Grayanotoxin poisoning from Rhododendron simsii in an infant

We report a case of severe poisoning in a 57-day-old infant who presented with vomiting, convulsions, and shock after ingesting a bottle of milk containing a decoction of Rhododendron simsii. The grandmother collected this toxic plant from a cultivated area, believing it was good for the airways. Grayanotoxin was detected in both the urine and plant specimens. The infant made a good recovery after requiring ventilatory support for 2 days. Rhododendron is a common gardening shrub in Hong Kong. Some Rhododendron species are poisonous and contain grayanotoxin. Intentional or accidental ingestion of toxic plants can be severe or even life-threatening. It is therefore essential that clinicians be familiar with local toxic plant species.     

新生儿食道闭锁术后并发症与生存率─—13年病例回顾

目的总结和讨论食道闭锁术后并发症的防治,以提高食道闭锁术后存活率。方法总结13年间29例先天性食道闭锁病例手术成活率的经验,分析并发症与存活率的关系。结果19例Ⅰ期食管气管疾管结扎切断、食管端端吻合,1例外院术后发生吻合口瘘转入的20例中15例获得痊愈（75％）,而1984～1990年间Ⅰ期手术治愈率为6／10（60％）,1991～1996年则提高为9／10（90％）。1996年度手术7例全部存活,其中2倒闭锁远近端食道距离大于2cm。结论加强术前术后的管理,积极有效的预防和治疗术后并发症是提高食道闭锁患儿存活率的关键。     

内镜下粘膜切除术治疗食管癌前病变的动态病理学观察

目的:探讨预防食管癌的发生和发展的方法.方法:273例可疑食管癌患者经内镜下Lugol液染色,取黏膜不着色区组织进行p53蛋白免疫组化检测,并对p53蛋白表达阳性病灶,进行内镜下黏膜切除.结果:在85处重度不典型增生的黏膜内,p53蛋白阳性34处(40.0%),其中9处经内镜下黏膜切除术治疗,治愈1处(11.1%),好转5处(55.6%),总有效率为60.7%.对照组好转2处(8.0%),两组总有效率比较差异有显著意义(P＜0.01).结论:内镜下黏膜切除术能有效切除食管癌前病灶,预防食管癌的发生和发展.     

自发性食管破裂的诊断和治疗

目的:探讨自发性食管破裂(Boerhaave's综合征)的诊断和治疗。方法:回顾性分析我院自1990年以来收治的15例自发性食管破裂的临床资料。均为胸段食管破裂,其中中段5例,下段10例;破裂至右侧胸腔8例,左侧胸腔6例,破裂至纵隔但尚未穿破纵隔胸膜者1例。结果:12例通过口服美蓝、碘剂造影得到确诊,3例行内镜检查得到确诊。1例保守治疗治愈,1例行单纯胸腔引流 冲洗,死于破裂后严重感染;11例于发病24h内手术修补,其中10例治愈,1例死于再破裂;另2例于发病24h后行破裂段食管切除食管胃吻合术,均治愈。结论:增强对本病的认识,详细采集病史及查体,口服美兰后胸穿及碘剂造影或胃镜检查有助于减少误诊和诊断。充分引流和及时开胸手术是有效而可靠的治疗方法。     

Cardiac transplantation in an 8-month-old female infant with subendocardial fibroelastosis

On Nov 1, 1984, an orthotopic cardiac transplantation was performed in an 8-month-old female infant with subendocardial fibroelastosis. Because of the advanced state of cardiac failure, the operation was done despite a positive tissue crossmatch for antitoxic donor-specific antibodies. Immunosuppression consisted of high doses of cyclosporine (up to 550 mg/m2 or 30 mg/kg) and steroids. Hypertension and tremor of the extremities, which were attributed to cyclosporine, occurred during the first week but resolved after seven days. No signs of nephrotoxic effects have been noted; however, a severe episode of allograft rejection was detected by endomyocardial biopsy on the seventh postoperative day, and a moderate rejection episode was noted on the 22nd postoperative day. Histologic improvement was seen after treatment with conventional steroid pulses. The patient was discharged on Nov 29, 1984. Complications consisted of four episodes of otitis media caused by Staphylococcus aureus and one rejection episode that was treated on an outpatient basis with an intravenous methylprednisolone sodium succinate pulse. Our experience emphasizes both the feasibility and importance of performing endomyocardial biopsies in infant recipients. Through biopsy, episodes of rejection can be discovered when clinical signs are not yet apparent. Eighteen months after transplantation, the child was developing and growing normally.     

