Relative analysis on mutilation disease and characteristics of dyslipidemia in the aged

Objective :To observe the character and the distribution of dyslipidemia and to explore the relationship between dyslipidemia and the incidence of certain diseases.Method :138 aged cases with dyslipidemia(group A) were observed.Compared with 103 aged cases with normal(group B),and with 126 non-aged cases with dyslipidemia(groupC) to explore the level of lipidemia,the distrbution of all kinds of dyslipidemia and the incidence of certain diseases in three groups.Result:The level of lipidemia in group A was showed that TC,TG and LDL-C were increased,HDL-C was decreased.The proportion of hypertriglydemia was the highest.Conclusion:Hypertriglydemia was closely related to atherosclerosis.     

Development of biovigilance in the United States

Background Hemovigilance systems have been in existence for over 10 years,a consequence of the transmission of HIV through the blood supply and the recognition of the impact of other serious adverse events associated with transfusion on the safety of blood transfusion.Hemovigilance systems now have been implemented globally in most developed countries,with a few exceptions,to monitor the adverse events and incidents associated with blood donation and transfusion.'Biovigilance' broadens the scope beyond blood to incorporate monitoring of adverse events associated with tissue,organs and cellular components.In the USA,while numerous separate programs existed to ensure biological safety,there was no comprehensive national Hemovigilance or broader biovigilance system. Beginning with the promulgation of the term 'biovigilance',the framework for a national biovigilance program began.     

高压氧对脑梗死患者血浆SOD和CRP的影响及临床意义

Objective To study the effect of hyperbaric oxygenation(HBO) therapy on the activities of serum SOD and CRP of patients with cerebral infarction and its clinical significance. Methods 78 patients with cerebral infarction were randomly divided into hyperbaric oxygen group (HBO Group, 40 cases)and clinical group (38 cases). The clinical group was treated with clinical conventional treatment only. HBO group was treated with HBO combined with clinical conventional treatment. 21 healthy volunteers were assigned to control group. Before and after treatment, the activities of serum SOD and CRP level were measured, and the curative effect were evaluated. Results The pretreatment serum SOD and CRP of the HBO group and clinical group were significantly different from the control group (P＜ 0. 01). Compared with the pretreatment and posttreatment serum level of the HBO group, SOD raised, CRP lowered, the difference was significant(P＜ 0. 01).Compared with clinical group, SOD raised, CRP lowered and the total cure rate of the HBO group were more significant different(P ＜0.01). Conclusion HBO therapy raised the activities of SOD and lower the level of CRP in serum of the patients with cerebral infarction, and improved the free radicals scavenging ability in the body. Therefore, HBO therapy has a good effect for cerebral infarction. The experiment suggests that the activities of SOD and CRP level in serum can be used to judge the curative effect and prognosis of HBO therapy for cerebral infarction.     

