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 investigate the clinical significance of routine application of choledochoscope during operation of biliary duct. Methods The clinical data of 136 patients with the routine application of intraoperative choledochoscope dealing with bile duct diseases in this hospital from October 2003 to July 2009 were analyzed and summarized. Results Intraoperative choledochoscope inspection, taking stones and targeted surgery were performed in 116 cases with extrahepatic and (or) intrahepatic bile duct stones. The taking out rate of extrahepatic bile duct stones was 100% (85/85), the residual stone rates of extrahepatic and intrahepatic bile duct were 0 (0/85) and 22.6% (7/31), respectively, with the total residual stone rate was 6.0% (7/116). By using intraoperative choledochoscope, benign intrahepatic bile duct stricture was found in 13 cases, malignant extrahepatic and intrahepatic bile duct stricture in 8 cases. Four cases of hilar cholangiocarcinoma and 4 cases of common bile duct cancer, 2 cases of lower segment of common bile duct polyp, 3 cases of hepatolithiasis with the left hepatic bile duct carcinoma were diagnosed by biopsy via choledochoscope. Causes were confirmed by applying choledochoscope in 16 patients with obstructive jaundice. The use of choledochoscope with surgical treatment enabled benign and malignant bile duct stricture to achieve good results, without serious complications such as bile duct dilaceration, subphrenic abscess or acute cholangitis. Conclusions Using choledochoscope can tremendously reduce the residual rate of stone in biliary duct surgery, increase the definite diagnosis rate of biliary duct diseases and play a role of reasonable instruction in its treatment options. It has unique advantages in identifying causes of jaundice. It is remarkable that the role of applying choledochoscope to diagnose and cure biliary duct diseases. It should be widely used.
Objective To explore the influence factors for the functional improvement after the fetal olfactory ensheathing cell (OEC) transplantation for chronic spinal cord injury(SCI). Methods The olfactory bulbs were harvested and trypsinized down to single fetal OEC. They were cultured for 12-17 days prepared for use. From November 2001 to December 2003, a total of 300 patients volunteered for the fetal OEC transplantation, among whom 222 suffered from complete chronicSCI and 78 suffered from incomplete chronic SCI. The procedures were performed on the patients with a disease course ranging from 6 months to 31 years (average 3.1 years) after their injuries. The fetal OEC was transplanted by the form of injections into the spinal cord at the upper and lower ends of the injury site. All the patients were assessed by the ASIA standard before the transplantation and 2-8 weeks after the transplantation. The influence factors including age, sex, duration after the injury, and injury degreesand levels were compared with those in the functional improvement after fetal OEC transplantation. Results The partially-improved neurological functions assessed by the ASIA standard were indicated by the motor scores increasing from 39.1±20.6 to 45.9±20.3 (Plt;0.001), the light touch scores from 51.7±24.9 to 63.4±23.0 (Plt;0.001), and the pin prick scores from 53.0±24.2 to 65.3±22.7(Plt;0.001). There was no significant difference in the functional improvement of the motor, light touch, and pin brick when compared with the age, sex, duration after theinjury, and the injury degrees and levels. The motor scores and light touch scores at the cervical level were higher than the scores at the thoracic level. Conclusion The fetal OEC transplantation can partially improve the neurological functions quickly in treatment of the chronic spinal cord injury. All the influence factors except the motor scores and light touch scores, which were higher at the cervical level than at thoracic level, have no impact on the functional improvement after the fetal OEC transplantation.
①供体授精:我们发现,在供体授精的效果方面,尚缺乏高质量证据.②胞浆内精子注射+体外授精:1篇系统评价发现,尚无足够的证据说明胞浆内精子注射+体外授精与单独使用体外授精何者效果更好.③宫腔内人工授精:两篇系统评价发现,宫腔内人工授精较宫颈内授精或自然性交,能明显增加每个周期的妊娠率.④体外授精与配子输卵管内移植:1个RCT显示,尚无足够证据证明体外授精与配子输卵管内移植何者效果更好.
