Objective To explore the clinical characteristics, serology, imaging, histopathology, treatment, and prognosis of IgG4-related diseases (IgG4-RD). Methods Clinical data of 76 patients diagnosed with IgG4-RD at the Second Hospital of Shanxi Medical University from 2013 to 2019 were retrospectively analyzed. Results Among the 76 patients, there were 39 males (51.3%) and 37 females (48.7%), with an average age of (56.1±11.8) years old. The most common involved organ was the submandibular gland (32.9%, 25/76), followed by the labial gland (15.8%, 12/76), pancreas (13.2%, 10/76), parotid gland (11.8%, 9/76), retroperitoneum (7.9%, 6/76), lymph nodes (5.3%, 4/76), sinus (2.6%, 2/76), lung (2.6%, 2/76), kidney (2.6%, 2/76), bile duct (2.6%, 2/76), skin (1.3%, 1/76), and colon (1.3%, 1/76). IL-6 was positively correlated with IgG4 (r=0.483, P 0.05). Histopathological examination was performed in 61 cases, which were mainly characterized by infiltration of lymphocytes and plasmacytes and fibrosis,>10 IgG4(+) plasma cells per high-power field, or ratio of IgG4(+)/IgG(+) cells > 40%. Of all patients included, 23.7%(18/76) were treated with glucocorticoid alone, 28.9% (22/76) were treated with hormone combined with immunosuppressive therapy, 44.7% (34/76) were treated with hormone combined with immunoregulatory therapy, 2.6% (2/76) were untreated, and 90.8% (69/76) responded well to initial treatment. Conclusion IgG4-RD is an autoimmune disease with multiple organ involvement. The most frequently involved organs are the submandibular gland, labrum gland, pancreas, and parotid gland. Combined detection of IL-6 and interferon-γ may play a predictive role in the pathogenesis of IgG4-RD, and they may become new targets for clinical treatment of IgG4-RD. Key words: Immunoglobulin G; IgG4-related disease; Interleukin-6; Interferon-γ; Clinical characteristics
目的 比较经外周静脉置入中心静脉导管(PICC)、经颈内静脉植入输液港(胸壁港)及经上臂静脉植入输液港(上臂港)对乳腺癌化疗患者生活质量的影响.方法 采用方便抽样法选取2018年11月至2019年6月在北京市2所三级甲等综合医院乳腺科的342例乳腺癌化疗患者作为研究对象,使用一般资料调查表及健康相关生活质量量表进行调查,比较置入不同中心静脉通路的患者生活质量的差异.结果 更多自费(10.2%)或新农合(16.2%)患者选择PICC作为化疗通路,且PICC患者带管时间[66(44,113)d]较胸壁港[130(68.5,325.5)d]和上臂港[184(65,323)d]更短(P<0.001).更多靶向治疗患者选择上臂港(49.5%)或胸壁港(48.4%)作为治疗通路(P=0.002).PICC患者的生理机能[75(65,80)分]、生理职能[0(0,0)分]、社会功能[44.4(33.3,66.7)分]、情感职能[0(0,66.7)分]以及生理健康[216(192,241)分]、心理健康[211.7(190.4,256.9)分]得分较胸壁港[分别为85(75,90)分、25(0,100)分、77.8(55.6,100)分、100(0,100)分、256(191,314)分、306.9(211.9,359.8)分]和上臂港[分别为80(75,90)分、50(0,100)分、88.9(55.6,100)分、100(0,100)分、277(199,356)分、319.8(235.8,360.9)分]更差(P均<0.05),PICC患者一般健康状况得分[57(50,72)分]低于上臂港[72(50,85)分,P<0.05].结论 使用PICC化疗的患者生活质量低于使用输液港化疗的患者,而不同部位置入输液港的患者生活质量差异不大.输液港是乳腺癌化疗患者的优选通路.
