Objective To evaluate the effect of regiono-perfusional chemotherapy of pancreatic adenocarcinoma, and to seek the management of its complications. MethodsThirty-six patients with unresectable pancreatic adenocarcinoma received selectively intra-arterial catheterization and perfused with 5-Fu, ADM, DDP. Results Six patients had complete response, 15 partial response, and one underwent radical resection subsequently. Cmplications occurred in 14 patients with 2 patients died of complications.Conclusion Regiono-perfusional chemotherapy of pancreatic adenocarcinoma is effective, but the complications can not be neglected.
Objective To review the progress in the diagnosis and treatment of distal tibiofibular syndesmosisinjury. Methods Different kinds of documents were widely collected, current developments of the diagnosis and treatmentof distal tibiofibular syndesmosis injury were summarized. Results The disease history (damage mechanism), cl inicalexamination, and imaging examination (X-ray, CT scan, and MRI) can assist the diagnosis of distal tibiofibular syndesmosisinjury. Patients with unstable distal tibiofibular syndesmosis injury needs active surgery treatment, and the princi ple isanatomical reduction and fixation so as to avoid the instabil ity of the ankle joint, long-term chronic pain, and traumaticarthritis. Conclusion The diagnosis of distal tibiofibular syndesmosis injury is still lack of specific quantitative parameters, socl inical study for large sample is needed to explicit the effectiveness.
【Abstract】Objective To investigate the protective effect of improving the pancreatic ischemia and calcium channel blockers on preventing the progression of acute pancreatitis. Methods Twenty-four patients with mild acute pancreatitis were randomly divided into two groups： control group and treated group. Within the first 72 hours from the onset of AP, routine conservative managements were performed in control group, improving the pancreatic ischemia and preventing Ca2+ overload were performed in treated group for two weeks. The hemorrheological parameters were measured at 1,4,7,14 days after adimission, simultanously, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were determined with ELISA methods. Results The hemorrheological changes were improved in treated group, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were significantly decreased each time point in treated group as compared with control group. Conclusion Improving the pancreatic ischemia and calcium channel blockers have protective effect through reducing the generation of cytokines and inflammatory mediators on preventing the progression of acute pancreatitis.
ObjectiveTo summarize the experience of diagnosis and treatment on primary gastric lymphoma. MethodsThirtyseven patients, proved by pathology, were included in the study. ResultsAmong clinical presentation, the upper abdominal pain, intestinal bleeding, and weight loss were common. Only 4 cases were diagnosed as PGL in 33 cases with the examination of Xray barium meal, 88.5% ( 23 of 26 cases) were missdiagnosed as gastric ulcer under gastroscopy. All cases underwent operation, among them 33 had been performed a radical operation. The survival period was over 5 years in 12 of 25 patients who have been followed up. ConclusionThe multiple biopsy sampling from submucosal layer via gastroscope may improve diagnostic rate on primary gastric lymphoma. Operative removal of the tumor should be the first choice of treatment. Additional chemotherapy after the surgery increases the fiveyear survival rate.
Abstract: Prosthetic valve endocarditis(PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. In the past nearly five decades, the microbiology, pathophysiology, clinical features, and therapeutic options in PVE have changed a lot, and there are new insight into the pathogenesis of PVE. The current comprehensive review will address various issues involved in the diagnosis and management of this complication.
Objective To investigate the efficiency of combining traditional Chinese medicine with western medicine in the treatment of severe acute pancreatitis (SAP). Methods The clinical results of sixty three cases of SAP of non-operative treatment with injection of Salia miltorrhizae composita, and oral or gastric tube feeding of decoction Qing-Yi-Tang were retrospectively studied. Results Thirty four cases were categorised as SAP Ⅰ grade, and 29 cases as SAP Ⅱ grade. A variety of complications occurred in 19 cases (30.16%), 3 patients died (4.76%), and 4 patients developing abscess of pancreas (6.35%) which had to be operated on.Conclusion The individualization principle on the basis of cause and clinical stage of the disease should be stressed in treating SAP. The patients who had complication needing to be operated on should be timely performed. There is a good efficiency in the treatment of SAP with the traditional Chinese medicine combining with western medicine.
