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Xu Ren Chun-Lan Zhu Xu-Fu Qin Hong Jiang Tian Xia Yong-Ping Qu 《World Journal of Clinical Cases》2019,7(1):102-108
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging. 相似文献
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脐尿管瘘是一种膀胱畸形疾病,男性多见.临床表现为脐部漏尿,漏尿程度视瘘管的大小而定,脐部漏口为皮肤或黏膜所覆盖.静脉注射靛胭脂或从尿道导管将亚甲蓝注入膀胱,可见染色尿液自脐部漏出,故可诊断[1]. 相似文献
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对自由基和抗氧化剂的基本知识,自由基在ICU常见疾病发生发展中的作用以及抗氧剂的临床应用四方面内容进行综述,提示了ICU护士了解这四方面内容是临床实践的组成部分. 相似文献
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1病例介绍患者女,67岁。因"发热半个月,黑便1d"于2006年6月9日入院。患者半个月前起发热,多次测得体温≥39.0℃,无寒战,无咳嗽、咳痰,无腹痛、腹泻,无尿急、尿痛,无腰痛、咽痛,当地医院予抗生素、激素治疗体温反复,昨日起解黑便,共2次,伴头晕,晕厥1次,无呕血,为进一步诊治转入本院。既往类风湿关节炎 相似文献
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代谢综合征又称代谢异常心血管综合征,它是一组心血管疾病危险因素的聚集和组合,包括高血压、高血脂(血脂异常)、高血糖(糖尿病、血糖调节受损、糖耐量异常)、肥胖、吸烟、炎症、血凝增强、纤溶降低等。心血管疾病是人类头号杀手,给社会和家庭带来了沉重的经济负担。对于心血管疾病这种新的流行病学表现, 相似文献
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Jun-Hui Guo Yuan-Yuan Wang Jiang-Wei Zhang Pei-Min Liu Yan-Jun Hao Hai-Rui Duan 《World Journal of Clinical Cases》2020,8(7):1326-1336
BACKGROUND Apatinib is a small-molecule multitargeted tyrosine kinase inhibitor.Apatinib has demonstrated encouraging antitumor activities.This study aimed to observe the efficacy and safety of apatinib for the treatment of multiple brain micrometastases.CASE SUMMARY We report two patients with multiple brain micrometastases after failure of second-line treatment.Both patients had extracerebral metastases.When the patients took 250 mg/d apatinib orally,the intracerebral lesions disappeared.The extracerebral lesions were partially alleviated.Both patients had a progressionfree survival of more than 12 mo and were still stable.The safety was good.The main adverse events(AEs)were mild hypertension and proteinuria,which could be controlled.CONCLUSION Apatinib has clear efficacy and good tolerance in patients with multiple brain micrometastases after failure of second-line treatment. 相似文献
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The growing elderly population will increase the need for assistive technology in the form of technical aids and housing adaptations to facilitate independence in activities of daily living. In this study, which was undertaken to facilitate a better understanding of the life-styles of the disabled elderly and the role of technical aids, 57 disabled persons over 74 years of age were studied. All of the subjects were residents of a rural Swedish community. The subjects had a total of 422 aids, an average of 7.4 per person. Seventy-five percent of the aids were being used, and 42 persons had at least one aid that granted autonomy. This finding illustrates the importance of technical aids in home care. It is recommended, therefore, that information about assistive technology be disseminated to personnel at all levels of community-based care. 相似文献
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One of the basic aspects that determines the success or failure in the use of assistive technologies on the part of people with disabilities is constituted by the ability that provide a disabled person with the technology that corresponds effectively to his needs and to his capabilities,thus to interpret correctly the problems and to find the right ways of transferring this technological "knowledge". If the aids answer the effective needs and capabilities of the person he can achieve significant improvement to reach the goals of his individual rehabilitative project. The article highlights the key factors of success. 相似文献
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Cristina Wångblad RPT Maria Ekblad ROT Helle Wijk PhD RNT RN Synneve Dahlin Ivanoff PhD ROT 《Scandinavian journal of caring sciences》2009,23(4):644-650
Caring for residents with dementia impose a higher challenge and workload on the nursing staff because of a higher degree of motor function and cognitive decline among the residents. Training in person transfer tasks for nursing staff has mostly been concentrated on ergonomics irrespective of the nature of the resident's functional decline. An increased knowledge about the nursing staffs' experiences of physical workload in dementia care and in how to reduce their physical strain is needed.
Aim: The aim of the study was to describe nurse's aids' experiences of physical strain during person transfer tasks at dementia care units.
Method: Four focus group interviews with altogether 16 nurses' aids, working at special care units for people with dementia, were performed.
Results: The results show that knowledge about the disease and personality of residents in dementia care units can help to decrease the physical strain on nurses' aids in person transfer situations.
Nurse's aids need to be flexible when performing transfer tasks to accommodate variations in the resident's functional ability. Physical strain associated with person transfer tasks is not related to the weight of the resident. Misunderstandings because of cognitive decline and communication problems increase physical strain on nurses' aids. Specialized training in person transfer tasks is needed for nurse's aids working in dementia care.
Conclusions: These results may serve to guide physiotherapists working in dementia care units in assessing residents' functional ability, in when to use assistive devices and mobility aids and in training and supervising nurse's aids in person transfer tasks. 相似文献
Aim: The aim of the study was to describe nurse's aids' experiences of physical strain during person transfer tasks at dementia care units.
