针刺、艾灸联合中药治疗双侧面瘫1例

徐某,女,53岁。主因双侧面瘫5 d,于2008-06-13以“双侧面瘫”收住院。患者于8d前因左上根牙疼痛拔牙1颗,5d前早上起床后,感觉颈部发僵,张口困难,双侧不能蹙额、闭眼、鼓腮,打口哨,双侧口角流涎,双侧腮部存有食物残渣,在家治疗（头孢菌素类抗生素静脉滴注）无好转,门诊收住院。刻诊：双侧面瘫,左耳后及下颌疼痛,左下颌不适,左侧拔牙牙根处红肿,无渗血,舌红,苔白腻,脉沉。神志清楚,无头痛头晕,无呛咳及吞咽困难,无外耳道疼痛,无偏身感觉障碍及四肢功能障碍。面无表情,双侧不能蹙额、闭眼、鼓腮,不能吹口哨,双侧眼睑下垂,双侧鼻唇沟变浅,双侧口角下垂,张口口裂变小,腭垂右偏,咽充血。西医诊断：特发性面神经炎。中医诊断：面瘫。证属风痰阻络型。治宜熄风化痰,疏经通络。①针刺治疗。取穴：迎香、地仓透颊车、下关、翳风、阳白、太阳、攒竹、四白、合谷、足三里、太冲。太冲穴用泻法,其余穴均用平补平泻法,行针30 min,每日1次。②隔姜艾灸。取穴：地仓、太阳、下关,选新鲜生姜,沿生姜纤维纵向切片,直径2 cm,厚约3 mm,置于穴上,用剪刀将艾条剪成2 cm高的艾柱置于姜片之上,线香点燃施灸。每日1次,不计壮数,以灸处皮肤潮红湿润为度,无烫伤皮肤。③牵正散加味。药物组成：白附子9 g,僵蚕9 g,全蝎6g,生地黄15 g,赤芍药15 g,川芎9 g,当归15 g,桑枝30 g,丝瓜络9 g,鸡血藤30 g。日1剂,水煎2次取汁300 mL,分早、晚2次温服。治疗5d后,患者鼓腮时漏气减少,流涎明显减少,双侧乳突及下颌疼痛减轻,无呼吸困难及肢体震颤,无肌力下降。治疗10 d后,患者额纹出现,面部表情较丰富,左眼能完全闭合,能鼓腮,流涎消失,双侧乳突及下颌疼痛消失,吞咽正常,舌红苔白,脉弦。牵正散加味方加柴胡6g疏肝理气,易桑枝50 g、丝瓜络25 g加大疏经活络力度。治疗17 d后,患者面瘫消失,额纹对称,能闭眼、鼓腮、吹口哨,流涎消失,腮内不存留食物残渣,张口大小正常,饮食、二便、睡眠均正常,复查肝、肾功能,血、尿常规,心电图均正常,痊愈出院。     

我国中医医院人力资源状况分析

目的 了解我国中医医院人力资源情况,为今后制定中医医院人力资源发展战略和有关政策提供依据。方法 采集2005年至2009年卫生部和国家中医药管理局的统计数据,分析中医医院职工的总体结构与趋势、卫技人员总量及结构、中医药人员的结构与趋势。结果 2009年,我国有中医医院2728所,职工51.85万人,其中卫生技术人员42.79万人,占职工总数的82.52％;中医类别的执业医师占中医医院医师的45.61％;中医医院护理人员相对不足,与综合医院差距较大。结论 修订中医医院人员编制标准是当务之急,同时要增加中医医院中医类别执业医师和护理人员的数量。     

SLE患者基因组DNA甲基化水平的检测

Objective To assess the DNA methylation status in peripheral blood mononulclear cells (PBMCs)from patients with systemic lupus erythematosus (SLE) using a constructed methyl-CpG-binding domain (MBD) proteins.Methods A recombinant plasmid MBD-pET30b+ was transformed into E.coli (DH5a)for clonal expansion followed by sequencing.Then,plasmids with correct sequence were transformed into E coli BL21 (DE3) for the expression of MBD proteins under the induction of isopropy-β-D-thiogalactoside (IPTG).The expression products were purified by Ni-NTA chromatography and identified by sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE)and Western blotting.Cultured 293T cells and isolated PMBCs from 21 patients with SLE and 15 normal human controls were immunostained with the expressed protein,and analyzed by fluorescence microscopy and flow cytometry.Results The sequence of recombinant plasmid was proved to be consistent with the expectation.SDS-PAGE and Western blotting demonstrated that the molecular weight of expressed tetrameric-protein was 46000,with the presence of N-terminal His-tag and C-terminal HA-tag.As fluorescence microscopy showed,the MBD proteins could specifically bind to intracellular CpG DNA in 293T cells.Patients with SLE had a significantly lower methylation level than the controls did(9.32±1.33 vs 11.66±1.04,t=5.68,P<0.05),and the DNA methylation level negatively correlated、with SLE disease activity index(r= -0.78,P<0.01).Condusions There is a lower DNA methylation in patients with SLE than in normal human controls,and the methylation level negatively correlates with SLE disease activity index.     