Objective To evaluate the efficacy and safety of Levofloxacin combined with Cefoperazone/Sulbactam on the patients with ventilator-associated pneumonia ( VAP) . Methods The clinical effect of Levofloxacin combined with Cefoperazone/ Sulbactam on ventilator-associated pneumonia in 58 paitiens with VAP were retrospectively analyzed. Results 26 patients ( 44. 8% ) were cured, 18 patients( 31. 1% ) were marked improved, and 14 patients ( 24. 1% ) were ineffective. The total clinical efficacy rate was 75. 9% . 55 strains of bacteria were isolated, and Gram-negative bacilli were dominant pathogens( 78. 2% ) . The bacterial clearance rate was 78. 2% . The prevalence of adverse reaction was 5. 1% . Conclusion Levofloxacin combined with Cefoperazone/ Sulbactam is effective and safe for patients with VAP.
ObjectiveTo evaluate the efficacy of intravenous glutamine on patients with severe acute pancreatitis. MethodsThe Cochrane Library, PubMed, EMbase, CNKI and CBM databases were searched up to January 2013. Randomized controlled trials (RCTs) that compared non-glutamine nutrition with intravenous glutamine supplemented nutrition in patients with severe acute pancreatitis were included. A method recommended by the Cochrane Collaboration was used to perform a meta-analysis of those RCTs. ResultsFour RCTs involving a total of 190 participants were included. Analysis of these RCTs revealed the presence of statistical homogeneity among them. Results showed that glutamine dipeptide had a positive effect on reducing the mortality rate[OR=0.26, 95%CI (0.09, 0.73), P=0.01], length of hospital stay[WMD=-4.85 d, 95%CI (-6.67, -3.03) d, P<0.001], and the rate of complications[OR=0.41, 95%CI (0.22, 0.78), P=0.006]. No serious adverse effects were found. ConclusionCurrent best evidence demonstrates that glutamine is effective for severe acute pancreatitis. Further high quality trials are required and parameters of nutritional condition and hospital cost should be considered in future RCTs with sufficient size and rigorous design.
Objetive To investigate the clinical characteristics, diagnosis, and treatment for diffuse alveolar hemorrhage. Methods The clinical data of 17 patients admitted to respiratory ICU with diffuse alveolar hemorrhage from July 1998 to May 2008 were reviewed. Results In the 17 cases, Wegener granulomatosis accounted for 6 cases, microscopic polyangiitis for 3 cases, systemic lupus erythematosis for 4 cases,mitral stenosis for 2 cases, and idiopathic pulmonary hemosiderosis for 1 cases. Clinical presentations included fever ( 76. 4% ) , hemoptysis( 47% ) , anaemia ( 100% ) , dyspnea ( 100% ) , hypoxaemia ( 100% ) ,and elevated total count of white blood cells ( 76. 4% ) . The titer of antineutrophil cytoplasmic antibody ( c-ANCA, p-ANCA) was 1∶( 46. 0 ±3. 7) , 1 ∶( 108. 0 ±16. 1) , respectively. Hemoglobin was ( 78. 0 ±2. 4) g/L. Bronchoalveolar lavage fluid presented with blood accounted for 35. 3% . Siderophages was found in all cases. Computed tomography showed areas of consolidation interspersed with areas of ground-glass attenuation and reticular interstitial opacities. Mortality was 29. 4% . Conclusions Diffuse alveolar hemorrhage is an acute life-threatening event. The clinical presentations of hemoptysis, dyspnea, and anaemia, and chest imaging studies provide clues to diagnosis of diffuse alveolar hemorrhage. Corticosteroids and immunosuppressive agents have proven effective in diffuse alveolar hemorrhage.
OBJECTIVE: To discuss the diagnosis and treatment of tarsal tunnel syndrome. METHODS: From 1998 to 1999, 10 cases of tarsal tunnel syndrome were reviewed, and the outcomes of operation were analyzed according to Pefeiffer’s method. Out of 10 cases, 6 were examined using electromyography preoperatively. RESULTS: After 1 to 2 year follow-up, postoperative outcomes were excellent in 5 cases, good in 4 cases, and poor in 1 case according Pefiffer’s methods. CONCLUSION: A combination of symptoms and physical signs, and electromyography may increase the diagnosis rate; and early operation will improve the therapy results.