口腔急诊中非外伤牙痛临床诊疗特征分析

目的:分析非外伤牙痛临床诊疗特征。方法:纳入非外伤牙痛就诊患者1127例。根据疼痛发生的组织来源分为牙髓来源(51.5%)、牙周来源(28.0%)、口腔颌面部肿痛(10.0%)、不明原因(7.7%)和非急性痛(2.8%)5组。根据年龄分为青年(20~39岁,337例)、中年(40~59岁,353例)、老年(60~89岁,377例)3组。分别比较5组诊断组间疼痛特征及处置措施差异,3组不同年龄组间急诊处置措施及全身疾病情况差异。数值变量分析应用独立样本t检验,分类变量分析应用χ2检验。结果:5组诊断组间年龄差异有统计学意义P=0.000,牙髓源性疼痛发病率最高(59.2%),牙周源性最高(34.7%),1095例确定为急诊患者中,629例(57.4%)采取相应急诊手术治疗,青年组手术治疗比例(63.9%)高于中年组(55.9%)和老年组(52.2%)(P=0.006),老年组伴有全身疾病者(35.3%)多于中年组(33.1%)和青年组(31.6%)(P=0.000)。结论:建议在口腔急诊分级标准中细化以牙痛为就诊需求的口腔急症,关注患者全身疾病情况,保障口腔急诊诊疗安全。

非外伤性口颌面部疼痛老年患者的临床特征分析

目的分析老年患者非外伤性口颌面部疼痛的临床特征。方法回顾性分析470例非外伤口颌面部疼痛老年患者的临床资料,根据疼痛组织部位来源分为牙源性、牙周源性和颌面部源性三组,比较各组间疼痛差异和处置措施,分析老年患者就诊特点。结果470例患者年龄(68.66±7.40)岁,其中60~69岁患者最多。牙源性疼痛患者占58.3%,且疼痛评分最高,为5.00(3.00,6.00)分,牙周源性疼痛评分与其余两组比较差异有统计学意义(P<0.05)。性别不影响各组疼痛评分(P>0.05)。老年患者忍受牙周源性疼痛时间最长,为10.00(5.00,15.00)d,且忍受疼痛加重的时间比其余两组差异有统计学意义(P=0.001)。有71.9%的患者合并全身系统疾病,其中高血压占首位。牙周源性疼痛实施临床操作人数在各组中占比最高(71.7%),颌面部源性疼痛患者多采取药物治疗(60.9%)。结论老年人口颌面部疼痛来源多为牙源性疾病,但接受操作治疗的患者相较牙周源性疼痛患者少。牙周源性疾病因疼痛程度低而易受到老年人的忽视从而延误治疗。

老年性肺炎临床诊疗分析

目的:研究老年性肺炎的临床特征及具体诊疗方法。方法:将我院确诊为老年性肺炎的98例患者随机分为治疗组(49例)和对照组(49例),治疗组予以左氧氟沙星治疗,对照组予以头孢唑啉治疗,对两组患者治疗后的各种症状及X片肺部炎症的吸收率差异进行统计学分析。结果:除肾功能的损害外,两组在各种症状、X线片肺部炎症吸收率等方面存在显著差异(P<0.05)。结论:左氧氟沙星在老年性肺炎的临床治疗方面,效果优于头孢唑啉,但应注意对肾脏功能的损害。

Characteristics and pathological mechanism on magnetic resonance diffusion-weighted imaging after chemoembolization in rabbit liver VX-2 tumor model

