张兰教授中西医结合治疗亚急性甲状腺炎经验

张兰系辽宁中医药大学附属医院医学博士、教授、博士研究生导师,国家中医药管理局重点学科内分泌学科学术带头人,辽宁省百千万人才工程"百"人成员,辽宁省教育厅优秀人才,第七届辽宁省优秀科技工作者,辽宁省卫生科教工作先进个人,沈阳市名中医,辽宁中医药大学科技拔尖人才。致力于综合治疗甲状腺、糖尿病等内分泌疾病临床研究数十年,将现代医学诊断、治疗与传统中医病因病机、辨证论治紧密结合,在西医明确诊断该病的基础上进行中医辨证论治,疗效显著。

伏立康唑静脉/口服序贯治疗肺部侵袭性曲霉菌感染临床观察

目的研究肺部侵袭性曲霉菌感染的危险因素,及应用伏立康唑治疗的疗效、安全性,观察对比拟诊治疗(经验性治疗)、临床诊断治疗的疗效差别。方法对我院肺部侵袭性曲霉菌感染病例进行分析,把患者分为拟诊治疗组和临床诊断治疗组,均应用伏立康唑,重症患者联合卡泊芬净。观察指标为住院天数、总费用、临床有效率、死亡率。结果肺部侵袭性曲霉菌感染的危险因素有免疫功能低下、慢性疾病等。拟诊治疗组住院天数、总费用少于临床诊断治疗组,有效率高于临床诊断治疗组,死亡率低于临床诊断治疗组,差异明显。结论肺部侵袭性曲霉菌感染的预防措施是积极治疗基础病及合并症,增强免疫力,合理应用抗生素、激素、免疫抑制剂。伏立康唑静脉/口服序贯治疗肺部侵袭性曲霉菌感染副作用轻微、效果较好,早期经验性治疗可降低死亡率,改善预后。

Clinical Experience in Electro-Acupuncture Treatment

According to the author's clinical experience, when the therapeutic effect of acupuncture is not so satisfactory, electro-acupuncture with modified current intensity and pulse frequency can be adopted for better results. The following are some examples.

Antimicrobial management of intra-abdominal infections:Literature's guidelines

Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

Cadaveric liver transplantation for non-acetaminophen fulminant hepatic failure:A 20-year experience

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT. Most frequent causes of FHF were hepatitis B virus and drug-related (not acetaminophen) liver failure. All surviving patients were regularly controlled at the out-patient clinic and none was lost to follow-up. Mean follow-up was 101 mo. RESULTS: One month, one-, five- and ten-year patient survival was 79%, 72%, 68% and 68%, respectively. One month, one-, five- and ten-year graft survival was 69%, 65%, 51% and 38%, respectively. Six patients needed early (< 2 mo) retransplantation, four for primary non-function, one for early acute refractory rejection because of ABO blood group incompatibility, and one for a malignant tumor found in the donor. Two patients with hepatitis B FHF developed cerebral lesions peri-transplantion: One developed irreversible and extensive brain damage leading to death, and one suffered from deep deficits leading to continuous medical care in a specialized institution. CONCLUSION: Long-term outcome of patients transplanted for non-acetaminophen FHF may be excellent. As the quality of life of these patients is also particularly good, LT for FHF is clearly justified, despite lower graft survival compared with LT for other liver diseases.

Small Intestinal Perforation Caused by Metastasis from Squamous Cell Carcinoma of Scalp --One Case Report

The small bowel metastases from head and neck regions are extremely rare. The diagnosis and treatment of such kind of small bowel metastases remain unclear. This paper reports on a 53-year-old case with small intestine perforation caused by metastasis from squamous cell carcinoma of scalp. After surgical treatment, the patient had a relatively better survival. This paper shares the clinical experience we have learned from managing this patient in hope that it will help other medical professionals in oncology to recognize the disease.

Prof. Zhou Xuewen's Experience in Treating Superior Mesenteric Artery Syndrome

Prof. Zhou Xuewen (周学文), a veteran TCM doctor,is an expert in treating miscellaneous internaldiseases. I have the honor to follow him and havebenefited from his teaching. The following is hisexperience in treating superior mesenteric arterysyndrome that I would like to introduce below.