患者,男性,48岁,农民,因"咳嗽、气促、间断咯血3 年,加重伴发热4 d"于2016 年11 月12 日入住高州市人民医院.患者4年前有肺结核病史,自诉已治愈,具体不详.患者3年前无明显诱因反复出现咳嗽,间断性咯鲜红色血,多为痰中带血丝,伴活动后气促,可自闻及喘鸣音,反复在当地医院治疗,具体用药不详,症状反复.个人史及家族史无特殊.查体:双肺呼吸音减弱,可闻及大量散在痰鸣音及少许哮鸣音,心律齐,双下肢无水肿.入院后查血常规:白细胞总数14.04×109/L,中性粒细胞百分比78.20％;C 反应蛋白浓度>200 mg/L;红细胞沉降率67 mm/h;结核感染T 细胞检测阴性,肝肾功能无明显异常;多次痰液查抗酸杆菌阴性;结核菌素试验5 mm× 6 mm.
Objective To assess clinical outcomes of surgical management of adults with thoracic and lumbar tuberculosis in Tibet by comparing posterior only, anterior only, and combined posterior and anterior surgical approaches. Methods The medical records for 62 patients treated for thoracic and lumbar tuberculosis between January 2010 and September 2018 were retrospectively reviewed. Among them, 28 patients were treated with single-stage anterior debridement and interbody fusion with instrumentation (Group A), 11 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 23 patients with posterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale score (VAS), complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups. Results The patients were followed for 5-96 months, with an average of (10±5) months. The operative time of Group C [(213.5±42.3) min] was significantly shorter than that of Groups A [(260.9±58.1) min] and B [(292.7±45.2) min] (P 0.05). There was no statistically significant between groups in length of stay (P>0.05). The correction rate was superior in Groups B [(73.4±11.2)%] and C [(72.5±13.4)%] compared with Group A [(45.2±16.8)%], whereas the VAS score showed no statistically significant difference among the groups (P>0.05). Two patients developed recurrence 4 and 7 months after operation, one in Group A and one in Group B. During the operation, there were five cases of pleura rupture leading to hemopneumothorax (3 in Group A and 2 in Group B) and two cases of peritoneum rupture in Group B. Conclusion For patients with thoracic and lumbar tuberculosis, the use of single-stage anterior debridement and interbody fusion with instrumentation approach is limited for the unsatisfactory corrective effect and high complications. Although the combined approach produces satisfactory outcomes, it remains more traumatic and is associated with longer operative time and more blood loss. Therefore, the posterior approach is recommended, not only because it achieves good results, but also because it has reduced complications, shorter operative time, and less blood loss. Key words: Tuberculosis, spinal; Surgical procedures, operative; Treatment outcome; Complications
目的 观察核因子相关因子2(Nrf2)、血红素加氧酶1(HO-1)在原发性胆汁性胆管炎(PBC)患者治疗前后血清中的水平变化,并探讨二者与熊去氧胆酸(UDCA)短期疗效的相关性.方法 纳入山西医科大学第一医院PBC患者及健康对照者各80例.收集PBC患者治疗前后的临床资料及血清样本,采用ELISA法检测样本中Nrf2及HO-1的含量,硫代巴比妥酸法、黄嘌呤氧化酶法分别检测丙二醛(MDA)及超氧化物歧化酶(SOD)的含量,并进一步分析UDCA治疗前后PBC患者血清中Nrf2、HO-1的水平变化及临床意义.结果 治疗前PBC患者血清Nrf2、HO-1含量分别为(626.07±103.95)U/L、(16.62±5.06)U/L)显著高于健康对照者[分别为164.45±35.12)U/L、(11.74±2.0)U/L],差异均有统计学意义(P均<0.001);与治疗前比较,UDCA治疗后1个月PBC患者血清中Nrf2[(754.30±104.36)U/L]、HO-1[(22.60±5.51)U/L]含量显著增加(P均<0.001),肝功能各项指标也得到改善(P均<0.001).患者治疗前血清中Nrf2水平(r=0.751,P=0.012)、HO-1水平(r=0.621,P=0.038)与治疗效果均呈正相关.以治疗前Nrf2=586.17 U/L作为阈值,预测的UDCA短期疗效的敏感度为84.6%,特异度为77.5%,曲线下面积为0.824(P<0.05);以治疗前HO-1=14.92 U/L作为阈值,预测的UDCA短期疗效的敏感度为88.5%,特异度为75.0%,曲线下面积为0.861(P<0.05).结论 Nrf2、HO-1在PBC患者疾病过程中发挥重要作用,二者在血清中的基线水平及动态变化同UDCA疗效相关,可以提示PBC患者对UDCA短期治疗的应答情况.
