急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

保留部分上鼓室外侧壁鼓室成形术临床初探

目的 :探讨保留部分上鼓室外侧壁鼓室成形术的临床价值。方法 :对 4例慢性化脓性中耳炎患者行保留部分上鼓室外侧壁鼓室成形术的临床资料进行回顾性分析。结果 :经随访半年 ,听力提高 10～ 2 0dB ,鼓膜外形正常 ,全部干耳。结论 :保留部分上鼓室外侧壁鼓室成形术能有效提高听力和干耳率 ,且手术安全     

中药“二黄”滴耳剂治疗急慢性化脓性中耳炎的临床观察(附1000例分析)

本文总结了“二黄”滴耳剂治疗急慢性中耳炎1000例，结果表明总有效率为89％，尤其对急性化脓性中耳炎效果更为明显，与其它抗生素相比具有很多优点。抗菌谱广，对革兰氏阳性菌及革兰氏阴性菌、病毒都有一定作用，低浓度抑菌，高浓度杀菌，不易产生抗药性及过敏反应，对第八对脑神经无毒性，价格低廉应用方便优于任何一种抗生素。     

急性鼻窦炎模型大鼠服用鼻渊舒口服液后血清中锌离子浓度的变化研究

目的 :探讨鼻渊舒口服液对大鼠实验性急性化脓性鼻窦炎的治疗情况及其作用机理 ,为临床推广应用中医药治疗鼻窦炎提供实验依据。方法 :采用向大鼠上颌窦腔内注射金黄色葡萄球菌混悬液法 ,建立实验性急性化脓性鼻窦炎模型。结果 :实验性急性化脓性鼻窦炎大鼠一般情况较差 ,鼻渊舒口服液低、中剂量治疗后症状明显改善。其中鼻渊舒中剂量提高了模型大鼠血清锌离子浓度。鼻渊舒口服液高剂量组无明显改善。结论 :推测适宜浓度范围的鼻渊舒口服液通过调整体内微量元素锌离子浓度 ,从而来调节机体新陈代谢 ,增强机体免疫功能等作用达到有效地治疗鼻窦炎的目的。     

Lacrimal gland abscess in children: Two case reports and literature review

Acute suppurative bacterial dacryoadenitis (ASBD) with abscess formation is rarely seen in clinical practice. A retrospective review of medical records in the past 8 years identified two unilateral cases in children, one developed presumably after methicillin-sensitive Staphylococcus aureus (MSSA) conjunctivitis and the other due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Computerized tomography scans showed globe indentation by the enlarged lacrimal glands with rim-enhancing lesions. After failing to respond to intravenous antibiotics, both abscesses resolved promptly with surgical drainage without any long-term sequelae.     

MRI在急性化脓性骨髓炎早期诊断中的应用及临床意义

目的探讨MRI在急性化脓性骨髓炎早期诊断中的应用及临床意义,为早期诊断及临床治疗提供影像学依据。方法 8例经临床证实的急性化脓性骨髓炎患者于发病后2~14 d分别行X线、CT及MRI检查,分析各项检查结果。结果 X线检查结果显示:28例病程12 d内仅见局部软组织肿胀;2例病程14 d可见局限性骨质疏松,未见骨皮质破坏。CT检查结果显示:28例病程7 d仅见局部软组织肿胀;4例病程7~10 d可见局限性骨质疏松,病程10 d后可见明显骨皮质破坏及骨膜反应表现。MRI结果显示:28例病程2 d内可见局部软组织肿胀;25例3 d内骨髓内可见异常信号影;27例6~14 d内可见明显骨膜反应及骨质破坏。结论 MRI在急性化脓性骨髓炎的早期诊断中优于X线及CT,为临床早期治疗提供了影像学依据。     

Etiological factors associated with chronic suppurative otitis media in a population of Han adults in China

Objective: Risk factors for chronic suppurative otitis media (CSOM) were not clearly established. The study was to investigate the etiological factors for CSOM from a population of Han adults in China.

Methods: A case-control study was conducted at Second Affiliated Hospital of Xi’an Jiaotong University, School of Medicine in China. A total of 416 individuals participated in this study, which included 206 cases and 210 controls.

Results: Multivariate logistic regression analysis revealed male (OR?=?0.42; 95% CI: 0.21–0.83), BMI increasing (OR?=?0.85; 95% CI: 0.77–0.93), URTI (OR?=?152.85; 95% CI: 34.11–684.93), smoke/passive smoke (OR?=?7.11; 95% CI: 3.36–15.07), residential location (urban area) (OR?=?0.27; 95% CI: 0.13–0.56), serum calcium increasing (OR?=?0.09; 95% CI: 0.01–0.71) were prime risk factors for CSOM. Univariate analysis revealed that low socioeconomic status (OR=?2.33; 95% CI: 1.57–3.45) and hepatitis B (OR?=?4.90; 95% CI: 1.82–13.21) were risk factors together with the above variables.

Conclusion: This study has identified several variables as risk factors for CSOM, suggesting better healthcare, living condition, as well as better nutrition might decrease the development of CSOM. Further studies are necessary to assess the outcome of CSOM after interventions in the etiological factors.     

乳腺炎性病变的超声造影增强表现及误诊分析

目的 探讨乳腺炎性病变的超声造影增强表现并分析其误诊原因。方法 回顾性分析已证实的43个乳腺炎性病灶,定性分析其超声造影增强表现及其符合的造影预测模型,并对其误诊原因进行分析。结果 乳腺炎性病变符合乳腺造影恶性预测模型,主要表现为快进、非向心性、不均匀性高增强,增强后病灶变大等恶性病变的特点,与乳腺癌极为相似,其中以化脓性乳腺炎、浆细胞性乳腺炎及肉芽肿性乳腺炎等病理类型多见。结论 乳腺炎性病变病理特征复杂多变,超声造影后仍易误诊为乳腺癌,需结合临床症状及多种影像学诊断技术综合判断,最终确诊需依靠病理诊断结果。     

Recurrent deep neck abscess and piriform sinus tract: A 15-year review on the diagnosis and management

Background

Piriform sinus tract (PST) is a rare congenital condition. A delay in diagnosis is common leading to recurrent inflammation.

Method

A retrospective review was performed on all cases of PST treated at a tertiary referral centre between May 1997 and May 2012.

Results

Eighteen patients were reviewed with a mean age of 5.4 years at presentation (ranged from 0 day to 14 years). Most patients presented as acute inflammation (88.9%) and 16 had a left sided lesion. 72.2% of the PST are identified by contrast swallow study. The diagnostic yield was significantly higher if the study was done after the initial acute inflammation settled. Ultrasonography and computer tomography are less sensitive. The median duration from presentation to diagnosis was 17.6 months (ranged 0–120 months). Ten patients (55.6%) experienced recurrent inflammation before confirming the diagnosis. Fistulectomy alone was performed in 15 patients while an additional en-bloc hemithyroidectomy was done in 2 patients.

Conclusion

PST should be suspected in children presenting with a left deep neck abscess. Contrast swallow study is very effective in making diagnosis but has to be postponed after the acute inflammation settles. The condition can be effectively treated by fistulectomy without hemithyroidectomy in majority of our cases.