克罗恩病合并腹腔脓肿临床路径应用分析

目的 评价克罗恩病（CD）合并腹腔脓肿临床路径的实施效果。方法 回顾性分析2014年1-12月中国人民解放军南京总医院炎症性肠病治疗中心连续收治的进入临床路径的30例CD合并腹腔脓肿病人（路径组）临床资料。同时,以2013年1-12月收治的30例未采用临床路径的CD合并腹腔脓肿病人（非路径组）为对照,分析比较两组病人的治疗效果。结果 两组病人均全部治愈,无死亡病例。路径完成率为100%。路径组与非路径组手术率［80.0%（24/30） vs. 66.7%（20/30）］、术后并发症发生率［29.2%（7/24） vs. 50.0%（10/20）］、治疗费用［（56 745.2±45 465.4）元 vs. （73 928.3±50 576.6）元］差异均无统计学意义（P＞0.05）;相对于非路径组,路径组病人临时性肠造口发生率降低［16.7%（4/24） vs. 55.0%（11/20）,P=0.011］,住院时间缩短［（28.9±21.4）d vs. （43.8±34.3）d,P=0.047］。出院后随访1年,两组病人脓肿复发率差异无统计学意义（P=1.000）。结论 临床路径在确保疗效和安全的前提下,优化了CD合并腹腔脓肿的治疗,使临时性肠造口发生率降低并缩短了住院时间,具有应用和推广价值。     

Clinical immunology review series: an approach to the patient with recurrent superficial abscesses

Patients may be referred to the immunology clinic for investigation of recurrent superficial abscess formation. In the majority of adult patients this clinical presentation does not equate with an underlying primary immune deficiency. Nevertheless, recurrent mucocutaneous abscesses can be associated with significant morbidity and long-term complications, including scarring and fistula formation, and may be associated with underlying immune-mediated disease. This review sets out an approach to the patient with recurrent superficial abscesses, focusing on the differential diagnoses, investigation and management of both the common causes and those associated with specific immune deficiency.     

Acute diffuse phlegmonous gastritis

A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid. Histologically there was massive infiltration of polymorphonuclear leukocytes in the submucosa and muscularis of the stomach wall. The lamina muscularis mucosae was fragmented by the numerous small focal adscesses.     

Reoperation on the abdomen encased in adhesions

PURPOSE: To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions. METHODS: Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire. RESULTS: Only 1 postoperative death occurred, but 24 early complications appeared. At hospital discharge, obstruction, fistula and abscess were completely resolved in all but 3 patients (P <0.001). Only 2 of 16 patients on parenteral nutrition before operation (TPN) still required it (P = 0.004). At late follow-up (mean, 4.6 years) the patients' quality of life (mean score +/- SD, 8.6 +/- 2.1) was similar to that of a healthy control population (9.2 +/- 1.2, P = 0.17). CONCLUSIONS: Reoperation on the abdomen encased in adhesions restores most patients to good health and an excellent long-term quality of life.     

糖尿病并发细菌性肝脓肿临床特点

目的 :探讨糖尿病 (DM)并发细菌性肝脓肿的临床特点。方法 :回顾性分析15例DM并发肝脓肿病例。结果 :DM并发肝脓肿多发生于肝右叶 ,血糖控制不理想。胆道疾病为主要病因 (40 % ) ,临床症状不典型 ,容易误诊、漏诊 ,诊断首选B超检查(92 9 % ) ,治疗总有效率高 (93 3 % )。结论 :提高本病早期诊断是改善本病及预后的关键。治疗应以控制感染 ,处理脓肿为主 ,兼顾血糖控制及营养支持治疗。     

Microbiology and antibiotic treatment of head and neck abscesses in children

The clinical data, microbiological results and antibiotic treatment of 65 children who have required incision and drainage of suppurative head and neck abscesses was retrospectively investigated with the aim of developing a more effective clinical protocol of treatment, improving speed of resolution and rationalizing the need for surgical intervention. A positive culture grew in 78% of children and of these 45% were Staphylococcus aureus, 9% Streptococcus pyogenes, and 8% atypical mycobacteria. Only 3% of the samples grew anaerobes. All isolates of S. aureus were sensitive to Flucloxacillin and all isolates of S. pyogenes were sensitive to penicillin. All anaerobes were Metronidazole sensitive. In 40% of the children there were no localizing symptoms which could guide the treatment, therefore we recommend Flucloxacillin and Metronidazole as the antibiotic regimen of choice in acute suppurative lymphadenitis. The increasing incidence of atypical mycobacterial lymphadenitis is noteworthy.     

(1)H MR spectroscopy of inflammation, infection and ischemia of the brain

Different pathologic patterns in multiple sclerosis (MS) are reflected by alterations of metabolites in (1)H MR spectroscopy of the brain. Elevated choline (Cho), lactate (Lac), lipids and macromolecules are reliable markers for acute demyelination regardless of the clinical entity (also in acute disseminated encephalomyelitis). N-acetyl-aspartate (NAA) is a suitable marker for neuronal integrity. It is reduced in acute MS lesions and in normal appearing white matter, even distant to acute and chronic-lesions. Recovery from reduced NAA levels to subnormal values during remyelination, and varying time courses of NAA in normal appearing white matter during relapsing remitting disease indicate the value of this spectroscopic marker for monitoring activity and recovery. Inositol (Ins) is increased in chronic MS lesions being a marker for astrocytic gliosis. In viral disease, Cho and Ins are always increased, whereas a reduction of NAA mostly reflects an advanced or a detoriated clinical state. In bacterial brain abscesses, numerous amino acids, lipids and Lac can be elevated. In ischemia, especially the Lac/NAA in comparison with perfusion and diffusion weighted imaging seems to be a new measure for areas of metabolic need, and may help to better characterise the penumbra of the stroke and the final infarct size.     

腹部CT检查鉴别诊断恶性肿瘤患者小肝脓肿与肝转移瘤经验分析

目的 探讨在肝外恶性肿瘤患者,使用腹部CT检查鉴别小肝脓肿与肝转移癌.方法 2017年1月～2020年12月我院行肝脏增强CT检查且影像学报告中使用了"肝脓肿"或"肝转移癌"的患者,分析CT特征包括病灶直径、病灶数量、动脉期边缘强化、持续边缘强化和边缘低密度水肿带等.结果 在32例肝脓肿患者和28例肝转移癌患者,腹部C...