Death due to a bronchus-pulmonary artery fistula developed 19 years after radiotherapy: A forensic autopsy case report

Radiotherapy, one of the standard therapies for lung cancer management, may cause severe late complications. In this case report, we describe the forensic autopsy report of a middle-aged man who died from a massive hemoptysis due to a bronchus-pulmonary artery fistula that developed 19 years after radiotherapy. The man, in his 50 s, suddenly developed hemoptysis at home and collapsed. He was in complete remission with no signs of recurrence. Autopsy revealed massive hemorrhage from the bronchus-pulmonary artery fistula, where radiotherapy had been focused. Histopathological findings showed chondronecrosis of the bronchus, disruption of elastic fibers of the pulmonary artery, and marked thickening of the intima of the small arteries around the fistula, which were compatible with radiation reaction. Neither cancer recurrence nor infection was evident. This case suggests that a late complication of radiotherapy should be considered in the differential diagnosis of a patient who was previously received radiotherapy and presents with massive hemoptysis. In such cases, a detailed history on previous therapies and careful examination of the origin of hemorrhage are necessary to determine the cause of death.     

Evaluation of fistula rates in three cleft palate techniques without relaxing incisions

The aim of the present study was to investigate the incidence of postoperative fistula formation from a hybrid cleft palate repair compared to that from two well-established techniques.We performed a modified technique, Sommerlad-Furlow (SF), which combined the repositioning of the levator veli palatini muscles as described by Sommerlad with the double opposing Z-plasty of Furlow to lengthen the soft palate. A retrospective cohort study was conducted to evaluate patients who underwent cleft palate repair utilizing SF, Sommerlad, or Furlow techniques with the incidence of palatal fistula as the target endpoint.A total of 1,164 patients were included in the present study and underwent the following techniques: 603 cases with SF, 244 cases with Furlow, and 317 cases with Sommerlad. In addition to not requiring relaxing incisions, SF advantages included a consistently lower fistula rate compared to that of the Sommerlad technique, as well as the lowest fistula rate in patients with both hard and soft palate clefts without a cleft lip (OR:2.62 95% CI: 1.35, 5.09). However, the differences among the three techniques did not reach statistical significance in terms of a bilateral or unilateral cleft lip/palate, or in patients with a soft palate only or a submucosal cleft palate(OR: 2.22,95% CI:0.77, 6.37).Based on the results of our study, the Somerlad-Furlow technique should be preferred whenever possible.     

1例小肠唇状瘘、重度营养不良伴抑郁患儿的特殊分段肠内营养治疗

目的介绍1例车祸伤后小肠唇状瘘、重度营养不良伴抑郁患儿围手术期的临床营养专科管理方案。方法关瘘术前采用局部双腔套管负压引流,联合静脉使用生长激素及生长抑素,满足其经口进食欲望(限量半流质饮食),收集食物残渣后由瘘口排除,并通过远端空肠营养置管间歇输注个性化肠内营养液,实现分段肠内营养支持。关瘘术后逐渐恢复普通饮食。治疗期间利用儿童抑郁量表(children’s depression inventory,CDI)评估患儿的情绪及行为,积极辅以肠外营养支持,并持续监测患儿消化道情况、体重和营养相关生化指标,阶段性调整营养方案。结果患儿抑郁量表得分从31分降至14分,心理状态逐渐稳定,配合度逐渐提高,实现体重平稳增长,达到手术要求并顺利关瘘,行关瘘术后营养状况进一步改善,顺利出院。结论根据患儿心理特点和车祸伤后新的胃肠解剖结构,制定个性化的肠内肠外营养方案,可以保证患儿治疗依从性和治疗效果。     

1例胃癌术后并发严重腹腔感染患者的护理体会

目的总结1例“胃癌术后并发严重腹腔感染”患者的护理干预体会。方法依据引起腹腔感染的因素．采取相应的护理措施，制定一系列个体化的护理，如早期严密观察患者的病情变化，及时控制感染，监测腹内压，加强腹腔冲洗的护理，及时给予营养支持及行心理护理，预防各种并发症。结果经精心的护理，及时采取有效护理措施，患者于2个月后痊愈出院。结论采取正确的护理措施干预，可降低患者发生新的并发症，促进患者康复。     

1例脾动静脉瘘致肝硬化血性腹水合并全身多发血肿患者的护理

总结1例脾动静脉瘘致肝硬化血性腹水合并全身多发血肿患者的护理经验。护理要点包括:脾动静脉瘘导致血性腹水和消化道出血的病情观察过程中,大出血的识别和早期干预;抗静脉血栓栓塞治疗过程中出血倾向观察和多发性血肿的识别及干预。经实施上述综合护理措施,患者住院33 d后病情好转出院。