高雪病的诊断和治疗（附2例报告）

高雪病是罕见的家族性隐性遗传病，作者通过２例的治疗，观察。结合复习有关文献认为，该病以儿童多发，主要临床表现是进行性肝脾肿大，尤其是脾肿大更明显，并伴有脾功能亢进，常行骨穿刺找到高雪细胞确诊，目前虽有药物治疗，对脾功能亢进者，以脾切除最佳，术中发现付脾，也应予切除。     

二级脾蒂离断法脾切除术在肝硬化脾功能亢进中的应用

目的：探讨肝硬化脾功能亢进轻中度脾肿大行腹腔镜下二级脾蒂离断法脾切除术的可行性、有效性和安全性。方法：对2009年1月至2010年12月施行腹腔镜下二级脾蒂离断法行脾切除治疗肝硬化脾功能亢进轻中度脾肿大25例患者的临床资料进行回顾分析。结果：除1例因大出血中转开腹外,均顺利完成手术。手术时间平均180 min,术中平均出血量260 mL,无严重并发症。结论：肝硬化脾功能亢进轻中度脾肿大患者行腹腔镜下二级脾蒂离断法脾切除安全有效,并可降低手术费用,值得临床推广。     

脾切除术后并发症的观察及护理

脾脏是人体内最大的免疫淋巴器官 ,脾切除术是外伤性脾破裂、肝硬化、门脉高压症、脾功能亢进、脾囊肿以及某些血液系统疾病的主要外科治疗方法。因此 ,如何做好术后并发症的观察和护理是确保脾切除术患者早日康复的关键。我院自 1 998年— 2 0 0 2年共行脾切除术70例 ,现就脾切除术后并发症的临床观察和护理报告如下。临　床　资　料　　本组 70例患者中 ,男 45例 ,女 2 5例。年龄 2 1岁～ 65岁 ,平均 40 .6岁 ,肝硬化并发门脉高压、脾亢 3 5例 ,脾囊肿 6例 ,外伤性脾破裂 2 3例 ,单纯性脾肿大 4例 ,脾肿瘤 2例。 70例脾切除术后并发症 3 2…     

部分脾栓塞术治疗肝硬化脾机能亢进的疗效观察

目的观察部分脾栓塞术(PSE)治疗肝硬化脾机能亢进的疗效.方法对96例肝硬化并发脾机能亢进患者行PSE,并对其中81例进行为期2年的随访.结果外周血白细胞、血小板均上升(P＜0.01),脾脏及脾静脉均缩小(P＜0.01),食道静脉曲张程度减轻.结论PSE创伤小、并发症少、效果好,可作为治疗肝硬化脾机能亢进症的首选方法.     

部分脾栓塞术治疗脾肿大、脾功能亢进的临床观察(附6例报告)

目的：探讨部分脾栓塞术治疗脾肿大、脾功能亢进的方法及临床应用价值。方法：对6例脾肿大、脾功能亢进的患者,采用Sildinger穿刺技术,将导管选择性或超选择性插入脾动脉,注入PVA(聚乙烯醇栓塞颗粒)和俄1mm明胶海棉颗粒,栓塞部分脾动脉。结果：6例患者经部分脾栓塞术治疗后,外周血象2个月内恢复正常,脾脏明显缩小,保留了脾脏的免疫功能。结论：部分脾栓塞术避免了外科手术切脾,保留了脾脏的免疫功能,维持了人体免疫机制。本法具有手术简便、安全、创伤小、疗效显著等优点,且可重复治疗,是一种可替代外科脾切除术的治疗方法。     

门脉高压症患者脾切除术中自体脾血回输

门脉高压症是各种肝硬变的主要继发症。针对该病的并发症之一的脾脏肿大、脾功能亢进,仍采用外科手术切脾治疗[1]。我院在切脾手术中,均常规进行自体脾血回输。在目前日益提倡成份输血,严格输血适应症的医疗模式下,脾切除术中自体脾血回输具有临床应用价值。但如何实现自体脾血回输,怎样提高回输成功率是值得探讨的临床护理问题。现将我院1996年3月～2001年3月在术中护理回输脾血328例总结报告如下。     

