10140例肾结石患者临床合并症及相关因素分析

目的评估肾结石患者的人口学分布和临床合并症特点并探索其相关因素,为临床防治提供依据。方法回顾性分析2017年1月至2020年12月海军军医大学(第二军医大学)第一附属医院门诊及住院患者中影像学报告为肾结石的10140例患者资料。根据肾脏受累情况,分为单侧肾结石组(单侧组)及双侧肾结石组(双侧组),比较两组患者在年龄、性别、实验室检查指标、常见临床合并症上的差异,采用logistic回归分析探寻可能影响双侧肾结石形成的相关因素。结果10140例肾结石患者的年龄为(57.75±13.30)岁,其中≤30岁276例(2.7%),31~64岁6647例(65.6%),≥65岁3217例(31.7%);男7021例(69.3%),女3119例(30.7%),男女比例为2.25∶1。所有肾结石患者最常见的临床合并症依次为高血压病(3285例,32.4%)、肿瘤(2775例,27.4%)、高尿酸血症(2007例,19.8%)、糖尿病(1526例,15.0%)、冠心病(1072例,10.6%)、脑血管疾病(473例,4.7%)。单侧组8171例(80.6%),双侧组1969例(19.4%)。双侧组年龄低于单侧组,男性占比高于单侧组,血清肌酐、尿酸、尿pH值水平高于单侧组,高密度脂蛋白胆固醇水平低于单侧组,合并高血压病、高尿酸血症的患者占比高于单侧组,合并肿瘤、冠心病的患者占比低于单侧组,差异均有统计学意义(P均<0.05);两组患者BMI、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平及合并糖尿病、脑血管疾病的患者比例差异均无统计学意义(P均>0.05)。logistic回归分析结果显示,性别(男性)、高尿酸血症可能是双侧肾结石形成的重要危险因素,而合并肿瘤则更多见于单侧肾结石患者(P均<0.05)。结论肾结石更多见于中年男性,代谢综合征相关疾病在肾结石的发展过程中起着重要作用,有必要加强这些疾病的早期防治。肾结石患者肿瘤合并率高,提示两者存在关联。此外,较单侧肾结石而言,男性、合并高尿酸血症与双侧肾结石形成关系更为密切,应当引起重视。

208例早产儿临床分析及护理

早产儿由于各组织器官功能发育不成熟及免疫功能的低下,产生许多并发症而生存率低下,死亡率高,早期婴儿死亡率中75％与早产有关。新生几期死亡者有15％为早产儿。存活的早产儿有部分遗留障碍及神经系统的后遗症。提高早产儿成活率是降低围产儿死亡率的一个重要环节。因此,本文就早产发生的相关因素及护理进行分析。

Castleman病临床及病理类型与合并症关系分析：单中心大宗病例观察

目的研究Castleman病（CD）的临床及病理类型与各种合并症的关系，推测各种合并症的发病机制，以提高对本病的认识。方法回顾性分析北京大学第一医院自1977年以来共53例CD患者的临床特点，同时分析临床合并症与临床类型和病理类型的关系。结果53例CD患者中单中心型32例（60．4％），多中心型21例（39．6％）；病理分型示透明血管型（HV）37例（69．8％），浆细胞型（PC）9例（17．0％），混合型（MIX）7例（13．2％）。患者中32例有合并症，占60．4％。根据受累器官不同分为累及皮肤、内脏和血液系统。临床类型与某些合并症的发生密切相关，32例单中心型的主要合并症为副肿瘤性天疱疮（PNP）和闭塞性细支气管炎（BO），21例多中心型的主要合并症为肾脏、血液改变。病理类型与合并症的发生密切相关：透明血管型主要合并症为PNP和BO，浆细胞型和混合细胞型主要合并症为内脏和血液受累。合并PNP的CD患者的临床和病理分型均不同于其他CD。Kaplan—Meier分析显示：伴有合并症的患者生存率明显低于无合并症的患者（P=0．028）。结论CD患者的合并症与其临床、病理分型有关，合并PNP的CD患者应单独分型，有无合并症是影响CD患者预后的关键因素。

Poland综合征及其临床常见合并症

Poland综合征又称胸大肌缺损并指综合征,是一种较为少见的先天性胸壁及上肢畸形.最早于1841年由英国的医学生Alflred Poland在尸体解刮中发现,并在论文中进行了描述,因而得名[1].文献报道该综合征在新生儿中发病率为1/50000～1/20 000.男女比例约为3：1.目前还未发现有明显的家族遗传性,但个别家族性发病的病例在临床上亦有报道[2],其中我国学者初钊莲（1993年）报道了一个家族三代人中出现了5例患者,并在患者的染色体上发现了突变的等位基因,从而反映了该综合征的潜在遗传倾向.