Objective To provide a new method for predicting hematoma expansion in cerebral hemorrhage (ICH). Methods Initial CT scan images of 128 patients with spontaneous intracerebral hematoma were analyzed. Hematoma volumes were measured using the ABC/2 method and 3D Slicer. The difference of hematoma volume was calculated to predict hematoma expansion, and its predictive efficiency was compared with that of hematoma shape categories (hematoma expansion≥6.0 cm3 growth;≥12.5 cm3 growth). Results The hematoma volume initially measured using the ABC/2 method and 3D Slicer was (21.4±16.4) cm3 and (17.7±14.0) cm3, respectively. The hematoma volume measured by the ABC/2 method was significantly larger than that using 3D Slicer (t=11.869, P<0.001). The volume of ICH hematoma measured by the ABC/2 method [(26.3±21.8) ml] at the second CT scan was significantly larger than that at the first scan [(21.4±16.4) ml, t=8.599, P<0.001]. The difference of ICH hematoma volume measured using the ABC/2 method and 3D Slicer was correlated with regular (r=0.628, P<0.05), irregular (r=0.603, P<0.05), and multiple lobular hematoma expansion (r=0.591, P<0.05). The areas under the curve of hematoma volume difference between ABC/2 and 3D Slicer at the first scan for predicting hematoma expansion ≥6.0 cm3 and ≥12.5 cm3 were both greater than those of hematoma shape category (0.866 vs 0.755, Z=2.496, P=0.013; 0.911 vs 0.731, Z=2.674, P=0.008). Conclusion Compared to hematoma shape category, the difference of hematoma volume measured using ABC/2 and 3D slicer could better predict the hematoma expansion. Key words: Intracerebral hemorrhage; Hematoma expansion; Hematoma shape category; 3D Slicer
患者,男性,33岁.主诉无明显诱因出现进食冷硬食物后胸骨后不适3个月,不伴有恶心、呕吐,无腹痛、腹泻.为求进一步诊治入本院.胸部增强CT:食管下段、贲门区壁增厚(图1).超声胃镜检查:距门齿35～38 cm 处食管四壁黏膜增厚(图2),5层结构正常;病理:考虑T细胞淋巴瘤,免疫组化协诊:CD3(+),Syn(-),Ki-67(20％), CD43(+),CD79a(-),CD20(-),AE1/AE3(-), CD56(-).考虑食管T淋巴细胞瘤.按"CHOP"方案化疗2周期后,行全麻下腔镜食管肿瘤切除手术.术中行颈部吻合,并清扫了第1、2、7、8、106L、106R、107、108组淋巴结.术后病理:食管黏膜重度慢性炎症伴局灶淋巴结组织增生、鳞状上皮单纯增生,未见肿瘤残留;胃黏膜轻度慢性炎症;送检各组淋巴结呈反应性增生;食管、胃切缘及网膜组织均未见肿瘤累及(图3).患者术后恢复良好,并于术后3个月开始行"CHOP"方案化疗,共4周期,化疗结束后随访12个月,未见复发.
