315例骨科手术患者医院感染的临床分析与对策

目的 探讨骨科住院患者医院感染发生率及其相关感染因素,为临床预防医院感染提供指导.方法 回顾性统计分析2009年1月-2011年9月315例手术后发生医院感染患者的临床资料.结果 11 535例骨科手术患者中,有315例发生医院感染,医院感染率为2.73％;感染部位以切口感染为主,占61.90％,其次为下呼吸道、泌尿道,分别占17.14％、8.57％;医院感染的危险因素为年龄、手术性质、切口类型、手术及住院时间等(P＜0.05);检出病原菌349株,以铜绿假单胞菌为主,占34.07％,其次为金黄色葡萄球菌、鲍氏不动杆菌及阴沟肠杆菌,分别占19.48％、17.19％及13.18％.结论 骨科以切口感染多见,发生医院感染与多种因素有关;强调加强切口感染的监测与控制、重视各环节质量是预防医院感染的关键.     

低渗破红法在非小细胞肺癌患者血性胸水中的应用

目的探讨低渗破红法对非小细胞肺癌(NSCLC)患者血性胸水中肿瘤细胞形态的影响及其在分子病理检测前评估中的应用。方法收集2018年3月-2019年3月送检的经病理诊断为NSCLC的血性胸水样本24例,采用低渗破红法处理并制备成细胞块,并以50%乙醇+10%中性缓冲甲醛混合液破红和常规细胞块技术为对照,切片经H-E染色进行肿瘤细胞形态分析。此外,分别切取细胞蜡卷提取核酸,进行分子病理检测前的评估,并对低渗破红法处理制备的细胞块所提取的核酸进行肺癌靶向治疗相关基因检测。结果低渗破红法处理制备的细胞块与常规细胞块技术制备的细胞块相比较,切片中红细胞明显减少、肿瘤细胞丰度高,染色背景清晰,轮廓结构清楚,但与50%乙醇+10%中性缓冲甲醛混合液破红法相比较,差别无统计学意义(P>0.05); 细胞块核酸合格率与常规细胞块技术法相比较差别显著(P<0.05),与50%乙醇+10%中性缓冲甲醛混合液破红法相比较差别无统计学意义(P>0.05)。低渗破红法制备的细胞块行肺癌靶向治疗相关基因检测,其中13例检测出EGFR基因突变,未检测出EML4-ALK和ROS1融合基因。结论低渗破红法是处理NSCLC患者血性胸水良好的有效方法,并能够支持肺癌靶向治疗相关的基因检测。     

子宫动脉化疗栓塞治疗子宫切口妊娠的研究

目的探讨子宫动脉化疗栓塞术治疗子宫切口妊娠的细节及意义。方法回顾性分析2009年5月至2013年10月间19例采用子宫动脉化疗栓塞术联合清宫术治疗子宫切口妊娠患者的临床资料及诊疗经过。结果子宫动脉化疗栓塞术操作成功率为100%,清宫术中出血在20~100 ml,平均50 ml,且无严重并发症发生。结论子宫动脉化疗栓塞配合清宫术可明显大出血的风险,是子宫切口妊娠安全、损伤小、恢复快并能有效保留女性子宫及生育能力的治疗方法。注重治疗中的细节将有效减少术后并发症的发生,保证治疗效果,减少医疗风险。     

冲洗液的温度对前列腺术后患者膀胱痉挛的影响

目的探讨冲洗液的温度对前列腺术后患者膀胱痉挛的影响。方法将180例前列腺摘除术后并发膀胱痉挛的患者随机分为A、B、C3组,每组各60例患者,3组进行冲洗膀胱时的冲洗液温度分别选择在lO℃～15℃、20℃～27℃和30℃～37℃,采用疼痛视觉模拟评分法评定其膀胱痉挛的程度。结果3组不同温度冲洗液冲洗膀胱后对膀胱痉挛程度、持续时间、人均次数和膀胱痉挛发生率之间的差异均有统计学意义（均P〈0．05）,30℃～37℃冲洗液冲洗膀胱发生膀胱痉挛的程度、持续时间、发生次数和膀胱痉挛发生率均最小,其出现主观感觉不适发生率也最小。结论对前列腺术后患者持续膀胱冲洗的冲洗液可选择在30℃～37℃之间发生膀胱痉挛次数最少。     

Stroke of a cardiac myxoma origin

Objective

The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition.

Methods

Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014.

Results

Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%.

Conclusion

Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.     

Cardiac myxoma in pregnancy: a comprehensive review

Objective

Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses.

Methods

A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review.

Results

Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery.

Conclusion

The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.     

Sternal wound tuberculosis following cardiac operations: a review

Objective

The diagnosis and treatment of sternal wound infections with mycobacteria are challenging. Such an infection is often associated with a delayed diagnosis and improper treatment that may lead to a worsened clinical outcome. The present study is designed to highlight its clinical features so as to facilitate a prompt diagnosis and timely treatment.