Dysentery caused by Balantidium coliin a patient with non-Hodgkin's lymphoma from Turkey

Balantidium coli is the only parasitic ciliate of man. It is a flattened oval organism covered with cilia, and a gullet at the anterior end. It is infrequently pathogenic for man,although epidemic buds in tropical zones have been described. The infection fundamentally affects the colon and causes variable clinic pictures, from asymptomatic to serious dysenteric forms. We present a case of parasitologically diagnosed as causes of diarrhea in a patient with non Hodgkin's lymphoma from Turkey.In order to find out the causative etiologic agent of diarrhea,stool samples were examined by native,lugol and flotation methods and we detected moving trophozoites, which were approximately 60μm long and 35μm wide.These bodies were diagnosed as Balantidium coli This case underlines that Balantidium coli should also be considered as a possible pathogen in immunocompromised patients with diarrhea.

Bouveret's syndrome complicated by a distal gallstone ileus

AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary

Association between gamete source, exposure and preeclampsia: A review of literature

Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis ofpreeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.

Research progress of traditional Chinese medicine nursing techniques for the management of postoperative complications in mixed hemorrhoids

Mixed hemorrhoids,especially ring-shaped mixed hemorrhoid,is still a headache for anorectal surgeons due to its post-operative complications.In recent years,clinicians have been studying and exploring to avoid and alleviate these complications.In the Chinese medicine industry,the application of traditional Chinese medicine nursing technology has good and unique effect in prevent local pain,perianal edema,promote wound healing,relieve urinary retention,improve constipation,relieve anxiety,and so on.This article summarized the evidences of investigated the role of traditional Chinese medicine nursing technique in preventing and treating mixed hemorrhoid so that practitioners can make decision based on the best available evidences.

Medical comorbidities at admission is predictive for 30-day in-hospital mortality in patients with acute myocardial infarction： analysis of 5161 cases

Background The present study investigated the prognostic value of medical comorbidities at admission for 30-day in-hospital mortality in patients with acute myocardial infarction （AMI）. Methods A total of 5161 patients with AMI were admitted in Chinese PLA General Hospital between January 1, 1993 and December 31, 2007. Medical comorbidities including hypertension, diabetes mellitus, previous myocardial infarction, valvular heart disease, chronic obstructive pulmonary disease （COPD）, renal insufficiency, previous stroke, atrial fibrillation and anemia, were identified at admission. The patients were divided into 4 groups based on the number of medical comorbidities at admission （0, 1, 2, and ≥3）. Cox regression analysis was used to calculate relative risk （RR） and 95% confidence intervals （CI）, with adjustment for age, sex, heart failure and percutaneous coronary intervention （PCI）. Results The mean age of the studied population was 63.9 ± 13.6 years, and 80.1% of the patients were male. In 74.6% of the patients at least one comorbidity were identified. Hypertension （50.7%）, diabetes mellitus （24.0%） and previous myocardial infarction （12%） were the leading common comorbidities at admission. The 30-day in-hospital mortality in patients with 0, 1, 2, and ≥3 comorbidities at admission （7.2%） was 4.9%, 7.2%, 11.1%, and 20.3%, respectively. The presence of 2 or more comorbidities was associated with higher 30-day in-hospital mortality compared with patients without comorbidity （RR： 1.41, 95% CI： 1.13-1.77, P = 0.003, and RR： 1.95, 95% CI： 1.59-2.39, P = 0.000, respectively）. Conclusions Medical comorbidities were frequently found in patients with AMI. AMI patients with more comorbidities had a higher 30-day in-hospital mortality might be predictive of early poor outcome in patients with AMI.

Z-plasty for uterus-to-abdominal-wall fistula

Objective:Uterus-to-abdominal-wall fistula is a very rare complication after uterine-incision delivery over the last decades.It can even lead to death.Mainly,the fistula occurs when big tension and critical infection exist within the incision of uterus and abdominal wall.Methods:The authors described the clinical presentation,pathology of uterus-to-abdominal-wall fistula,and reported their experience in 6 cases who underwent Z-plasty operation for this rare complication from January 1998 to January 2008.Results:All flaps survived completely and all the wounds in abdominal walls healed very well.The six cases were followed up for 1 to 5 years,and no fistula recurrence occurred.Conclusion:Z-plasty technique is a very simple and efficient approach to repair uterus to abdominal fistula after uterine-incision delivery.