先天性食管闭锁术后再手术的临床分析

目的 总结先天性食管闭锁(CEA)术后再手术的原因及临床体会.方法 回顾性分析2006年9月至2015年11月徐州市儿童医院收治的5例CEA术后再次手术患儿的临床资料.结果 再手术患儿月龄5~14个月,所有患儿均为Gross Ⅲ型,1例食管气管瘘(TEF)复发,4例食管吻合口狭窄经食管扩张治疗无效.患儿术前均行食管造影及食管镜检查,TEF患儿行支气管镜检查明确瘘管.所有患儿均再次经胸完成手术,平均手术时间4.1 h,平均住院时间27 d.随访6个月~3年,无吻合口瘘及TEF复发,2例发生食管吻合口狭窄行食管扩张治疗痊愈.结论 TEF复发、严重食管吻合口狭窄是CEA术后再手术的主要原因,食管镜及支气管镜检查有助于术前诊断,再手术患儿预后良好.     

早期食管癌及其癌前病变内窥镜透明帽法食管黏膜切除术

目的 探讨透明帽法食管黏膜切除术治疗早期食管癌及食管鳞状上皮重度不典型增生的意义。方法 应用透明帽法对29例早期食管癌和42例食管鳞状上皮重度不典型增生行食管黏膜切除。应用氩离子束凝固术(APC)治疗残留及复发病灶。术后l、4及12个月进行内镜复查。结果(1)在内镜下应用透明帽法共对71例患者进行了局部黏膜切除,共切除病灶88块。切除标本每块平均为21.8 mm±1.02 mm×18.2 mm±1.02 mm。(2)本组术后5例出血,其中1例动脉出血,4例渗血,应用内镜压迫、肾上腺素盐水注射及氩离子束凝固术治疗均成功止血;71例无一例食管穿孔发生;术后4例发生狭窄,术后一个月应用水囊扩张,每一个月扩张一次,连续扩张3～4次,狭窄均缓解,进食无明显不适感。(3)58例(81.7％)患者的食管黏膜病变被完全切除,其余病例有不同程度的残留,应用氩离子束凝固术治疗残留病变。术后4个月内镜复查,病理证实3例早期癌、2例重度不典型增生局部复发,随访时间24.6个月,无明显不适感。结论 应用透明帽法食管黏膜切除术可简便、安全、有效地治愈早期食管癌及癌前病变。有较好的应用前景。     

小儿神经母细胞瘤13例临床分析

神经母细胞瘤属婴幼儿最常见恶性实质性肿瘤,我院近13年中诊断了13例。此病起病隐匿,诊断时往往已是晚期,治疗困难。对原因不明发热、进行性贫血、骨痛,尤其在婴儿腹部出现无痛性肿块时应首先考虑此病。必须强调早期诊断,因其对预后有决定意义。     

Membranous diaphragm presenting as esophageal atresia in a neonate

Whenever a newborn infant presents with excessive salivation and failure to pass nasogastric tube, one of the 5 major types of esophageal atresia is suspected. We report a rare case where a newborn infant presented with features of esophageal atresia due to membranous diaphragm.     

慢性重型肝炎上消化道黏膜病变的特点

目的探讨慢性重型肝炎（简称慢重肝）患者上消化道黏膜病变的特点。方法对85例慢重肝患者的胃镜检查结果进行回顾性分析，根据发生慢重肝的基础肝病情况，将患者分成两组：A组为肝硬化基础上发生的慢重肝，B组为慢性肝炎基础上发生的慢重肝。比较两组患者食管-胃底静脉曲张、胃黏膜病变（GML）、门脉高压性胃病（PHG）及其他上消化道疾病的发生情况。结果上消化道黏膜病变发生率为98．8％，其中食管-胃底静脉曲张、PHG和GML的发生率分别为70．6％、35．3％和9．4％。A、B两组患者食管-胃底静脉曲张发生率间差别有显著性意义（P〈0．01），而GML和PHG发生率间差别均无显著性意义（P〉0．05）。46例患者出现上消化道出血，与食管-胃底静脉曲张、PHG、GML相关的上消化道出血发生率为65．2％（30／46）。结论慢重肝上消化道黏膜病变发生率高，且易发生上消化道出血；上消化道出血是多种因素综合作用的结果，主要与食管-胃底静脉曲张、GML、PHG有关。     

婴幼儿复杂危重先心病术后心律失常的处理

目的：探讨婴幼儿复杂危重症先天性心脏病术后心律失常的发生原因及治疗方法。方法：2008年5月~2010年6月我科共为508例复杂重危先天性心脏病患儿施行了手术治疗,术后患儿均转入心胸外科监护室进行监护和治疗,通过持续心电监护,发现心律失常患儿96例,并进行相应的处理和治疗。结果：96例术后心律失常患儿中,92例痊愈,3例死亡,1例放弃治疗。结论：心律失常是婴幼儿复杂危重先天性心脏病手术后常见并发症之一,应早期发现、及时采用抗心律失常治疗并积极去除引起心律失常的病因。正确及时诊断和治疗心律失常可以有效地降低婴幼儿复杂危重先天性心脏病手术的死亡率。     

