超声诊断儿童腹股沟斜疝嵌顿的临床价值

腹股沟斜疝占各种疝的80％,10％～15％的腹股沟斜疝易发生嵌顿,儿童腹股沟斜疝者约有30％以嵌顿疝为首发症状。年龄愈小嵌顿机会愈多。本研究分析小儿腹股沟斜疝嵌顿的声像图特点,旨在进一步提高超声对其诊断水平。     

疝囊继发感染的诊治体会

目的：探讨疝囊继发感染的诊断和治疗。方法：回顾性分析12例疝囊继发感染的临床资料。结果：12中11例为腹股沟斜疝嵌顿引起．治疗先行嵌顿疝手术，后对疝囊感染进行处理。1例术前诊断阑尾脓肿继发疝囊感染，开腹脓肿切开引流并对患侧腹股沟内环口关闭及疝囊感染处理。12例患者皆一期治愈出院。结论：疝囊感染为继发感染，对原发病需进一步处理。     

急腹症腹腔镜手术25例分析

急腹症急诊腹腔镜手术25例，其中急性胆囊炎胆囊切除术12例，急性阑尾炎阑尾切除术6例，消化性溃疡穿孔穿孔修补术3例，胃大部切除、毕氏Ⅱ式吻合术1例，左侧腹股沟斜疝嵌顿、肠梗阻疝修补术1例，仅1例肠梗阻表现的升结肠癌和1例粘连性肠梗阻转剖腹手术。腹腔镜确诊率为100％，腹腔镜手术成功率为92％。     

新生儿嵌顿性腹股沟斜疝45例的护理

目的：探讨护理新生儿嵌顿性腹股沟斜疝的临床效果。方法：收集我科近10a来收治的新生儿嵌顿性斜疝45例。结果：手法复位成功15例,手术治疗30例,全部治愈出院。结论：加强嵌顿性腹股沟斜疝患儿的护理,可防止延误病情,使患儿得到及时有效的治疗。     

无张力疝修补术治疗成年人嵌顿性腹股沟斜疝28例

目的探讨无张力疝修补术在治疗成年人嵌顿性腹股沟斜疝中的应用。方法回顾分析在我院进行无张力疝修补术治疗的28例成年人嵌顿性腹股沟斜疝患者的临床资料。结果本组28例全部完成手术,手术效果满意,术后随访1～4年,均未见复发。结论无张力疝修补术可以安全、有效地应用于成年人嵌顿性腹股沟斜疝的患者。     

新生儿腹股沟嵌顿性斜疝的彩色多普勒超声诊断价值

目的分析新生儿腹股沟嵌顿性斜疝的声像图特征,评价彩色多普勒超声诊断价值。方法对11例新生儿腹股沟嵌顿性斜疝行超声检查,观察疝块的各项指标,包括大小、内部回声、形态及周边情况等,并用CDFI观察疝内容物的血流信号。结果新生儿腹股沟嵌顿性斜疝声像图多表现为阴囊内肿块,疝囊内容物以肠袢最为常见,超声可显示增厚的肠壁及肠腔内无回声区(积液)。CDFI:疝内容物血流信号较少。结论彩色多普勒超声能清晰地检出新生儿嵌顿性斜疝,是有效的诊断方法,对嵌顿性斜疝的诊断、鉴别诊断及预后评估有重要价值。     

女性婴幼儿嵌顿性腹股沟斜疝致附件坏死的诊治分析

目的总结女性婴幼儿嵌顿性腹股沟斜疝致附件坏死的临床特点和治疗经验。 方法回顾性分析昆明医科大学附属昆明市儿童医院2014年3月至2018年12月收治的94例女性婴幼儿嵌顿性腹股沟斜疝患儿的临床资料,并对其临床表现、诊断方法和治疗效果进行分析。 结果94例患儿均以腹股沟区包块就诊。51例彩色多普勒超声检查考虑附件嵌顿,11例考虑肠管嵌顿,7例考虑网膜嵌顿,25例性质不定;经急诊手术证实,61例附件发生嵌顿,其中19例为附件坏死,3例为肠管嵌顿,30例自行回复;19例附件发生坏死的患儿中,17例予以切除,2例家属拒绝切除予以还纳。1例术后复发。 结论女性婴幼儿嵌顿性腹股沟斜疝附件（多为卵巢及部分输卵管）嵌顿坏死发生率相对较高,需早发现、早诊断、早治疗,以减少附件嵌顿坏死手术切除的风险;彩色多普勒超声是诊断附件嵌顿性腹股沟斜疝的重要方法。     