单中心医疗机构20年肺栓塞发病的回顾性分析

Objective To evaluate the correlation of pulmonary embolism (PE) and original diseases by retrospectively analysis of the patients for 20 years in single medical center. Methods Five hundred and five patients with PE were admitted and treated in General Hospital of Chinese PLA from January 1989 to January 2009, and their clinical data were retrospectively reviewed to analyze the risk factors of PE and the correlations of PE with the original diseases. Results Of the 505 patients with PE in the past 20 years, the incidence of PE was increased year by year, especially it increased spectacularly after the year of 2004 [61.2% (309) vs. 38.8% (196)]. It was found to be most prevalent in patients of 41 - 60 years old. Its incidence in males was 1.52 folds higher than that of the females [60. 4% (305) vs. 39.6% (200)].Dyspnea, chest pain and hemoptysis were the initial symptoms in the PE patients. Among the 505 patients,40.0% of them complained dyspnea with chest pain and hemoptysis. Among them, dyspnea occurred in 100.0% of patients, hemoptysis in 52.1%, and chest pain in 40.0%. In 31.1% of the patients if was complicated with deep venous thrombosis (DVT), 19. 8% of them suffering from varicosity, 9. 5% of them had the history of surgery less than 30 days before, 22. 0% of them suffering from neoplasm, 3. 6% of them were accompanied with cerebrovascular disease within 4 days, 17.4% of them were accompanied with infection, 10. 1 % of them were accompanied with primary pulmonary hypertension, and 16. 8% of them were accompanied with heart diseases. Multivariate analysis showed that the history of surgery, DVT and neoplasm had significant correlation with the occurrence of PE [odds ratio (95% confidence interval), OR (95%CI) was 4.540 (2.186-9.443), 0.325 (0.155 -0.682), 2.610 (1.020-6.708), P＜0.05 or P＜ 0. 013, while oral contraception, primary pulmonary hypertension and cerebrovascular disease showed a less significant correlation with the occurrence of PE [OR (95%CI) was 0. 297 (0. 078 - 1. 126), 3. 210 (0. 855 -12. 110), 2. 939 (0. 862 - 10. 020), all P＞0. 05]. The age and infection did not show significant correlation with the occurrence of PE [OR (95%CI) was 1. 041 (0. 674 - 1. 607) and 0. 820 (0. 410 - 1. 665), both P＞0.05]. Conclusion The PE is difficult in diagnosis, but with increasing cognizance, the diagnostic rate of PE has been increased. Patients with history of surgical operation, DVT or neoplasm, who complain dyspnea without known cause, chest pain or hemoptysis, should be subjected to further examinations, as to confirm the diagnosis of PE, then the survival rate of the patients with PE may be elevated.     

Application of hybrid operating rooms for treating spinal dural arteriovenous fistula

BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence.Compared with direct occlusion of SDAVFs in microsurgery,hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate.At this point,our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.     

Accelerating the Implementation of the Incheon Strategy to Make the Right Real for Persons with Disabilities

The Background of the Asian and Pacific Decade of Persons with Disabilities The Asia and Pacific Region Asia and Pacific is a vast region.It has about 60％of the world population.In Asia,you can find some of the oldest civilizations and religions;some of the most advanced as well as poorest economies,and many Asians living in rural and mountainous areas.Diversities and differences among governments and peoples of Asia are the norm rather than the exception. Poverty situation of people with disabilities in Asia:People with disabilities in the region are facing critical and severe situations.About 80％ of Asian people with disabilities live in rural or remote areas.Among the 900million very poor people in the Region,the disabled are among the most discriminated against and the most impoverished.     

Experience of the treating application on transposition of pedicled periosteal flap for repairing the scaphoid bone nonunion

To explore the clinical result treating the scaphoid bone nonunion with vascularized periosteal flap.METHODS:26 cases of scaphoid bone nonunion underwent transplantation with the periosteal flap with dorsal carpal branch of anterior interosseous flap with dorsal carpal branch of anterior interosseous artery.RESULTS:Following up 4 months to 18 months,in the 26 cases of scaphoid bone nonunion,19 casesa appeared good(27%),CONCLUSION:The periosteal flap with dorsal branch of anterior interosseous were used in repairing of scaphoid bone nonunion,the effect is food.     

急诊科急性心肌梗死抢救护理流程模式的改进

Objective To increase the success rate of first-aid and nursing of patients with acute infarct of cardiac muscle in emergency departments.Methods A total of 50 patients with acute infarct of cardiac muscle were taken,for seeking for the most convenient,effective flow model for first-aid and nursing under current conditions,which has a smooth cooperation with doctors,and shortens the time of patients staying in hosptal.Results The 50 patients were primarily first-aided in emergency department,and shew a stable status of disease,and were sent to the complex ICU or the cardiacology department in the in-patient section with care.The success rate was 94%.Compared with 50 patients in the past,the success rate was increased by 10% (P＜0.05).The time for staying in hospital was reduced to 6 rain for a patient at a time in average,from the tradiational average time for a patient at a time of 15.5 rain.Conclusions This exploration in nursing model for first-aid and nursing of patients with acute infarct of cardiac muscle in emergency departments provides an improvement which can closely match with doctors,and increase the success rate of first aid.It clearly shortens the in-hospital time for patients.The model gives valuable time for the first-aid process which shows time is life,and increases the patients' satisfication degree.     

Composite pheochromocytoma masquerading as solidpseudopapillary neoplasm of pancreas

Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation.     