Method: Four focus group interviews with altogether 16 nurses' aids, working at special care units for people with dementia, were performed.
Results: The results show that knowledge about the disease and personality of residents in dementia care units can help to decrease the physical strain on nurses' aids in person transfer situations.
Nurse's aids need to be flexible when performing transfer tasks to accommodate variations in the resident's functional ability. Physical strain associated with person transfer tasks is not related to the weight of the resident. Misunderstandings because of cognitive decline and communication problems increase physical strain on nurses' aids. Specialized training in person transfer tasks is needed for nurse's aids working in dementia care.
Conclusions: These results may serve to guide physiotherapists working in dementia care units in assessing residents' functional ability, in when to use assistive devices and mobility aids and in training and supervising nurse's aids in person transfer tasks. 相似文献
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While multiple versions of shared decision making (SDM) have been advanced, most share two seemingly essential elements: (a) SDM is primarily focused on treatment choices and (b) the clinician is primarily responsible for providing options while the patient contributes values and preferences. We argue that these two elements render SDM suboptimal for clinical practice. We suggest that SDM is better viewed as collaboration in all aspects of clinical care, with clinicians needing to fully engage with the patient's experience of illness and participation in treatment. SDM can only take place within an ongoing partnership between clinician and patient, both respecting the other as a person, not as part of an isolated encounter. Respect for the patient as a person goes beyond respect for their choice. Non‐interference is not the only way, or even the most important way, to respect patient autonomy. Knowing the patient as a person and providing an autonomy‐supportive context for care are crucial. That is, the clinician must know the patient well enough to be able to answer the patient's question “What would you do, if you were me?” This approach acknowledges clinicians as persons, requiring them to understand patients as persons. We provide examples of such a model of SDM and assert that this pragmatic method does not require excessive time or effort on the part of clinicians or patients but does require direct and particular knowledge of the patient that is often omitted from clinical decisions. 相似文献
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Nearly all the topics considered by medical ethics generally present themselves to those caring for cancer patients. Although most attention may be given to questions of resource allocation and limiting treatment, other issues are of equal importance. Providing respect and compassion for patients may be even more important. The day-to-day treatment of the patient that recognizes the practical autonomy of the patient and legitimizes the patient's involvement in deciding about his or her own care may do more to preserve the integrity of the patient as a person than anything else that happens to someone who accepts the cancer diagnosis. The physician who can accept the patient's judgment and participation and who can help the patient find positive meaning in what can be a personally and socially devastating disease experience has enacted a highly laudatory ethical standard of patient care. 相似文献
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Crowe M 《Journal of psychiatric and mental health nursing》2004,11(3):335-340
This paper is the second part of two papers that explore the affect of shame and its role in the manifestation of symptoms that could be regarded as evidence of mental disorder. The clinical implications for nursing a person with an overwhelming shame response are discussed in this paper. It is proposed that a discursive approach to nursing care may assist mental health nurses to provide care that best meets the needs of people experiencing these symptoms. The paper suggests that this nursing care involves recognizing the impact of shame; making connections between how the person has learned to cope with shame and their current mental distress; situating shame in its socio-cultural context; focusing on subject-object differentiation and promoting acceptance of difference and exploring alternative subject positions for managing feelings of shame. The focus of these interventions is to encourage awareness of interactions with others, how the person positions her or his self in relation to others, and the communication patterns that perpetuate feelings of shame. It also involves helping the person to integrate the ideal image of her or his self with subject positions that are more flexible. 相似文献
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Nurses working in the head and neck oncology field will be conscious of the possible risk of carotid artery rupture in their patients. This complication occurs swiftly and the patient requires the nurse to rapidly change focus from acute care and cure to palliative care and comfort. Prior decisions need to be made as to whether or not active resuscitation is to be undertaken. In this final article, the ethical issues surrounding this decision-making process are discussed, including patient autonomy, advocacy, beneficence and justice. The facts as they relate to each individual patient should be discussed truthfully and openly with them and their significant others. Each person should be assisted to come to his own decision, following discussion of the prognosis and risks that are pertinent to that individual. Respect for the autonomy of patients should be a guiding principle governing the conduct of decisions. 相似文献
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Anne L Dewar BA BScN MHP Janice M Morse PhD PhD FAAN 《Journal of advanced nursing》1995,22(5):957-964
Inherent in the illness experience are multiple assaults on one's self and one's body These assaults may be interpersonal (such as an unwitting remark made from another), or intrapersonal (such as unrelenting symptoms that are a part of illness, injury or treatments) These assaults may accumulate until the situation becomes unbearable, the person can no longer 'take it', and the person loses control In this paper, the authors examine the circumstances that resulted in the breakdown of endurance, and noted that while some of the factors remained unbearable, others are managed The authors suggest that the patient's response, that is'loosing it', may be beneficial'Losing it'is a means of ensuring changes in care for a patient, or aids in the relinquishment of unrealistic expectations of one's self and one's future In all instances, however, the patient's plan of care should be carefully examined and, if necessary, modified 相似文献
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Hanssen I 《Nursing ethics》2004,11(1):28-41
This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients' possibly harmful choices is discussed, the focus is on 'forced' autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively participate neither in the treatment offered nor in making choices regarding that treatment. Nurses' demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person's autonomy is also respect for the person, one's respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second-order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. 相似文献