应用中心静脉导管治疗自发性气胸的疗效观察及护理

目的对比分析中心静脉导管与普通胸腔抽气或闭式引流治疗自发性气胸的疗效，并总结中心静脉置管治疗自发性气胸的护理要点。方法将100例自发性气胸患者按治疗顺序分为治疗组和对照组，每组各50例。治疗组采用中心静脉导管胸腔抽气或引流；对照组采用普通胸腔穿刺针接50mL注射器抽气或行胸腔闭式引流。结果2组患者自发性气胸治愈率比较无统计学差异（P〉0．05）；而2组在胸膜反应的发生情况和住院时间方面比较有统计学差异（均P〈0．05），其中治疗组胸膜反应发生率低于对照组，而住院时间短于对照组。结论应用中心静脉导管治疗自发性气胸并发症少，置管期间辅以护理人员的精心护理，有利于减轻患者痛苦、缩短住院时间。     

Early response to pulse oximetry alarms with telemetry

Twenty ICU patients were monitored for an average of 45 hr each, with both bedside and nursing station monitors, which were set to alarm audibly if the patient’s oxygen saturation dropped below 90%. Bedside alarms alerted caregivers to 51 of the 74 hypoxemic events; central alarms alerted personnel to the other 23 events. The alarms led to a change in treatment in 35 of the 48 (73%) true desaturation episodes. We conclude that central oximetric monitoring may help with detection of arterial desaturation events even in a well-staffed ICU.     

不同护理方式对肿瘤患者置管并发症的影响

目的探讨肿瘤患者经外周静脉穿刺置人中心静脉导管（peripherally inserted central catheter，PICC）在化疗间歇期居家护理对并发症的影响，以减少并发症发生，延长导管留置时间及使用寿命。方法将213例PICC并携带导管出院的肿瘤患者，随机分为定期回本单位护理组108例和社区护理组105例，比较2组患者间歇期并发症的发生情况。结果回本单位护理组总的并发症发生率为13．8％（15／108），社区护理组总的并发症发生率为51．4％（54／105），差异有统计学意义，P〈0．01。结论肿瘤患者PICC居家护理方式与导管留置过程并发症发生率有相关关系，建议患者尽可能回本单位护理以避免并发症的发生。     

集束化护理干预在PICC置管病人中的应用

[目的]观察集束化护理干预在经外周静脉置入中心静脉导管(PICC)病人中的应用效果。[方法]将120例留置PICC的病人按照入院顺序分为对照组与观察组,每组60例,对照组病人给予常规护理,观察组病人实施集束化护理,对两组病人的护理效果进行比较。[结果]观察组的静脉穿刺次数、制动时间及PICC置管时间均显著少于对照组(P0.05);干预后观察组血D-二聚体(DD)及同型半胱氨酸(Hcy)水平显著低于对照组(P0.05);观察组静脉血栓(VT)发生率显著低于对照组(P0.05)。[结论]在PICC置管病人中应用集束化护理管理能够减少VT发生,延长PICC使用时间。     

Intraparenchymal myofibromatosis of the brain in an adult: report of an unusual case

An unusual case of intraparenchymal myofibromatosis of the brain occurring in a 29‐year‐old woman is described. Preoperative CT and MRI examinations revealed two well‐circumscribed nodular masses localized in the wall of the left lateral ventricle and right temporal lobe, respectively. Both masses were completely resected, and the patient remains disease‐free 2 years post‐surgery. Histopathologically, the lesions were characterized by stratification. From outer to inner, there was a reactive glial component, lamellated well‐differentiated muscle‐like cells, densely compact collagen fibers and cellular tumor with nodular and hemangiopericytoma‐like patterns, respectively. The myofibroblastic nature of this tumor was verified by immunohistochemical staining and ultrastructural analysis. Intraparenchymal myofibromatosis may be confused with, and should be distinguished from, meningioma, myopericytoma, solitary fibrous tumor, leiomyoma and inflammatory myofibroblastic tumor for accurate diagnosis and optimal treatment.     

