藏毛窦1例

患者男 ,2 4岁。因骶尾部中线处脓肿自行破溃 ,形成窦道而来我院。查体 :骶尾部有一窦道口 ,有水样物流出 ,局部潮红、压痛 ,周围体毛浓密。用探针可探及一沿正中线向上约5 cm的窦道。治疗 :剃除窦道口周围毛发 ,在局麻下切开其窦道 ,见窦道有 4个分支 ,近口处有一束毛发。其内壁为肉芽组织、纤维结缔组织及散在毛发。即清理窦道 ,用刮匙将内壁肉芽组织刮净 ,一期缝合 ,术后加用抗生素治疗。术后 8天拆线时 ,在原窦道末端又发现一窦道 ,深约 7cm。切开后见其有 3个分支 ,内含物及内壁同上。在局麻下行袋形手术 ,用油纱填塞 ,加抗生素治疗 ,…     

骶尾部藏毛窦的诊断与治疗新进展

骶尾部藏毛窦在我国是一种少见的皮肤上含有毛发的窦道,其发病率近几年在我国具有明显上升的趋势,本文在查阅文献的基础上,对骶尾部藏毛窦的流行病学数据、发病机制、病理特征、临床表现、诊断及治疗进行了详细的综述,以便于更好地认识及治疗骶尾部藏毛窦。     

窦道切除伤口开放术联合辨证分期换药治疗骶尾部藏毛窦临床观察

目的 探讨骶尾部藏毛窦患者采用窦道切除伤口开放术联合辨证分期换药治疗的临床效果。方法 选取骶尾部藏毛窦患者80例,采用随机数字表法将其分为对照组及观察组,各40例。两组均给予窦道切除伤口开放术治疗,观察组同时给予辨证分期换药治疗。治疗后随访6个月,比较两组的创面愈合时间、住院时间、恢复正常工作时间及临床总有效率、一次性愈合率、并发症发生率、复发率。结果 观察组创面愈合时间、住院时间、恢复正常工作时间均短于对照组（P均<0.05）。观察组治愈27例、好转11例、未愈2例、总有效率为95.00%(38/40),对照组分别为14、18、8例及80.00%(32/40),观察组总有效率高于对照组（P<0.05）。观察组一次性愈合31例（77.50%）、复发0例,对照组分别为20例（50.00%）、4例（10.00%）;观察组一次性愈合率高于对照组,复发率高于对照组（P均<0.05）。观察组发生张力性水疱1例、创面感染0例,切口渗血1例,不良反应发生率为5.00%,对照组分别为2、3、2例及17.50%;观察组不良反应发生率低于对照组（P<0.05）。结论 窦道切除伤口开...     

经骶尾部入路取出直肠巨大球形异物一例

直肠异物临床少见,较小异物容易经肛门取出,而较大异物、特殊形状异物经肛门取出困难。本文报道了一例经骶尾部入路巨大球形直肠异物取出的新方法,患者预后良好,为该类患者的诊治提供一定的指导和帮助。     

骶尾部内胚窦瘤1例报告

患儿女,14个月,因骶尾部占位于2011年5月入院。CT检查示,骶尾部及盆腔内骶前实质性占位,其最大截面积为4.1 cm×2.4 cm;骶3、4椎体可见骨质破坏,肿块部分向椎管内生长,考虑为恶性肿瘤。血清神经元特异性烯醇化酶(NSE)42.45     

十二指肠癌骨髓转移并发溶血性贫血一例

患者男 ,40岁。因恶心、呕吐、体重减轻 2个月 ,于 2 0 0 0年 5月 5日入院。 2个月前无诱因开始反复恶心、呕吐 ,进食量减少 ,曾在外院就诊 ,化验空腹血糖 16 6 5ｍｍｏｌ/Ｌ ,餐后 2ｈ血糖 14 32ｍｍｏｌ/Ｌ ,诊断为糖尿病。做胃镜检查示十二指肠球部溃疡 ,经药物治疗后仍无好转 ,体重下降 15ｋｇ ,为进一步诊治收入我院。体检 :全身浅表淋巴结不大 ,皮肤、巩膜无黄染 ,心肺正常 ,腹软无压痛 ,肝脾未及 ,下肢不肿。实验室检查 :γ 谷氨酰转肽酶 10 0 5ＩＵ/Ｌ(正常值 8～ 5 5ＩＵ/Ｌ) ,碱性磷酸酶 (ＡＫＰ)196 4Ｕ/Ｌ(正常值 30～ 15 0Ｕ/…     

