视网膜母细胞瘤保守治疗相关性临床因素分析

目的 分析及探讨视网膜母细胞瘤(Rb)保守治疗的相关临床因素.方法 对1996～2005年所收治采用保守治疗方法的34例(35只眼)Rb患儿的临床资料作回顾性分析.结果 保守治疗成功组初诊年龄、保守治疗时间以及瘤体直径分别为(16.33±16.28)月、(1055±554)d及(6.92±2.99)mm,失败组分别为(21.90±12.18)月、(878±76)d及(9.54±3.17)mm,差异无统计学意义(P＞0.05);保守治疗成功组瘤体厚度为(3.06±1.00)mm,失败组为(6.11±2.48)mm,差异具有统计学意义(P＜0.05);Rb肿瘤位于后极部保守治疗失败率为86%,周边部为44%,差异具有统计学意义(P＜0.05).结论 保守治疗效果与眼内肿瘤大小以及位置之间存在一定关系,肿物越小、位置越靠近周边部保守成功率越高;肿瘤较大、位置靠后是保守治疗失败的主要因素.     

单孔局麻胸腔镜滑石粉胸膜粘连术治疗气胸

目的评价在单孔局麻气管镜下喷洒滑石粉治疗重症气胸安全性和临床效果。方法回顾分析江西省胸科医院2009年7月至2011年7月,经单孔局麻气管镜下喷洒滑石粉治疗重症气胸20例。临床资料:其中男17例,女3例,患者持续漏气7d以上,或反复发作,肺功能差或者合并哮喘等基础疾病不能耐受手术。采用冲洗器和引流管制成的简易装置向胸腔内喷洒5g医用滑石粉,气管镜下观察到滑石粉在胸膜腔内均匀分布,置28F胸管引流直至无漏气,术后复查胸片观察肺复张情况。结果20例患者中17例治愈,13例胸痛,9例发热,3例皮下气肿,3例持续漏气,拔管中位时间为5d(3d-8d),在随访期间(18-42个月)[中位时间36个月]无复发。无重大并发症发生。结论单孔局麻支气管镜下喷洒滑石粉治疗重症气胸是一项安全、有效、费用低廉的治疗方法,不仅可以治疗这类气胸,还可以预防气胸复发。     

Recovery of complete left bundle branch block in a dilated cardiomyopathy patient after treatment with sacubitril/valsartan: A case report

Rationale:The treatment of dilated cardiomyopathy (DCM) has recently been greatly improved, especially with the widespread use of sacubitril/valsartan (ARNI) combination therapy. We know that ARNI-like drugs can significantly improve the symptoms of heart failure with reducing ejection fraction. However, clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. In this case, we report a patient with complete left bundle branch block (CLBBB) associated with DCM whose CLBBB returned to normal after treatment with ARNI.Patient concerns:A 38-year-old man was admitted to the hospital for 20 days for idiopathic paroxysmal dyspnea. He presented with exacerbated dyspnea symptoms at night, accompanied by cough and sputum.Diagnosis:Physical examination revealed a grade 4/6 systolic murmur could be heard in the apical area of the heart and mild edema was present in both lower limbs. Laboratory examination found that the B-type natriuretic peptide was significantly increased. Echocardiography indicated left atrial internal diameter, right ventricular internal diameter, and left ventricular diastolic diameter were enlarged and ejection fraction was significantly decreased. Besides, the pulsation of the wall was diffusely attenuated. Electrocardiogram was suggestive of tachycardia and CLBBB. A diagnosis of DCM with CLBBB was considered based on a comprehensive evaluation of the physical examination, laboratory examination, echocardiography and electrocardiogram.Interventions:The patient was treated with ARNI at a dose of 50 mg (twice a day) at first, gradually increasing to the target dose (200 mg, twice a day) in the following 9 months as shown in Table ​Table1,1, along with metoprolol 25 mg (once a day [qd]), diuretics 20 mg (qd), and aldosterone 20 mg (qd).Table 1Specific medications used in treatment.