Personal experience with the procurement of 32 liver allografts

AIM: To introduce the American Pittsburgh's method of rapid liver procurement under the condition of brain death and factors influencing the quality of donor liver.METHODS: To analyze 32 cases of allograft liver procurement retrospectively and observe the clinical outcome of orthotopic liver transplantation.RESULTS: Average age of donors was 38.24±12.78 years,with a male:female ratio of 23:9. The causes of brain death included 21 cases of trauma (65.63%) and nine cases of cerebrovascular accident (28.13%). Fourteen grafts (43.75%) had hepatic arterial anomalies, seven cases only right hepatic arterial anomalies (21.88%), five cases only left hepatic arterial anomalies (15.63%) and two cases of both right and left hepatic arterial anomalies (6.25%) among them. Eight cases (57.14%) of hepatic arterial anomalies required arterial reconstruction prior to transplantation. Of the 32 grafts evaluated for early function, 27 (84.38%) functioned well, whereas three (9.38%) functioned poorly and two (6.25%) failed to function at all. Only one recipient died after transplantation and thirty-one recipients recovered. Four recipients needed retransplantation. The variables associated with less than optimal function of the graft consisted of donor age (35.6±12.9 years vs 54.1±4.3 years, P＜0.05), duration of donor's stay in the intensive care unit (ICU) (3.5±2.4 d vs 7.4±2.1 d, P＜0.005), abnormal graft appearance (19.0% vs 100%, P＜0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (89.3% vs 50.0%, P＜0.005).CONCLUSION: During liver procurement, complete heparization, perfusion in situ with localized low temperature and standard technique procedures are the basis ensuring the quality of the graft. The hepatic arterial anomalies should be taken care of to avoid injury. The donor age,duration of donor's staying in ICU, abnormal graft appearance and recipient problem are important factors influencing the quality of the liver graft.

Control Experimental Study on the Application of Acupuncture Therapy to the Treatment of Peripheral Facial Neuritis in Acute Phase and Its Nursing

Objective： This study aimed to prove acupuncture therapy exerted an obvious clinical efficacy in the treatment of peripheral facial neuritis in acute phase. Methods： 60 clinically collected cases were chosen in the study and randomly divided into control group and treatment group. In control group, dexamethasone, vitamin B, vitamin B 12, and mecobalamine were applied in acute phase, and then acupuncture therapy was combined in remission. In treatment group, western medicine combining with acupuncture therapy was used in acute phase, and three courses of treatment were totally applied. Results： The final conditions of two groups were good, and the grouping was balanced, so the comparability between them was good （P〉0.05）; the curative effects of two groups were significantly different： the effect of treatment group was better than that of control group （P〈0.01）. Conclusion： The acute phase was necessarily grasped to apply acupuncture therapy to the treatment of peripheral facial neuritis, and the curative effect would be more significant if acupuncture therapy was more early used.

Surgical treatment of primary tracheobronchial malignant tumors

Objective： The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors. Methods： The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively. The surgical management included sleeve tracheal resection in 8 cases, lower trachea and carina resection with carina reconstruction in 4 cases, local enucleation of the tumor in 4 cases, left or right carino-pneumon-ection in 2 cases, and resection of the tracheal or bronchial tumor and reconstruction of the airway under cardiopulmonary bypass （CPB）in 6 cases. Results： Among the 18 cases, there were 7 adenoid cystic carcinomas, 9 squamous cell carcinomas, 1 lymphoepithelial-like carcinoma and 1 follicular non-Hodgkin tymphoma. All the cases recovered well except one who died of endotracheal bleeding and asphyxia at the 10th postoperative day. Conclusion： Surgical resection is the most effective treatment for primary tracheobronchial malignant tumors. The selection of operation modes should be individualized according to patients＇ condition. Both complete resection and safety should be taken into consideration simultaneously.

Introduction to professor HE Pu-ren's three-edged needle therapy techniques

Dr.He＇s bloodletting therapy utilizing three edged needles is one of his ＂three adjusting methods of acupuncture＂. During his 70 years of clinical practice, he developed the theory that most diseases are caused by qi stagnation, and in order to restore qi circulation one needs to improve the blood circulation first. Based on this theory, in combination with empirical insights from clinical practice, he has developed a unique technique for using three-edged needles. He has also categorized and extended the application of bloodletting therapy with three edged needles to cover over 150 diseases. In addition, Dr. He＇s bloodletting therapy with three edged needles is an innovation that may inspire other physicians to develope and expand the use of acupuncture-related therapies to treat disease.

Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases

Objective ：To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. Methods： The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. Results： In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% （181/1 206） and 79.9% （ 612/766 ） in patients with thoracic and abdominal injury （ P 〈 0.01 ）, 5.2 % （39/758） and 31.7% （142/448） in patients with blunt and penetrating chest trauma （P〈0.01）, and 72.4% （359/496） and 93.7 % （253/270） in patients with blunt and penetrating abdominal injuries （P〈0.01）, respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9 % （75/950） and 3.6 % （21/590）, respectively （P〈0.01）. Most patients died from exsanguination. Conclusions： The first ＂golden hour＂ after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

Three Unblocking Methods of Acupuncture Therapy of Chinese Medicine Master HE Pu-ren

The knowledge on acupuncture changed in the successive dynasties and the therapeutic methods in acupuncture were also numerous. Through long-term practice and study, Prof. HE Pu-ren, master of Chinese medicine, pointed out that no matter in cold, heat, deficient or excessive patterns.

ZHANG Ren＇s Needling Experience in Treating Refractory Diseases

Chief doctor ZHANG Ren has been engaged in acupuncture practice and literature research for about forty years, with abundant knowledge and clinical experience, particularly in the application of needling techniques. This article presents his experience in the treatment of refractory diseases.