新生儿腹股沟斜疝嵌顿误诊分析

新生儿腹股沟斜疝是新生儿先天性腹膜鞘状突闭塞发生停顿、迟缓或不完全,使鞘突管仍然保持开放而造成的,而腹腔脏器进入疝囊后不能自行复位而停留在疝囊内造成腹股沟斜疝嵌顿。新生儿腹股沟斜疝嵌顿在临床上较少见,我院收住二例新生儿腹股沟斜疝嵌顿,资料如下:     

高频超声对腹外疝的诊断价值

目的:探讨高频超声对腹外疝的临床诊断价值.方法:对96例经手术证实的腹外疝的高频超声声像图特点进行回顾性分析.结果:本组96例腹外疝中,腹股沟斜疝83例,直疝5例,脐疝3例,切口疝、白线疝各2例,股疝1例,其中11例(斜疝嵌顿10例,股疝嵌顿1例)诊断为嵌顿疝,2例诊断为绞窄性腹股沟斜疝.疝内容物为肠管68例,大网膜28例;3例嵌顿疝发生肠坏死.结论:高频超声检查腹外疝可清晰显示疝囊及其内容物,并能对可复性疝与嵌顿性疝作出鉴别,有很高的临床实用价值.     

儿童嵌顿性斜疝致腹膜炎10例分析

儿童腹股沟斜疝是外科的常见疾病 ,嵌顿致腹膜炎者占一定比例。我院自 1997- 0 3～ 2 0 0 1- 0 3,共收治儿童嵌顿性腹股沟斜疝致腹膜炎 10例 ,均由下级医疗机构转诊 ,占同期儿童腹股沟斜疝的 3.38% (10 / 2 96 )。现就其致腹膜炎的原因分析如下。1　临床资料本组男 9例 ,女 1例 ,年龄 3个月～ 13岁 ,平均为 5 .6 8岁 ,右腹股沟斜疝 7例 ,左斜疝 2例 ,双侧斜疝 1例。病史 4d～ 5 a,嵌顿至就医时间为 6～ 10 8h,仅 1例并存有先天性心脏病。手法复位致肠破裂者 2例 ,均为医源性 ,其中医源性假性整复致肠坏死穿孔 1例 ,复位时漏诊嵌顿肠管坏死 1…     

Hypothyroidism in elderly people

Abnormal thyroid function tests are common for older adults, but the clinical significance of abnormal results and the need for treatment vary. Nonthyroidal illness (eg, low T3 and T4 syndromes) needs to be ruled out before making the diagnosis of hypothyroidism. Overt hypothyroidism and myxedema coma always require treatment, but treatment of subclinical hypothyroidism is not as clear. The purpose of this review article is to summarize existing data in the elderly population on the etiology, diagnosis, and management of overt hypothyroidism and subclinical hypothyroidism.     

双侧输卵管同时妊娠1例报告并文献复习

目的提高双侧输卵管同时妊娠的临床认识,避免误诊误治。方法报道1例双侧输卵管妊娠临床资料并复习相关文献。结果双侧输卵管妊娠临床表现不典型,术前诊断困难,多数超声仅诊断单侧病变,容易误诊误治。结论双侧输卵管妊娠虽然罕见,但处理棘手,故临床医师应予以重视。     

老年急性阑尾炎45例诊疗体会

目的分析老年急性阑尾炎患者的临床特点,指导老年急性阑尾炎的正确诊断和合理治疗。方法对45例60岁以上的老年急性阑尾炎患者的临床诊断及治疗的相关资料进行收集分析。结果 45例患者均行手术治疗,单纯阑尾切除41例,阑尾切除加腹腔冲洗术4例,所有患者均痊愈出院。结论老年人急性阑尾炎临床表现多不典型,且发展快,阑尾穿孔率高,病死率高,老年急性阑尾炎极易误诊和误治;符合手术条件的早期手术是治疗老年急性阑尾炎成功的关键。     

An epistemological shift: from evidence‐based medicine to epistemological responsibility