Objective To invesitgate the prevalence of pulmonary thromboembolism （PTE） in hospitalized patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）from January 2004 to December 2008，and analyse its impact on the severity of OSAHS. Methods Demographic and clinical characteristics of 24 OSAHS patients complicated with PTE were analyzed. 30 OSAHS patients without PTE were served as controls. Results PTE was detected in 2.44% （31/1268） of the OSAHS patients. When compared with the OSAHS patients without PTE，the OSAHS patients with PTE had a significantly higher apnea hypopnea index （AHI） [（27.8±11.6）/h vs. （18.2±8.1）/h，P=0.038] and a lower LSpO2 （lowest saturated pulse arterial oxygen level） [（78.4±8.5）% vs. （85.2±7.9）%，P=0.035]. Both groups received continuous positive airway pressure （CPAP） ventilation. Anticoagulation and/or thrombolysis treatment were used in the OSAHS patients with PTE. Conclusions We found a higher prevalence of PTE in patients with OSAHS. Compared with those without PTE，OSAHS patients with PTE have more severe sleep apnea-hypopnea and hypoxemia in sleep. Comprehensive treatments including anticoagulation and CPAP should be used in these patients.
【Abstract】 Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure. Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory filure since October 2009 were retrospectively analyzed. Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever, dyspnea, severe hypoxemia, large amounts of bloody sputum, wet rales over both lungs, and with other organs involved or even septic shock. Early lung pathological features were inflammatory exudate in alveoli and lung interstitium, infiltration of inflammatory cells, and extensive hemorrhage. Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa, replaced of alveolar spaces by fibrosis. Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS. Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of greatsignificance for effective and timely treatment.
Severe heart and great vessel injuries were a fatal traumatic entity. How to improve the survival rate of these victims still was a challenge to date. This paper included： the pathogenesis and resuscitation of commotio eordis ; traumatic pericardial rupture associated with heart luxation and/or diaphragmatocele in pericardial cavity; indication selection of emergency room thoracotomy for severe heart injury and traumatic aortic disruption treated with endovascular stent graft. For the purpose of increasing our recognition of the severe trauma and making the early diagnosis and management as early as possible. The main relative references published in recently 5 years were reviewed.
ObjectiveTo explore the pathogenesis, diagnosis and treatment of superior mesenteric artery syndrome (SMAS) complicated with Wernicke encephalopathy (WE). MethodsThe clinical data of 11 cases of SMAS patients complicated with WE were retrospectively analyzed. ResultsOf 9 SMAS patients complicated with WE, 8 patients were gradually awake and the time of consciousness recovery was from 7 d to 9 weeks (mean 5.2 weeks). Another 1 patient died of multiple organ failure attributed to severe condition. The symptoms of ophthalmopegia and ataxia in the rest 2 patients improved. All of symptoms such as ataxia, nystagmus, tinnitus, nausea, and sweating gradually disappeared. The nystagmus disappeared from 3 h to 4 d (mean 2.3 d) in five patients and the ataxia disappeared from 3 d to 12 weeks (mean 7.0 weeks) in 4 patients. The tinnitus, nausea, and sweating in 6 patients disappeared within 1 week. ConclusionImproving the understanding of SMAS complicated with WE is important during clinical practice and early diagnosis and intervention is the key point for a good prognosis.
Objective To summarize the current status and progress of treatment for ductal carcinoma in situ （DCIS）. Methods The related literatures on actuality and advancement of treatment for DCIS were searched and reviewed. Results As the increase of incidence， the treatment options for DCIS continued to evolve. Surgical treatment options included mastectomy and breast-conserving surgery. Postoperative radiation therapy in combination with breast-conserving surgery was considered to be the standard for the decrease of local recurrence. The role of endocrine therapy was also being evaluated currently. Conclusions Breast-conserving surgery and combined therapy have became the main methods for treatment of DCIS. Further studies are necessary to determine which subset of patients with DCIS require only surgery alone without adjuvant therapy. Minimally invasive treatment will be a developing direction of DCIS.
Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.