喉部手术后失音患者的沟通训练

目的 :探讨运用伯洛的沟通理论及沟通过程 5项要素与喉部手术后失音患者进行有效沟通的模式。方法 :因患咽喉疾患而致一段时间失音的患者 10 2例 ,分为 2组 ,进行身心需求问卷调查并运用图片卡交流 ;训练组患者同时进行特定的沟通手段及术前适应行为训练 ,应用图片卡、自编手语、写字板 3种方法进行护患沟通。结果 :2组患者在与护士进行有效沟通的领会程度上差异存在显著性 (P <0 .0 5 )。结论 :完善沟通过程 5项要素是与喉部手术后失音患者有效沟通的关键 ,适应行为训练是达到护患沟通的必要手段。     

癔症性失声患者疾病不确定感与医学应对方式相关性分析

目的调查癔症性失声患者疾病不确定感与医学应对方式现状,探讨二者之间的关系。方法应用Mishel疾病不确定感量表与医学应对方式量表,对106例癔症性失声患者进行调查。结果癔症性失声患者疾病不确定感得分为(120.85±10.14)分,处于偏高水平;面对应对方式与疾病不确定感复杂性呈显著负相关,屈服应对方式与疾病不确定感不可预测性呈显著正相关。结论护士应及时评估癔症性失声患者的疾病不确定感水平,制定有效干预措施,以降低其疾病不确定感水平,提高其应对水平。     

Using sign language with tracheotomized infants and children

Children's ability to communicate with others is important for cognitive development. However, the number of infants and young children deprived of vocalization (aphonia) is increasing in the pediatric patient population due to tracheotomy. The Communication Program for Infants and Parents (CPIP) uses sign language as an alternative system to verbal communication.     

郁证发微(四十九)--郁证咽病论

该文主要探讨郁证性咽(喉)病的因机证治。举凡梅核气、咽嗌不利、咽中热灼以及喉痹声喑等,皆可由七情不遂所致,病机涉及肝郁失疏、肝火灼烁、思虑伤及心脾以及痰涎瘀血阻滞。郁证性咽(喉)病通常伴有情志类临床表现及一系列纷繁复杂的躯体症状。治疗当重视疏肝解郁,养心安神;开郁顺气,化痰散结;及散血养荣,活血祛瘀等。现代医学咽异感症、癔症球、癔症性失音以及其他咽喉神经与精神性疾病可属郁证性咽(喉)病范畴,心理暗示及抗抑郁、抗焦虑治疗对上述病症有效。     

The use of relevant life experiences as the basis for suggestive therapy

A brief, directive method of hypnotherapy is described which combines limited insight therapy with hypnotic suggestions based on relevant life experiences of the patient. By integrating suggestions and experiences familiar to the patient, the former are more likely to be followed, have greatex meaning to the patient and are therefore more dective. The essential technique ia to utilize therapeutically suggestions which reproduce events from the life history of the patient. Three case reports are given to illustrate how this technique ia applied in different ways. A caae of conversion aphonia and another of convexxiion paralysis are both cured in one seasion. In a third patient this technique is successfully used to produce painlem childbirth.     

Diagnosis and Management of Dyspepsia

The exact incidence of laryngocele is unknown. It has been stated that it probably is always a congenital condition, but it may manifest itself at any age.

Symptoms include peculiar timbre, alteration of tone, and hoarseness or weakness of the voice; various degrees of aphonia; difficult respiration; coughing bouts; and a lateral mass in the neck.

A possible relation between laryngocele and carcinoma of the larynx has been postulated by some observers.

Treatment of laryngocele is surgical, although internal laryngoceles in adults require no treatment. The prognosis is good in both children and adults if no complications develop.     

Oropharyngeal Airway Obstruction after the Accidental Ingestion of Arisaema Amurense

Background

Arisaema amurense is widely known in Korean folklore as a poisonous plant, and its lethal toxicity has long been recognized. The toxicity of Arisaema amurense is due to its content of calcium oxalate, which causes painful oropharyngeal edema, hypersalivation, aphonia, oral ulceration, esophageal erosion, and hypocalcemia.

