急诊重症肺炎早期并发感染性休克的临床诊断治疗以及效果分析

研究急诊重症肺炎(SP)早期并发感染性休克患者的早期诊断方法与治疗效果。方法 选取2023年06月-2024年06月期间本院收治的急诊SP早期并发感染性休克患者100例,随机数字分为研究组、对照组,单组50例,分析诊断治疗效果。结果 研究组治疗效果、28d生存率、细菌清除率高于对照组,P<0.05;研究组机械通气时间、住院时间均低于对照组,P<0.05;治疗后,研究组PaO2、氧合指数高于对照组,PaCO2低于对照组,P<0.05;治疗后,研究组CRP、PCT低于对照组,P<0.05。结论 对急诊SP早期并发感染性休克患者开展诊断治疗,可有效的优化治疗效果,改善患者氧合指数、炎症因子指标,缩短康复时间,建议运用。

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

健康状况调查问卷(SF-36)在老年性痴呆患者的生活质量调查研究现状

随着中国人口老龄化的现象增多,老年痴呆患者也在在增加,其将带来严重的社会问题和医疗问题,而老年痴呆患者及其家人的生活质量将会受到影响,给家庭造成了沉重的经济负担和心理压力。因此老年痴呆患者社会功能恢复及评价,是老年痴呆治疗措施的重要指标。因此积极开展对老年痴呆的生活质量调查研究已十分迫切。本文通过对健康状况调查问卷(the short form-36 health survey,SF-36)在老年性痴呆患者的生活质量调查研究中的作用及优缺点进行分析,为痴呆的诊断及治疗效果评价提供重要的参考依据。

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.