哺乳期乳腺脓肿146例治疗体会

目的探讨哺乳期乳腺脓肿的有效治疗方法。方法146例哺乳期乳腺脓肿患者,103例行脓肿切开引流,39例行脓肿穿刺,4例穿刺后转切开引流,术后均应用抗生素治疗。结果脓肿切开引流者愈合时间为15~60d,平均25d;穿刺者7～15天治愈,平均10d。结论部分哺乳期乳腺脓肿可经多次穿刺抽吸治愈,穿刺抽吸较切开引流愈合快,痛苦小;细菌培养显示,大多数为金黄色葡萄球茵产8内酰胺酶菌株感染,青霉素耐药者多,预防及治疗中头孢类抗生素当为首选。     

脐部胰腺异位1例

患儿男,3岁。因反复发热15 d,发现脐部包块2 d,于 2005年11月21日入住本院。患儿1岁时发现脐部一包块 1．0 cm×1．0 cm,不红、无压痛。在当地医院诊为脐疝,未予处理。15 d前患儿出现发热,体温为38℃-39℃(伴咳嗽),当地医院诊为支气管炎,经头孢噻肟钠,病毒唑治疗半月,仍发热,脐部包块增大,转入本院。T:T38．5℃,P:88次/min,R:24次/ min;发育正常,精神好,心肺(-)。脐部见一包块3 cm×3 cm,表面发红,压痛,实验室检查发现,血WBC:10.07×109/L,中性     

哺乳期与非哺乳期患者乳腺脓肿病原菌分布及耐药性分析

目的对比哺乳期与非哺乳期乳腺脓肿患者的病原菌分布及耐药性。方法选取医院2013年6月-2016年3月142例哺乳期乳腺脓肿患者为哺乳期组,76例非哺乳期乳腺脓肿患者为非哺乳期组,行细菌培养、分离、鉴定及药敏试验,对比两组病原菌分布与耐药情况。结果哺乳期患者检出病原菌株167株,其中革兰阳性球菌160株占95.81%,革兰阴性杆菌7株占4.19%,非哺乳期患者检出病原菌株86株,其中革兰阳性球菌62株占72.09%,革兰阴性杆菌22株占25.58%,真菌2株占2.33%;哺乳期患者革兰阳性球菌检出率显著高于非哺乳期(P<0.01),革兰阴性杆菌及真菌检出率显著低于非哺乳期患者(P<0.05);哺乳期患者金黄色葡萄球菌检出率79.04%显著高于非哺乳期患者34.88%,差异有统计学意义(P<0.01);哺乳期患者金黄色葡萄球菌对苯唑西林、左氧氟沙星、红霉素、克林霉素、利福平的耐药性显著低于非哺乳期患者,差异有统计学意义(P<0.05)。结论哺乳期与非哺乳期乳腺脓肿患者致病菌检出率以及对某些药物的敏感性存在明显差异,应针对不同患者选择敏感抗菌药物,以提高治疗效果,避免抗菌药物滥用现象的发生。     

异位胰腺1例报告

患者 女，56岁，以间歇性腹胀20d入院。体检：全身皮肤黏膜无黄染。腹平软，未见腹壁静脉曲张，无压痛及反跳痛，未触及腹部包块，肝脾肋下未触及，Murphy征阴性，移动性浊音阳性，肠鸣音可。腹部B超示腹水，胆囊壁不规则增厚，宫腔内少量积液；上腹部CT：肝硬化，胆囊内软组织块影，强化CT值83HU，腹水；查血清糖抗原19—9（CA19—9）示431．6U／ml。     

