全内脏反位腹腔镜胆囊切除胆总管取石1例报告

<正>患者男,78岁,因左上腹及剑突下疼痛反复发作7年,加重半年入院。入院查体:生命体征平稳,痛苦面容,巩膜无明显黄染,心肺无明显异常,腹平软,左上腹及剑突下偏左压痛(+),反跳痛(-),墨菲征(+),无手术史。肝、胆、脾彩超示:肝、胆、脾     

腹腔镜治疗先天性膈疝并急性肠梗阻1例

<正>一般资料患者,男性,38岁,左上腹痛3 d,疼痛加重伴呕吐1 d急诊入院,该患者3 d前无明显诱因突然出现左上腹胀痛,疼痛较重,呈阵发性发作,很快发展至全腹痛,不向它处放射,有恶心感,未呕吐,无其他不适症状。到当地医院门诊,给予抑酸、补液等治疗后症状稍好转。1 d前,患者诉腹痛较前加重,伴有呕吐多次,呕吐物为胃内容物,呕吐量大。在当地医院急诊行腹部平片检查,结果提示"左侧膈疝";行上腹部CT     

脾脏血管肉瘤伴肝转移1例

患者,男,34岁.因左上腹部胀痛不适4个月于2008年10月28日入院.患者4个月前出现反复左上腹坠胀不适,伴轻度疼痛,近两个月出现右侧腰背部胀痛.伴右肩背部束带感.外院B超、CT检查提示"脾脏占位,肝脏多发结节"(见图1).人院查体:全身浅表淋巴结未及肿大,皮肤巩膜无黄染.腹平软,无压痛,脾脏肋下2 cm,质韧,轻度压痛.     

肝脏淋巴增生性病变1例报道

病例资料患者,女,40岁,因"左上腹疼痛1月余,CT检查发现左肝占位10多天"入院。患者于1个多月前无明显诱因出现左上腹疼痛,于当地医院行B超检查提示左内叶查见一约1.6 cm×1.5 cm大回声团,形态规则,边界欠清,增强CT检查提示肝左内叶有一直径约1.6 cm低密度影,增强后呈快进快出表现,符合恶性肿瘤影像学表现。遂行肝脏穿刺活检,病理结果提示为结节性肝硬变伴重度慢性间质性肝     

胃海绵状淋巴管瘤一例

患者女,39岁。因上腹部疼痛伴发热3d,于2002年8月6日入院。患者3d前无明显诱因出现上腹部疼痛,为持续性胀痛,并向背部及左腰部放射,伴发热,体温38.9℃,有恶心、无呕吐和腹泻。于当地医院就诊,B超及CT均发现上腹部胰尾后方至胃大弯处有一较大肿物,考虑为“腹膜后恶性肿瘤”,给予对症治疗后无明显好转。入院时体格检查:一般情况好,腹平坦,左上腹及上腹正中部压痛明显,无反跳痛,肝脾未触及,未触及包块。辅助检查:CT发现腹膜后胰尾后方至胃大弯有囊实性占位性病变,约12cm×8cm。B超显示:于胰尾部后方,腹主动脉左外上方可见11.3cm×8.7cm囊实…     

B型尼曼匹克病致巨脾1例及文献复习

<正>患者,女,47岁,因"左上腹肿块伴胀痛1年余"入院。年幼时曾因体格发育迟缓于当地医院检查,血常规发现"三系下降",此后多次复查均提示"三系下降",但无任何不适,能胜任日常工作,已婚并育有一子。1年前发现左上腹肿块,逐渐增大伴胀痛,外院B超提示"肝脾肿大"。入院时查体:左腹明显膨隆,脾肿大至骨盆上缘。     

