预防性抗生素在经直肠前列腺穿刺活检术中的应用

目的 评价和探讨抗生素防治前列腺穿刺活检术后感染的有效方法。方法 对192例前列腺疾病患者行经直肠超声引导13点前列腺系统穿刺活检术。所有患者随机分为3组。A组62例,口服安慰剂（维生素C）;B组64例,口服单剂量环丙沙星0．5g加甲硝唑0．4g/d;C组66例,分2次口服环丙沙星1.0g加甲硝唑0.8g/d,共3d;所有患者均在活检后48h进行尿培养,发热者再进行血培养。结果 3组患者感染性并发症（尿路感染和发热）的发生率为A组11％（7／62）,B组3％（2／64）,C组3％（2／66）,C组3％（2／66）。感染性并发症的发生率在A组明显高于B组（χ^2=7.16)和C组（χ^2=7.34),差异具有显著性意义（P＜0．01）。而B、C两组间感染性并发症的发生率相当（χ^2=0.23),差异无显著性意义（P＞0．05）。结论 应用恰当的单剂量抗生素预防经直肠前列腺穿刺活检术后的感染是有效的。     

Complications after LP related to needle type: pencil-point versus Quincke

OBJECTIVES: We studied the incidence of complications after diagnostic lumbar puncture (LP) related to needle type. MATERIAL AND METHODS: A 5 months' observational study of routine diagnostic LP in 83 patients was conducted. RESULTS: Significantly more headache was observed after LP using thicker cutting needles (20G Quincke) compared with thinner cutting or non-cutting needles (22G Quincke or pencil-point). No significant difference in complications after LP was found between the 22G Quincke and pencil-point needles. CONCLUSION: The size of the needle and not the needle shape seems to be the main determinant for post-dural puncture headache (PDPH).     

Penetration of the Duodenum by an Ingested Needle with Migration to the Pancreas: Report of a Case

A case of a penetration of the duodenum by a needle with migration to the pancreas in a 50-year-old man is reported herein. The patient was referred to us with a chief complaint of diarrhea. An abdominal plain roentgenogram showed a needle in the upper abdominal area. An abdominal computed tomography scan and contrast X-ray revealed the foreign body to be located outside of the duodenum and in the head of the pancreas. An emergency operation was therefore performed on the first day and the needle in the head of the pancreas was thus extirpated safely. A perforation of the gastrointestinal tract by an ingested foreign body is difficult to accurately and quickly diagnose when no peritonitis or abscess formation is observed. Therefore, the use of contrast X-ray is considered to be useful in the diagnosis of such a perforation. Received: January 24, 2000 / Accepted: July 25, 2000     

岛叶部脑梗死1例报道

1 病案资料 患者,男,62岁,右利手,因突发意识不清7h,于2007年11月27日入院治疗.既往心肌缺血病史5年.查体:血压120/70mmHg,昏睡状态,强刺激可唤醒,模糊回答问题,言语欠清,双眼球左右活动尚可,无眼震,双侧瞳孔等大同圆,直径2.5mm,对光反射灵敏,右侧疼痛刺激肢体活动较左侧少,腱反射对称存在.右侧巴氏征( ),颈软,克氏征(-).     

等离子关节镜手术系统治疗膝关节内滑膜血管瘤

目的 探讨等离子关节镜手术系统治疗膝关节内滑膜血管瘤的优越性.方法 回顾1990年至今的11例经病理确诊的膝关节内滑膜血管瘤病例,观察并对比采用等离子关节镜手术系统和传统关节镜手术系统治疗膝关节内滑膜血管瘤的疗效.结果 随访11例,平均39个月,其中传统关节镜手术5例,等离子关节镜手术8例(包括2例复发后再次手术者),术后症状、体征均明显改善或完全消失.结论 等离子关节镜手术系统克服了传统关节镜手术的难点,是治疗膝关节内滑膜血管瘤的理想手术方法 .     

Quality of life after radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma: comparison with transcatheter arterial chemoembolization alone

Objective Comprehensive studies are scarce with regard to the quality of life (QOL) of hepatocellular carcinoma (HCC) patients after transcatheter arterial chemoembolization (TACE) and/or radiofrequency ablation (RFA) treatment. The purpose of this study was to examine the impact of TACE alone and that of the TACE followed by RFA (TACE–RFA) on QOL in HCC patients. Methods QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G) (Version 4.0) questionnaire, translated into Chinese, as a measure of QOL among Chinese HCC patients. Prospectively, 83 patients in both TACE group (n = 40) and TACE–RFA group (n = 43) completed the questionnaire at baseline and 3 months after treatment, respectively. Results The TACE–RFA group resulted in a significantly higher total QOL score, socio-family well-being score, and functional well-being score than that of TACE group, 3 months after respective treatment. Liver function, tumor recurrence and complication, age, income were the most important factors affecting the QOL of HCC patients after treatment. The logistic regression analyses showed that Child-Pugh Class and tumor recurrence after treatment were independent predictors of post-treatment QOL scores of HCC patients. Conclusions The overall QOL of HCC patients in TACE–RFA group was maintained at a relatively higher level than that of TACE group. TACE followed by RFA appeared to be more favorable than TACE alone with respect to QOL.     

射频导管消融治疗特发性室性心动过速及顽固室性早搏

目的探讨特发性室性心动过速（IVT）和顽固性室性早搏（VPC）的射频消融（RFCA）治疗效果及该方法的可行性和必要性。方法对10例左室特发性室速（ILVT）、9例右室流出道室速（IRVT）及22例右室流出道（RVOT）室性早搏、2例左室流出道（LVOT）室性早搏，分别采用激动顺序标测法及起搏标测法行射频消融治疗。结果43例患者术中，总成功率为97．7％，室速成功消融率19／19（100％），室早成功消融率23／24（95．8％），术中、术后均无并发症；术后随访3-40mo，室速无复发，室早消融复发率低1／23（4．3％）。结论射频消融治疗特发性室速或室早是安全、有效且成功率高的一种方法。     

射频消融治疗高血压人群中室性早搏的中长期随访

目的:了解射频消融治疗高血压人群中室性早搏患者的临床疗效及手术对患者生活质量的影响。方法:在进行高血压规范化治疗并达标的基础上,对27例高血压人群中频发室性早搏患者,采用起搏标测法/激动标测法或两者结合进行标测消融,并让患者在术前和术后分别检查动态心电图、心脏超声、手术前后测定心肌钙蛋白I(cTnI),以及在手术前、手术后3月、12月分别填写SF-36调查表,量表采用标准分法进行评分、统计分析。结果:即刻成功率89%(24/27),总成功率96.3%,1例患者早搏次数较术前有明显好转,但次数仍大于3000次/d。cTnI在手术后稍升高[手术前后分别为(0.15±0.19)和(1.09±0.40)μg/L,P<0.01],但仍在正常范围内;患者左心室舒张末期内径(LVEDd)[手术前后分别为(44.40±5.07)mm(42.44±5.60)mm,P<0.01]、左心室收缩末期内径(LVESd)[分别为(33.07±2.30)mm和(31.66±2.20)mm,P<0.01]在手术后有所缩小,可以提高左室射血分数(LVEF)[分别为(56.07±1.59)%和(59.92±1.49)%,P<0.01]。患者群整体的生活质量各项指标在术后均有明显提高(P<0.01)。射频消融治疗能降低患者就医次数、医药费用(P<0.01),随访中无并发症。结论:射频消融治疗高血压人群中室早患者安全、有效,能进一步改善心功能;可显著提高患者生活质量。