腹腔镜脾切除术联合贲门周围血管离断术治疗肝硬化脾机能亢进的临床效果研究

目的探讨腹腔镜脾切除术(LS)联合贲门周围血管离断术(ED)在肝硬化脾机能亢进患者中的应用价值。方法回顾性分析2013年5月～2017年7月我院接收的120例肝硬化脾机能亢进患者,其中行LS+ED治疗60例,行开腹脾切除术(OS)+ED治疗60例。比较两组患者手术治疗效果、并发症发生情况,并于治疗前后检测两组患者的外周血细胞数量及肝功能指标。结果观察组术中出血量、术后引流量、肛门排气时间、住院时间均显著低于对照组(P0.05),两组手术时间比较无明显差异(P0.05)。两组术后2周白细胞计数、血小板计数均较术前显著上升(P0.05),但红细胞计数无明显变化(P0.05);且两组手术前后以上指标组间比较差异无统计学意义(P0.05)。两组术后2周ALT、AST、TBIL水平均较术前显著下降(P0.05),但ALB无明显变化(P0.05);且两组手术前后上述肝功能指标组间比较无统计学差异(P0.05)。观察组并发症发生率为15.00%(9/60),与对照组[48.33%(29/60)]比较显著降低(P0.05)。结论 LS联合ED治疗肝硬化脾机能亢进可有效改善患者的肝功能、解除脾亢进状态,且手术创伤小、并发症少。     

部分脾栓塞术治疗脾亢研究现状

脾功能亢进（以下简称脾亢）是指脾肿大伴红细胞、白细胞及血小板一种或多种减少,骨髓呈增生状态,脾切除后可恢复的一组综合征。临床上曾用脾切除术治疗内科治疗无效的脾亢,但是脾切除术往往伴有机体免疫功能下降,易并发感染和出血。全脾切除者比未切脾者感染率高58倍,病死率高出200倍。而部分脾栓塞术（partial splenic embolization,PsE）治疗脾功能亢进时,既能抑制亢进的脾功能和减少过大的脾体积,又能保留部分脾脏的功能,     

腹腔镜下脾切除51例分析

目的总结51例接受腹腔镜下脾切除术患者的围手术期资料,探讨腹腔镜下脾切除术的可行性和安全性。方法分析2007年7月至2010年5月接受腹腔镜下脾切除术的51例患者的临床资料,其中血液病29例,肝硬化、门静脉高压、脾肿大、脾功能亢进20例,脾占位性病变2例。其中9例合并胆囊结石。结果 51例平均脾脏切除手术时间2 h,术中平均出血量189.5 ml,术后平均住院时间9.3 d。5例术后出现发热,均为原发病所致;1例因术前长期使用糖皮质激素,术后过早停药后出现肾上腺皮质危象;1例出现皮下血肿;其余患者无腹腔镜手术相关的术后并发症,无死亡病例。9例同时行腹腔镜胆囊切除术。35例行全腹腔镜下脾切除术,16例行手助腹腔镜脾切除术。其中7例中转开腹手术。结论腹腔镜下脾切除术是安全可行的,适用于各种脾脏疾病。     

脾动脉的解剖学基础及在脾切除术中的应用

脾切除术是治疗脾肿大、门静脉高压症、脾囊肿及脾肿瘤的主要方法之一,其效果经多年临床实践已经得到肯定,而脾切除术中重要的步骤之一就是脾动脉的结扎及处理,因此,对于脾动脉的临床解剖学知识的掌握尤为必要。     