哺乳期与非哺乳期患者乳腺脓肿病原菌分布及耐药性分析北大核心CSCD

目的对比哺乳期与非哺乳期乳腺脓肿患者的病原菌分布及耐药性。方法选取医院2013年6月-2016年3月142例哺乳期乳腺脓肿患者为哺乳期组,76例非哺乳期乳腺脓肿患者为非哺乳期组,行细菌培养、分离、鉴定及药敏试验,对比两组病原菌分布与耐药情况。结果哺乳期患者检出病原菌株167株,其中革兰阳性球菌160株占95.81%,革兰阴性杆菌7株占4.19%,非哺乳期患者检出病原菌株86株,其中革兰阳性球菌62株占72.09%,革兰阴性杆菌22株占25.58%,真菌2株占2.33%;哺乳期患者革兰阳性球菌检出率显著高于非哺乳期(P<0.01),革兰阴性杆菌及真菌检出率显著低于非哺乳期患者(P<0.05);哺乳期患者金黄色葡萄球菌检出率79.04%显著高于非哺乳期患者34.88%,差异有统计学意义(P<0.01);哺乳期患者金黄色葡萄球菌对苯唑西林、左氧氟沙星、红霉素、克林霉素、利福平的耐药性显著低于非哺乳期患者,差异有统计学意义(P<0.05)。结论哺乳期与非哺乳期乳腺脓肿患者致病菌检出率以及对某些药物的敏感性存在明显差异,应针对不同患者选择敏感抗菌药物,以提高治疗效果,避免抗菌药物滥用现象的发生。     

162例乳腺包块调查分析与乳腺疾病健康教育

目的 探讨乳腺包块的早发现、早诊断、早治疗及乳腺疾病健康教育.方法 收集分析本院门诊手术室2010-2011年两年1 62例乳腺包块摘除术病人病理检查及相关资料.结果 乳腺纤维瘤和乳腺增生是乳腺包块的常见疾病,乳腺癌也占有较高比例.乳腺癌主要发生在30岁以上人群.结论 广泛开展健康教育,普及乳腺疾病防治知识,成年女性定期进行乳腺包块排查,对于保护女性身心健康十分必要.     

动态观察治疗妊娠期、哺乳期乳腺良性肿瘤102例分析

目的:探讨妊娠期、哺乳期乳腺良性肿瘤手术时机的选择、病理特点及手术并发症,预防妊娠期乳腺癌的发生。方法:对门诊观察和住院手术的102例妊娠期乳腺良性肿瘤患者进行临床分析。结果:不同年龄、不同孕期乳腺良性肿瘤的病理类型不同,不同手术时期发生并发症的情况亦不同。结论:对妊娠期、哺乳期乳腺良性肿瘤应严密动态观察,选择最佳时机尽早手术,以减少手术并发症和预防妊娠期乳腺癌的发生。     

肝脏异位妊娠1例

患者女性,35岁。因"超声检查发现左侧附件包块7d"于2010-06-26入本院。病史采集:G5P2,LMP:2010-05-01(停经56d)。入院前7d本院超声检查示左侧附件包块。入院当天完善各项术前检查后,行剖腹探查术。术中见腹腔内陈旧性血液约50mL,左侧卵巢囊肿(9cm×9cm×8cm)与周围组织     

试论72例乳腺积乳囊肿患者临床手术的治疗体会

目的探讨和分析乳腺积乳囊肿患者手术治疗的临床表现和治疗效果。方法选取自2009年11月—2012年8月收治的乳腺积乳囊肿患者共72例,对于伴随有乳疼痛患者,或是存在局部压痛或着腋窝淋巴结肿大患者,先当运用抗生素或者进行理疗,待患者疼痛减轻,其淋巴结变小或者消失以后,进行外科手术治疗。手术标本在冰冻以后都进行病理检查。结果患者均进行病理学检查结果均属于乳腺积乳囊肿,对于伴随有乳疼痛患者,或是存在局部压痛或着腋窝淋巴结肿大患者,先当运用抗生素或者进行理疗,待患者疼痛减轻,其淋巴结变小或者消失以后。进行外壳手术治疗,共有46例进行进行肿物切除,有26例进行了区段切除,患者切除的标本手术以后都进行病理检查。结论对于乳腺积乳囊肿患者应当在科学诊断的基础上,加强手术前处理,能够提高手术的成功率。     

超声引导下置管负压引流治疗哺乳期乳腺脓肿的效果

目的 探讨超声引导下置管负压引流治疗哺乳期乳腺脓肿的临床效果.方法 收集2016年9月-2018年9月滕州市中心人民医院哺乳期乳腺脓肿住院患者86例临床资料,以患者自愿选择手术方法为依据随机分为对照组和观察组各43例.对照组采取传统切开引流方法,观察组在超声引导下行乳腺脓肿置管引流术,术后引流管接负压球持续负压引流.对...     