In decision making concerning the diagnosis and treatment of patients, doctors have a responsibility to do this to the best of their abilities. Yet we argue that the current paradigm for best medical practice – evidence‐based medicine (EBM) – does not always support this responsibility. EBM was developed to promote a more scientific approach to the practice of medicine. This includes the use of randomized controlled trials in the testing of new treatments and prophylactics and rule‐based reasoning in clinical decision making. But critics of EBM claim that such a scientific approach does not always work in the clinic. In this article, we build on this critique and argue that rule‐based reasoning and the use of general guidelines as promoted by EBM does not accommodate the complex reasoning of doctors in clinical decision making. Instead, we propose that a new medical epistemology is needed that accounts for complex reasoning styles in medical practice and at the same time maintains the quality usually associated with ‘scientific’. The medical epistemology we propose conforms to the epistemological responsibility of doctors, which involves a specific professional attitude and epistemological skills. Instead of deferring part of the professional responsibility to strict clinical guidelines, as EBM allows for, our alternative epistemology holds doctors accountable for epistemic considerations in clinical decision making towards the diagnosis and treatment plan of individual patients. One of the key intellectual challenges of doctors is the ability to bring together heterogeneous pieces of information to construct a coherent ‘picture’ of a specific patient. In the proposed epistemology, we consider this ‘picture’ as an epistemological tool that may then be employed in the diagnosis and treatment of a specific patient.     

子宫血管瘤1例报告并文献复习

目的：探讨子宫血管瘤的临床病理特点、鉴别诊断及治疗原则。方法：观察分析1例子宫血管瘤的临床病理特点并相关文献复习。结果：子宫血管瘤临床表现不典型，术前诊断困难，容易误诊误治。结论：子宫血管瘤虽然为罕见的良性肿瘤，但它可危及患者生命，故临床医师应予以重视。     

Symptoms and treatments of polycystic ovary syndrome

Up to 10% of women may suffer from polycystic ovary syndrome (PCOS). The clinical symptoms may vary, so the biochemical profile and ultrasonography are used to predict an accurate diagnosis. Many studies have indicated that a relationship may exist between hyperinsulineamia and hyperandrogenism but the exact pathogenesis remains obscure. PCOS is treated by a combination of surgery or pharmacological management. Treatment is not always successful therefore women in these cases require support and care from nursing staff to help overcome the disappointment of treatment failure. To support women with PCOS, nurses need to be knowledgeable about the condition and its clinical manifestations and available treatment options. This article aims to examine the current aetiology, clinical manifestations, pathophysiology, diagnosis and treatment options available to women with a diagnosis of PCOS.     

肾纤维肉瘤1例报告并文献复习

目的探讨肾纤维肉瘤的临床特征及诊疗方案。方法对我院1例左肾纤维肉瘤患者的临床资料进行整理和总结,并通过检索Pubmed数据库对肾纤维肉瘤的相关文献进行复习和讨论。结果患者在我院行左肾肿瘤根治术,肾组织病理诊断为纤维肉瘤,未行放、化疗,门诊随访5个月仍健存。结论肾纤维肉瘤起病一般以腰部疼痛为主,可伴肉眼血尿,临床症状不特异,术前不易明确诊断,确诊需借助免疫组织化学染色。根治性肾切除是目前唯一有效的治疗措施,放、化疗对患者的生存期影响尚不明确。     

An approach to throat complaints. Foreign body sensation, difficulty swallowing, and hoarseness

There is a great deal of clinical overlap in patients with throat complaints. Foreign body sensation, difficulty in swallowing, and hoarseness may all stem from one entity or may be totally unrelated. First and foremost, always protect the airway. Thereafter, a thorough history, combined with a directed physical examination and radiologic studies, will provide a concise differential diagnosis. Once the diagnosis is formulated, treatment may take place in the Emergency Department or the patient may be referred to the appropriate specialist for definitive diagnosis or treatment.     

Diagnosis and treatment of ventilator-associated pneumonia in children

The purpose of the investigation was to optimize the diagnosis and treatment of ventilator-associated pneumonia (VAP) in children. The prevalence, etiology, and onset of VAP in a pediatric intensive care unit, and the diagnostic value the clinical pulmonary infection score scale were studied. The prevalence of VAP was found to be 37.56 per 1,000 mechanical ventilation days, and the CPIS scale was not always useful in diagnosing VAP in children. The most common causative agents of VAP were Enterobacteriaceae spp, and its major pathogen is P. aeruginosa. Early adequate antibacterial therapy prevents and treats VAP, without causing any complications.     

Psychosis or simply a new manifestation of neurosyphilis?

The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. Neurosyphilis was diagnosed during the clinical evaluation. Blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal Disease Research Laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin G and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.