2008-2012年广州市传染病类突发公共卫生事件流行病学特征分析

目的了解广州市传染病类突发公共卫生事件的流行病学特征,为预防、控制及有效处理传染病类突发公共卫生事件提供科学依据。方法应用描述流行病学方法对2008-2012年广州市通过国家"突发公共卫生事件报告管理信息系统"报告的传染病类突发公共卫生事件进行统计分析。结果 2008-2012年广州市共报告传染病类突发公共卫生事件539起,发病12 236人,死亡22人。事件级别以未分级事件为主,占报告事件总数的89.98%。呼吸道传染病占事件总数的82.56%。报告居前4位的病种为甲型H1N1流感、水痘、流行性感冒和手足口病。2009年是事件发生的高峰,占事件总数的59.55%,其中甲型H1N1流感占70.09%。事件的月份分布与呼吸道传染病的分布基本一致,6、9、11月份报告较多。学校为事件发生的主要场所,占事件总数的80.52%,其中小学占学校发生总数的52.07%,中学占20.97%,幼托机构占15.21%。结论传染病类突发公共卫生事件以呼吸道传染病为主,学校为主要发生场所,建议进一步加强学校传染病尤其是呼吸道传染病和手足口病的预防与控制。     

2009年唐山市法定传染病疫情及防控对策分析

目的了解我市1年来法定传染病流行态势,掌握传染病的流行特点和影响因素,为制订传染病防治对策提供科学依据。方法采用描述性流行病学方法对我市2009年各类法定报告传染病疫情资料进行分类统计分析。结果 2009年我市共报告乙丙类传染病23种35 010例,发病率479.59/10万,无甲类传染病疫情。传染病构成以肠道传染病、血液及性传播疾病、呼吸道传染病为主,其中感染性腹泻(30.33%)、病毒性肝炎(22.21%)、手足口病(21.37%)、肺结核(12.29%)和流行性腮腺炎(4.96%)等传染病发病率位居前5位。结论预防控制肠道传染病、血液及性传播疾病、呼吸道传染病是今后传染病防治工作的重点。     

Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.     

Notification of occupational and work-related diseases and poisonings in Malaysia, 1997-1998

In 1997, the Ministry of Health Malaysia introduced a surveillance programme for occupational and work-related diseases including poisonings for cases seen in government health facilities. Between June 1997 and November 1998, there were 36 cases of respiratory disease and 95 cases of poisoning by chemicals and pesticides notified while skin diseases were 108 cases. Respiratory diseases reported were predominantly occupational asthma (25%), pneumoconiosis (17%) and infections (39%). The commonest reported skin disease was contact dermatitis (87%). The commonest causes of occupational poisonings were paraquat (19%), organo-phosphates (16%), agro-chemicals excluding pesticides (15%) and gases (10%). The number of cases reported is still relatively few compared to data from other countries, suggesting that there is still considerable under reporting.     

深圳市南山区2011年法定传染病疫情分析

目的 了解2011年南山区法定传染病的流行规律及变化趋势,为制定传染病防制策略提供科学依据.方法 采用描述性流行病学方法对国家疾病报告管理信息系统上报的法定传染病资料进行分析.结果 2011年南山区共报告乙、丙类法定传染病24种6 691例,年发病率为615.03/10万,无甲类传染病报告.报告死亡病例3例,年死亡率为0.18/10万.传染病构成以血源及性传播疾病和呼吸道传染病为主.报告的主要传染病种为手足口病、其它感染性腹泻、肺结核、淋病、梅毒、痢疾和猩红热.结论 血源及性传播疾病和呼吸道传染病是南山区的主要传染病,手足口病、其它感染性腹泻、肺结核等是重点防治的传染病.     

Active abdominal tuberculosis in Canada in 1970-81.

We reviewed all 341 cases of abdominal tuberculosis reported in Canada between 1970 and 1981. Over the study period abdominal tuberculosis accounted for a stable proportion (0.8%) of all reported cases of tuberculosis in Canada. Its incidence declined steadily. It was more common in women, in native Indians and in people born in Asia. Detailed records of the 55 cases reported to Statistics Canada from British Columbia and of an additional 31 cases not reported to Statistics Canada (usually because they involved concomitant disease elsewhere, notably the lungs) were studied. Five of the 55 cases reported to Statistics Canada had been reported incorrectly. Of the 81 cases in British Columbia 51% involved peritonitis, 21% ileocecal disease, 20% anorectal disease, 10% mesenteric lymphadenitis, 1% disease of the sigmoid colon and 1% disease of the liver. The rate of bacteriologic confirmation was low (51%).     