海蓝组织细胞增生症一例

患者男性,44岁.因体检发现脾脏内多发占位于2008年6月16日入院.患者无发热、恶心、呕吐、腹痛、腹胀、呕血、黑便,无厌油腻食物感,无乏力、消瘦等自觉症状.家族中无有类似疾病病史者.体检:无颜面部畸形,无皮肤、巩膜黄染,全身未触及肿大淋巴结.腹部略膨隆,无腹壁静脉曲张,未见胃肠型及蠕动波.全腹无压痛、反跳痛及肌紧     

中段胰腺切除术

Medial pancreatectomy has been gradually used in the treatment of benign tumors in neck and body of pancreas since less removal of the pancreas and the retainment of the duodenum,spleen and functional pancreas,it is less harmful to the endocrine and exocrine function of the patients.Seventeen patients received medial pancreatectomy for benign tumors in neck and body of the pancreas in the China-Japan Union Hospital of Jilin University from November 2005 to December 2010.Fifteen patients received the closure of broken ends of pancreatic head,pancreaticojejunostomy,and the other 2 received pancreaticojejunostomy.No perioperative death was found.All the patients were followed up for 2 to 45 months,and no death was recorded.No patient got new-onset diabetes and pancreatic pseudocyst,and their tumors were not relapsed.Now the retrospective analysis was carried out to this group of patients and to further regulate the surgical operation of the medial pancreatectomy.     

急性胆囊炎腹腔镜手术时中转开腹原因分析

目的探讨急性胆囊炎腹腔镜胆囊切除手术中转开腹的原因. 方法回顾分析32例急性炎症期行腹腔镜胆囊切除术的临床资料. 结果 32例中成功25例(78.1%), 中转开腹7例(21.9%).中转开腹原因主要是胆囊坏疽(4例)和不能清楚显露胆囊三角(3例). 结论对坏疽性胆囊炎和不能清晰解剖胆囊三角的急性胆囊炎应及时中转开腹手术.     

功能性胰岛素瘤的诊治(附12例)

目的 探讨功能性胰岛素瘤的诊治特点,提高对该病的认识.方法 回顾性分析2000年至2009年吉林大学中日联谊医院收治的12例功能性胰岛素瘤临床资料.结果 12例术前空腹血糖值和胰岛素阳性率分别为92%和89%,IRI/G和C-肽的阳性率达100%.术前腹部超声、CT和MRI定位诊断准确率分别是75%、36%和0%,而术中扪诊结合术中超声的定位准确率达100%.术中血糖监测,10例在肿瘤切除后1 h内血糖上升1倍以上,2例1.5 h后上升1倍以上.随访7例,均未再出现低血糖症状.3例胰瘘.结论 对疑有功能性胰岛素瘤的病例,除检测血糖、胰岛素外还应检测IRI/G、C-肽.术中扪诊及超声是肿瘤定位的有效手段.监测肿瘤切除后血糖变化,结合术中快速病理可判定肿瘤是否完全切除.     

椎管内肿瘤的临床及MRI诊断分析

报道了１８例椎管内肿瘤，均经手术病理证实。对其临床表现、分型及ＭＲＩ表现进行分析。对其临床表现、分型及ＭＲＩ表现进行分析。行顺磁造影对其定位定性诊断有很大帮助。为临床治疗提供了可靠依据。     

海分枝杆菌致游泳池肉芽肿

报告1例海分枝杆菌致游泳池肉芽肿。患者女,66岁。右手背及手腕结节1个月,有右拇指鱼刺刺伤史。皮肤科检查:右手背一淡紫红色结节,直径约4 cm,高出皮面,其上干燥、脱屑,中央破溃伴黄色脓液,质韧,边界不清;右手腕一淡红色结节,稍高出皮面,直径约8 mm,界不清,无压痛。皮损组织病理检查:表皮大致正常,真皮内可见中性粒细胞性脓疡形成,外围淋巴细胞及组织细胞浸润,偶见多核巨细胞。抗酸染色及结核感染T细胞斑点试验(T-SPOT.TB)均阳性,微生物培养及16 S测序示海分枝杆菌。诊断:游泳池肉芽肿。     

不孕妇女血清中白细胞介素Ⅵ Ⅷ及肿瘤坏死因子水平的检测

目的 探讨白细胞介素及肿瘤坏死因子与女性不孕的方法。对２６例抗精子抗体阳性、１５例抗精子抗体阴性的不孕妇女及１３例已生育的健康妇血清中的白细胞介素Ⅵ、Ⅷ及肿瘤坏死因子进行了检测。