个案追踪法在急性心肌梗死患者护理质量控制中的应用

目的：探讨个案追踪法在急性心肌梗死患者护理质量控制中的应用效果。方法：运用个案追踪法对急性心肌梗死行急诊PCI术的患者接受的诊疗护理服务进行追踪检查,比较两组护理质量得分情况。结果：实施个案追踪法后,观察组护理质量得分、住院时间、满意度及桡动脉穿刺术后出血发生率均优于对照组。结论：通过运用个案追踪法进行分析及评价,解决临床实际问题,提升护理质量,促进护理质量的持续改进。     

脾炎症性肌纤维母细胞瘤肝转移1例报告并文献复习

目的：探讨炎性肌纤维母细胞瘤的临床病理特点、鉴别诊断及预后。方法：观察分析1例脾炎症性肌纤维母细胞瘤术后4 a肝转移病例的临床病理特点及免疫表型,并对相关文献复习。结果：瘤细胞梭形,呈束状、旋涡状或席纹状排列,间质大量炎症细胞弥漫浸润,脾肿瘤细胞形态温和无明显异型,肝转移灶瘤细胞轻度异型,局部呈浸润性生长;免疫组化Vimentin、SMA阳性,ALK阴性。结论：炎性肌纤维母细胞瘤是少见肿瘤,诊断须依赖病理形态及免疫组化,大多预后较好，出现异型提示预后不良。     

Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report

BACKGROUNDFecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals. Fecal impaction is generally preventable, and early recognition of the typical radiological findings is important for making an early diagnosis. The factors that lead to fecal impaction are usually similar to those causing constipation. Few cases with fecal impaction associated with a diverticulum have been reported.CASE SUMMARYWe present the case of a 62-year-old woman who suffered from abdominal pain and vomiting, had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography (CT) imaging. After examination by gastrografin-enhanced colonography following colonoscopy and CT colonography, the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon. The fecalith was surgically resected, and a histological diagnosis of pseudodiverticulum was made. There was no recurrence during 33 mo of follow-up.CONCLUSIONThis case highlights the importance of accurate identification and treatment of a fecal impaction. This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction. A fecal impaction was associated with the diverticulum. Consequently, the planned diverticulectomy was performed. Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.     

Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis: A case report

BACKGROUNDPrimary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare. In addition, Epstein-Barr virus (EBV) has been reported to play a role in the development of human immunodeficiency virus (HIV)-related malignant lymphomas. To the best of our knowledge, there is no report for the HIV-associated, EBV-positive primary diffuse large B-cell lymphoma (DLBCL) in the frontal sinus.CASE SUMMARYWe present a unique case of HIV-associated, EBV-positive DLBCL in the frontal sinus in a 46-year-old man. Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling. Based on the clinical and radiological findings, the initial diagnosis was complicated frontal sinusitis, presenting Pott’s puffy tumor. Unexpectedly, HIV testing was positive on preoperative laboratory test, and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.CONCLUSIONThrough this article, we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses. We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.     

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports

BACKGROUNDPseudogout is a benign joint lesion caused by the deposition of calcium pyro-phosphate dihydrate crystals, but it is invasive. Pseudogout of the temporo-mandibular joint (TMJ) is uncommon, and it rarely invades the skull base or penetrates into the middle cranial fossa. The disease has no characteristic clinical manifestations and is easily misdiagnosed.CASE SUMMARYWe present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa. A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region. Another patient, a 52-year-old man with a mass in the left TMJ for 6 years, was admitted to the hospital. Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area. Both patients underwent excision of the lesion. The lesion was pathologically diagnosed as tophaceous pseudogout. The symptoms in these patients were relieved after surgery.CONCLUSIONTophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction. A pathological examination is the gold standard for diagnosing this disease. Surgical treatment is currently the recommended treatment, and the prognosis is good after surgery.     

