捡了西瓜，就该丢掉芝麻吗——浅谈医源性Wernicke脑病

探讨医源性Wernicke脑病（WE）的病因、临床及磁共振图像特点,回顾性分析6例医源性WE病例。医源性WE病前均有禁食史,其临床表现多样。磁共振图像为中脑导水管周围T2WI及Flair高信号。大部分病例补充维生素B1后可好转。提示医源性禁食导致体内维生素B1耗竭是医源性WE的病因,及时补充维生素B1是预防及治疗本病的关键。     

捡了西瓜,就该丢掉芝麻吗——浅谈医源性Wernicke脑病

探讨医源性Wernicke脑病(WE)的病因、临床及磁共振图像特点,回顾性分析6例医源性WE病例.医源性WE病前均有禁食史,其临床表现多样.磁共振图像为中脑导水管周围T2WI及Flair高信号.大部分病例补充维生素B1后可好转.提示医源性禁食导致体内维生素B1耗竭是医源性WE的病因,及时补充维生素B1是预防及治疗本病的关键.     

原发性阑尾肿瘤30例临床诊治分析

为探讨原发性阑尾肿瘤的临床特点,提高阑尾肿瘤的诊治水平,本文回顾性分析本院2009年1月~2016年7月经手术治疗的原发性阑尾肿瘤30例患者临床资料。本组30例患者临床表现主要为阑尾炎和腹部包块,均经手术和病理确诊,包括黏液性肿瘤19例,阑尾腺癌8例,阑尾类癌2例,恶性淋巴瘤1例。行右半结肠切除术3例,行回盲部切除术8例,15例行单纯阑尾切除,其他手术方式4例。随访25例,2例腺癌术后死于其他疾病,1例粘液性肿瘤死于白血病,1例腺癌于术后10个月复发,余均无复发和转移。阑尾肿瘤临床少见,缺乏特异临床表现,术前诊断困难,主要依靠术中快速冰冻切片和术后病理确诊。手术为主要的治疗方法,术式选择是影响预后的关键因素。     

老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

原发性肝癌术后肝内复发:再手术还是射频消融

观察射频消融治疗原发性肝癌术后肝内复发的临床疗效.选取我院确诊为原发性肝癌行根治性手术治疗后肝内复发且没有肝外转移的患者168例,其中99例患者行射频消融术治疗,69例行再手术治疗.观察两组患者的临床疗效、术后并发症、生存率.结果射频消融及再次手术治疗均能明显消除肝内复发病灶,射频消融治疗组未出现严重并发症,而再手术组1例患者因术后肝功能衰竭死亡.射频消融组和再手术组的1年、2年生存情况差异无统计学意义(P>0.05).应用射频消融治疗原发性肝癌术后肝内复发的临床疗效及预后与再手术治疗类似,但射频消融治疗方法的适应证更宽、术后并发症更少、更易于被患者和家属接受,可推广临床应用.     

2例异位甲状腺误诊的讨论

探讨异位甲状腺的临床特征、诊断及处理.报导2例误诊的异位甲状腺患者的临床资料,其中一例临床诊断为甲状舌管囊肿,另一例临床诊断为血管瘤.结果2例均行手术切除,一例术后证实为副甲状腺,另一例则为迷走甲状腺需终身服用甲状腺素.医生对异位甲状腺的认识不足及诊断思路较窄,是导致误诊、误治的主要原因.     

胃癌行全胃胰体尾脾脏切除并扩大右半结肠切除术15例临床分析

探讨进展期胃体癌浸润周围脏器的联合脏器切除的适应证、手术入路、手术方法及意义.回顾性分析2009年2月至2011年10月我院15例胃癌直接浸润胰腺、脾脏和横结肠而施行全胃切除及胰体尾脾脏切除并扩大右半结肠切除术患者的临床资料.术后出现1例腹腔感染,1例切口感染,经通畅引流、局部冲洗及切口换药后均痊愈出院,无再手术及死亡病例.术后均进行随访,1例在术后14个月时出现局部复发,1年生存率100％,2年生存率38％.以右下腹肾前间隙开始的全胃切除及胰体尾脾脏切除并扩大右半结肠切除术,明显缩短手术时间,符合肿瘤的切除原则,提高了手术的安全性.     

