肝癌介入化疗患者医院感染的临床特征和预防策略分析

目的回顾性分析该院的医院感染的临床特征，提出相对应的预防策略，为临床提出科学的指导意见以减少肝癌患者医院感染的发生。方法回顾性调查分析2010年1月-2013年10月在该院行肝癌介入化疗的患者1258例，调查表由该院自行统一制定，对肝癌介入化疗患者发生医院感染的临床资料进行统计分析，包含患者的感染部位、感染病原菌以及年龄等。结果医院感染发生率为5.33％；肝癌介入化疗患者以腹部和消化道、呼吸道的感染率比较高，分别为38．81％和29．84％；肝癌介入化疗患者中共检出病原菌37株，其中大肠埃希菌和铜绿假单胞菌的菌株比例最多，分别为18．92％和18．92％；肝癌介入化疗后感染患者各年龄组对比差异有显著性（P〈0．01）。结论在临床上，对于肝癌介入化疗患者需要重点保护易感人群，采取相应的有效预防策略。可以有效的减少医院感染的发生率。

猫所致狂犬病的临床特征

猫所致狂犬病的临床特征余光开，李梦东，彭建一，张瑞，陈国民，叶世金１９８８年４月～１９９４年３月共收治狂犬病３６例，所有患者均有特异性诊断依据，其中被猫咬伤、抓伤或接触的５例现报告如下。一、临床资料（一）一般情况本组５例中，男４例，女１例；年龄在６～...

175例2型糖尿病合并水疱患者的临床特征和护理体会

目的通过对2型糖尿病合并水泡病的临床特征的探讨,从而更好的为患者提供治疗。方法对175例2型糖尿病合并水泡病进行回顾分析。结果经过治疗,171名患者均治愈出院,4例溃疡扩大,感染浸及骨,继发骨髓炎。结论糖尿病水泡病往往发生在糖尿病病程长、全身状况差并有严重并发症的患者身上,所以患者的预后差,甚至可导致患者死亡。

老年女性乳腺癌的临床特征分析

目的：探究老年女性乳腺癌的临床特症,分析临床的治疗方法.方法：回顾分析2014年3月-2015年3月某院收治的67例老年乳腺癌患者的临床病例,总结患者的临床病理症状,得出结论.结果：67例老年女性患者中有54例患者伴有其他的疾病,合并症的发生率为80.6%;患者的病理类型分为3类：脉管瘤栓的患者为11例,占16.4%;浸润性导管癌为33例,占49.3%;雌、孕激素受体阳性为9例,占13.4%.患者在接受治疗的有效率为67.2%（45/67）,22例患者在治疗后发生不同程度的复发或转移,10例患者死亡,6例患者的死亡原因为乳腺癌,4例患者的死亡原因是其他疾病.结论：老年乳腺癌患者易发生合并症,治疗过程中要密切关注患者的生命体征,有效预防患者合并症的发作;老年人体质特殊,医生应依据患者的自身情况确定治疗方案.

生物膜形成菌所致感染病的特征

一年前本刊曾在 2 0 0 0年第 4、5期日本来稿栏目中连载了日本千叶旭中央病院院长村上信乃的撰文———日本国感染病预防、医疗新法介绍 ,经过一年多的实践 ,医学のあゆみ 2 0 0 0年第 1 95卷第 5期 ( 1 1月 4日 ) ,推出特集 :感染症———最近の题 ,就感染病新法的理念、一年来实施的状况以及今后的研讨课题进行了回顾和展望。全集共载文 2 2篇 ,限于版面 ,哈尔滨医科大学内科姚桢教授对全集作了精细整理 ,浓缩成本专辑 。