Wilson disease — the impact of hyperimmunity on disease activity: A case report

BACKGROUNDIn Wilson disease lack of biliary copper excretion causes hepatocellular injury by accumulation of free toxic copper. Its overspill to serum accounts for neuronal damage as second common manifestation. Therapy with copper chelators or zinc targets the removal of this free copper. However, in some patients liver disease persists for unknown reason despite normalized free copper. The discovery of a hyperimmunity as a contributing pathogenetic factor was discovered in this case report with implication also for other liver diseases.CASE SUMMARYA 9-year-old girl was diagnosed in August 2009 by family screening of having asymptomatic Wilson disease with elevated transaminases. Already at time of diagnosis antinuclear antibodies (ANA) were elevated without hyperimmunoglobulinemia (immunoglobulin G, IgG). After one year of therapy with D-penicillamine transaminases normalized together with free serum copper. Under continuous therapy with copper chelators free copper remained normal until today, whereas transaminases raised to alanine aminotransferase values of 571 U/L in December 2019. For hyperimmunity a tentative steroid course on top of D-penicillamine improved transaminases. Thus, hyperimmunity may have impact on liver inflammation after control of the metabolic disturbance. A retrospective cohort study confirmed the common association of elevated transaminases with ANA, but no IgG elevation.CONCLUSIONThis hyperimmune-triggered condition may represent a new entity which per se or on top of other liver diseases induces liver inflammation responsive to steroids.     

1994年山东省布氏菌病流行状况及病例分析

对山东省１９９４年布氏菌病的流行情况进行了分析，表明疫区主要在鲁中地区，并有继续扩大蔓延之势，通过对１２４例病人的个案调查发现，临床表现较为典型，具有诊断意义的游走性关节炎和单侧睾丸炎出现频率较高。     

胸腺瘤伴弥漫性泛细支气管炎一例报告并文献复习

目的　提高对弥漫性泛细支气管炎 (DPB)的认识。方法　对 1例经胸腔镜肺活检病理确诊为DPB患者的临床资料进行分析 ,并结合文献复习。结果　DPB是一种慢性小气道疾病 ,以两肺弥漫性呼吸性细支气管的炎症为特征。DPB的病因及发病机制尚不清楚 ,可能与遗传和免疫因素有关。临床表现为慢性咳嗽、咳痰、活动后气短 ,常合并铜绿假单胞菌感染。如不治疗 ,患者可发展为呼吸衰竭 ,预后不良。结论　遇到不明原因的双肺结节状阴影应想到DPB ,并争取做肺组织活检以明确诊断。长期低剂量红霉素治疗可能通过控制炎症作用改善患者预后     

The utility of Vibratip in accurate identification of loss of protective sensation in the contralateral foot of patients admitted with a diabetic foot ulcer

Background and aimsDiabetic foot ulcer (DFU) is a debilitating complication of type 2 DM. Complexity of foot examination often precludes proper clinical assessment of the foot during routine evaluation. We assessed the utility of novel device, vibratip, both singly and in combination with standard bedside tools for assessment of loss of protective sensation.Methods75 patients admitted with DFU were included in the study. Clinical examination of the contralateral foot was done - temperature perception, vibration, pinprick sensation, Achilles tendon reflex and Neuropathy disability score were assessed. Testing using 10 g Monofilament, Vibratip and biothesiometer were also done. Considering the biothesiometer as the reference standard, three bedside tests (Vibratip, 10 g monofilament and 128 Hz tuning fork) were compared against it singly and in combinations.ResultsWhen compared against biothesiometer, vibratip performed significantly well with a positive predictive value of 90.3% and specificity of 84.2%. Sensitivity, however, was only 50%. On combining bedside tests, the best combination strategy was seen with vibratip and 10 g monofilament, which improved the sensitivity to 62.5%. Combining all three bedside tests further improved sensitivity to 64.3%.ConclusionAll the patients with an at-risk foot may not be identified with vibratip alone. Nevertheless, an abnormal result is almost always associated with loss of protective sensation, and such persons should be suitably educated.LimitationsDue to small size of the study population, it is not possible to generalize the findings to all patients with diabetes mellitus. A larger study would be required to provide more confirmatory findings.