双支架治疗食管癌引起的重度气管狭窄

目的探讨气管、食管双支架留置术治疗恶性气管、食管狭窄的安全性和临床疗效。方法回顾性分析16例食管癌联合重度气管狭窄的患者行气管及食管腔内支架植入术的方法,相关的术中麻醉支持和指征监测及围术期处理。结果所有患者均成功置入气管、食管双支架,手术成功率100%。共放置内支架32枚（气管支架及食管支架各16个）。术后肺通气功能及吞咽功能均明显改善。术后生存期〈3个月者3例,3～6个月8例,〉6个月5例。结论气管、食管双支架留置术是治疗恶性气管、食管狭窄安全、有效的治疗方法。对于同时伴有气管、食管狭窄的患者,应首先置入气管支架。     

内镜下非密集套扎与密集套扎对重度食管静脉曲张的疗效比较

目的:对比分析内镜下非密集套扎与密集套扎对重度食管静脉曲张的治疗效果.方法:选择2013年1月~2015年12月在我院进行诊治的肝硬化并发重度食管静脉曲张患者61例,按照治疗方法的不同分为两组,A组采用内镜下非密集套扎治疗,B组采用内镜下密集套扎治疗.比较两组的治疗效果和套扎次数,并随访1年观察两组的死亡情况.结果:B组的总有效率为94.28%(33/35),明显高于A组的80.76%(21/26);B组套扎1次和2次的发生率明显高于A组,套扎3次和4次的发生率明显低于A组;B组的死亡为8.57%(3/35),明显低于A组的15.38%(4/26).结论:对重度食管静脉曲张患者在内镜下采用密集套扎治疗的疗效明显优于非密集套扎,可以明显减少套扎次数,值得应用推广.     

Aurora-A在食管鳞癌及癌前病变中的表达特点和研究意义

目的 探讨极光激酶(aurora kinases A,Aurora-A)在食管鳞癌及癌前病变(主要为癌旁癌前病变)组织样本中的表达特征及其在食管鳞癌发生、发展过程中的作用。 方法 应用组织芯片技术和免疫组织化学方法(S-P法)检测Aurora-A在9例重度不典型增生组织和122例食管鳞癌组织以及它们的癌旁癌前病变组织中的表达情况;并使用实时荧光定量PCR法检测Aurora-A基因在8对癌前病变组织和5对早期食管癌组织中的表达水平;同时运用蛋白免疫印迹法和实时荧光定量PCR法检测Aurora-A基因在各细胞株(人食管上皮永生化细胞株及食管鳞癌细胞株)中的差异性表达情况。 结果 免疫组化结果显示Aurora-A在正常食管黏膜上皮、轻度不典型增生、中度不典型增生、重度不典型增生及食管鳞癌组织中的阳性率分别为17.2%、27.6%、50.0%、71.2%和84.3%,其表达率随病变程度加重而递增。Aurora-A基因mRNA水平在8例癌前病变组织和5例早期食管癌组织中的表达程度也明显高于其相应正常组织,其中病变组织存在Aurora-A显著性高表达的比率分别为75.0%(6/8)和60.0%(3/5)。与人食管上皮永生化细胞株相比,Aurora-A在ESCC细胞株中的表达水平也明显升高。 结论 Aurora-A激酶表达水平与食管癌癌前病变严重程度呈正相关(r=0.548,P=0.000),提示Aurora-A可能参与食管鳞癌的发生与发展,有望为食管鳞癌的早期诊断及治疗提供新的方向。     

Acute life-threatening arrhythmias caused by severe hyperkalemia after induction of anesthesia in an infant with methylmalonic acidemia

Methylmalonic acidemia (MMA) is a very rare genetic disease of metabolism that progressively leads to neurological and renal sequelae. This report describes an unusual case of a patient with MMA who developed severe hyperkalemia and severe dysrhythmia during anesthesia. A 13-month-old male infant with MMA underwent urgent insertion of a port-a-cath under general anesthesia. A life-threatening arrhythmia suddenly occurred, with severe hyperkalemia (up to 7.4 mmol/L), immediately following induction of anesthesia. Emergent resuscitation was successfully carried out, with a complete neurological recovery after 7 days after surgery. Although MMA is a rare complication, the possibility of severe hyperkalemia should be considered in the differential diagnosis of patients with MMA presenting with wide QRS complex tachycardia. The management and intraoperative complications of this disorder are reported here, and the available literature is reviewed.     

