黄疸、消瘦、恶心、呕吐、黑便等。现将一例十二指肠乳头腺癌的患者的观察及护理报告如下:1临床资料患者,男,56岁,以上腹部胀痛不适半月余,伴尿黄为主诉,以胆囊炎、胆道梗阻、阻塞性黄疸为诊断收入我科。查体:正常,全身皮肤、巩膜重度黄染,右上腹深度压痛。在无明显诱因下发生腹痛,右侧腰背     

阑尾子宫内膜异位伴急性化脓性炎1例

正患者,女,44岁,因"腹痛1天"于2016年1月30日收入院。1天前患者无明显诱因出现腹部疼痛不适,无恶心、呕吐、腹泻、便秘、便血等症状,症状呈进行性加重,遂就诊于我院,入院诊断为"急性阑尾炎?"。查体:T 38.8℃,P 104次/min,R 21次/min,Bp 144/75mm Hg。患者既往有剖宫产手术史,腹平坦,未见胃肠型及蠕动波,全腹压痛,下腹部尤重,伴轻度反跳痛及肌紧张。肝脾未触及,叩鼓音,移动性浊音(-),肠鸣音弱。实验室检查:WBC 14.01×109/L,中性细胞比率91.5%,淋巴细胞比率6.0%,中性细胞数12.82×109/L。急诊行阑尾切除术,术中见脓性积液约50ml,阑尾位     

Chemotherapy-associated enterocolitis--a rare but potentially lethal side effect of adjuvant breast cancer treatment: a case report

ANAMNESIS: A 60-year-old patient underwent breast-preserving surgery for breast cancer of TNM stage pTla (m), pN2a (8/12), G2, pMO. After the operation, she received 4 cycles of epirubicin/cyclophosphamide (90/600 mg/m2), followed by 2 cycles of docetaxel (100 mg/m2). Four days after the second cycle of docetaxel, the patient presented with abdominal pain, nausea, vomiting and obstipation of 3 days' duration. FINDINGS: The physical examination showed a distended abdomen, absence of peristaltic sounds and pressure pain in the lower left abdomen. The laboratory examination was conspicuous for granulocytopenia of NCI grade Ill and an increased CRP concentration of 7.7 mg/dl. DIAGNOSIS: The main diagnosis was suspected chemotherapy-associated enterocolitis with signs of paralytic ileus; the latter was confirmed by computer tomography and laparotomy. THERAPY AND COURSE: Primary treatment consisted of placing a stomach tube, infusion therapy, broad-spectrum antibiotics and G-CSF. Later on, 5 explorative laparotomies with abdominal lavage were performed due to deterioration of the general condition and suspicion of intra-abdominal compartment syndrome. After a temporary improvement, the patient died of protracted multi-organ failure 8 weeks after hospitalization. CONCLUSION: Chemotherapy-associated enterocolitis is a very rare but potentially lethal side effect of cytostatic therapy. Therefore, gastrointestinal symptoms should be carefully noted in order to minimize the mortality risk by a timely therapeutic intervention.     

Appendicitis in pregnancy: diagnosis, management and complications.

BACKGROUND: Acute appendicitis is the most common surgical emergency in pregnancy. The purpose of this study is to investigate the clinical presentation, management and outcome in patients who underwent appendectomy during pregnancy. MATERIAL AND METHODS: The case records of 56 women who underwent appendectomy during pregnancy between January 1985 and December 1997 were reviewed and analyzed. RESULTS: The incidence of appendicitis in pregnancy was one in 766 births. The preoperative diagnosis was correct in 75% of the cases. Uterine contractions and a history of diffuse or periumbilical pain migrating to the right lower abdominal quadrant were significantly more frequent among women with appendicitis compared to those patients where the appendectomy revealed a normal appendices. Abdominal pain, nausea, vomiting, leukocyte count, CRP and body temperature were not helpful in establishing the correct diagnosis. There was no maternal morbidity related to the appendectomy. Pregnancy complications were found to be considerable: 4/12 (33%) who underwent appendectomy for appendicitis during the first trimester aborted spontaneously. Second trimester appendectomy for appendicitis was followed by premature delivery in 4/28 (14%). However, no pregnancy complications were observed following third trimester appendectomy for appendicitis. We found no increase in pregnancy complications in cases with perforated appendicitis. CONCLUSION: Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain. No laboratory finding was found to be diagnostic for acute appendicitis during pregnancy. Considerable fetal loss was found after appendectomy during pregnancy in the first and second trimester. No increase in pregnancy complications in cases with perforated appendicitis was observed. The combination of symptoms and clinical judgement is still vital in deciding which patient needs surgical treatment. Based on the results in the present study we recommend prophylactic antibiotic treatment in all laparotomies during pregnancy when appendicitis is suspected.     

Rupture of a pregnant unscarred uterus in an early secondary trimester: a case report and brief review

Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.     

The value of ultrasound in patients with acute onset of abdominal pain

Emergency admissions with acute abdominal pain provide the gynaecologist with a large workload. There is a wide spectrum of differential diagnoses, including gynaecological and non-gynaecological causes—making the correct diagnosis can sometimes be challenging as the symptoms are largely subjective, and physical findings can be equivocal. Ultrasound scanning complements the physical examination but cannot replace the clinical history, which is essential. Ultrasound examination allows an assessment of the pelvis and abdomen and a transabdominal ultrasound scan should always be performed before a transvaginal scan so that large pelvic masses are not missed and causes of pain referred to the pelvis can be identified. Unlike laparoscopy, ultrasonongraphy carries no contraindications, and the procedure does not require a general anaesthetic. The technique is not, however, always appropriate. It is useful in patients who have symptoms and signs that do not indicate the presence of a specific condition requiring immediate surgery, but who may need surgery after a short period of observation and investigation. During scanning, the identification of areas of pain or discomfort can help with making the correct diagnosis. The majority of patients who present with acute abdominal pain and have a normal ultrasound scan show an improvement or resolution of their symptoms. The development of ultrasound has been a major advance in the management of bleeding in early pregnancy and is a quick, risk-free investigation, which should be used in the first-line management of patients with acute abdominal pain.     

