黄芪建中汤加减联合针刺治疗消化性溃疡

目的探究黄芪建中汤加减方联合针刺治疗消化性溃疡(脾胃虚寒型)的疗效。方法选取2016年6月-2019年6月本院门诊收治的消化性溃疡(脾胃虚寒型)患者96例作为研究对象,年龄在26~68周岁。根据门诊单双号分为治疗治疗组和对照组,每组48例。对照给予常规口服埃索美拉唑镁肠溶片、阿莫西林胶囊、克拉霉素缓释片、胶体果胶铋胶囊等,治疗组则给予黄芪建中汤加减联合针刺治疗,疗程6周。观察两组患者治疗有效率及不良反应,并采用专业量表调查患者治疗前后中医症候积分、简式McGill疼痛问卷结果。结果两组疗效对比显示,治疗组总有效率明显高于对照组,差异对比有统计学意义(P <0.05);两组患者在中医症候积分、简式McGill疼痛问卷各项积分方面均有显著降低,提示两组均有明显治疗效果。治疗组简式McGill疼痛问卷表中VAS、PPI及PRI(感觉项总分、情感项总分)、差异有统计学意义(P <0.05)。两组不良反应发生情况差异无统计学意义(P> 0.05)。结论黄芪建中汤联合针刺治疗可有效缓解消化性溃疡(脾胃虚寒型)患者中医症候及降低简式McGill疼痛问卷各项积分,疗效可靠,值得临床应用。     

Unusual association of Axenfeld-Rieger syndrome and wandering spleen:A case report

BACKGROUND Axenfeld-Rieger syndrome(ARS)is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering spleen(WS)has not been reported to date to the best of our knowledge.This study aimed to describe a rare case of ARS observed at our emergency department.CASE SUMMARY A 25-year-old female presented with a constant lower abdominal pain of increasing severity.Diagnostic computed tomography with intravenous contrast material showed a non-homogenously enhanced splenic parenchyma with a twisted vascular pedicle.Further,an emergent laparoscopic exploration was performed,and an ischemic spleen without its normal ligamentous attachments was noted.Notably,the spleen did not regain its normal vascularity after detorsion;thus,we performed the laparoscopic total splenectomy.The postoperative course was uneventful,and the patient was discharged on the 5th postoperative day.This case demonstrates a rare association of WS and ARS.CONCLUSION Early diagnosis of WS in the emergency department is important to prevent pedicle torsion or splenic necrosis and to avoid splenectomy.     

Tumour-like lesions of the spleen

Tumour-like lesions of the spleen are very rare lesions but can cause diagnostic confusion due to their varying morphologic patterns. These lesions behave in a benign fashion. Included in this group are hamartomas, sclerosing angiomatoid nodular transformation (SANT), inflammatory pseudotumors, and possibly IgG4-related disease. Clinically, these lesions are often discovered incidentally on imaging or at autopsy. However radiological and morphological findings can be misleadingly worrisome. It is therefore important to be familiar with these lesions to distinguish them from malignant lesions.     

32例自体血回输在外伤性脾破裂手术中应用的临床研究

目的研究分析在外伤性脾破裂手术中的自体血回输的适应症、流程、安全性等问题。方法选取2010年1月—2013年1月间入院治疗的单纯外伤性脾破裂患者32例,应用自体血液回收技术回输,注意流程的严密性、科学性,加强护理干预操作。结果 32例患者通过自体血回输,有效扩充了血容量,平安度过危险期,均安全出院。32例患者中自体回输血量28160mL,占总引流血量49060mL的57.40%,其中最小回输550mL,最多1400mL,平均回输880mL。其中7例患者应用异体输血共2870mL,占总输血量的10.21%。3例发热患者2例伤口感染经对症处理后恢复正常,无溶血反应,未见持续出血、输血后并发症、过敏反应、细菌污染等疾病。结论外伤性脾破裂中应用自体血回输,操作简便,安全可靠,患者并发症较少,并且减少了血资源的浪费和异体输血排异反应及传染疾病的发生率。     

针刺肾俞五十七穴配合闪罐法治疗肝郁脾虚型肥胖并发高脂血症104例

目的 :探讨针刺肾俞穴配合闪罐法治疗肝郁脾虚型肥胖并发高脂血症的临床疗效。方法 :208例患者随机分为治疗组与对照组,每组104例,治疗组给予针刺肾俞穴配合闪罐法,对照组给予普通针刺治疗。观察两组患者治疗前后各项肥胖指标、血脂指标的变化,并统计临床疗效。结果:两组临床疗效总有效率分别为92.31%、74.04%,差异有统计学意义(P<0.05);治疗后治疗组与对照组在肥胖指标、血脂指标方面比较差异有统计学意义(P<0.05)。结论:针刺肾俞穴配合闪罐法治疗肥胖并发高脂血症具有减肥降脂双重作用,针刺肾俞穴配合闪罐法治疗肥胖并发高脂血症疗效优于普通针刺组。     

