Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.     

Vascular compression of the airway: Indications for and results of surgical management

Vascular compression of the airway is a significant cause of respiratory compromise in children. While the indications for surgical repair are sometimes life threatening, they can also be subtle. This retrospective study examines 45 surgical cases of tracheobronchial compromise secondary to vascular compression at a large children's hospital between July 1983 and February 1996. A total of 34 were diagnosed with innominate artery compression, ten with a double aortic arch and one with an anomalous right subclavian artery. The 45 patients, 25 male and 20 female, ranged in age from 12 days to 11 years at surgery (average 13 months). A total of 21 (47%) presented with proven or suspected episodes of cyanosis or apnea. All 45 patients had evidence of vascular compression during microlaryngoscopy and bronchoscopy. The diagnosis was confirmed by magnetic resonance imaging (MRI) in 23/45 (51%), barium swallow in 22/45 (49%) and aortogram in 3/45 (7%). There was one death. One patient had a tracheotomy before surgery and continues to require it after surgery. Complete resolution of symptoms was achieved in 39/45 (87%) with five requiring more than one operation before their symptoms resolved completely. A total of four patients experienced a recurrence of symptoms within a variable length of time after surgery. Surgical indications and treatment alternatives will be discussed.     

血管内皮生长因子及其受体对喉癌细胞生长的影响

为探讨血管内皮生长因子（ＶＥＧＦ）在喉癌中的作用及可能的作用方式，用抗ＶＥＧＦ抗体及其受体ｆｌｔ抗体通过微波处理暴露抗原后，进行标准化的ＥｌｉｔｅＡＢＣ染色；将不同浓度的抗ＶＥＧＦ及抗ｆｌｔ抗体分别加入ＨＥＰ－２细胞的培养液中，培养５ｄ后测ＨＥＰ－２细胞的活性（ＭＴＴ法）。结果：免疫组化染色显示ＶＥＧＦ及其受体ｆｌｔ主要在喉癌细胞和血管内皮细胞表达；不同浓度的ＶＥＧＦ抗体及抗ｆｌｔ抗体对ＨＥＰ－２     

公共卫生危机管理探讨

本文以社会学、心理学的相关原理为理论基点 ,论述了危机、卫生危机及公共卫生危机的概念、因素和影响 ,探讨了政府在公共卫生危机管理中应对策略 ,以资政府相关组织借鉴。     

Vascular ultrasound in obstetrics

The usefulness of the vascular ultrasound in the field of obstetrics is now well recognized. Intima-media thickness (IMT) and elastic property of the common carotid artery are affected by pregnancy and vary with complications. Flow-mediated vasodilation (FMD) of the brachial artery reflects the vascular endothelial function and is reported to be useful in the management of complicated pregnancy, especially pre-eclampsia. For the screening of deep vein thrombosis of the lower extremities in the perinatal period, compression ultrasonography (CUS) is useful.     

动脉疾病的微创治疗32例分析

目的探讨介入技术在动脉疾病中的应用及与手术联合使用的意义。方法对32例不同的动脉疾病采用介入技术或介入联合手术的方法进行治疗,对临床治疗效果及介入技术的应用进行分析。结果31例患者治疗成功,1例失败。平均随访9个月,1例降主动脉瘤破裂形成食道瘘患者,出院后1个月因支架感染而死亡。其余症状均消失或改善。结论动脉疾病的介入治疗可以减轻患者痛苦,减少手术风险,缩短住院时间。与手术联合使用可以减少手术的创伤或扩大介入技术的运用范围。     

血管内皮生长因子、微血管密度及Ki-67在宫颈鳞癌中的表达及意义

目的探讨血管内皮生长因子(VEGF)、微血管密度(MVD)及Ki-67在宫颈鳞状细胞癌中的表达及意义。方法采用免疫组织化学S-P法测定45例宫颈鳞癌组织和10例正常宫颈组织中VEGF、Ki-67和F8的表达。结果宫颈鳞癌中VEGF的表达阳性率为77.78%,Ki-67标记指数(Ki-67LI)和MVD分别为12.7±4.1和37±10,VEGF表达水平与肿瘤恶性程度、Ki-67 LI和MVD计数呈正相关。结论VEGF有促进肿瘤细胞增殖及血管生成的作用,联合检测VEGF、Ki-67和F8可作为病理诊断的补充,对患者预后判断和治疗方案的选择有重要的参考价值。     

宫颈癌全子宫切除术后发生毛细血管渗漏综合征 1例

目的探讨宫颈癌病人术后发生毛细血管渗漏综合征( capillary leakage syndrome,CLS)的病因、临床表现及处理措施,为临床医师提供可靠经验,提高此类疾病诊治水平。方法分析 1例 2022年 7月于潍坊医学院附属医院术前诊断为子宫颈原位癌而术后病理为浸润性宫颈癌的病人术后发生 CLS的过程及诊疗经过,结合相关文献报道,总结宫颈癌病人术后发生 CLS的机制及处理措施。结果病人术中生命体征平稳,手术结束恢复体位时出现血压下降,给予去甲肾上腺素升压,待血压升至 100/60 mmHg返回病房后陆续出现胸闷、憋气及双下肢中度水肿,行 CT检查提示大量胸腹腔积液,给予地塞米松、羟乙基淀粉、血浆及人血白蛋白改善毛细血管通透性,补充血容量,限制性补液并间断性给予利尿剂等处理,经过积极治疗后病人病情好转。结论针对宫颈癌术后的病人,医务人员需严密观察,对胸闷、憋气、双下肢水肿等症状提高警惕,首先排除是否出现 CLS,一旦确诊立即给予相应的处理。     

血管内皮生长因子单抗对大鼠肝缺血再灌注损伤的影响

目的研究再灌注期使用血管内皮生长因子单抗(Vascular endothelial growth factor monoclonal antibody,简称VEGFmAb)对大鼠肝缺血再灌注损伤的影响。方法将SD大鼠18只分为两组(每组n=9)。C组:实验对照组,常规行肝缺血再灌注损伤实验;V组:VEGFmAb处理组:在再灌注期使用血管内皮生长因子单抗。于术后2h、24h分别取血测肝功能,术后24h切取缺血肝叶检测热休克蛋白(heat shock protein 70,简称HSP70)RT-PCR表达、肝病理组织学改变,观察生存状态1周。结果与C组比较,V组HSP70的RT-PCR表达未见明显改变;V组ALT、AST在术后明显下降,肝病理组织学改变有所减轻,1周生存率提高(55.56%vs0)。结论再灌注期使用VEGFmAb有助于减轻大鼠对缺血再灌注损伤,改善预后。