胆道蛔虫症合并胆囊结石1例

正1病例资料患者女性,61岁,因"反复上腹部疼痛1周,再发加重1 d"入院。患者入院1周前因出现上腹部胀痛,伴有剑突下疼痛及腰背部放射痛,自诉疼痛为游走性、性质不明,无恶心呕吐、无畏寒发热等。当地社区卫生服务中心彩超提示:胆囊结石。遂自服消炎利胆片后症状缓解。1 d前患者上腹部及剑突下疼痛症状呈持续性加重,遂来我院住院治疗。查体:皮肤巩膜轻度黄染,中上腹触之软,右上腹及剑突下深压痛,无反跳痛     

先天性融合型横过异位肾误诊为胰腺囊肿1例

患者,女,52岁。因发热伴尿频、尿痛,左下腹阵发性疼痛1个月,于2001年12月29日收入院。体检:左肾区叩击痛,左上腹部可触及10 cm×7 cm大小肿块,压之有囊性感,活动度差。左下腹轻压痛,无反跳痛。尿常规白细胞<15-20/HP。B超     

胰腺体尾部癌误诊为脾脓肿1例报告

患者:女,61岁。因感冒发热并左上腹持续性隐痛3天,于1989年2月16日就诊。体检:T41℃,皮肤及巩膜无黄疸,左上腹季肋区有压痛,无反跳痛,未扪及包块,肠鸣音正常。左肾区叩击痛(+)。B超:脾内后下方示5.5×3.4cm无回声区,边界欠清,不规则。诊为“脾脓肿”。收往内科,经用大剂量抗生素及肾上腺皮质激素治疗20天,效果不佳。复查B超4次,结果同前。转外科治疗后因疼痛及发热等症状好转,未行手术者自动出院,继续药物治疗。出院后半月因突然发生机械性肠梗阻而再次住院,行急症剖腹探查术:见左上腹有非化脓性炎性     

巨大外生性肝癌一例

患者　男性 ,52岁 ,农民。左上腹阵发性钝痛间断发作半年 ,近 3个月症状加重 ,于 1 997年 1 1月 1 3日入我院。查体 :体温 37 4℃ ,体质良好 ,浅表淋巴结未及肿大 ;无腹壁静脉曲张 ,左上腹隆起 ,可及一质硬肿块 ,剑突下 4cm ,左肋弓下 1 0cm ,表面光滑边缘清 ,有分叶感 ,随呼吸上下活动度达 2cm ,轻度压痛 ;肝脏右肋下未及 ,无腹水征 ,肠鸣音正常 ;Hb 1 2 5g/L ,HBsAg(- ) ,AFP(- ) ,CEA(- ) ,白蛋白 38 8g/L ,肝肾功能均正常 ;全胃肠道钡餐检查未见明显异常 ;B超左上腹探及巨大肿块 ,内回声不均 ,肝胆胰脾未探及异常 ,提示肿块可能来…     

Double fractures of the bones of the crus and their treatment

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.     

复方当归提取物对皮肤抗氧化作用实验研究

目的:观察含复方当归提取物的护肤品对皮肤的抗氧化作用。方法:测定含复方当归提取物护肤品对D-半乳糖衰老模型小鼠皮肤超氧化物歧化酶(SOD)、羟脯氨酸(Hyp)及皮肤含水量的影响。结果:含复方当归提取物护肤品具有使D-半乳糖衰老模型小鼠皮肤SOD、Hyp含量增高的作用(P<0.05),对小鼠皮肤含水量有增高趋势,但无统计学意义。结论:含复方当归提取物的护肤品对皮肤的抗氧化作用与提高皮肤SOD活性、增加Hyp含量有关。     

In Vitro Assessment of the Hemocompatible Properties of Polymers

Summary: Based on the available data in the literature and personal results, a system of in vitro tests, consisting of two levels of selection, was proposed for assessment of hemocompatible properties of polymers. The first level consists of rapid methods for preliminary assessment (clotting time, hemolytic activity of the sample, and number of adhesive platelets). The second level involves methods for final selection and consists of measurement of the kinetics of the initial stages of adsorption of albumin, the degree of activation of the complement system, the intensity of radical oxidation of the lipid fraction of the blood, and the degree of platelet spreading. Comparative experimental assessment of these methods was conducted with a number of polymers and revealed the confidence limits for the application of each test and suggested quantitative criteria for selection.     

