微波热凝下鼻甲并发牙髓炎2例

例1,女27岁.因鼻塞2年余于2002年5月20日就诊,诊断为慢性肥厚性鼻炎,次日在鼻腔表面麻醉下行微波热凝术,功率调至50W,用针尖状辐射器插入下鼻甲黏膜内,由后向前点状热凝,每点作用时间4s,术后用呋喃西林麻黄素滴鼻液滴鼻.

糖尿病性胃轻瘫患者血浆胃动素的变化

糖尿病患者中有相当一部分人伴发胃肠运动障碍,包括胃排空的极度延缓及与排空延迟有关的胃动力紊乱,称为糖尿病性胃轻瘫,其发生机制至今仍不十分清楚。为探讨其中机制,我们观察了68例非胰岛素依赖型糖尿病(NIDDM)患者的胃排空时间、血浆胃动素水平及四肢运动神经传导速度的变化,现报道如下。

胆管结石并胆管旁静脉系统曲张22例分析

目的 探讨胆管结石并胆管旁静脉系统曲张的诊断与治疗。方法 对 2 2例胆管结石并胆管旁静脉系统曲张的病因、手术方法、术后并发症进行回顾性分析。结果 2 2例均行手术治疗。T管引流 16例 ,T管引流加左肝叶切除 5例 ,1例因出血无法切开胆管终止手术。治愈 18例 ,好转 2例 ,死亡 2例。结论 当胆管旁静脉系统曲张时 ,手术极易损伤曲张静脉引起出血 ,特别是伴肝硬化或胆道再次手术时 ,更应该做好充分术前准备。手术方式应简单有效。不要轻率的采用内引流术 ,以免广泛切开胆管时引起大出血。如确实无法切开胆管可试行将结石挤入肠道或放弃手术改行其他方法治疗。

颅脑损伤合并脑疝164例分析

颅脑损伤1小时后,迅速出现两侧瞳孔散大、对光反应消失、昏迷加深、去大脑强直者,多为原发性严重脑挫裂伤并发脑疝,也应考虑合并颅内血肿,病情危重,如果伤员伴有颅底骨折,则生命垂危.我院自1990年8月至1999年12月共收治颅脑损伤合并脑疝的病人164例,现报告如下.

蒙诺治疗充血性心力衰竭并肾功能不全临床观察

蒙诺(福辛普利)为含磷酸基团的血管紧张素转换酶抑制剂(ACEI),经肝脏和肾脏双重排泄.本报道旨在探讨充血性心力衰竭并肾功能不全时使用的安全性.1 对象与方法1.1 对象46例充血性心力衰竭并肾功能不全者均来自本院1998年1月至1999年12月住院及门诊病人,其中高血压31例,糖尿病9例,扩张型心肌病5例.按美国纽约心脏学会心功能的分级(陈国伟主编《现代心脏内科学》),其中心功能Ⅱ级29例,Ⅲ级15例,Ⅳ级2例,男性31例,女性15例,年龄50～74岁,平均(62.5±4.9),其肾功能改变见表2.1.2

Nutrition support in surgical patients with colorectal cancer

AIM: To review the application of nutrition support in patients after surgery for colorectal cancer, and to propose appropriate nutrition strategies. METHODS: A total of 202 consecutive surgical patients admitted to our hospital with a diagnosis of colon cancer or rectal cancer from January 2010 to July 2010, meeting the requirements of Nutrition Risk Screening 2002, were enrolled in our study. Laboratory tests were performed to analyze the nutrition status of each patient, and the clinical outcome variables, including postoperative complications, hospital stay, cost of hospitalization and postoperative outcome, were analyzed. RESULTS: The "non-risk" patients who did not receive postoperative nutrition support had a higher rate of postoperative complications than patients who received postoperative nutrition support (2.40 ± 1.51 vs 1.23 ± 0.60, P = 0.000), and had a longer postoperative hospital stay (23.00 ± 15.84 d vs 15.27 ± 5.89 d, P = 0.009). There was higher cost of hospitalization for patients who received preoperative total parenteral nutrition (TPN)than for patients who did not receive preoperative TPN (62 713.50 ± 5070.66 RMB Yuan vs 43178.00 ± 3596.68 RMB Yuan, P = 0.014). Applying postoperative enteral nutrition significantly shortened postoperative fasting time (5.16 ± 1.21 d vs 6.40 ± 1.84 d, P = 0.001) and postoperative hospital stay (11.92 ± 4.34 d vs 15.77 ± 6.03 d, P = 0.002). The patients who received postoperative TPN for no less than 7 d had increased serum glucose levels (7.59 ± 3.57 mmol/L vs 6.48 ± 1.32 mmol/L, P = 0.006) and cost of hospitalization (47 724.14 ± 16 945.17 Yuan vs 38 598.73 ± 8349.79 Yuan, P = 0.000). The patients who received postoperative omega-3 fatty acids had a higher rate of postoperative complications than the patients who did not (1.33 ± 0.64 vs 1.13 ± 0.49, P = 0.041). High level of serum glucose was associated with a high risk of postoperative complications of infection. CONCLUSION: Appropriate and moderate nutritional intervention can improve the postoperative outcome of colorectal cancer patients.