A Case of Multiple Sexually Transmitted Diseases (STDs),with Stevens-Johnson Syndrome and Mediastinal Tumor

A 29-year-old man was admitted for erythema, papules and erosions. Erosions and purulent secretions were seen in the circumference of the mouth, eyes, oral mucosa,tongue, and preputium. Conjunctivas were swollen and the urethral orifice was red, both were accompanied by purulent secretions. Multiple vesicles were shown in the penis.The patient was diagnosed with:①Stevens-Johnsonsyndrome;②gonococcal ophthalmoblennorrhea;③nongonococcal urethritis, gonococcal urethritis;④genital herpes;⑤mediastinal tumor.

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Objective: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. Methods: A total of 2 165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. Results: After treatment, 2024 ( 93.49%) cases survived and the other 141 ( 6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 ( 46.71%) and 53 ( 24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%- 65.96% and 28.57% respectively, indicating a significant difference (P< 0.05). Conclusions: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Fixation of complex proximal humeral fractures in elderly patients with a locking plate： A retrospective analysis of radiographic and clinical outcome and complications

Purpose： The optimal surgical treatment of displaced type B and C fractures of the proximal humerus in the elderly remains controversial. Good clinical results have been reported by plating these fractures as well as a high rate of complications. Our retrospective study aims to evaluate clinical recovery and complications using the S3 locking plate in elderly patients. Methods： Fifty-one patients older than 65 years of age, with a complex proximal humeral fracture type B or C （AO classification system）, were included. Patients have been followed up for a minimum of 12 months. We assessed callus formation, radiological results, clinical outcome （according to the Constant Shoulder Score System） and complications. Any difference in the clinical recovery among the 2 types of fracture pattern （B and C） was investigated. Results： The mean time of fracture healing was 12.4 weeks. The mean Constant score at 3, 6 and 12 months was 68, 73 and 75 respectively. No statistically significant difference in the clinical outcome was observed between the 13 and C fracture patterns （p 〉 0.05）. We noticed an overall of 5 complications （9.8%）. There was no need to revision any of the implants. Conclusion： Anatomic reduction and proper plate positioning are essential for minimizing implant- related complications. In our experience the S3 angular stability system offers a proper osteosyntesis and a ~ood clinical recovery with a low rate of complications.

Clinical outcomes of influenza-like illness treated with Chinese herb- al medicine： an observational study

OBJECTIVE: To present and analyze treatmentsand clinical outcomes of Chinese patients with influenza-like illness.METHODS: We conducted a multi-site observational study from December 2009 to April 2010. Patients with influenza-like illness from 45 hospitals were enrolled. Patients received Chinese herbal medicine(CHM), conventional treatments, or CHM plus conventional treatments(combination treatment) according to the guidelines for influenza A/H1 N1 2009 in China. The primary outcomes were the time to alleviation of symptoms and the incidence of complications. The secondary outcomes were the time until becoming afebrile, incidence of severe illness, testing negative on an influenza A viral test, and total medical fees.RESULTS: In total, 5967 patients were enrolled. The percentages of patients prescribed CHM alone, conventional treatment, and combination treatment were 27.8%, 5.1%, and 67.7%, respectively. There were no significant differences in the time to alleviation of symptoms, incidence of complications,time to becoming afebrile, or rate of severe illness among the CHM, conventional, and combination treatment groups. The rates of testing negative on the influenza virus A rapid test and H1 N1 virus test were 90.3% and 76.3%, respectively. However,significant differences were found in the total medical fees among the three groups: CHM treatments were more economical than the other two treatments.CONCLUSION: The efficacy of CHM for influenza-like illness was not different from that of conventional treatments, but it was more economical.

Thoracic spinal trauma associated with closed thoraco-abdominal injury

Objective: To explore the management of thoracic spinal trauma (TST) associated with closed thoraco abdominal injuries (CTAI). Methods: A retrospective study was made on 259 patients with TST admitted to our department as an emergency treatment from January 1996 to June 2001. We summarized the clinical features of TST associated with CTAI. Results: Among 259 patients with thoracic spinal trauma, 112 were associated with CTAI. Traffic accident was the most common cause. The force causing upper TST was more violent than that causing the lower. Pulmonary complications were the leading cause of death in this group. Surgery could not improve neurological function for completely paraplegic patients. Conclusions: The reason that upper TST has the tendency to be associated with CTAI is its special anatomical feature. Routine ultrasonic examination can avoid misdiagnosis of latent closed abdominal injuries associated with spinal injury. The presence of potential injuries, especially CTAI, should be considered when deciding whether or not to perform surgery early.