Tubo-ovarian Abscess in Virginal Adolescent Females: A Case Report and Review of the Literature

BackgroundA tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.CaseA 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.ConclusionReview of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.     

Sigmoid volvulus in children: report of two cases.

Volvulus of the sigmoid colon is rare in children. An early, accurate diagnosis can avoid unnecessary surgery and reduce the risk of complications. This condition is mainly due to a redundant sigmoid colon with a narrow mesosigmoid attachment. We describe two cases of sigmoid volvulus, which showed different clinical severities and were treated with different methods. Patient 1, a 9-year-old boy, presented with acute abdominal pain and vomiting. Patient 2, an 11-year-old boy, presented with abdominal pain, abdominal distention, and bloody mucoid stool. Plain abdominal radiographs revealed a distended colonic loop extending upward from the pelvis in patient 1 and a typical "coffee bean" sign in patient 2. Barium enema examination was used to confirm the diagnosis in both cases. The volvulus was reduced by insertion of a rectal tube in patient 1 and surgically in patient 2. Sigmoid colon volvulus should be included in the differential diagnosis of childhood abdominal pain or distention. This report suggests that nonsurgical reduction should be attempted first for uncompromised sigmoid volvulus in children, unless bowel ischemia or perforation develops.     

Emergency Department Evaluation of Abdominal Pain in Female Adolescents

Study ObjectiveEvaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department.Study DesignA retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented.ResultsA total of 1082 girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. Sexually transmitted infection (STI) testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic examination performed. In multivariable modeling, Black patients were significantly more likely than White patients to have STI testing performed (adjusted risk ratio [aRR] = 1.39; confidence interval [CI] = 1.13-1.70) and to undergo a pelvic examination (aRR = 2.45; CI = 1.34-4.50), and less likely to undergo imaging (aRR = 0.69; CI = 0.59-0.81).ConclusionThe assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities, and evidence of potential racial disparities.     

Omphalocele and gastroschisis: prenatal diagnosis and peripartal management. A case analysis of the years 1989-1997 at the Department of Obstetrics and Gynecology, University of Homburg/Saar

OBJECTIVE: The article presents a retrospective analysis (1989-1997) of the prenatal diagnosis, the course and completion of pregnancy of 26 fetuses with omphalocele and 18 fetuses with gastroschisis. SUBJECTS: 44 pregnancies with anterior fetal wall defect diagnosed by prenatal ultrasound, clinical or patho-anatomic examination between 1989 and 1997 at the Department of Obstetrics and Gynecology, University of Homburg/Saar. RESULTS: In 40 of 44 pregnancies (91%) the fetal ventral abdominal wall defect could be detected antenatally with ultrasound. Associated malformations in fetuses with omphalocele were seen in 18 cases (69%), whereas only five fetuses with gastroschisis (28%) had an associated malformation. Nineteen of 26 fetuses (73%) with omphalocele had a normal karyotype. Seven of 26 fetuses (27%) with omphalocele had an abnormal karyotype. Eleven fetuses with omphalocele were live born, three of them with minor anomalies. Ten babies with omphalocele survived. No chromosomal anomalies were detected in fetuses with gastroschisis. There were four gastrointestinal malformations and one lethal associated malformation in fetuses with gastroschisis. There were 15 live born babies with gastroschisis, all of whom have survived. In 20 of 44 cases (45%) with ventral abdominal wall defect oligohydramnios could be detected by ultrasound. In 28 of 44 cases (64%) we found fetal growth retardation <10th percentile for gestational age. CONCLUSION: In case of a fetal ventral abdominal wall defect, the detection and appropriate classification of associated fetal anomalies is of great importance for the further course of pregnancy. Fetal karyotyping should be offered in case of a fetal abdominal wall defect. Early and close prenatal consultation of the neonatologist and the pediatric surgeon will favorably influence the perinatal outcome.     

Delayed abdominal pain after outpatient endometrial biopsy in the luteal phase

Outpatient endometrial biopsy was followed by delayed abdominal discomfort in 50% of cases. The pain started 2-3 h after the procedure, lasted for about 2 h and was described in most cases as similar to dysmenorrhoea of a moderate degree. Appropriate explanation and the use of a simple analgesic may reduce the discomfort and the anxiety with which it is associated.     

Laparoscopy in pelvic pains

An evaluation is made of laparoscopy in the case of pelvic pains. Laparoscopy is an excellent method for diagnosis, but should not be performed systematically; it is expensive and in some cases, may endanger the patient. The clinical examination must be done extremely carefully. Laparoscopy should be considered only if the clinical examination does not explain at all the cause of the pain. Most doctors believe that laparoscopy should be performed if the clinical examination is negative or uncertain, if the pain is serious or old, and if the treatments administered have not worked. Laparoscopy allows for recognition of lesions, avoids inadequate treatments and performs therapeutic tests. Laparoscopy does not solve all problems of pelvic pain, and it is often difficult to determine whether the lesion discovered is actually responsible for the pain. It is concluded that although it is a precious tool for diagnosis, laparoscopy is sometimes insufficient, and often unnecessary; the symptoms of the patients should first be analysed very carefully and one should not perform laparoscopy systematically.