马鞍疝1例

1 临床资料 患者,男性,75岁.因＂左侧腹股沟区可复性肿物3月,右侧腹股沟区可复性肿物1天＂于2011年5月23日入院.患者3个月前发现左腹股沟区一鸡蛋黄大小肿物,未进入阴囊,轻度坠胀感,站立及行走时明显,平卧位时可消失,无发热,无腹痛、腹胀,3个月来肿物逐渐增大,现约鸡蛋大小：1天前发现右侧腹股沟区一鸡蛋黄大小肿物,未进入阴囊,无明显不适症状,平卧后可消失：既往高血压、冠心病、阻塞性肺气肿、脑血栓病史.     

促纤维组织增生性小圆细胞肿瘤1例报告

患者男．14岁．因发现右腹股沟肿物伴右下肢肿胀1个月于2008年11月13日入院．患者于2008年10月运动后出现右腹股沟处疼痛．并发现该处有一约1cm×1cm大小肿物。1个月后肿物逐渐增大至5cm×4cm×3cm,并伴有局部疼痛及右下肢肿胀。腹盆CT示腹膜后右侧髂动脉旁结节状肿物．约4cm×5cm×18cm,挤压右侧腰大肌使之明显移位,包绕右侧髂总动脉。右侧腹股沟区多个淋巴结融合成团,约4cm×4cm×3cm。B超示双侧腹股沟区多发肿大淋巴结,右侧胭窝区多发肿大淋巴结．均考虑为淋巴结转移。     

儿童间变性大细胞淋巴瘤的诊断与治疗

1病历摘要 患儿,男,1岁,因“腹部皮下结节2个月余”入院。患儿于2个月前发现腹部散在丘疹样皮下小结节,无发热及疼痛,伴瘙痒,抗过敏及抗菌治疗无效。入院体查：发育营养良好,皮肤黏膜无黄染,腹部触及多个直径约0．5cm皮下结节。颌下、双侧腹股沟淋巴结多枚（0．2～0．5cm）,左侧腹股沟可触及大小约3．0×4．0cm肿物,右腋前可触及大小约5．0×6．0cm肿物,质中。余体查正常。     

腹股沟部基底细胞癌1例

患者,女,53岁.发现左腹股沟肿物3.5年,破溃不愈3年.3.5年前无意中发现左侧腹股沟区有一黑色肿物,约"黄豆"大小,无自觉症状,故未作诊治.3年前肿物出现破溃,到当地医院局部持续换药未愈,后破溃较前增大,于2008年10月12日来我院就诊.可见左腹股沟中下部约2.5 cm×1 cm大小溃烂区,局部红肿,创面新鲜,触之易出血,腹股沟区未触及淋巴结.破溃处取材病理:基底细胞癌.故在硬膜外麻醉下行左腹股沟肿物局部扩大切除术+左腹股沟淋巴结摘除术.切口愈合良好,随访8个月未见复发.     

憩室性直疝伴肠脂垂嵌顿后脂肪瘤变1例

1一般资料患者,男,62岁.因左侧腹股沟区无痛包块逐渐增大1月余入院.查体：腹软,无压痛,左侧腹股沟区可触及一大小约4cm×3cm包块,表面光滑,质硬,与周围分界清,活动度好,无触痛,不能还纳.双侧阴囊无肿大,睾丸于阴囊内.B超示：左侧腹股沟囊袋状肿物,其与腹腔相通．     

腹腔镜手术治疗卵巢甲状腺肿1例报告

1临床资料 患者,女,46岁,因发现卵巢肿物伴有经量增多、周期缩短、经期延长1年入院.曾就诊于当地医院,彩超提示"卵巢肿物,子宫肌瘤",卵巢肿物大小约7 cm× 5 cm,子宫肌瘤直径约1cm.因无其他明显不适,除定期复查彩超外未予系统诊治,半个月前复查彩超无变化.入院查体:一般状态正常.妇科检查:外阴发育正常,已婚已产型;阴道通畅,黏膜无充血;宫颈光滑,无接触性出血,子宫前位,正常大小,活动度良好;左附件区可触及一囊性肿物,大小约8 cm×6 cm×4 cm,形状较规则,活动度良,压痛阴性;右侧附件未触及明显异常.     