复发性鼻腔及鼻窦恶性黑色素瘤的治疗

目的 探讨鼻腔及鼻窦恶性黑色素瘤复发的原因和治疗方法.方法 回顾性分析1993～2003年我科收治的11例复发性鼻腔及鼻窦恶性黑色素瘤患者的临床资料.结果 临床误诊或误治引起的复发患者4例,病理明确手术治疗后复发7例,其中5例为单纯手术后复发,2例为手术加术后放疗后复发.11例复发病例中,局部复发局限于鼻腔及鼻窦7例;局部复发侵犯眼眶、颅底、软腭及硬腭1例;局部复发侵犯腮腺和皮肤1例;面部、眼眶及颅底广泛侵犯者1例;颈部淋巴结转移复发1例.首次复发时间最短为治疗后10个月.所有病例再次手术治疗后的累积生存率为:1年生存率72.7%,2年生存率18.2%,3年生存率9.1%.结论 减少误诊,选择适当的治疗方法是提高复发性鼻腔及鼻窦恶性黑色素瘤治愈的主要手段.     

Tolerance of salivary gland botulinum toxin A injection under local anesthesia for the treatment of sialorrhea in children: An observational study

ObjectivesThe main objective of this study was to assess tolerance of botulinum toxin A injection into the salivary glands under local anesthesia in a pediatric population. Secondary endpoints comprised efficacy and side-effects.Material and methodsA retrospective observational study included children treated between January 2013 and March 2020 for sialorrhea and/or pharyngeal salivary congestion. Children were identified from the botulinum toxin A injection database. The study included 162 injection sessions in 55 children. Injections were performed under local anesthesia with nitrous oxide, after clinical location of the site. Epidemiological and clinical data, injection tolerance on the FLACC scale, treatment response and complications were recorded.ResultsFor submandibular gland injections, pain was absent in 81 cases, mild in 64, moderate in 4 and intense in 1. In parotid gland injections, pain was absent in 45 cases, mild in 89, moderate in 17 and intense in 1. Injection tolerance was significantly poorer (P < 0.005) in parotid than submandibular glands. Seventy-seven percent of the injections had a positive effect on sialorrhea. Fifteen patients presented transient adverse events: mainly dysphagia and paradoxical increase in sialorrhea.ConclusionSalivary gland botulinum toxin A injections in under local anesthesia were well-tolerated, safe and effective for children with sialorrhea and/or pharyngeal salivary congestion.     

The morphology of the atrioventricular node in scleroderma -- a three-dimensional reconstruction

A new technique for looking at the atrioventricular node andbundle is described and applied to the conducting system insix patients with scleroderma. The conducting system blockswere removed, sectioned, appropriately stained and photographed.Outlines of the atrioventricular node and bundle were generatedand digitized. From the digital information three-dimensionalimages were generated and the atrioventricular node and bundlewere rotated so that the shape could be studied from any view.In striking contrast to normal atrioventricular nodal reconstructions,those from the patients who had scleroderma showed a narrowand flattened proximal atrioventricular node. The nodal microscopy,on the other hand, did not differ significantly in architecture.It is postulated that the alterations by fibrous replacementof the proximal node could account for the relatively high frequencyof atrioventricular conduction Scleroderma, problems in patientswith scleroderma and could paradoxically account for the relativelyfrequent occurrence of supraventricular tachycardias that arealso found in this disease.     