负压封闭引流技术治疗骶尾部褥疮33例分析

目的观察负压封闭引流（VSD）技术治疗Ⅲ、Ⅳ期骶尾部褥疮的疗效。方法对2010-02～2012-07临床收治的33例骶尾部褥疮患者行清创手术,应用负压封闭引流敷料覆盖创面,封闭创面后持续负压吸引治疗7～10d,拆除敷料行再次手术,直到创面炎症消退、肉芽组织生长良好。结果17例使用VSD治疗1～2次,13例治疗3—4次,3例治疗5～6次后均治愈;其中27例患者VSD治疗后可以直接缝合愈合,6例VSD治疗后需行皮瓣转移修复后愈合。经随访,所有病例均无复发,效果满意。结论VSD技术可以有效地解决困扰褥疮治疗中面临的难题,是治疗褥疮较为理想的方法。     

原发性骨髓纤维化并发脾动静脉瘘一例

本文报道了1例罕见的原发性骨髓纤维化并发脾动静脉瘘的病例,通过脾动脉造影、骨髓穿刺及基因检测,得以明确诊断。该病例提示在临床遇到不明原因的脾动静脉瘘时,要考虑到少见病因,如骨髓纤维化。     

骨髓增生异常综合征并发戈谢细胞一例

1病例介绍患者文，50岁，1992年2月无明显诱因出现头晕、乏力，皮肤有出血点，入牡丹江医学院三院，诊断为再生障碍性贫血，经用康力龙、一叶秋减治疗3个月，好转出院。1996年7月因感冒后出现头晕、发热、心悸、气短、皮肤出血点，入我院治疗。查体：体温37．5”C，脉搏105次／     

高血压脑出血术后黏液性水肿昏迷一例

患者男,53岁。2009年3月3日因“突发肢体无力、头痛、喷射样呕吐1h”入北京协和医院急诊室。既往高血压多年,未经系统治疗;10余年前因甲状腺机能亢进行甲状腺手术,术后出现甲状腺机能减退（简称“甲减”）,长期服用甲状腺激素行替代治疗,但服药不规律,也未监测甲状腺功能。体检：肥胖体型,体检欠合作。血压170／110mmHg,     

A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more

Background The surgical management of sacrococcygeal pilonidal sinus (PS) is still a matter of discussion. Therapy ranges from complete wide excision with or without closure of the wound to excochleation of the sinus with a brush. In this paper, we introduce a novel limited excision technique. The aim of this study was to assess the morbidity and recurrence rate of this technique. Materials and methods Limited excision consisted of a selective extirpation of the sinus after tagging the tract with methylene blue. Ninety-three consecutive patients, who underwent surgery between 2001 and 2004, were analyzed. The patients’ survey was performed by mail questionnaire and telephone interview inquiring recurrence, time off work, and time to wound healing. Results Seventy-three percent of the patients were treated in an outpatient setting. With a median follow-up of 2 years, the recurrence rate was 5%. The median time off work was 2 weeks. The median wound healing time was 5 weeks. Conclusion Limited excision for PS can be done in an outpatient setting with a low recurrence rate and short time off work.     

Septic arthritis due to bacteroides fragilis after pilonidal sinus resection in a patient with rheumatoid arthritis

Summary Bacteroides fragilis is a rare cause of septic arthritis. Most patients with B.fragilis septic arthritis have a chronic joint disease, particularly rheumatoid arthritis, and sources of infection are lesions of the gastrointestinal tract and the skin. We report a 69-year-old male, who developed B.fragilis septic arthritis after pilonidal sinus resection. High level of suspicion of development B.fragilis septic arthritis must be present in patients with chronic joint disease in whom gastrointestinal or skin surgery was previously performed.     