Unexplained liver laceration after metastasis radiofrequency ablation

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the f irst. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.

Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts?

AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P=1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.

Influences of different time intervals between loop electrosurgical excision and abdominal hysterectomy or radical hysterectomy on postoperative complications: a retrospective analysis

Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.

Clinical analysis of PF plus concurrent radiotherapy in locally advanced nasopharyngeal carcinoma

Objective： The prognosis of patients with nasopharyngeal carcinoma （NPC） depends on the stage of the disease at diagnosis. Unfortunately, at diagnosis, most of patients have locally advanced, non-metastatic stage III or IVa disease. The study was to evaluate the efficacy and toxicities of cisplatin plus 5-fluorouracil combined with concurrent radiotherapy for locally advanced nasopharyngeal carcinoma. Methods： Sixty-six patients with locally advanced nasopharyngeal carcinoma received chemotherapy of cisplatin plus 5-fluorouracil jointing concurrent radiotherapy; concurrent radiotherapy started on day 1 in the first cycle of chemotherapy of PF, 5-fluorouraci1500 mg/m^2 intravenous infusion on days 1-5, cisplatin 80 mg/m2 intravenous infusion on days 1-3, 21 days for a cycle, a total of three cycles; nasopharyngeal lesions and positive lymph node were given a total amount of 70 Gy, prophylactic neck radiation were given the amount of 50 Gy, radiotherapy five times a week, Gy/f. Results： All patients who can be evaluated, the response rate （RR） was 100%; 1-, 3- and 5-year overall survival （OS） were 100%, 86.4%, 21.2%, respectively; 3-year, 5-year disease-free survival （DFS） were 72.7% and 18.2%, respective- ly; the average survival time and median survival time were 49.0 months and 48.5 months, respectively; the average survival time and median survival time of DFS were 46.1 months and 46.5 months, respectively. Conclusion： For patients with locally advanced nasopharyngeal carcinoma, who accepted RT combining concurrent chemotherapy of cisplatin plus 5-fluorouracil, clinical efficacy is satisfaction and toxicities could be tolerated.

Sepsis caused by endoscopic clipping for colonic diverticular bleeding: A rare complication

We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2℃. Laboratory data included a white blood cell count of 18 100/mm3 and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later.

Enteroenteroanastomosis near adjacent ileocecal valve in infants

AIM:To investigate the feasibility and the effectiveness of ileoileostomy in the region adjacent to the ileocecal valve,which can retain the ileocecal valve in infants.METHODS:This is a retrospective review of 48 patients who underwent ileoileostomy in the region adjacent to the ileocecal valve(group 1) and 34 patients who underwent ileocecal resections and ileotransversanastomosis(group 2).Patients were monitored for the time to flatus,resumption of eating,length of hospital stay after surgery,serum total bile acid,vitamin B12 and postoperative complications.RESULTS:The time to flatus,time until resumption of eating and post-operative length of hospital stay showed no statistically significant differences between the two groups.Serum total bile acid and vitamin B12were not significantly different between the two groups at post-operative day 1 and day 3,but were significantly decreased at 1 wk after operation in group 2.None of the patients died or suffered from stomal leak in these two groups.However,the incidence of diarrhea,intestinal infection,disturbance of acid-base balance and water-electrolytes in group 1 was lower than in group 2.CONCLUSION:Ileoileostomy in the region adjacent to the ileocecal valve is safe and results in fewer complications than ileotransversanastomosis in infants.

Comprehensive Treatment and Prognostic Factors in Patients with Carcinoma of the Cervical Stump

OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.

The application of load balancing technology in campus network based on LVS-NAT

The concurrent processing and load capacity of a single server cannot meet the growing demand of users for a variety of services in a campus network system. This document put forward to solve this problem using load balancing techniques based on LVS-NAT, discussed the key technologies of LVS-NAT, designed and implemented campus network service system with LVS-NAT load balancing technology and tested. The results showed that this system improved the processing and load capacity of the concurrent server effectively and provided a good reference to building the efficient and stable digital campus network system.

Design of Capacitor Bank in Parallel to Photovoltaic Power Plant

The purpose of the paper is to develop a solution for application of PV （photovoltaic） generators in MV （medium voltage） distribution system without unacceptable voltage changes due to drops of PV power output. The proposed solution includes operation of PV with predetermined leading power factor and addition of a capacitor bank in parallel to PV plant in order to compensate the reactive power absorbed by the PV inverters. The analytical expression of required power factor angle is derived. Adding a capacitor bank in parallel to PV power plant may pose a problem because of space limitations. The dimensions and cost of small MV capacitor banks depend significantly on the capacitor bank protection against internal faults. Application of the developed negative-sequence current difference method for the unbalance protection of the capacitor banks enables to achieve a compact and cost-reduced design of the banks connected in parallel to PV power plants. A real-world example of operation of the PV plant in parallel to the capacitor bank with the novel protection scheme is described.