直肠高级别上皮内瘤变经肛肿瘤手术后诊断为pT1b直肠癌患者的再手术指征分析

研究直肠高级别上皮内瘤变经肛肿瘤切除术后pT1b直肠癌患者再行补救性根治术后的临床病理特点、合理的治疗方案及手术指征。经乙状结肠镜或结肠镜活检诊断为41例直肠高级别上皮内瘤变,随后Park经肛直肠肿物切除术或经肛内镜显微手术后确诊为34例≥pT1b直肠癌,再行补救性根治术后最终诊断为29例pT1b直肠癌。pT1b直肠癌按浸润深度分为SM1-2组和SM3组,观察两组临床病理特点。Multivariate回归分析结果,发现淋巴脉管浸润是肿瘤浸润深度的独立预测因素(P0.05)。直肠高级别上皮内瘤变需积极行经肛肿瘤切除术确诊;当其术后浸润深度为SM3的pT1b直肠癌合并淋巴脉管浸润时,建议行积极的补救性根治术等再手术干预。     

TIPS在肝移植术后难治性腹水中的应用

两例肝移植术后患者出现难治性腹水,明确病因、改善一般状况及肝肾功能后,给予TIPS治疗.TIPS术后1周,两例患者腹水消失,至今已分别随访15月、37月,均未出现肝性脑病、肝功能异常等并发症.肝移植术后TIPS的主要适应症为难治性腹水、食道静脉曲张出血及流出道梗阻.TIPS是治疗肝移植术后难治性腹水一种安全、有效的方法,具有一定的临床治疗意义.     

4例剖宫产术后并发肠梗阻的护理

对4例剖宫产术后并发肠梗阻患者进行临床分析,采用保守治疗并及时实施有效的护理措施,4例患者均治疗成功,无肠穿孔、肠坏死等严重并发症发生.认为密切观察腹部体征、及时明确诊断、采用正确的治疗及护理方法是患者痊愈的关键.     

Dieulafoy 病导致上消化道大出血的成功救治体会

一例肾移植术后患者行盆腔磁共振检查后出现剧烈呕吐,引起严重的上消化道大出血,行急诊胃镜后确诊为 Dieu-lafoy 病并给予内镜下钛夹止血治疗,治疗效果满意,随访至今未再复发。消化内镜对于 Dieulafoy 病的诊断及治疗均具有重要的意义：内镜不仅成为 Dieulafoy 病变诊断的首选,也逐渐成为该病治疗及诊断的一线选择方案。本文病例的成功诊治,亦得益于及时的急诊胃镜,故可见胃镜对于 Dieulafoy 病诊治的可行性与重要性。     

Intrusions and perseverations

Twenty-two subjects with presumed senile dementia of the Alzheimer's type (SDAT), twenty-two with dementia other than SDAT, twenty with aphasia, and seventeen healthy controls over 50 years of age were examined for intrusions and perseverations. Perseverations were defined as the immediate inappropriate repetition of a prior response whereas intrusions were defined as the inappropriate repetition of prior responses after intervening stimuli. Intrusions and perseverations occurred in demented and aphasic subjects, but were rare in controls. Intrusions occurred most often in SDAT or Wernicke aphasia, but also in dementia other than SDAT. Intrusions were not correlated with dementia severity. Intrusions are a useful sign of dementia, but they cannot be considered pathognomonic of SDAT. They appear to arise when subjects are unable to access correct responses from long-term memory and instead substitute erroneous responses selected from short-term memory. Perseverations were most common in the Wernicke aphasics and subjects with dementia due to communicating hydrocephalus. Although frontal lobe dysfunction is prominent in communicating hydrocephalus, it is absent in cases of Wernicke aphasia. Thus, we have confirmed prior suggestions that perseveration can occur in the absence of frontal lobe injury. Failure to self-monitor speech as well as an inability to change mental set probably plays an important role in the genesis of perseverations. There was no statistically significant correlation between dementia severity and number of perseverations. Low correlations were found between intrusions and perseverations suggesting that these seemingly similar behaviors are distinct and are probably produced by separate neuropsychological mechanisms.     

地佐辛混合液对预防腭咽成形术苏醒期不良反应观察

比较应用芬太尼和地佐辛在预防腭咽成形术苏醒期,因疼痛以及口咽部呼吸道梗阻引起的患者躁动,恶心呕吐等不良反应情况,寻找最佳药物以及方法组合。200例美国麻醉师协会（ASA）分级I级～Ⅱ级患者,随机分为A、B、C、D四组,给药时间均为手术结束前15分钟,A组：单次静注芬太尼0．1μg·kg^-1;B组单次静注地佐辛0．1mg·kg^-1;C组单次静注地佐辛0．1mg·kg^-1＋氟哌利多2．5mg;D组单次静注地佐辛0．1mg·kg^-1＋氟哌利多2．5mg＋伤口涂抹复方利多卡因乳膏。记录患者苏醒时间,拔管后呼吸抑制,恶心呕吐等情况。结果D组出现恶心呕吐、头痛头晕例数明显少于A、B、C三组（P〈o．05）。手术结束前15分钟单次静注地佐辛O．1mg·kg^-1＋氟哌利多2．5mg＋伤口涂抹复方利多卡因乳膏,对于有效预防腭咽成形术苏醒期疼痛、恶心呕吐、头痛以及躁动是有效的。     