AIM: To investigate dynamic characteristics and pathological mechanism of signal in rabbit VX-2 tumor model on diffusion-weighted imaging (DWI) after chemoembolization. METHODS: Forty New Zealand rabbits were included in the study and forty-seven rabbit VX-2 tumor models were raised by implanting directly and intrahepatically after abdominal cavity opened. Forty VX-2 tumor models from them were divided into four groups. DWI was performed periodically and respectively for each group after chemoembolization. All VX-2 tumor samples of each group were studied by pathology. The distinction of VX-2 tumors on DWI was assessed by their apparent diffusion coefficient (ADC) values. The statistical significance between different time groups, different area groups or different b-value groups was calculated by using SPSS12.0 software. RESULTS: Under b-value of 100 s/mm2, ADC values were lowest at 16 h after chemoembolization in area of VX-2 tumor periphery, central, and normal liver parenchyma around tumor, but turned to increase with further elongation of chemoembolization treatment. The distinction of ADC between different time groups was significant respectively (F = 7.325, P < 0.001; F = 2.496, P < 0.048; F = 6.856, P < 0.001). Cellular edema in the area of VX-2 tumor periphery or normal liver parenchyma around tumor, increased quickly in sixteen h after chemoembolization but, from the 16th h to the 48th h, cellular edema in the area of normal liver parenchyma around tumor decreased gradually and that in the area of VX-2 tumor periphery decreased lightly at, and then increased continually. After chemoembolization, Cellular necrosis in the area of VX-2 tumor periphery was more significantly high than that before chemoembolization. The areas of dead cells in VX-2 tumors manifested low signal and high ADC value, while the areas of viable cells manifested high signal and low ADC value. CONCLUSION: DWI is able to detect and differentiate tumor necrotic areas from viable cellular areas before and after chemoembolization. ADC of normal liver parenchyma and VX-2 tumor are influenced by intracellular edema, tissue cellular death and microcirculation disturbance after chemoembolization.

ENDOMYOCARDIAL FIBROSIS IN CHINA

To introduce the epidemical, pathological, and clinical characteristics as well as the diagnostic and therapeutical experiences of endomyocardial fibrosis(EMF) in China. [WT5”BX] Data sources.[WT5”BZ]A CMBdisc search was done of the Chinese language literature published from January 1983 through June 1997 about EMF and/or restrictive cardiomyopathy. A manual search was then done for other contributions, including abstracts, between January 1965 and June 1997. [WT5”BX] Results. [WT5”BZ]Eighty seven Chinese cases of EMF were collected in this paper. There were 49 men and 38 women, with a mean age of 28±13 years(range, 8 to 68 years). The distribution of the cases is mainly in the south of China. Combined right and left ventricular disease occurs in 48 percent of cases, with pure right ventricular involvement occurring in 42 percent and pure left ventricular involvement in the remaining 10 percent of patients who are examined postmortem. The diagnosis of EMF was confirmed in 21 cases at autopsy, and in 66 cases by echocardiography, angiocardiography, and/or endomyocardial biopsy which showed the characteristic changes. Clinically, right sided disease is the commonest variety. Endocardiectomy and tricuspid(n=7) or mitral(n=1) valves replacement have been performed in 8 patients. There were 2 operative deaths. Six patients had a satisfactory recovery postoperatively and living well in the follow up duration. [WT5”BX] Conclusion.

DIAGNOSIS AND TREATMENT OF PULMONARY HAMARTOMA

From 1970 to 1997, 67 patients with pulmonary hamartoma were operated on in our hospital. There were 38 men and 29 women with a M/F ratio of 1. 3: 1. The mean age was 47 years (range 21 to 82 years). The peak incidence was 40 to 60 years. 39% Patients had pulmonary symptoms: hemoptysis, cough, phlegm and chest pain. All were solitary. 68. 7% tumors were located in right lung and 64. 2% in upper or middle lobe. 80. 6% hamartomas were less than 3 cm in transverse diameter. On chest films, the opacity was homogeneous in 79.1% cases, heterogeneous in 20.9% and calcifications in 9.0%. The vast majority of shadows were heterogeneous on CT films. Operation is the best treatment for hamartomas. Postoperative mortality was 1. 5%. There was none recurrences and canceration during the follow-up (mean 14 years).