Professor Tian Cong-huo's commonly used acupuncture methods and their clinical application

To introduce Prof. T ian Cong-huo’s commonly used acupuncture methods and their clinical application, in order to summarize the famous doctor’s experience, promote the experience inheritance of Chinese acupuncture, and enhance the therapeutic effect of acupuncture.

Acupuncture for Primary Dysmenorrhea: A Randomized Controlled Trial

Objective： To observe the clinical therapeutic effects of acupuncture treatment for primary dysmenorrhea. Methods： 122 cases of primary dysmenorrhea were randomly divided into three groups. Fifty-two cases in the acupuncture group were treated with acupuncture. Forty cases in the medication group were treated with oral administration of Ibuprofen. Thirty cases in the placebo group were treated with oral administration of vitamin B1. The therapeutic effects were observed after treatments for three menstrual cycles. Results： The total effective rate was 96.2% in the acupuncture group, 80.0% in the medication group and 13.3% in the placebo group. By statistical management, the differences among the acupuncture group, the medication group, and placebo group were statistically significant （P〈0.05）. Conclusion： Both acupuncture and western medication are effective for primary dysmenorrhea and acupuncture treatment is better than Ibuprofen

Experimental Study on Acupuncture Activating the Gonadotropin-releasing Hormone Neurons in Hypothalamus

Objective:To probe into the most effective site,extra-ordinary point,acupoint and channel for regulating reproductive endocrine function by means of the study on acupuncture activating the gonadotropin-releasing hormone neurons(GnRH) in hypothalamus.Methods:Female SD rats of reproductive age were used,and the in vivo study on GnRH neurons in hypothalamus was made with mimic sexual stimulation and feedback regulation.The neuron-activating effects of the acupoints on the channels pertaining to the zang-and fu-organs related with reproductive endocrine and the extra-ordinary points in different regions were studied using the discharge of the neuron as index,and then the neurons were labeled with horseradish peroxidase(HRP) .Results:Acupuncture was given at two acupoints each on the three yin channels of foot,the three yang channels of foot,the Conception Vessel and the Governor Vessel.The order of the mean increasing percentage in the hypothalamic GnRH neuron electric activity was:the Gallbladder Channel>the Spleen Channel>the Stomach Channel/the Bladder Channel/the Conception Vessel>the Liver Channel>the Kidney Channel>the Governor Vessel;for different acupoints,it was:Guanyuan(CV 4) >Sanyinjiao(SP 6) >Zusanli(ST 36) >Daimai(GB 26) /Yanglingquan(GB 34) >Shenshu(BL 23) >Weizhong(BL 40) >Yaoyangguan(GV 3) /Liangmen(ST 21) /Fujie(SP 14) >Qimen(LR 14) /Yingu(KI 10) >Tangzhong(CV 17) /Zhiyang(GV 9) ;for different positions,it was:the lower abdominal part/the lower limb part>the thoracodorsal part;for the extra-ordinary points,it was:Zigong(EX-CA1) >Dannang(EX-LE6) /Yaoyan(EX-B7) >Baichongwo(EX-LE3) /Qianzheng>Jingbi/Bizhong/Taiyang(EX-HN5) >Erbai(EX-UE2) /Dingchun;and for the distribution sites of the extra-ordinary points:lower abdominal region>the lower limb region>the craniofacial region>the upper limb region/the thoracodorsal region.Conclusion:For regulating the reproductive endocrine function,the acupoints located at the same neural segment with the reproductive organ should be selected as the main points,and it is necessary to combine with syndrome differentiation of the viscera and channels.

Academic Ideas of Chinese Medicine Master HE Pu-ren

Prof. HE Pu-ren has been dedicated to the inheritance, exploration and development of acupuncture in his 70-year medical career. His academic ideas are now summarized as follows.

YANG Yong-xuan's Theory on Acupuncture

1 Theory on Superficial Puncture and Cupping Dr. YANG recommended ＂superficial puncture＂. ＂Superficial puncture＂ is named so depending upon the implication of ＂superficial puncture meaning regulation＂. Namely, this technique has the effects to regulate yin and yang, regulate and dredge qi and blood in the meridians and collaterals. The needle tool corresponding to ＂superficial puncture＂ is ＂superficial needle＂. Based upon the descriptions of ＂the theory of nine needles＂ and ＂nine needles and twelve resources＂ in Ling Shu （Spiritual Pivot）. Dr.

Brief Talk on Sun Lijuan’s Clinical Experience in Acupuncture

Professor Sun Lijuan has been engaged in acupuncture clinics for over 40 years and has created many specific acupuncture methods based upon her academic thoughts in respecting but not limited to ancient methods and by creating but not indulgent in new techniques, and by learning widely from other＇s strong points, she has achieved remarkable therapeutic effects in the treatment of difficult and intractable diseases not ideally treated by Chinese and western medications. The authors are very lucky to study with Prof. Sun in clinical workshop and to listen to her teachings. Now, Prof. Sun＇s clinical experience in acupuncture is briefly explained as follows.