四肢长骨骨折内固定的合并症

从１９７５年８月－１９９３年１２月，我院共共收治因内固定不当所致的合并症的１７７例，１２种类型，计骨不连４５例，感染２３例，肪肪栓塞１２例，神经损伤１１例，血管损伤４例，关节僵直２１例，髓外钉８例，髓内钉进退困难１４例，髓内钉、钢板弯曲、折断１２例，钉尾过长１５例，髓内钉进入关节１０例，肌腿损伤２例。本文对上述合并症发生的原因及预防进行了简要探讨。     

Clinical and morphological substantiation of the surgical treatment of post-traumatic neurogenic deformations of the limbs in children

The authors have analysed and determined the role of such clinical factors as the age of the patients, the level of the nerve lesion, the period of time since the moment of the injury, the lesions of the arterial vessels and the individual regenerative capacity of various nerves with the aim of defining the optimal period of time for surgical correction of neurogenic deformations of the extremities in children in cases of the peripheral nerve lesions. Morphological investigation of the paralysed muscles of 56 patients with lesions of the peripheral nerves was carried out. Characteristic structural and functional changes in the denervated muscles were established and the terms of appearance of irreversible changes were determined.A conclusion about the necessity of surgical treatment within the period of 1 year and more since the time of the nerve injury has been made on the basis of the investigation. Positive results of the treatment of 180 patients confirmed the correctness of the authors' conclusions.     

Acute insufficiency of the gastrointestinal tract in patients with severe gunshot injury

Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.     

Cost-based evaluations of the treatment of back pain: a primer for health-care professionals.

BACKGROUND CONTEXT: There is an extensive literature on the costs of back pain and on cost-based evaluations of the effectiveness of alternative modes of care for back pain. An understanding of the adequacy of a study often requires information that is not part of the experience or training of health-care professionals. The article seeks to provide clinicians with some criteria by which to judge the validity of cost-based evaluations of the treatment and consequences of back pain. PURPOSE: This article is not a comprehensive, critical review of the research literature on the costs of back pain or the relative cost-effectiveness of different methods of care for back pain. It presents, instead, a discussion of some important characteristics of cost-related studies of back pain and some criteria that can be used to evaluate the validity of cost estimates and cost-effectiveness analyses related to back pain. STUDY DESIGN: A guide for the evaluation of cost-based studies of back pain. METHODS: A summary of criteria for the evaluation of the validity of cost-based studies of back pain. RESULTS: Three sets of criteria for evaluation, ranked from most important to least important. CONCLUSIONS: Application of the suggested criteria can enhance the ability of health-care professionals to better understand the limits and relative adequacy of cost-based studies of back pain.     

A new method of surgical treatment of vasculogenic impotence

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.     

The use of external fixation apparatus in injuries to the hand bones]

An analysis of experimental studying the stability of osteosynthesis and clinical application of apparatuses of external fixation in 282 patients with fractures and sequellae of traumas of the bones and joints of the hand is presented. Main conditions influencing stability of fixation of the hand bones were determined. A universal complex of details is recommended which allows to make the optimum construction of the device as applied to the specific kind of trauma. It was proved that choice of the individual construction of the apparatus considerably widened the scope of using the method of external fixation and improved results of the treatment.     

Diet regimes in acute pancreatitis]

A method of determination of the duration of curative fasting in acute pancreatitis, depending on the degree of severity of patients' condition is described. The dependence between the probability of exacerbation of the process after resumption of feeding, the degree of severity of the condition at admittance, the duration of the fast vs degree of the severity of the condition in which the feeding was resumed was studied, for this purpose the method for calculation of so called coefficient of the degree of severity of acute pancreatitis was developed. 130 patients with acute pancreatitis underwent the treatment according to this method.