Évolution du contrôle religieux la première année suivant l’annonce d’un cancer du sein : quels liens avec les stratégies de coping,l’anxiété, la dépression et la qualité de vie ?

The aim of this study was to examine the evolution of perception of religious control during the first year after breast cancer diagnosis and to establish how this evolution could have an effect on coping strategies, psychological distress and quality of life. One hundred and seventeen patients completed four self-reports questionnaires at surgery time and 1, 4, 7, 10, 13 months after the first assessment. Findings showed that religious control declined during the first 4 months treatment, although it is stable after. Furthermore, maintenance of religious control was associated with lower helplessness-hopelessness, denial, anxious preoccupations and avoidance and with better emotional and physical quality of life at all times of the study. We found no association with anxiety or depression.     

准确、完整的诊断与临床决策

正确的诊断是正确的临床决策的基础,正确的诊断依赖于详细的病史、准确全面的体格检查、合理的辅助检查资料的分析及正确的临床诊断思维方法。如果其中任何一项被忽视,临床医生可能会做出错误的诊断和错误的治疗,给病人造成不必要的损害。为了避免上述情况的发生,临床医生必须在掌握全面的临床资料的基础上,加以科学的综合分析,这样才能得出正确的诊断,给病人以正确的治疗。     

Listeriosis of the central nervous system in children beyond the neonatal period

Observations on three children with neurolisteriosis (one case of meningitis, two cases of meningoencephalitis, each Serovar 4 b), show that even after the neonatal period, listeriosis must not be ignored in the process of diagnosis and therapy. It is the bacteriological examination of the cerebrospinal fluid, together with the blood culture, and not clinical symptoms and serology that guarantee a timely diagnosis and therapy (ampicillin and gentamicin).     

腹腔肿块外科处理的临床决策

临床经常会面对诊断、来源、性质不清的腹腔内肿块。腹腔内肿块是临床常见的病症之一,大多需要外科手术。如何合理应对、妥善处置、科学决策是临床医师对本病诊治的要求和不懈追求。诊断的过程中,依靠详尽的病史、细致的体格检查、恰当的辅助检查,并进行综合的分析以及逻辑思维,做出正确的鉴别和诊断,以解决是否为腹腔内肿块;而后,尽快确定肿块的部位及性质,确定处理的方法和原则,制订详尽的手术方案和步骤。     

Voice onset time in aphasia: Thai II. Production

The aim of this study was to investigate voice onset time (VOT) production in homorganic word-initial stops in Thai in order to explore the nature of speech production deficits across clinical varieties of aphasia. Thai exhibits a three-category distinction in bilabial (/b,p,ph/) and alveolar (/d,t,t,h/) stops, and a two-category distinction in velar (/k,kh/) stops. Subjects included three Broca asphasics, one transcortical motor asphasic, two global asphasics, one conduction aphasic, one Wernicke aphasic, one nonaphasic dysarthric patient, one right-brain-damaged patient, and five normal controls. Test stimuli consisted of eight monosyllabic real words. The results of VOT measurements indicated that Broca and global asphasics exhibited a more severe production disorder than Wernicke, conduction, or transcortical motor asphasics. The right-brain-damaged patient showed no impairment in VOT production. Comparisons are drawn to earlier studies of VOT production in aphasia in two-category languages. Issues concerning the underlying basis of the production deficit for nonfluent aphasics, fluent aphasics, and nonaphasic dysarthrics as well as the relation between perception and production of VOT are discussed.     

浅谈肝移植术后患者长期随诊的临床意义

回顾性分析肝移植术后随访中的临床与非临床因素对移植物和受体长期存活的影响。选择术后3年以上病例,在并发症的诊断处理、患者各种非医疗不良因素（依从性）方面调查分析和总结。结果多数术后患者均能有良好的依从性,配合移植医师的术后治疗、随访及心理健康指导,但有些患者因为个人、医院等原因不能很好地得到随访,发生并发症及不能及时处...