A clinical dilemma:abdominal tuberculosis

AIM:To evaluate the clinical,radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis. METHODS:Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul,Turkey were evaluated prospectively.Complete physical examination,medical and family history,blood count erythrocyte sedimentation rate,routine biochemical tests, Mantoux skin test,chest X-ray and abdominal ultrasonography (USG) were performed in all cases,whereas microbiological examination of ascites,upper gastrointestinal endoscopy,colonoscopy or barium enema,abdominal tomography,mediastinoscopy,laparoscopy or laparotomy were done when needed. RESULTS:The median age of patients (14 females,17 males) was 34.2 years (range 15-65 years).The most frequent symptoms were abdominal pain and weight loss. Eleven patients had active pulmonary TB.The most common abdominal USG findings were ascites and hepatomegaly.Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2%).Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients.Colonoscopy performed in 20 patients showed ulcers in 9 (45%),nodules in 2 (10%) and,stricture,polypoid lesions,granulomatous findings in terminal ileum and rectal fistula each in one patient (5%). Laparoscopy on 4 patients showed dilated bowel loops, thickening in the mesentery,multiple ulcers and tubercles on the peritoneum.Patients with abdominal TB were divided into three groups according to the type of involvement. Fifteen patients (48%) had intestinal TB,11 patients (35.2%) had tuberculous peritonitis and 5 (16.8%) tuberculous lymphadenitis.The diagnosis of abdominal TB was confirmed microbiologically in 5 (16%) and histo- pathologically in 19 patients (60.8%).The remaining nine patients (28.8%) had been diagnosed by a positive response to antituberculous treatment. CONCLUSION:Neither clinical signs,laboratory,radiological and endoscopic methods nor bacteriological and histopathological findings provide a gold standard by themselves in the diagnosis of abdominal TB.However,an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of this insidious disease which primarily necessitate a clinical awareness of this serious health problem.

Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease

Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases(IBD).The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis.Arthritis associated with IBD belongs to the category of spondyloarthropathies.Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease.Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients.Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately.Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations.The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.

Meckel's diverticulum masked by a long period of intermittent recurrent subocclusive episodes

Meckel's diverticulum(MD) is the most frequent congenital abnormality of the small bowel and it is often diff icult to diagnose.It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding,intestinal obstruction,and inflammation.The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting,symptoms erroneously related to a cyclic vomiting syndrome but not to MD.The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.

Biliary cystadenoma

The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction.

Surgical Treatment of Intralobar Pulmonary Sequestration

Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

Clinical Characters of Gastrointestinal Lesions in Intestinal Behcet's Disease

Objective To investigate the clinical features,diagnosis methods,therapeutic principles of intestinal Behcet's disease.Methods The clinical data of 45 patients with confirmed intestinal Behcet's disease admitted to Peking Union Medical College Hospital from August 1998 to April 2010 were retrospectively analyzed.Results The clinical courses of patients with intestinal Behcet's disease were from 26 days to 33 years,and the average duration was 6.32±1.01 years.The appearance of extra-gastrointestinal symptoms was significantly earlier than that of gastrointestinal symptoms(7.35±1.39 years vs.3.24±0.82 years,P<0.05).The predominant gastrointestinal manifestations were right lower quadrant pain(95.56%) and hematochezia or melena(40.00%).Misdiagnosis occurred in 17 cases.In patients without systemic medicine therapy before surgery,the incidence of postoperative infection of incision site and abdominal cavity was significantly higher than that in those undergoing systemic medicine therapy(80.00% vs.0%,P<0.05).Conclusions Because of the diversity of gastrointestinal manifestations,intestinal Behcet's disease is easily misdiagnosed.The systemic medical therapy before surgery could decrease the incidence of infection of incision and abdominal cavity.

Unsuspected Gallbladder Cancer During or After Laparoscopic Cholecystectomy

Objective To summarize the clinical features and outcomes of unsuspected gallbladder carcinoma （HGC） detected during or after laparoscopic cholecystectomy. Methods Medical records of 8005 patients, who underwent laparoscopic cholecystectomy in Peking Hnion Medical College Hospital between June 1993 and June 2011, were reviewed. Patients that pathologically diagnosed as HGC were retrospectively studied in terms of clinical features, preoperative and postoperative diagnosis, surviving period, and complications. Results In the 8005 patients who received laparoscopic cholecystectomy, 36 （0.45%） were diagnosed as LIGC during （25 patients） or after （11 patients） laparoscopic cholecystectomy. The gallbladder cancer was staged as T1 in 16 patients, T2 in 11 patients, and T3 in 9 patients. The 1-, 3-, and 5-year survival rates of all the patients were 88.9% （32/36）, 63.9% （23/36）, and 58.3% （21/36）. The 5-year survival rates in T1 stage, T2 stage, and T3 stage patients were 100%, 75.0%, and 0.0%, respectively. Conclusions The survival rate of HGC is associated with tumor stage, not with operation approaches. Laparoscopic cholecystectomy is appropriate for T 1 patients.

