Diagnosis of acute surgical abdomen – The best diagnostic tool to reach a final diagnosiscin

ObjectiveTo evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland.MethodsData was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients' charts were searched manually and final diagnosis of each patient was recorded.ResultsOut of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation.ConclusionsAppendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.     

早期运用刺络放血疗法治疗疾病急性期临床概述

查阅近5年刺络放血疗法治疗病症急性期的相关文献,从刺络放血疗法应用于痛症急性期、感染性疾病急性期、神经血管系统疾病急性期3个方面进行归纳总结,认为刺络放血有泄热解毒、活血化瘀、调和气血、通经活络、开窍醒神、引邪外出等作用,早期运用刺络放血疗法可以有效提高疾病急性期治疗效果,为临床运用刺络放血疗法治疗疾病急性期提供参考。     

不同途径镇痛在开胸手术患者的应用比较

目的比较经静脉注射病人自控镇痛(PCIA)和经硬膜外病人自控镇痛(PCEA)在开胸手术患者的应用效果。方法两组病人各50例,观察两组病人的镇痛效果、病人的满意度、病人的配合性及并发症等情况。结果PCEA组与PCIA组在镇痛效果、满意度、尿潴留、导管堵塞、术后主动配合比较,差异有显著性,P<0·05;在恶心、呕吐、瘙痒、静脉炎、导管脱落、肺部感染方面比较,差异无显著性,P>0·05。结论PCIA与PCEA用于开胸术后镇痛均安全有效,但PCEA对开胸术后病人的镇痛效果优于PCIA,患者满意度高。     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

Neuropsychological follow-up in neonatal screening: issues, methods and findings

There are several ongoing studies of psychological outcome in children identified through neonatal screening with phenylketonuria, congenital hypothyroidism or congenital adrenal hyperplasia. These studies document the reduction in mental retardation, learning difficulties and behaviour problems associated with neonatal screening. They also describe other behavioural changes resulting from these disorders. Some behavioural changes are transient or preventable with early diagnosis and treatment, whereas some appear to be irreversible, reflecting permanent brain effects of abnormalities associated with the disease. Despite the variety of disorders studied, there are commonalities in approach and issues, including a developmental neuropsychological perspective resulting in behavioural assessments specific to the disorder and its likely manifestations, a recognition that behaviour may change across time in association with brain development and an understanding of the neural mechanisms underlying the behavioural changes. Assessments go beyond IQ, and include specific intellectual abilities, social behaviour, temperament, behaviour problems and identity. Behavioural changes are related to specific characteristics of the disease and its treatment, including the timing of exposure to abnormal hormones and/or neurotransmitters, the severity of the disease, and the age at initiation and adequacy of treatment. These studies provide information about the ways in which hormones and neurotransmitters affect the development and ongoing function of the brain, and an understanding of the ways in which neonatal screening results in improved psychological outcome. They also provide models for psychological follow-up of other disorders detected through neonatal screening.