揭阳市区2006年法定传染病疫情报告分析

目的分析揭阳市区2006年法定传染病的流行情况，为制定传染病防治对策提供科学依据。方法对揭阳市区2006年法定传染病疫情资料进行统计分析。结果2006年无甲类传染病报告；报告乙类传染病9种834例，死亡5例，报告发病率为119．8217／10万；报告丙类传染病3种540例，无死亡病例，报告发病率为77．5824／10万。报告乙类传染病前三位分别为肺结核、病毒性肝炎和麻疹，分别占传染病报告总数的40．83％、10．92％和4．73％，丙类传染病中以其他感染性腹泻报告发病数最高，占传染病报告总数的37．12％。结论应加强对肺结核、乙肝、麻疹、其他感染性腹泻的监测及防治工作。     

造影超声心动图诊断永存左上腔静脉合并先天性心脏病(附10例报告)

本文总结了10例永存左上腔静脉(PLSVC)合并先天性心脏病。10例中9例经手术证实,8例经二维超声心动图及造影超声心动图诊断。本文认为先天性心脏病手术前,常规进行二维超声心动图和造影超声心动图检查是很有必要的。     

福建晋江市2006～2010年儿童传染病流行病学分析

目的了解晋江市2006～2010年15岁以下儿童报告传染病的流行概况,探讨儿童传染病现状和变迁趋势,为今后制定有效预防和控制措施提供科学依据。方法收集晋江市2006～2010年15岁以下儿童报告传染病资料,并进行统计分析。结果共报告传染病31种9 260例,死亡6例,平均发病率为450.15/10万,病死率为0.65‰,死亡率为0.29/10万,其中手足口病发病率最高,共报告4 932例,占总病例数的53.26%,报告发病率达239.75/10万。发病高峰出现在5～7月份,但不同传染病高峰季节不尽相同;各镇/街道均有病例报告,以陈埭、安海、池店等工业较发达、流动人员较多的镇/街道为多。男性多于女性,男女之比为1.98：1;以0～5岁发病最多,特别是其中的1～岁组儿童发病率最高,达2413.13/10万;职业上以散居儿童居多,占63.32%。结论切实做好以手足口病、其他感染性腹泻防控、流行性感冒、流行性腮腺炎等为主的肠道和呼吸道传染病防控工作,是预防和控制儿童传染病的关键。     

The 'epidemiologic necropsy'. Unexpected detections, demographic selections, and changing rates of lung cancer

When rising rates of occurrence are reported for a particular disease, clinicians often cannot determine whether the disease has increased in actual occurrence or in the improved detection provided by better diagnostic technology and expanded access to medical care. The epidemiologic use of necropsy data, which might help answer these questions, has been inhibited by fears of bias in demographic and clinical selection of patients for necropsy. The demographic problem can be managed by suitable adjustment and standardization of the disease rates found at necropsy, and the clinical problem can be reduced or avoided by studying the rates with which the disease is found unexpectedly in necropsies performed for other, unrelated clinical reasons. The results, obtained in population groups "screened" via necropsy, can suggest the magnitude of the "undetected reservoir" that coexists and supplements the rates of reported occurrence for a disease. In a study of necropsies at Yale-New Haven (Conn) Hospital from 1972 to 1981, the necropsy detection rates for lung cancer were slightly higher for women than for men, and were substantially higher for both genders than the customarily reported rates in the general population. The results suggest that the reported rates may continue to rise in both genders until they become essentially equal at a size approximating that of the currently undetected reservoir. The "epidemiologic necropsy" offers a potentially valuable method to help distinguish the true occurrence rates of disease from the changes attributable to improved diagnostic detection with modern technology.