Age distribution,polyps and rectal cancer in the Egyptian population-based cancer registry

AIM:To describe the clinical and epidemiologic profiles of the disease and to compare the findings with those generated from the previous hospital-based studies.METHODS:The Gharbiah cancer registry is the only population-based cancer registry in Egypt since 1998.We analyzed the data of all colorectal cancer patients included in the registry for the period of 1999-2007.All medical records of the 1364 patients diagnosed in Gharbiah during the study period were retrieved and the following information abstracted:age,residence,diagnosis date,grade,stage,topology,clinical characteristics,and histology variables.Egyptian census data for 1996 and 2006 were used to provide the general population's statistics on age,sex,residence and other related demographic factors.In addition to age-and sex-specific incidence rate analyses,we analyze the data to explore the incidence distribution by rural-urban differences among the 8 districts of the province.We also compared the incidence rates of Gharbiah to the rates of the Surveillance Epidemiology and End Results(SEER) data of the United States.RESULTS:Over the 9 year-period,1364 colorectal cancer cases were included.The disease incidence under age 40 years was relatively high(1.3/10 5) while the incidence in the age groups 40 and over was very low(12.0/10 5,19.4/10 5 and 21.2/10 5 in the age groups 40-59 years,60-69 years and > 70 years,respectively).The vast majority of tumors(97.2%) had no polyps and 37.2% of the patients presented with primary lesions in the rectum.Colorectal cancer was more common in patients from urban(55%) than rural(45%) areas.Regional differences in colon and rectal cancer incidence in the 8 districts of the study province may reflect different etiologic patterns in this population.The registry data of Egypt shows a slightly higher incidence of colorectal cancer than the United States in subjects under age 40 years.The results also shows significantly lower incidence of colorectal cancer in subjects over age 40 years compared to the same age group in the United States SEER.CONCLUSION:Low rate of polyps,low incidence in older subjects,and high rate of rectal cancer in Egypt.Future studies should explore clinical and molecular disease patterns.

Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM： To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS： The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and de- mographic characteristics, function in the activities of daily living （ADL）, co-morbidities and drug use were collected by a structured interview. Upper gastroin- testinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters： （1） abdominal pain syndrome; （2） reflux syndrome; （3） indigestion syn- drome; （4） bleeding, and （5） non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS： 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointes- tinal symptoms was 43.0%, i.e. cluster （1） 13.9%, （2） 21.9%, （3） 30.2%, （4） 1.2%, and （5） 4.5%. Upper gastrointestinal symptoms were more frequently re- ported by females （P 〈 0.0001）, with high number of co-morbidities （P 〈 0.0001）, who were taking higher number of drugs （P 〈 0.0001） and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex （OR = 1.39, 95% CI： 1.17-1.64）, dis- ability in the ADL （OR = 1.47, 95% CI： 1.12-1.93）, smoking habit （OR = 1.29, 95% C]： 1.00-1.65）, and body mass index （OR = 1.06, 95% CI： 1.04-1.08）, as well as the presence of upper （OR = 3.01, 95% C]： 2.52-3.60） and lower gastroenterological diseases （OR = 2.25, 95%CI： 1.70-2.97）, psychiatric （OR = 1.60, 95% CI： 1.28-2.01） and respiratory diseases （OR = 1.25, 95% C]： 1.01-1.54） were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION： Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symp- toms in older subjects.

