The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with i...The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.展开更多
目的:探讨梧桐护理模式下父母陪伴麻醉诱导(parent presence at the induction of anesthesia,PPIA)对行肝穿刺活检术的肝移植状态患儿麻醉诱导期合作度及苏醒期谵妄(Emergence Delirium,ED)的影响。方法:采用随机数字表法,将2021年9月...目的:探讨梧桐护理模式下父母陪伴麻醉诱导(parent presence at the induction of anesthesia,PPIA)对行肝穿刺活检术的肝移植状态患儿麻醉诱导期合作度及苏醒期谵妄(Emergence Delirium,ED)的影响。方法:采用随机数字表法,将2021年9月至2022年3月在全身麻醉下进行肝穿刺活检术的肝移植状态患儿124例分为对照组和观察组各62例。对照组给予常规护理模式下父母陪伴麻醉诱导,观察组行梧桐护理模式下父母陪伴麻醉诱导。比较两组患儿在麻醉诱导时、苏醒时、术后1 h的平均动脉压、心率变化。采用麻醉诱导期合作程度量表(Induction Checklist Compliance,ICC)比较两组患儿麻醉诱导时合作程度,采用苏醒期谵妄量表(Pediatric Anesthesia Emergence Delirium scale,PAED)比较两组患儿苏醒时、术后1 h、术后6 h、术后12 h谵妄评分及谵妄发生率。结果:两组患儿各时间点平均动脉压、心率组间比较差异无统计学意义(P>0.05);观察组患儿诱导时ICC评分低于对照组,苏醒时及术后1 h PAED评分均低于对照组,差异有统计学意义(P<0.05);两组患儿术后6 h、12 h PAED评分比较差异无统计学意义(P>0.05);观察组总体谵妄发生率低于对照组,差异有统计学意义(P<0.05)。结论:梧桐护理模式下父母陪伴麻醉诱导可提高肝移植后肝穿刺活检患儿麻醉诱导期合作程度,降低苏醒期谵妄发生率,对于加速患儿康复,提高患儿围手术期安全具有积极意义。展开更多
文摘The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.
文摘目的:探讨梧桐护理模式下父母陪伴麻醉诱导(parent presence at the induction of anesthesia,PPIA)对行肝穿刺活检术的肝移植状态患儿麻醉诱导期合作度及苏醒期谵妄(Emergence Delirium,ED)的影响。方法:采用随机数字表法,将2021年9月至2022年3月在全身麻醉下进行肝穿刺活检术的肝移植状态患儿124例分为对照组和观察组各62例。对照组给予常规护理模式下父母陪伴麻醉诱导,观察组行梧桐护理模式下父母陪伴麻醉诱导。比较两组患儿在麻醉诱导时、苏醒时、术后1 h的平均动脉压、心率变化。采用麻醉诱导期合作程度量表(Induction Checklist Compliance,ICC)比较两组患儿麻醉诱导时合作程度,采用苏醒期谵妄量表(Pediatric Anesthesia Emergence Delirium scale,PAED)比较两组患儿苏醒时、术后1 h、术后6 h、术后12 h谵妄评分及谵妄发生率。结果:两组患儿各时间点平均动脉压、心率组间比较差异无统计学意义(P>0.05);观察组患儿诱导时ICC评分低于对照组,苏醒时及术后1 h PAED评分均低于对照组,差异有统计学意义(P<0.05);两组患儿术后6 h、12 h PAED评分比较差异无统计学意义(P>0.05);观察组总体谵妄发生率低于对照组,差异有统计学意义(P<0.05)。结论:梧桐护理模式下父母陪伴麻醉诱导可提高肝移植后肝穿刺活检患儿麻醉诱导期合作程度,降低苏醒期谵妄发生率,对于加速患儿康复,提高患儿围手术期安全具有积极意义。