Embryonal tumor with abundant neuropil and true rosettes: Morphological,immunohistochemical, ultrastructural and molecular study of a case showing features of medulloepithelioma and areas of mesenchymal and epithelial differentiation

Embryonal tumors are a group of malignant neoplasms that most commonly affect the pediatric population. Embryonal tumor with abundant neuropil and true rosettes is a recently recognized rare tumor. It is composed of neurocytes and undifferentiated neuroepithelial cells arranged in clusters, cords and several types of rosettes in a prominent neuropil‐rich background. We describe a new case of this tumor. The patient, a 24‐month‐old female infant, was referred to the Meyer Children's Hospital with a history of right brachio‐crural deficit associated with occasional episodes of headache and vomiting. Computed tomography scan and MRI revealed a large bihemispheric mass. The patient underwent two consecutive surgeries. The resultant surgical resection of the tumor was macroscopically complete. The postoperative period was uneventful. On light microscopy the tumor showed a composite morphology: embryonal tumor with abundant neuropil and true rosettes (specimen from the first surgery); medulloepithelioma with mesenchymal and epithelial areas (specimen from the second surgery). The immunohistochemistry evidenced the heterogeneous (neuronal, mesenchymal and epithelial) immunoprofile of tumoral cells. By real‐time polymerase chain reaction (RT‐PCR), the PTEN gene expression in the tumor was lower than in the five non‐neoplastic brain tissues used as control. Mutation analysis did not show any variation in INI‐1 and PTEN sequence while P53 analysis showed the presence of homozygote P72R variation. Fluorescent in situ hybridization analysis showed polysomy of chromosome 2 while amplification of N‐MYC was not detected. Owing to the rarity of embryonal tumor with abundant neuropil and true rosettes, each new case should be recorded to produce a better clinical, pathological and molecular characterization of this lesion.     

B‐cell dominant lymphocytic primary angiitis of the central nervous system: Four biopsy‐proven cases

We report four cases of biopsy‐proven B‐cell‐rich primary angiitis of the central nervous system (PACNS). The mean age of the patients was 29 years (range, 23–37 years). The patients suffered from unilateral weakness (n = 2), seizure (n = 1), and hypersomnia, anorexia and confusion (n = 1). The vital signs and the results of laboratory tests were within normal limits in all the four cases except erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP). ESR was elevated in one patient and CRP was elevated in two patients. The magnetic resonance imaging (MRI) scans revealed single (n = 2) or multiple (n = 2) irregularly enhancing lesions. Radiological studies initially indicated tumors such as glioma (n = 2) or lymphoma (n = 1), except in one case, in which the radiological analysis indicated vasculitis or demyelinating disease. All the cases involved both medium‐sized (50–250 µm in diameter) and small‐sized vessels (20–49 µm in diameter). The vascular, perivascular and parenchymal lymphocytes were polymorphous; however, CD20‐positive B‐cells were predominated in blood vessels while the CD8‐positive T‐cells infiltrated predominantly in brain parenchyma. Therefore, our patients revealed B‐cell dominant lymphocytic vasculitis. Two patients who underwent active treatment (corticosteroid alone or with cyclophosphamide) showed remarkable clinical and radiological improvement but two patients still have initial neurological symptoms, namely, confusion and newly developed seizures, respectively, during the 19–101‐month follow‐up periods; this effect can be attributed to irreversible brain damage. Therefore, although early brain biopsy may be associated with histopathologic diagnostic pitfalls, it is a mandatory procedure for obtaining a confirmative diagnosis as well initiating early therapy, thereby reducing brain damage.     

Dual pathology in Rasmussen's encephalitis: A study of seven cases and review of the literature

Dual pathology has previously been reported in less than 10% of cases of Rasmussen's encephalitis (RE). Given the rarity of RE, it appears unlikely that dual pathology in RE is merely a coincidence. We therefore reviewed all cases of RE experienced in our institution to assess for an additional/associated pathology. A total of seven patients with RE were identified in our archives. Seven children (4 boys and 3 girls, age range: 3–16 years, mean: 9.5 years) with medically refractory epilepsy underwent surgical resection for intractable seizures. The surgical specimens were examined with routine neurohistological techniques, and immunohistochemistry was performed with an extensive panel of antibodies for viruses, lymphocytes, microglia/macrophages, human leukocyte antigen (HLA)‐DR, astrocytes, and neurons. Relevant literature was reviewed. Microscopically, all seven cases demonstrated the inflammatory pathology of RE in the cortex and white matter with leptomeningeal and perivascular lymphocytic infiltration, microglial nodules with/without neuronophagia, neuronal loss and gliosis. The HLA‐DR antibody was extremely helpful in highlighting the extent of microglial cell proliferation/activation that was not appreciable with standard histology. An unexpected finding in all seven cases was the presence of cortical dysplasia. In our series of seven cases, there was co‐occurrence of the inflammatory/destructive pathology of RE with malformative/dysplastic features in cortical architecture in 100% of cases, raising questions about the possible relationships between the two entities. Awareness of the possibility of dual pathology in RE is important for clinical and pathological diagnosis, and may affect the management and outcome of these patients. Immunohistochemistry is very helpful to make a definitive diagnosis of both pathologies.