复方甘草酸苷联合局部浸润治疗带状疱疹后神经痛及其对免疫功能的影响

目的探讨复方甘草酸苷注射液联合局部浸润治疗老年带状疱疹后神经痛(PHN)的临床效果及其对免疫功能的影响。方法老年PHN20例,静脉滴注复方甘草酸苷40mg(5%葡萄糖注射液250ml),1次/d,连续3周为1个疗程,同时口服复方甘草酸苷片50mg,3次/d;以0·2%布比卡因20ml(含加入醋酸泼尼松龙30mg、利巴韦林0·4g,弥可保1mg)在皮损疼痛区皮下浸润,2次/d。以VAS评分法评价治疗前后的临床效果;检测治疗前和治疗后7、14、21d外周血淋巴细胞亚群变化。结果治疗后VAS评分显著降低(P<0·01);治疗后CD3 、CD4 、CD4 /CD8显著回升(P<0·01),并接近正常水平。结论老年PHN免疫功能可受到不同程度抑制,采用复方甘草酸苷联合皮损区局部浸润对缓解PHN患者的神经病理性疼痛有显著效果,并有提高及调节免疫功能的作用。     

Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值

目的探讨Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值。方法回顾性选取2016年2月至2021年2月北京中医医院怀柔医院中重度高脂血症性急性胰腺炎患者100例,依据病情严重程度分为中度组(全身或局部并发症2 d以上无持续性器官衰竭或短暂性器官衰竭2 d内消退,n=40)、重度组(2 d以上持续性器官衰竭可能对肾脏、心血管、呼吸等系统至少一个器官造成累及,n=60)两组。统计分析两组患者的临床资料、Ranson评分,并统计分析不同Ranson评分患者的多脏器功能衰竭综合征、感染、局部并发症发生情况、死亡情况。结果两组患者的性别构成比、年龄、血脂最高水平之间的差异均无统计学意义(P> 0.05),重度组患者血糖> 11 mmol/L、血钙≤2 mmol/L、LDH> 350 U/L、白细胞数计数> 16×10⁹/L、Hct降低> 16×10⁹/L、碱缺乏> 6 mmol/L、液体需要量> 6 L的患者比率、Ranson评分均高于中度组,差异均有统计学意义(P <0.05)。重度组...     

夹闭大鼠双侧颈总动脉对胃运动的影响

采用动脉夹夹闭大鼠双侧颈总动脉,胃内放置水囊记录胃运动的方法,观察了脑供血不足对胃运动的影响。结果表明:(1)夹闭30 min过程中,最初2 min内的胃运动指标(收缩频率、总收缩时程、总收缩幅度、胃运动指数)较夹闭前2 min内抑制显著;夹闭第28~30 min(即松开动脉夹前2 min内)的胃运动各项指标较夹闭前2 min均无显著差异。(2)松开动脉夹30 min过程中,松开后最初2 min内与松开前2 min内相比,胃运动抑制显著;但松开后第28~30 min的胃运动与松开前2 min内的胃运动相比,无显著差异。这些结果说明:夹闭双侧颈总动脉造成脑局部供血不足初期,对胃运动有抑制作用,但随着结扎时间的延长,这种抑制作用逐渐消除,可能是椎-基底动脉环起了代偿作用。     

全身放射治疗用肺挡铅三自由度精准对位器的研制

目的：研制一个肺挡铅固定架,使得该挡铅具有三自由度调节的空间定位功能,以保证使用的肺挡铅在全身放射治疗时定位精准.方法：设计制造一个装置,由3个部分组成：（1）装有4根挡铅固定柱的旋转轴及其轴套和锁紧螺栓;（2）透明材质制作的连接板;（3）通过燕尾槽相互契合的X、Y轴向滑块及其底座,并配有X和Y轴向调节螺栓.结果：此肺挡铅对位器,可做到：（1）肺挡铅能被轻松固定在拟定位置上;（2）肺挡铅的毫米级转向调节和任意角位调节,并且能反复修正至所需精度,重复定位误差≤2 mm; （3）肺挡铅的安装、定位时间大大缩短,20 min以内即可完成;（4）每一具装置承载铅块的质量可达20 kg.结论：此肺挡铅对位器可轻松、快速地实现肺挡铅的高精度空间定位.