Increased rat mammary tissue vitamin A associated with increased vitamin A intake during lactation is maintained after lactation

Although increases in dietary vitamin A increase milk vitamin A, little is known about effects of vitamin A intake on mammary tissue vitamin A levels during and after the reproductive cycle. First, we measured vitamin A concentrations in milk, mammary tissue and liver of lactating rats fed 0, 4, or 50 micromol of vitamin A/kg diet during pregnancy and through d 12 of lactation. Liver vitamin A concentration was significantly affected by diet in lactating females and pups 12 d after parturition. Milk vitamin A concentrations were significantly higher (7.1 +/- 2.2 micromol/L, n = 8) in dams fed 50 micromol/kg than in those fed 0 or 4 micromol/kg (1.9 +/- 0.3, n = 5 and 2.9 +/- 0.7 micromol/L, n = 7; P < 0.001), as were mammary tissue vitamin A concentrations (5.1 +/- 1.1 versus 2.2 +/- 0.4 and 2.4 +/- 0.6 nmol/g; P < 0.001). Next, we maintained female rats on 50 or 10 micromol vitamin A/kg diet during pregnancy and lactation and then on 4 micromol/kg diet after pups were weaned on d 21. On d 21, mammary tissue vitamin A concentrations were 3.14 +/- 0.75 versus 1.52 +/- 0.21 nmol/g in dams fed 50 versus 10 micromol/kg (n = 4/group; P < 0.001). Mammary tissue vitamin A concentrations were not significantly affected by time from 7 to 49 d after lactation and averaged 8.5 +/- 0.4 and 4.9 +/- 0.8 nmol/g on d 49 in dams fed 50 versus 10 micromol/kg (n = 4; P < 0.001). We conclude that diet-induced differences in rat mammary tissue vitamin A developed during pregnancy and lactation are maintained for > or =7 wk after lactation.     

Arsenic in breast milk during the first 3 months of lactation

Increased concentrations of arsenic were found in soil and ground water from a military training area in Munster, Lower Saxony, Germany, where chemical weapons were dumped after World War II. In order to assess the possible impact of this contamination for nursing new-borns and infants, samples from breast milk of 36 women were analysed with respect to arsenic content. Study participants came from three different regions: the city of Hamburg, the rural area of Soltau, Lower Saxony, and from Munster, the potentially contaminated area. Breast milk samples were collected immediately before and after nursing on days 2, 5, 15, 30, 45, 60, 75, and 90 post partum. At least 10 ml were required for measurements of arsenic, and 187 samples were of that volume. Samples were analysed with a Perkin-Elmer Type 403 hydride-generation atomic absorption spectrometer, equipped with an arsenic EDL-lamp. Arsenic was not detectable, i.e. below 0.3 microgram/l, in 154 of 187 samples. The highest concentration of 2.8 micrograms/l was measured in a sample from the rural area of Soltau. Geometric means of arsenic concentrations were comparable in the three regions. Concentrations did neither differ in samples obtained before and after nursing nor with respect to age of the infant. The calculated daily intake of arsenic was in the range of 0.02 to 0.06 microgram per kg body weight, which is far below the lower limit of daily permissible intake for adults (WHO/JECFA recommendation 1993) of 15 micrograms/kg/wk. In conclusion, we found concentrations of arsenic in breast milk within the reported safety limits. This was also true for samples from women living in a region which has previously been shown to be contaminated with arsenic from chemical weapons.     

Changes in specific nutrients in breast milk during extended lactation

An increasing trend towards breast-feeding infants beyond 6 mo of age has been observed in this country. The present study was designed to examine the effect of extended lactation on the concentrations of vitamins B6 and C, free and total folacin, calcium, zinc, and magnesium. Forty mothers were studied from 7 months of lactation until they stopped breast-feeding. Subjects were requested to collect milk samples monthly at a morning feeding between 7 AM and 10 AM. Between 7 and 25 mo of lactation, levels of zinc, calcium, vitamin B6, and vitamin C tended to decrease, whereas levels of free and total folacin remained unchanged. Magnesium levels decreased only after 18 mo of lactation. The decrease in concentrations of zinc and calcium paralleled the decrease in feeding frequency. Changes observed in this study on the composition of human milk may reflect physiological changes in the mammary gland during weaning.     