Objective

We report a case of accidental poisoning after ingestion of the rhizome of Arisaema amurense, resulting in airway obstruction that required endotracheal intubation.

Case report

A 60-year-old man developed oral pain and swelling after accidentally ingesting a rhizome from the Arisaema amurense plant as a medicinal herb. His symptoms worsened upon his arrival in the Emergency Department, and he was unable to speak due to oral swelling and hypersalivation. The patient underwent endotracheal intubation to protect his airway and was treated with antihistamines and corticosteroids. Three days after treatment, he had improved and was extubated.

Conclusion

We describe an emergent treatment course for a patient with acute airway obstruction resulting from the ingestion of Arisaema amurense.     

Atrial fibrillation and concomitant left subclavian,axillary and brachial artery embolism after fiberoptic bronchoscopy: A case report

BACKGROUNDFiberoptic bronchoscopy has been widely used in the diagnosis and treatment of respiratory diseases. Numerous major and minor complications have been reported following this procedure. The incidence of major postoperative complications is approximately 0.5% and includes respiratory depression, pneumothorax, pulmonary edema, pneumonia, airway obstruction and cardiorespiratory arrest. Minor complications include vasovagal reactions, cardiac arrhythmias, hemorrhage, pneumothorax, aphonia, nausea, vomiting and fever. However, to our knowledge, a case of atrial fibrillation (AF) concomitant with fatal arterial embolism in the upper extremities following diagnostic bronchoscopy has never been reported.CASE SUMMARYA 70-year-old female patient presented with a history of rheumatic heart disease beginning at 10 years of age and an approximately 10-year history of hypertension. The patient was transferred from the cardiology department to the respiratory department due to recurrent coughing, pneumonia, and fever. She underwent fiberoptic bronchoscopy in the respiratory department. Approximately 2 h after completion of bronchoscopy, she complained of left arm numbness and weakness. Physical examination detected cyanosis of the left upper extremity, grade III weakened limb muscle strength, and undetectable left brachial artery pulsation. Auscultation indicated AF. B-mode ultrasound examination of the blood vessels showed hyperechoic material in the left subclavian, axillary and brachial arteries, and parallel veins. As our hospital has no vascular surgery capability, the patient was transferred to a specialized hospital for emergency thrombectomy that day. A tracking investigation found that the patient’s conditions improved after successful thrombectomy.CONCLUSIONThromboembolism following bronchoscopy is rare, and only a few cases of cerebral air embolism after bronchoscopy have been reported.     

晶状体后脱位的彩色多普勒超声诊断价值

目的：探讨晶状体后脱位的超声诊断价值。方法：应用彩色多普勒超声对38例不同类型的晶状体后脱位患者的眼球进行超声检查，了解晶状体在眼内的位置、形态、回声以及与周围组织的关系。结果：完全性品状体后脱位13例，人工晶状体后脱位3例，不完全性品状体后脱位22例。合并玻璃体出血4例，玻璃体混浊、增殖及机化13例，玻璃体后脱离15例，视网膜脱离3例。38例患者中33例进行了玻璃体切除联合品状体切除或取出术，超声诊断符合率100％。结论：超声在晶状体后脱位的诊断中具有很高的实用价值，是临床上诊断晶状体后脱位的重要手段之一；同时，为晶状体后脱位手术治疗方法的选择提供有价值的参考。     

示指关节活动空间及其应用

目的 测量健康和受伤后示指关节活动空间,探讨其在康复中的应用价值。方法 招募示指未受过伤的健康大学生志愿者30例(健康组)和示指近期受伤的大学生志愿者3例(患者组),嘱其在示指独立以及与中指协同状态下做屈伸、内收、外展和环转运动,每个动作重复2次,间隔30 s。采用高清相机记录示指运动轨迹,MATLAB软件整理分析视频,比较两组不同动作的运动范围,绘制伤指运动空间和范围对比图。结果 与健康组相比,患者组示指独立屈伸及内收-外展范围分别缺失26.5%和24.6%。由于伤指恢复程度不同,3例患者环转运动缺陷个体差异较大,最大缺失方向分别在160°、70°和170°。结论 观察示指运动空间缺失范围百分比和最大缺陷方向,有助于对伤指的康复评定。