Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We ...Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.展开更多
Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures ...Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.展开更多
BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to q...BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate analyses.RESULTS In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In the logistic regression model, odds ratios (ORs) were significantly high in nausea/vomiting (OR: 3.89, 95%CI: 2.04-7.42) and anorexia (OR: 2.13, 95%CI: 1.06-4.28). ORs were significantly lower with a longer onset-to-visit interval (OR: 0.84, 95%CI: 0.72- 0.97), RLQ pain (OR: 0.28, 95%CI: 0.11-0.71), history of diverticulitis (OR: 0.034, 95%CI: 0.005-0.20), and CRP level > 3.0 mg/dL (OR: 0.25, 95%CI: 0.14-0.43). The regression model showed good calibration, discrimination, and optimism. CONCLUSION Clinical findings can differentiate AA and ARCD before imaging studies;nausea/vomiting and anorexia suggest AA, and longer onset-to-visit interval, RLQ pain, previous diverticulitis, and CRP level > 3.0 mg/dL suggest ARCD.展开更多
This paper is a summary of clinical studies on auricular acupoint penetration needling along the skin for treatment of pain and dysfunction in recent 10 years.Auricular acupoint penetration needling along the skin was...This paper is a summary of clinical studies on auricular acupoint penetration needling along the skin for treatment of pain and dysfunction in recent 10 years.Auricular acupoint penetration needling along the skin was used to observe rapid analgesic effects and clinical efficacy on cervical spondylopathy,periarthritis of shoulder,pain in waist and lower extremities,migraine,and other peripheral neuropathic pain,and stroke sequels,soft tissue injury,and so on.Self-control method was used in the studies at the first stage,and clinically randomized control trial methodwas used for systematic comparison with other therapies at the second stage.Results indicated that the auricular acupoint penetration needling along the skin had obviously clinical effects on cervical spondylopathy,periarthritis of shoulder,pain in waist and lower extremities,migraine,soft tissue injuries and stroke sequels,with a better rapid analgesic effect as compared with ear perpendicular needling method.展开更多
We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination reveal...We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a "C"-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root ofileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after opera-tion with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it.展开更多
Objective: To observe the clinical efficacy of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation (LIDH). Methods: A total of 70 patients with LIDH were randomized into an observatio...Objective: To observe the clinical efficacy of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation (LIDH). Methods: A total of 70 patients with LIDH were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with acupuncture at abdomen acupoints plus tuina, while the control group was treated only with tuina treatment. The clinical efficacy was observed after one course of treatment. Results: The cure rate and the total effective rate of the observation group were 83.3% and 96.7%, respectively. The cure rate and the total effective rate of the control group were 39.4% and 78.8%, respectively. There were significant differences in the cured rate and the total effective rate between the two groups (both P<0.05). There was no significant differenee in Japanese Orthopedic Association (JOA) score between the two groups before treatment (P>0.05). After treatment, the JOA scores of both groups in creased sign ifica ntly, and the in tra-group differe nces were statistically sign ifica nt (both P<0.05);the JOA score of the observation group was significantly higher than that of the control group (P<0.05). Conclusion: Acupuncture at abdomen acupoints plus tuina has a better therapeutic effect than tuina alone in the treatment of LIDH.展开更多
The patient was in conception 27 weeks+6 days,and got right waist pain,complicated with nausea,vomiting(vomit as gastric content),which was diagnosed as non-specific pain on waist after consultations of many departmen...The patient was in conception 27 weeks+6 days,and got right waist pain,complicated with nausea,vomiting(vomit as gastric content),which was diagnosed as non-specific pain on waist after consultations of many departments.The patient received acupuncture with the following acupoints:Shuǐgōu(水沟 GV26),Yìntáng(印堂 EX-HN3),left Hégǔ(合谷 LI4),and right Tàichōng(太冲 LR3).On the first date of acupuncture,the patient felt pain relieved obviously,occasionally with slight pain that did not influence normal diet and rest.On the next day,the patient took acupuncture continuously,the doctor added Tàixī(太溪 KI3)acupoint.The patient received acupuncture for 3 times in all.The pain and soreness of the patient almost disappeared,only with slight discomfort occasionally that did not influence the normal life.Through follow-up half a year,the patient born a live male infant by cesarean section on March 20,2019,both the mother and her infant were safe.展开更多
文摘Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.