管状胃延长术是食管癌切除术后胃食管高位吻合时的应急选择

目的介绍管状胃延长术这一创新的手术方法,并报道应用该手术方式实行食管癌切除及食管-管状胃颈部吻合的成功案 例。方法报道我科自2015年9月~2016年10月收治的5名食管癌患者,2例诊断为颈段食管癌,3例胸中段食管癌,颈段食管癌 患者行下咽切除+全喉切除+食管内翻拔脱+胃口咽吻合术,胸中段食管癌患者行左颈、右胸、腹正中三切口食管癌切除+食管-胃 颈部吻合术,术中发现患者胃长度不够,难以在口咽部进行吻合,故被迫进行管状胃延长术以尽量延长管状胃。结果全部患者 手术成功,术后恢复情况良好,术后7~12 d行上消化道造影未发现明显异常,术后2~3周病情平稳出院。结论食管癌切除食管- 胃高位吻合时,若发现管状胃长度不够或吻合口张力较高,管状胃延长术也许是个不错的应急选择。     

营养支持法治疗ICU食道癌重症患者的观察

目的探讨营养支持法治疗ICU食道癌重症患者的临床效果。方法选择2015年1月~2016年12月于我院就诊的ICU食道癌重症患者84例,采用数字随机法,分为观察组(n=42)与对照组(n=42),对照组患者给予常规治疗,观察组患者在此基础上给予肠内营养支持治疗,比较两组患者的治疗效果。结果观察组治疗后营养良好率显著高于对照组(P0.05);观察组患者的MNA(13.44±1.88)分、BMI(11.72±12.69)kg/m2、ALB(35.35±3.12)g/L、HBG(108.48±13.04)g/L均显著高于对照组(P0.05);但两组患者的MAC比较差异无统计学意义(P0.05);观察组患者并发症发生率显著低于对照组(P0.05)。观察组患者并发症发生率9.52%,显著低于对照组的21.43%,两组比较差异有统计学意义(P0.05)。结论给予ICU食道癌重症患者营养支持法治疗,能够有效改善患者的营养状况,减少肠胃并发症,安全有效。     

Vidarabine therapy for severe herpesvirus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency.

Six patients with severe herpesvirus infections were successfully treated with vidarabine. One patient had a previously undescribed syndrome of chronic cutaneous varicella infection of eight months' duration, associated with transient but complete duppression of lymphocyte response to conconavalin A. Other diagnoses were severe varicella pneumonia, progressive cytomegalovirus pneumonia associated with acute lymphocytic leukemia, herpes simplex encephalitis, severe zoster associated with stage IV lymphoma, and disseminated herpes simplex in a patient receiving high doses of steroids. All patients showed cessation of new lesions or abrupt clinical improvement between days 2 and 4 after initiation of therapy, and all were cured of their clinical infection. Dramatic improvement in all of our patients and the minimal toxicity observed make vidarabine suitable for use in severe herpesvirus infections.     

An unusual cause of an epidural abscess

A previously well 30-year-old man presented with severe progressive back pain, joint pain and fever. Magnetic resonance imaging confirmed an epidural abscess. A sexual history revealed both risk factors for and previous symptoms of a sexually acquired infection. Neisseria gonorrhoeae was isolated from a rectal swab and from a wrist aspirate, consistent with disseminated gonococcal infection. The epidural abscess resolved clinically and radiologically after treatment for N. gonorrhoeae with ceftriaxone.     

TP与FP方案治疗晚期食管癌的疗效与安全性的Meta分析

目的系统评价比较紫杉醇联合顺铂(TP方案)与5-氟尿嘧啶联合顺铂(FP方案)治疗晚期食管癌的疗效及不良反应。方法计算机及手工检索相关文献,纳入比较TP与FP方案治疗晚期食管癌的随机对照试验进行系统评价。结果共有4个随机对照实验符合纳入标准,共计240例晚期食管癌患者。纳入研究普遍质量较低,大多只对近期疗效进行研究,缺乏对远期疗效的评估。Meta分析显示:TP方案完全缓解率[=0.44,I2=0%,RR=2.93,95%CI(1.05,8.21),P=0.04]及有效率[=0.88,I2=0%,RR=1.78,95%CI(1.38,2.28),P<0.01]均明显高于FP方案,有统计学意义;但TP组重度骨髓抑制(白细胞减少)、严重脱发、严重关节肌肉痛等不良反应的发生率明显高于FP组(P<0.05)。结论本系统评价纳入研究均为中文文献,数量较少,质量普遍较低,且缺少对远期疗效的评估。虽目前研究提示TP方案治疗晚期食管癌疗效优于FP方案,但尚需更多高质量的多中心临床随机对照试验进一步验证。同时在临床工作中,TP方案易导致的严重不良反应如骨髓抑制等,也值得警惕。