Effects of early and late adverse experiences on morpho-quantitative characteristics of Sprague-Dawley rat spleen subjected to stress during adulthood

Morpho-quantitative studies of the spleen indicate that the proportions of the compartments and sub-compartments are stable in normal conditions. However, disorders due to stress can influence the number and function of the immune cells in this organ. The aim of this study was to determine, through the model of altering the early mother-infant bond and altering the late social bond through isolation, the effect on the morpho-quantitative characteristics of the spleen in adult Sprague-Dawley rats subjected to intermittent chronic stress in adulthood. Twenty-five newborn female rats were used, kept under the standardized lactation and feeding conditions. The rats were assigned randomly to 2 control groups (C1 and C2) and 3 experimental groups, exposed to early (E1), late (E2) or early-late (E3) adverse experiences and then subjected to intermittent chronic stress in adulthood (C2, E1, E2 and E3). The spleen of each animal was isolated and its morphometric characteristics were determined: volume density (Vv) of the red pulp, white pulp, marginal zone, splenic lymph nodule, periarterial lymphatic sheath and germinal center; areal number density (Na), surface density (Sv), number density (Nv), diameter (D) and total number of splenic lymph nodules. The mass of each compartment was also determined. A one-way analysis of variance (ANOVA) and Scheffé’s post hoc test were used for the statistical analysis. The p values were considered significant when they were less than 0.05 (*) and very significant at less than 0.025 (**). There were significant differences in the Vv of the red pulp, white pulp and their sub-compartments between the control and experimental groups. The white pulp increased significantly (P = 0.000) in E1, E2 and E3 compared to C1 and C2. The average Na and D values of the splenic lymph nodules were also higher in the experimental groups. The ANOVA for the mass of the spleen and the red pulp revealed no differences between the groups. The mass of the white pulp and its subcompartments was greater in the experimental groups. A higher proportion of white pulp in the experimental groups could be associated with an increase in spleen immune activity, with alterations depending on certain cell subsets. The chronic stress produced morpho-quantitative changes in the rat spleen, and these depended on the animal’s history of stress, whether it had been previously stressed or not, with further exposure to stress in adulthood.     

脾胃湿热证胃炎患者舌苔脱落细胞中微核细胞及P53表达

[目的]探讨脾胃湿热证和脾气虚证慢性浅表性胃炎患者舌苔脱落细胞微核细胞和P53表达的意义.[方法]用Feulgen法和免疫细胞化学法显示正常对照者及脾胃湿热和脾气虚患者舌苔脱落细胞中微核细胞、P53表达.[结果]脾胃湿热组和脾气虚组微核细胞的反应强度及出现频率均高于正常对照组(均P＜0.05);脾气虚组的P53阳性反应高于正常对照组,差异有统计学意义(P＜0.05).[结论]微核细胞在两患者组的舌苔脱落细胞内反应强度及出现频率较高,提示有较多的分裂畸变细胞;而P53的表达与微核细胞的出现有关,两者可能代表了证候发展不同的过程.     

浅析《症因脉治》中脾主运化理论

《症因脉治》是明代医家秦昌遇所撰的临床型医书。脾者,乃仓廪之本,气血生化之源。通过对脾主运化观点的阐释,说明脾主运化的重要性。根据本书特点并结合《症因脉治》中的症、因、脉、治4个方面对脾主运化理论进行探讨,同时结合诸贤附论与临床实践阐明对脾主运化的理解。     

Composite hemangioendothelioma of the spleen with multiple metastases: CT findings and review of the literature

Composite hemangioendothelioma (CHE) is a rare vascular neoplasm of intermediate malignant potential. Only 52 cases have been reported in the English literature, and one case previously reported occurred in the spleen. The purpose of our study was to report a 65-year-old man diagnosed as CHE primary arising from the spleen with multiple metastases.Clinical and imaging features, laboratory tests, and pathological results about CHE were described in detail in this study.The patient presented with multiple lesions in bilateral lungs and spleen that had been incidentally detected by computed tomography (CT). Except for thrombocytopenia, other laboratory tests were not significant. The CT scan of the abdomen revealed multiple round-like and irregularly mixed density masses with unclear borders in enlarged spleen. And contrast enhancement showed mild heterogeneous enhancement. CT scan also showed widespread liver, ribs, lungs, and vertebral bodies metastases. This diagnosis was confirmed by histopathological examination. The patient underwent splenectomy and still survives with tumors after six months followed-up.Due to the lack of specificity of clinical features and laboratory tests, it is necessary to combine imaging features and pathological findings to make a correct diagnosis.