Management of pilonidal sinus with the limberg flap

PURPOSE: The aim of this study was to demonstrate the advantages of rhombic excision and Limberg flap closure in the treatment of pilonidal sinus disease. METHODS: We treated 24 patients who had chronic pilonidal sinus disease with rhomboid excision and Limberg flap closure. RESULTS: All patients were followed up for a period of 27 months. Mean hospital stay was 4.1 days, and mean time until return to work was 17.5 days. There was no surgical wound infection. Complication rate was 12.5 percent. During the follow-up period, no recurrence was found. CONCLUSION: Because other treatment methods carry a significant failure rate, this technique is an effective alternative in the treatment of pilonidal sinus disease.     

A new technique for treatment of pilonidal sinus

Twenty-seven patients with chronic pilonidal sinus were treated by a new adopted technique. It was found to be simple, time-saving and to minimize the postoperative morbidity and hospital stay. Results of this new technique were compared with those of other excisional methods in the literature and were found to be superior to them with a shorter hospital stay. The new technique also preserves the internatal cleft, which is valuable in restoring the normal configuration of the breech. Six-year follow-up revealed no recurrence.     

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence

Abstract Background Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods. Methods In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined. Results The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05). Conclusions Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.     

原发性胆汁性肝硬化被误诊为骨髓增生异常综合征1例

正原发性胆汁性肝硬化(PBC)是以血清存在具有高度特异性抗线粒体M2抗体(AMA-M2)及渐进性肝内胆管破坏为特征的慢性胆汁淤积性肝病~[1~3]。我院近期收治1例PBC患者,现报道如下。1病例摘要患者女,42岁,汉族。主因"反复乏力5年,发现贫血3年"于2015年10月17日入院。患者因乏力于2011年7月至2014年7月先后13次在多家医院住院治疗,第一次诊断     

Transitory bone marrow oedema of the hip in pregnant patient with antiphospholipid syndrome: A case report

BackgroundTransient bone marrow oedema (BMO) of the hip presents with pain, is diagnosed by magnetic resonance imaging (MRI), and usually resolves within 6 months. Risk factors include pregnancy. Avascular necrosis of bone and an association with BMO are among the less common presentations of antiphospholipid syndrome (APS).Aim of the workTo present a young Croatian female APS patient who developed transient BMO during pregnancy which spontaneously resolved postpartum.Case reportAfter developing left leg deep vein thrombosis and positive lupus anticoagulant at 22 years old, the patient was diagnosed with primary APS. Antinuclear antibody was borderline, but classification criteria for SLE were not fulfilled. She had an early missed abortion during her first pregnancy while receiving low-weight molecular heparin (LWMH) (enoxaparin 40 mg), and her second pregnancy was to term with LWMH, aspirin, and hydroxychloroquine 200 mg daily. During the third trimester of this pregnancy, she developed excruciating bilateral hip pain to the point she could barely walk. Based on an MRI scan, the patient was diagnosed with bilateral BMO of the femoral head. The condition improved and resolved within four months with conservative treatment postpartum, as confirmed by followup MRI.ConclusionConsidering that pregnancy and APS are risk factors for BMO, both played a role in the development of BMO and the severity of presentation. This case report presents a differential diagnosis of hip pain in pregnant patients, especially with APS. Although APS is commonly associated with AVN, it may also be associated with transient BMO.     

骨髓移植采髓术麻醉方式的选择

目的：为骨髓移植采髓术寻找一种安全、有效、简便和经济的麻醉方式。方法;对18例行自体骨髓移植术的恶性血液病患者采用局部麻醉方式进行采髓,局麻药为利多卡因,平均用量为93．3mg。结果：平均采髓量862.5ml,术中患者无疼痛感,术后局部有微痛。结论：在局麻下采髓是安全、有效,简便、经济的麻醉方式。     

Acute pericarditis presenting with sinus bradycardia: A case report

Acute pericarditis is almost invariably associated with sinus tachycardia. Recent-onset chest pain in the presence of (sinus) bradycardia is considered to be associated with an acute ischemic syndrome rather than acute pericarditis. This report describes a patient with acute pericarditis initially presenting with sinus bradycardia, probably due to a vasovagal response to (chest) pain.