子宫阔韧带腺肌瘤嵌顿疝1例

1 病例介绍 患者,女,44岁,因左侧腹股沟可复性肿物半年,不可复并疼痛2个月,于2008年9月28日入院.患者平素月经规律,近2个月月经周期缩短,经期延长.入院查体:T 36.5 ℃,P 75次/min,R 19次/min,BP 100/65 mm Hg.腹部平坦,左腹股沟区可见一梨形包块,大小约4 cm×3 cm×3 cm,无法还纳腹腔,有压痛,伴咳嗽冲击感.B超检查:左腹股沟区可探及一4 cm×2.8 cm×2.5 cm大小的囊实性包块,边界清楚,有完整包膜,包块与腹腔相连;子宫体积增大,横切面宫体左侧偏,浆膜下见多个实性低回声结节,包膜完整,界限清楚,左子宫阔韧带与腹股沟区肿物界限不清,似相连.     

阴囊脂肪母细胞瘤1例

1 临床资料 患儿13岁,因发现左侧睾丸肿大6个月余而入院.查体左侧睾丸肿大,质中,表面光滑,无红肿,有轻度压痛,两侧腹股沟淋巴结无肿大,全身也无其他阳性发现.遂行肿物单纯切除术.术中见左阴囊内睾丸内侧有一肿物,与睾丸及精索无联系,包膜完整,表面光滑,大小3 cm×3 cm×2 cm.     

以腹股沟淋巴结肿大为首发症状的输卵管癌1例

<正>1临床资料患者,女,68岁。因“扪及右腹股沟区包块1年余,确诊转移性低分化腺癌4日”于2021年3月29日入住大连医科大学附属第二医院妇产科。1年前,患者自觉包块直径约1 cm,边界清,无触痛,未到医院诊治。后因包块进行性增大于2021年3月17日当地医院就诊,行盆腔CT示：双侧腹股沟区见大小不等结节影,较大灶约5.8 cm×4.2 cm（图1）,进一步行肿物穿刺活检,病理提示：转移性低分化腺癌,倾向卵巢来源。入院后,我院病理会诊：符合高级别浆液性腺癌（图2A）,请查附件及盆腹膜。查体：右侧腹股沟区可触及一肿物,大小约6 cm×6 cm×3 cm,边界尚清;左侧腹股沟区可触及一肿物,大小3 cm×2 cm×2 cm,边界尚清。     

精原细胞瘤颈部转移1例

1临床资料 患者,男,46岁,因左侧睾丸肿大7 年,术后2 月伴左颈部包块进行性增大于2005年10月3日入院.患者于2005年7月11日因左侧睾丸进行性增大(14cm×10 cm×7 cm),在当地医院行高位睾丸切除及精索结扎术,术后病理切片经当地医院会诊为精原细胞瘤.术后未行放、化疗,后发现左颈部1枚约2×2cm3包块,进行性增大,无疼痛,当地医院穿刺活检为转移癌(多系精原细胞瘤).体查:发育正常,左侧锁骨上可见6cm×5em大小包块,质硬,活动度差,无压痛,左侧腹股沟可扪及3枚直径1cm质硬肿大淋巴结,右侧腹股沟可扪及1枚直径2cm质硬肿大淋巴结.入院诊断:精原细胞瘤术后颈部转移Ⅳ期.入院后血分析:WBC:7.40×109/L,NEU:9.41×109/L,RBC:5.69×1012/L,HGB:145g/L,PLT:158×109/L,尿分析:UBG:17μmol/L,MS: ,肝功:ALT:48.7U/L,TBIL:9.5μmol/L,AST:49.7U/L,B超:肝、胆、胰、脾、双肾、输尿管、盆腔内未见确切异常,大便正常.入院后行VP-16、顺铂化疗,配合TDP照射左颈部,化疗期间予格拉司琼、胃复安防止恶心呕吐,别嘌呤醇防尿酸生成,化疗1疗程后复查:左颈部包块3×3cm3,左侧腹股沟扪及1枚直径1cm肿大淋巴结,右侧腹股沟肿大淋巴结变化不明显.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.