Methods

MEDLINE, Highwire Press, and Google search engine were searched for publications in the English language, with no time limit, reporting on sternal wound infection caused by tuberculosis after cardiac surgery.

Results

A total of 12 articles reporting on 14 patients were included in this study. Coronary artery bypass grafting was the underlying surgical procedure in more than half of the cases. Purulent discharge and cold abscess were the two main presenting symptoms. Diagnosis of sternal wound infection was evidenced in all 14 patients by different investigations, with culture of samples being the most sensitive method of identifying the pathogen. Good response to first-line anti-tuberculous agents was noted. Almost all patients required surgical debridement/resection and, sometimes, sternal reconstruction. A delayed diagnosis of sternal wound infection may lead to repeated recurrences. A comparison between patients with sternal wound infection due to tuberculosis and non-tuberculous mycobacterial infections showed that the former infections took an even longer period of time. Comparisons also revealed patients with sternal tuberculosis infection had a significantly higher mortality than patients with sternal non-tuberculous infection (29.2% vs. 0%, P=0.051).

Conclusion

Sternal infection caused by tuberculosis after cardiac surgery has a longer latency, better response to first-line drugs, and better outcomes in comparison with non-tuberculous sternal infection. Early diagnosis and early anti-tuberculous treatment can surely improve the patients'' prognosis.     

莆田地区畲族的骨密度与骨生化指标以及睾酮雌二醇之间的关系

目的 探讨莆田地区畲族健康人群骨密度与骨生化指标、睾酮以及雌二醇之间的关系,并与汉族人群比较,为本地区骨质疏松防治提供依据。方法 选择本地区畲族聚集地40岁以上健康成年人,其中畲族532人,汉族563人,应用美国Osteometer Medi Tech公司生产的DTX-200骨密度吸收仪检测骨密度,以及用罗氏公司的骨生化指标仪器及试剂盒,测量骨密度以及25羟维生素D（25（OH）D3）、骨钙素（BGP）、雌二醇（E2）、睾酮（T）、甲状旁腺激素（PTH）、1型前胶原氨基末端肽（P1NP）、碱性磷酸酶（ALP）。把上述检测的数据结果输入电脑,应用SPSS17.0软件包进行数据分析。结果 不管畲族和汉族的骨密度均随着年龄的增大而下降,同年龄段男性均高于女性。畲族女性除在40～49岁年龄段稍高于汉族外,其他年龄组汉族女性均高于畲族。而畲族男性在60～69岁年龄段稍高于汉族男性,其他年龄组汉族男性均高于畲族,但汉族与畲族间都没有显著性差异（P>0.05）。汉族的25(OH)D3明显高于畲族,尤其女性在40～60岁年龄段、男性在50～69岁年龄段为正相关（P<0.05）;汉族的BGP高于畲族(P<0.05),汉族男的E2指标均高于畲族男,且40～59年龄段尤为明显（P<0.05）。P1NP在汉族男女性高于畲族男女性（P<0.05）。经皮尔森相关分析,骨密度与E2、25OHD3、T成正相关,而与PTH、BGP、ALP成负相关,与ALP无相关。结论 本研究25（OH）D3、BGP、P1NP、E2测定可以作为汉族、畲族健康人群早期检测指标,畲族的25（OH）D3水平普遍偏低,可能与他们的生活方式或者维生素D基因有关,值得进一步研究。骨密度与25（OH）D3、E2、T有明显正相关,而与PTH、PINP、BCG负相关,与ALP无明显相关。     

典必殊眼膏联合睑板腺按摩治疗睑缘炎临床观察

目的慢性睑缘炎在红霉素眼膏和思然眼水的治疗基础上加用典必殊眼膏联合睑板腺按摩后的疗效观察。方法慢性睑缘炎患眼120眼,裂隙灯下观察睑缘炎类型,其中前睑缘炎40眼,后睑缘炎40眼,混合型睑缘炎40眼,各类型随机分为A、B治疗组,A组常规给予红霉素眼膏局部涂眼,思然眼水点眼。B组在红霉素眼膏局部涂眼及思然眼水点眼基础上加用典必殊眼膏点眼联合睑板腺按摩,裂隙灯下观察睑板腺分泌物性状,角膜病变临床表现及病变范围,随访观察1年,比较两组治疗后复发率。结果治疗组总有效率为76.67%,对照组总有效率为46.16%,二者相比具有统计学差异(P〈0.05);治疗前睑缘炎相关角膜病各组间差异无统计学意义(P>0.05),治疗后1个月各组间区组统计P〈0.05〉;随访1年后,根据诊断标准,各组间复发比较P〈0.05,B组复发率小于A组。结论典必殊眼膏联合睑板腺按摩在睑缘炎治疗中具有良好的作用,可以有效地改善患者的症状和体征及治疗后复发。