DIAGNOSIS AND TREATMENT OF THE MIRIZZISYNDROME

Objectives. The aim of this paper is to describe the clinical characteristics, diagnostic procedure and operative management of Mirrizi syndrome. Methods. Sixteen cases of Mirrizi syndrome were selected and reviewed from 1987 to 1997. Results. In the 16 cases, 6 cases were male, 10 cases were female, the average age was 62.7 years old. Ten cases were diagnosed to be Mirrizi syndrome preoperatively(62.5%); 3 cases were considered to bile duct tumor, the other 3 cases were emergency, they were confirmed the diagnosis after the operation. Conclusions. Ultrasound is recommended as the first choice of screening method, while ERCP may confirm the diagnosis. Surgical approach is considered to be the choice and technical procedures are suggested to prevent intraoperative injury and to repair defects of the common bile duct.

Clinical analysis of 78 cases of paroxysmal nocturnal hemoglobinuria diagnosed in the past ten years

OBJECTIVE: To learn more about the clinical and laboratory features of patients with paroxysmal nocturnal hemoglobinuria (PNH) diagnosed in the past ten years. METHODS: Clinical and laboratory data for 78 cases of PNH diagnosed from January 1990 to November 1999 in our hospital were analyzed retrospectively. RESULTS: In comparison with PNH cases reported in the 1980s, the newly diagnosed PNH cases showed the following features: (1) older age of disease onset (from 27 to 34 years); more female cases (from 18.5% to 38.5%); more cases without hemoglobinuria (from 24.2% to 38.5%). (2) No positive family hereditary history. (3) Bone marrow dysplasia, abnormal karyotype and negative sister chromatid differentiation were found in 19.2%, 12.2% and 8.9% of the PNH patients, respectively. 12.3% of the patients had bone marrow hypoplasia, and most of them had no hemoglobinuria. Ham's tests were negative in about 34.2% of the cases. CD55 and CD59 on peripheral blood cells were deficient in 100.0% of the cases, suggesting that CD55 and CD59 tests can improve the diagnosis of PNH. (4) Adrenocortical hormone was effective in 83.8% of the patients, 54.2% of whom relapsed within one year. Eight refractory and relapsed patients were treated with low dose chemotherapy (MP therapy: Melphalan 2 - 6 mg x d(-1); Prednisone 0.5 mg x kg(-1) x d(-1)). Five (62.5%) of them showed positive responses. Bone marrow failure and other side effects were not serious in this group of patients. CONCLUSIONS: PNH, an acquired blood disease seen more often among adult males, can be diagnosed more sensitively by hemocyte member CD55 and CD59 tests and treated more effectively with adrenocortical hormone or low dose chemotherapy.

Treatment of limb arterial injuries caused by traffic accidents

Objective: To analyze the features, diagnosis and treatment of limb arterial injuries caused by traffic accidents. Methods: A total of 43 patients with limb arterial injury admitted in our department over the past 30 years (about 50% of them happened during the last 10 years) were analyzed retrospectively in this article. The popliteal, femoral and brachial arteries were mainly involved, accounting for 43.2 %, 20.5 % and 20.5 % respectively of all the involvements. There were 35 cases of open injury and 9 of close injury. The involved vessels were transected in 43.2 % of the cases and contused in 40.9 %. All the patients had various complications, such as fractures, dislocations and severe soft tissue injuries. The injured vessels were repaired by means of end to end anastomosis in 10 cases, autogenous vein graft in 23 cases and intraluminal hydraulic dilatation in 4 cases. Results: Successful limb salvage was achieved in 34 cases initially, whereas 10 amputations were carried out due to injuries to popliteal arteries in 7, femoral arteries in 2 and humeral artery in 1 and severe soft tissue damages in 9 cases. Twenty nine patients were followed up for 1 156 months, with the average of 48.8 months. There was good circulation in 22 cases and certain ischemia in 5 cases. Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2 cases. There was no death in this series. Conclusions: The limb arterial injuries caused by traffic accidents are severe and complicated. It is proposed that particular attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.