患者临床诊断及治疗方法研究神经内科昏迷

目的探究神经内科昏迷患者的临床诊断及治疗方法。方法选取2017年1月至2018年1月在我院神经内科接受治疗的100名昏迷患者,回顾性分析其临床资料,并总结昏迷原因。结果 100名昏迷患者中,由脑血管疾病、糖尿病、急性中毒所致的人数最多,在经抢救后,9名患者抢救失败,抢救成功率为91%;患者经抢救后其Pa O_2与SaO_2水平有明显上升,P<0.05;而抢救后的PaCO_2与RR水平明显不及抢救前,P<0.05,有统计学意义。结论综上所述,神经内科昏迷患者通常病情较重,因此,在最短的时间里对患者的病因做出判断并给出具有科学性、规范性、合理性的抢救方案是重中之重,唯有如此,才能提高昏迷患者的抢救成功率。

亚急性甲状腺炎40例临床分析

目的:探讨亚急性甲状腺炎的临床特点。方法:回顾性分析2007～2009年亚急性甲状腺炎患者40例的临床资料。结果:40例患者均有发热病史,22例颈部疼痛,34例颈部触痛,38例甲状腺肿大,血沉增快,甲状腺吸碘率均低于正常,29例出现FT_3、FT_4增高,甲状腺摄碘率下降的分离现象,糖皮质激素治疗均有效。结论:亚急性甲状腺炎的主要临床特点为发热、甲状腺肿大及疼痛、血沉增快。及FT_3、FT_4增高,甲状腺摄碘率下降的分离现象,糖皮质激素治疗效果好。

CLINICAL DIAGNOSIS AND TREATMENT OF NONFUNCTIONING PHEOCHROMOCYTOMAS IN 14 PATIENTS

Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocy- toma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomo- graphy scan, thoracic X-ray and 131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found inciden- tally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusion 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.no recurrence and metastasis})

Primary gastric melanoma: A case report

Melanoma accounts for 1-3 per cent of all malignant tumors. Except cutaneous, other less common melanomas include, among others, those in the GI tract. However, their primary or secondary nature is often difficult to establish. Referring to the stomach, scattered cases of primary melanomas have been reported in the literature. We report a case of a man with an ulcerated submucosal mass at the antrum of the stomach, manifested with dull upper abdominal pain, nausea, vomiting, fatigue and anemia. This lesion was histologically proved to be melanoma. A detailed clinical and laboratory investigation revealed no primary site elsewhere. To our knowledge, very few cases of primary gastric melanoma have been reported. Our case is the fourth ever published and the first located at the antrum of the stomach. The debate upon the primitive nature of such lesions still persists. Thus, specific diagnostic criteria have been proposed.

Should we redefi ne large common bile duct stone?

The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.

Diagnosis and treatment of prolactinoma:clinical analysis of 124 prolactinomas

Objective： To study the diagnostic and therapeutic features of prolactinoma. Methods： 124 patients with prolactinoma were studied in clinical manifestation, pathologic, endocrinological, radiographic and therapeutic features. Results： The average age of the male patients was 41.6 years, 32.3 years of females. The major clinical manifestation in males were sexual and visual disfunction. In females, disfunction of menstruates and galactorrhea. Average serum prolactin was 1875.22 in males, 376.6 ng/mL in females. Average diameter of the tumors was 38.05 mm in males, and 83.3% of the tumors were invasive, in females were 15.25 mm and 49%. After surgery, the average serum prolactin decreased to 385.84 ng/mL （P〈 0.05）, 13 of 15 patients improved in sexual function, 82.6% patients improved in eyesight and visual field. In females prolactin decreased to 23.93 ng/mL （P 〈 0.05）, and 81.25% infertility with microprolactinoma got pregnancy, higher than controls of drug therapy （P 〈 0.05）. Conclusion： In males, the tumors were usually larger and more invasive, and serum prolactin levels were higher. The patients were elder. But in females, much younger than males, most of the tumors were microadenoma, and after operation the prolactin usually decrease to normal level and more chance of pregnancy. Results of a single therapy were with less satisfaction, we advocate integrated therapy around operation.

FDG-PET AS A ROUTINE SURVEILLANCE TOOL IN HEAD AND NECK CARCINOMA SIX MONTHS AFTER TREATMENT

Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.

CLINICAL VALUE OF ALARM SYMPTOMS IN DIAGNOSIS OF LOWER GASTROINTESTINAL DISEASES

Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during the period of Oct. 2002 to Dec. 2003 were retrospectively analyzed. The prevalence of alarm symptoms in Shanghai patients with colorectal malignancies or other organic or functional lower gastrointestinal diseases was investigated. Results 83 （4. 9% ） cases of colorectal malignancies were found in 1681 patients referred to the center for colonoscopy because of lower gastrointestinal symptoms. All these malignancies were verified to be in the progressive stage. The prevalence of alarm symptoms was 81.9% （68/83）. Hematochezia （ OR 4. 1, 95% CI 3.3 -5.2, P 〈0. 001）, melena （0R6.4, 95%CI3. 7-11. 0, P 〈0. 001） and anemia （OR 9.6, 95%C13. 7 - 25. 0, P 〈 0. 001 ） were the most common and specific alarm symptoms. All the patients without alarm symptoms were above the age of 40 years. 264 （15. 7% ） cases of organic colorectal diseases other than malignancies and 1334 （ 79. 4% ） cases with no causal pathology identified were found in 1681 patients, and the prevalence of alarm symptoms in these two groups was 48. 5% （128/264） and 14. 8% （197/1334）, respectively. Conclusion Alarm symptoms including hemotochezia, melena, and anemia were useful in distinguishing organic from functional colorectal diseases in patients over 40 years old at the onset of symptoms. Furthermore, hematochezia, melena, anemia, severe weight loss, and abdominal mass were helpful in differentiating malignant from non-malignant colorectal diseases. Colonoscopy should be recommended for patients regardless of age with these alarm symptoms, and so do patients above the age of 40 years with no alarm symptoms before the diagnosis of functional diseases are made.

Diagnosis and treatment of diffuse axonal injury in 169 patients

To evaluate current diagnosis and therapeutic effect and outcome of diffuse axonal injury （DAI） in 169 patients. Methods ： The data of 169 DAI patients treated in the Second, Sixth, Eighth and Ninth Hospitals of Shenzhen and Shekou Hospital from January 2001 to January 2005 were collected. The imaging features, classification, GCS （Glasgow coma scale）, treatment and outcome of the 169 patients were retrospecti.vely analyzed. Results ： The simpler the imaging features, the closer the focus of DAI to the periphery of hemisphere and the higher the GCS score, the better the prognoses of DAI patients will be. Conclusions： The prognoses of DAI patients are closely related to the imaging features and classification, GCS and clinical treatment.