Analysis of the clinical characteristics between cavitating squamous cell lung carcinoma and non-cavitating squamous cell lung carcinoma

Objective： To identify the differences between cavitating squamous cell lung carcinoma （cSLC） and non-cavitating squamous cell lung carcinoma （ncSLC）. Methods： Fifty-one patients with cSLC and 281 with ncSLC confirmed by surgery in our hospital between 1999 to 2000 were collected and their clinical, histological and survival features were retrospectively ana（yzed. Results： Patients with cSLC had more frequent manifestation of infection and weight loss. They usually experienced longer duration of pre-diagnosis and showed bigger tumor mass, larger primary tumor invasion with worse differentiated than ncSLC patients. There was no significant difference in age, sex, smoking history, family tumor history, personal tuberculosis history, disease location, TNM stage, lymph node invasion, and metastasis between the two groups. Median survival time was 29 months for cSLC and 35 months for ncSLC. One- and 3- year survival rates were 86.3% and 43.1% for cSLC vs. 91.1% and 47,0% for ncSLC respectively （P〉0.05）. Conclusion： Patients with cSLC presented with a bigger mass, a larger extent of primary tumor invasion, worse differentiated, more obstructed pneumonia that might result in longer duration of pre-diagnosis and more weight loss. As lack of differences in disease stages, lymph node invasion, metastasis and especially survival time with ncSLC, cSLC couldn＇t be classified as a special type of squamous cell carcinoma by present evidences.

SENILE OSTEOPOROSIS AND HIP FRACTURE

A randomized block design was used to compare the Singh index, the cortical index of the femoral neck and the lateral cortical width of the femur of a group of patients with femoral neck fracture, a group with intertrochanteric fracture, and a normal control group among a total of 102 postmenopausal women.The three indices in fracture group were very significantly (P<0.01) or significantly (P<0.05) different from those in the normal control subjects. The importance of osteoporosis in hip fracture of the aged is con firmed. Radiographic measurement of bone mass was found to have some predictive value for the risk of hip fracture.

DIAGNOSIS AND SURGICAL TREATMENT OF BRONCHOGENIC CYSTS

Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years. The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40. 9%). There were symptoms (chest pain and recurrent bronchiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal compression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a round shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative cornphcations. late complications, or recurrence developed in our patients.

Helical CT findings and clinicopathologic features in malignant gastrointestinal stromal tumors: the correlation between radiologic appearance and malignant potential

Objective： In this pictorial essay, we described the clinical, pathologic, and computed tomographic （CT） findings of malignant gastrointestinal stromal tumors （MGISTs） and attempt to establish the correlation between radiologic appearance and malignant potential. Methods： This retrospective analysis included 20 patients receiving treatment for MGIST between 2008 and 2010. The diagnosis was established by pathology and immunohistochemistry. All these patients underwent pre- operative CT. Clinical presentation, pathology and CT images were analyzed. Helical CT images were reviewed for morpho- logic features such as tumor size, number and location, tumor margins, necrosis, degree of enhancement and metastasis. Results： Gastrointestinal bleeding, abdominal pain and discomfort, and without clinical symptom were common findings and were observed in 9 （45%）, 6 （30%）, and 5 （25%） of the 20 patients. 8 （40%） tumors were located in stomach, and 10 （50%）, 1 （5%） and 1 （5%） were located in small intestine, mesentery and peritoneum, respectively. Male to female ratio was about 1：2. The size of MGIST ranged from 2.6 cm to 17.5 cm with a mean of 8.7 cm. All tumors density was inhomogeneous and heterogeneous enhancement. MGISTs with highly malignant located in small intestine were about 30% higher than stomach. The ＂satellite＂ turnouts were found in 6 cases with high malignant risk. 7 cases were suffered from liver metastasis, and 4 cases went with seeding into the abdominal cavity, 1 cases went with lymph node metastasis. Histologically, 19 cases （95%） were of spindle cell type. Immunohistochemical stains demonstrated a strong positivity for both c-kit （CDl17） and CD34s enhancement in 19 （95%）. Conclusion： Clinical expression is varied in MGIST patients. Female might be predominance in MGIST. The GISTs located in small intestine would tend to be more aggressive. The satellite tumours, necrosis and cystic degeneration were strongly benefit for MGIST diagnosis. Furthermore, intestinal obstruction doesn＇t support the diagnosis. Lymph node metastasis and calcification is rare.