Bilateral rupture of diaphragm with delayed strangulation

A 64-year-old woman presented in shock. The computed tomography (CT) scan confirmed rupture of the left diaphragm with strangulation. Three days after surgery, the patient developed herniation of abdominal contents on the right side with cardiorespiratory collapse. Marlex mesh was used to repair on the right side. Postoperatively, she needed partial gastrectomy for massive duodenal ulcer bleeding. A dual chamber pacemaker was used to correct the complete heart block.     

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis.

A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis. In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically. EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n=1) or indefinite (n=3). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported. Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.     

大咯血的急诊外科治疗

目的　总结 4 4a急诊手术治疗大咯血经验。方法　回顾性研究 195 8～ 2 0 0 1年在本院急诊手术的 89例大咯血患者 ,收集临床表现、诊断方法、原发病因、治疗和结果等相关资料。结果　 85 4 %病例的X线表现与出血部位一致 ,其它诊断方法 (支气管镜、CT、血管造影术等 )作为重要补充。由于 1982年后的早期外科干预 ,术前咯血总量、咯血平均量和低血压、休克发生比例较前明显减少 ,术后并发症从 1982年前的 2 2 2 %降至 17 1% ,围手术期死亡率从 9 3%降至 0。急诊全肺切除术并发症 ( 2 3 3% )高于肺叶切除术 ( 15 2 % )。在过去 4 4a肺结核一直是大咯血的主要原发病因。结论　符合新的外科治疗标准的患者应及早手术 ;选择切除范围要保守 ,首选叶切