文摘Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.
文摘BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate analyses.RESULTS In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In the logistic regression model, odds ratios (ORs) were significantly high in nausea/vomiting (OR: 3.89, 95%CI: 2.04-7.42) and anorexia (OR: 2.13, 95%CI: 1.06-4.28). ORs were significantly lower with a longer onset-to-visit interval (OR: 0.84, 95%CI: 0.72- 0.97), RLQ pain (OR: 0.28, 95%CI: 0.11-0.71), history of diverticulitis (OR: 0.034, 95%CI: 0.005-0.20), and CRP level > 3.0 mg/dL (OR: 0.25, 95%CI: 0.14-0.43). The regression model showed good calibration, discrimination, and optimism. CONCLUSION Clinical findings can differentiate AA and ARCD before imaging studies;nausea/vomiting and anorexia suggest AA, and longer onset-to-visit interval, RLQ pain, previous diverticulitis, and CRP level > 3.0 mg/dL suggest ARCD.
基金supported by a TCM Grant for Middle-aged and Young Persons of Hebei Medical University (No.030015)Plan Project of TCM Administration Department of Hebei Province (No.05032, No.200657)+1 种基金The National Natural Science Foundation of China (No. 81072883)Acup-mox key discipline of State TCM Administration Bureau of China
文摘This paper is a summary of clinical studies on auricular acupoint penetration needling along the skin for treatment of pain and dysfunction in recent 10 years.Auricular acupoint penetration needling along the skin was used to observe rapid analgesic effects and clinical efficacy on cervical spondylopathy,periarthritis of shoulder,pain in waist and lower extremities,migraine,and other peripheral neuropathic pain,and stroke sequels,soft tissue injury,and so on.Self-control method was used in the studies at the first stage,and clinically randomized control trial methodwas used for systematic comparison with other therapies at the second stage.Results indicated that the auricular acupoint penetration needling along the skin had obviously clinical effects on cervical spondylopathy,periarthritis of shoulder,pain in waist and lower extremities,migraine,soft tissue injuries and stroke sequels,with a better rapid analgesic effect as compared with ear perpendicular needling method.
文摘We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a "C"-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root ofileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after opera-tion with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it.
文摘Objective: To observe the clinical efficacy of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation (LIDH). Methods: A total of 70 patients with LIDH were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with acupuncture at abdomen acupoints plus tuina, while the control group was treated only with tuina treatment. The clinical efficacy was observed after one course of treatment. Results: The cure rate and the total effective rate of the observation group were 83.3% and 96.7%, respectively. The cure rate and the total effective rate of the control group were 39.4% and 78.8%, respectively. There were significant differences in the cured rate and the total effective rate between the two groups (both P<0.05). There was no significant differenee in Japanese Orthopedic Association (JOA) score between the two groups before treatment (P>0.05). After treatment, the JOA scores of both groups in creased sign ifica ntly, and the in tra-group differe nces were statistically sign ifica nt (both P<0.05);the JOA score of the observation group was significantly higher than that of the control group (P<0.05). Conclusion: Acupuncture at abdomen acupoints plus tuina has a better therapeutic effect than tuina alone in the treatment of LIDH.
文摘The patient was in conception 27 weeks+6 days,and got right waist pain,complicated with nausea,vomiting(vomit as gastric content),which was diagnosed as non-specific pain on waist after consultations of many departments.The patient received acupuncture with the following acupoints:Shuǐgōu(水沟 GV26),Yìntáng(印堂 EX-HN3),left Hégǔ(合谷 LI4),and right Tàichōng(太冲 LR3).On the first date of acupuncture,the patient felt pain relieved obviously,occasionally with slight pain that did not influence normal diet and rest.On the next day,the patient took acupuncture continuously,the doctor added Tàixī(太溪 KI3)acupoint.The patient received acupuncture for 3 times in all.The pain and soreness of the patient almost disappeared,only with slight discomfort occasionally that did not influence the normal life.Through follow-up half a year,the patient born a live male infant by cesarean section on March 20,2019,both the mother and her infant were safe.
