皮肤浸润表现为主的原发性乳腺癌1例

报告１例女病人，６８岁，左乳房外上象限有９ｃｍ×８ｃｍ×３ｃｍ大小、高出皮面０．５～１ｃｍ、呈浅红色的皮肤肿块，病期４年。组织病理诊断为乳腺浸润性导管癌，腋淋巴结未见转移的癌细胞（０／１０）。术后随访６．５年病人健在。     

原发性喉恶性淋巴瘤19例临床分析

目的 根据１９例原发性喉恶性淋巴瘤，结合文献分析该病的临床、病理、治疗及预后。方法 １９例中声门上区１４例，声门区５例。间接喉镜或纤维喉镜下呈粘膜光滑肿瘤１４例，坏死糜烂性改变５例，病理均为非霍奇金淋巴瘤（ＮＨＬ）。Ｂ细胞ＮＨＬ９例，Ｔ细胞ＮＨＬ１０例，其中中线Ｔ细胞ＮＨＬ５你，治疗均以放射治疗为主，采用６ＭＶＸ照射或＾６０Ｃｏγ照射，以局部野为主，照射野后部分加照９～１２ＭｅＶ电子线。放射治疗前     

电针预处理对胃癌根治术患者应激状态及术后谵妄的影响

目的 探讨电针预处理对胃癌根治术患者应激状态及术后谵妄的影响.方法 将80例行胃癌根治术的患者依据术前处理方式不同分为电针组(42例)和常规组(38例),常规组予以常规麻醉,电针组在常规麻醉前予以电针预处理,比较两组患者手术相关指标、应激状态、麻醉药物用量及术后并发症发生情况.结果 两组患者手术时间、术中出血量、术中输液量、拔管时间、苏醒时间比较,差异均无统计学意义(P﹥0.05).预处理前,两组患者心率、血氧饱和度及平均动脉压比较,差异均无统计学意义(P﹥0.05);开腹时及手术结束后,电针组患者心率均低于常规组,血氧饱和度、平均动脉压均高于常规组,差异均有统计学意义(P﹤0.05).治疗前,两组患者CD4+、CD4+/CD8+及超敏C反应蛋白(hs-CRP)水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者CD4+与CD4+/CD8+均降低,hs-CRP均升高(P﹤0.05),且电针组患者CD4+与CD4+/CD8+均明显高于常规组,hs-CRP明显低于常规组(P﹤0.01).电针组患者瑞芬太尼用量少于常规组,视觉模拟评分(VAS)低于常规组,谵妄发生率低于常规组,差异均有统计学意义(P﹤0.05).结论 电针预处理能够减少全身麻醉药物瑞芬太尼用量,降低机体应激反应,减少术后谵妄的发生.     

Transient Coagulopathy Due to Wasp Sting: A Case Report

Background

Insect venom anaphylaxis is a potentially life-threatening disorder. Transient coagulopathy in insect venom anaphylaxis is a rare phenomenon.

室房传导对血液动力学及体液因子的影响

为探讨室房传导（ＶＡＣ）所致的起搏器综合征（ＰＭＳ），于植入起搏器术中观察室房顺序起搏（ＶＡＰ）引起的血液动力学及神经体液因子的变化。１９例患者中，ＶＡＰ使２６．３％的患者出现典型的ＰＭＳ。ＶＶＩ起搏仅使１５．８％的患者出现轻度症状。ＶＡＰ及ＶＶＩ起搏均引起血浆心钠素及去甲肾上腺素增高（Ｐ均＜０．０１），后者增高的程度ＶＡＰ（７３．１±５３．２ｐｇ／ｍｌ）大于ＶＶＩ起搏（３５．６±４６．３ｐｇ／ｍｌ），Ｐ＜０．０５。研究结果表明ＶＡＣ是ＰＭＳ最重要的致病因素。     

替牙期唇腭裂患者的正畸治疗

替牙期是唇腭裂患者正畸治疗的关键时期,牙槽嵴裂植骨与生长改形等都将在此期进行.由于唇腭裂畸形的复杂多样、严重的颅面部生长缺陷,再加上替牙期的特殊性,使得此时期的正畸治疗充满了挑战与争议.因此,笔者就替牙期唇腭裂患者的正畸治疗程序与方法作一综述,以期为临床提供指导.     

A case of primary angiosarcoma of small intestine presenting as recurrent gastrointestinal bleeding]

Angiosarcoma is a rare malignant tumor which occurs frequently in the skin and soft subcutis. Moreover, primary gastrointestinal angiosarcomas are very rare. This tumor manifests as non-specific symptoms such as gastrointestinal bleeding, abdominal pain and nausea. The diagnosis is often made at an advanced stage. Surgery, chemotherapy and radiotherapy are the mainstay of treatment. However, the prognosis is very poor. We report a case of primary angiosarcoma of the small intestine presenting as recurrent gastrointestinal bleeding. A 54-year-old man was admitted with recurrent gastrointestinal bleeding. An abdominal CT scan revealed an ileo-ileal intussusception. Segmental resection was performed with ileo-ileal anastomosis. The ileal mass was diagnosed as angiosarcoma on immunohistochemical stain. He received 3 cycles of chemotherapy, but died 5 months after the diagnosis.     

Multiple Genetic Analysis System-Based Antibiotic Susceptibility Testing in Helicobacter pylori and High Eradication Rate With Phenotypic Resistance-Guided Quadruple Therapy

Antibiotics resistance in Helicobacter pylori (H. pylori) is the major factor for eradication failure. Molecular tests including fluorescence in situ hybridization, PCR-restriction fragment length polymorphism, and dual priming oligonucleotide-PCR (DPO-PCR) play critical roles in the detection of antibiotic susceptibility; however, limited knowledge is known about application of multiple genetic analysis system (MGAS) in the area of H. pylori identification and antibiotics resistance detection.The aim of this study is to determine the antibiotics resistance using different molecular tests and evaluate the treatment outcomes of E-test-based genotypic resistance.A total of 297 patients with dyspepsia complaint were recruited for gastroscopies. Ninety patients with H. pylori culture positive were randomly divided into 2 groups (test group and control group). E-test, general PCR, and MGAS assay were performed in test group. Patients in control group were treated with empirical therapy (rabeprazole + bismuth potassium citrate + amoxicillin [AMX] + clarithromycin [CLR]), whereas patients in test group received quadruple therapy based on E-test results twice daily for 14 consecutive days. The eradication effect of H. pylori was confirmed by ¹³C-urea breath test after at least 4 weeks when treatment was finished.Rapid urease test showed 46.5% (128/297) patients with H. pylori infection, whereas 30.3% (90/297) patients were H. pylori culture positive. E-test showed that H. pylori primary resistance rate to CLR, AMX, metronidazole, tetracycline, and levofloxacin (LVX) was 40.0% (18/45), 4.4% (2/45), 53.3% (24/45), 0% (0/45), and 55.6% (25/45), respectively. In addition, there are many multidrug resistant (MDR) phenotypes, and the MDR strains have higher minimum inhibitory concentration than their single-drug resistant counterparts. Considering E-test as the reference test, the sensitivities of general PCR and MGAS in detecting CLR resistance were 83.3% (15/18) and 94.4% (17/18), whereas in detecting LVX resistance were 100% (25/25) and 83.3% (15/18), respectively. Finally, the eradication rate in test group was significantly higher than that in control group as demonstrated by intention-to-treat analysis and per-protocol analysis.MGAS is a promising assay for H. pylori identification and antibiotic susceptibility testing. Phenotypic resistance-guided quadruple therapy showed a high efficacy in treating patients with H. pylori infection.