曼月乐尾丝宫颈异位1例

<正>1 主持人河南省人民医院妇科主任,王悦主任医师2 病例汇报人河南省人民医院妇科,王洁主治医师3 病例摘要某女,47岁,平素体健,G4P4,顺产4次,5年前因子宫腺肌病宫内放置曼月乐1枚,手术过程顺利,5年内定期复查彩超均提示环位正常,5年内月经量逐年减少,近半年月经未来潮;自诉白带无明显异常,无腹痛、腰酸、腰痛等症状。于2018年3月23日就诊,因曼月乐到期要求取出。妇科检查:外阴已婚已产式,阴道畅,内见少量白色分泌     

中医哺乳知识健康教育对哺乳期乳房疾病的预防作用

目的探讨孕妇学校中进行中医哺乳知识健康教育对哺乳期乳房疾病的预防作用。 方法选择2012年10月至2013年10月在石家庄市第四医院分娩的1 022例产妇为研究对象,按照是否在孕妇学校接受中医哺乳知识健康教育,将其分为研究组(n＝512,接受产前中医哺乳健康教育)和对照组(n＝510,未接受产前中医哺乳健康教育)。观察两组产妇哺乳期乳汁淤积症、乳头皲裂及乳腺炎发生情况。 结果本研究研究组产妇在哺乳期乳汁淤积症、乳头皲裂、乳腺炎发生率均显著低于对照组,两组比较,差异有统计学意义(χ²＝37.75,38.56,46.17;P<0.05)。 结论中医哺乳知识健康教育对预防产妇哺乳期乳房疾病有重要临床意义,并有助于促进母乳喂养的推广普及。     

腹膜后异位妊娠1例病例报告

异位妊娠是一种常见的妇科急症,由于内出血严重,可能危及孕妇生命,是妊娠所致死亡的主要原因之一.腹腔妊娠常因缺乏典型临床症状,易被忽视和误诊[1].其中腹膜外异位妊娠作为一种腹腔妊娠类型,十分罕见[2].我院近期收治1 例妊娠组织种植于腹膜和直肠间隙之间的患者,现将病例报道及文献复习如下.     

Zinc in breast milk during prolonged lactation: comparison between the UK and the Gambia

A total of 580 breast milk samples were collected from 56 lactating women living in a rural village community in The Gambia, West Africa, and 92 samples were obtained from 57 lactating women living in Cambridge, England. Total zinc content of each sample was measured by atomic absorption spectrometry, and pooled samples of the Gambian breast milks, representing successive periods of lactation, were fractionated into fat, whey and insoluble casein fractions, to examine zinc distribution. The two sets of milks both exhibited a dramatic decline in total zinc concentrations with increasing duration of lactation, in common with previous studies. However, the UK milks unexpectedly had lower zinc contents at all stages than the Gambian milks. Milk zinc levels were not significantly related to either maternal age or parity in the Gambian women. The proportion of zinc found in the sedimentable fraction remained nearly constant with increasing duration of lactation, but the proportion found in the fat fraction increased and the proportion in the whey fraction declined. These observations are potentially relevant for estimations of milk zinc availability and the fulfillment of zinc requirements by infants, and hence for infant feeding practices.     

哺乳期乳腺脓肿病原菌分布及耐药情况

目的了解哺乳期乳腺脓肿患者病原菌分布及其耐药情况,以指导临床医生进行合理治疗。方法回顾性分析2015年1月—2016年12月某专科医院哺乳期乳腺脓肿患者脓液分离病原菌及其药敏结果。结果共收集142例哺乳期乳腺脓肿患者脓液标本,其中98份脓液标本分离病原菌99株,金黄色葡萄球菌94株(94/99,94.95%),耐甲氧西林金黄色葡萄球菌(MRSA)43株(43/94,45.74%),肺炎克雷伯菌2株,表皮葡萄球菌、粪肠球菌和彭氏变形杆菌各1株。金黄色葡萄球菌对青霉素耐药率高达90.43%,对红霉素、克林霉素、四环素耐药率分别为55.32%、39.36%和27.66%,对环丙沙星、莫匹罗星、复方磺胺甲口恶唑、阿米卡星耐药率相对较低,尚未发现耐万古霉素、夫西地酸、替考拉宁、奎奴普丁/达福普汀、利奈唑胺菌株;43株MRSA对红霉素、克林霉素、四环素耐药率分别为83.72%、72.09%和44.19%。结论引起哺乳期乳腺脓肿的病原菌主要为金黄色葡萄球菌,其对青霉素、红霉素、克林霉素和四环素耐药率相对较高,不应经验性选择上述药物治疗乳腺脓肿;同时,应警惕MRSA感染存在的可能,根据药敏结果合理选择抗菌药物,对暂停哺乳者进行母乳移除的指导。