目的 通过分析非M3型急性髓系白血病(AML)患者的临床和实验室资料,进一步阐明DNMT3A基因突变在非M3型AML患者预后中的意义及其影响AML发生发展的可能机制.方法 采用R语言3.5.1版本RTCGAToolbox包下载癌症基因组图谱数据库180例非M3型AML患者临床及突变信息,数据为开放性数据.将患者按照突变状态进行分组,比较各组患者外周血白细胞计数、骨髓原始细胞比例、无事件生存期以及总体生存期有无差别.将患者按照年龄分为<60岁组和≥60岁组,使用Kaplan-Meier方法绘制生存曲线,并运用Log-rank检验进行<60岁和≥60岁患者、DNMT3A突变组及野生组患者生存率的比较.采用Cox比例风险模型进行DNMT3A突变和其伴随突变及年龄分层等因素对患者总体生存期的单因素和多因素分析.结果 共纳入非M3型AML患者180例,DNMT3A突变组与野生组患者临床特征比较发现突变组白细胞计数显著高于野生组(Z=-2.606,P=0.009),且DNMT3A突变多见于中危患者.值得注意的是,DNMT3A突变常伴随FLT3(P=0.025)、NPM1(P<0.001)、IDH1(P=0.002)突变的发生,且DNMT3Awt/FLT3wt组无事件生存期显著高于DNMT3Amut/FLT3mut组(11.00个月vs 6.15个月,P=0.005),而与DNMT3Amut/FLT3wt、DNMT3Awt/FLT3mut组之间的差异无统计学意义.Cox多因素分析结果显示,高龄是AML患者总体生存的独立危险因素(HR=2.974,95％CI:1.966～4.500,P<0.001);另外,DNMT3A R882突变是AML患者预后不良的独立预测因子(HR=1.937,95％CI:1.179～3.182,P=0.009).结论 高龄(≥60岁)和DNMT3A R882突变为预后不良的独立预测因子.DNMT3Amut/FLT3mut亚型与DNMT3Awt/FLT3wt、DNMT3Amut/FLT3wt、DNMT3Awt/FLT3mut相比,临床预后更差.
目的 明确成都地区儿童幽门螺杆菌根除治疗成功率,分析可能导致儿童根除失败的主要因素.方法 收集2012年1月至2019年6月成都市妇女儿童中心医院经碳13尿素酶呼气试验和胃镜检查确诊幽门螺杆菌感染且需要根除治疗的患儿临床数据,包括疾病人口学数据、根除方案、可能导致根除失败的原因等进行统计分析.结果 共纳入974例确诊幽门螺杆菌感染且需根除治疗的患儿(男性514例,女性460例,<6岁402例,6～9岁371例,≥10岁201例).所有患儿根除成功率69.82%(680/974),首次根除成功率64.99%(633/974);失败后家长同意继续根除治疗116例,最终成功率40.52%(47/116);因溃疡行根除治疗成功率72.00%(18/25).共完成1135次根除,成功率59.91%(680/1135),6种治疗方案的治疗成功率差异无统计学意义(χ2=7.070,P=0.07).2012至2015年成都地区儿童根除以含甲硝唑根除方案为主,根除成功率63.49%;2015年中国儿童幽门螺杆菌诊治专家共识出版后,2016至2019年首选克拉霉素方案,根除成功率提高至73.83%,差异有统计学意义(χ2=11.72,P=0.001).幽门螺杆菌感染家族史是影响儿童根除率的主要因素[优势比=3.921,95%CI(1.249～12.305),P=0.019].结论 成都地区儿童幽门螺杆菌感染总体根除成功率尚未达到80%,初次根除选择克拉霉素三联方案能够提高成功率;有幽门螺杆菌感染家族史是影响成功的主要环境因素.
患者女性,42岁,因突发头痛、头晕5天,加重半天于2019年9月26日收住我院神经内科.既往体健.查体见神志清,言语流利,脑神经检查未见异常,颈部有抵抗感,四肢肌力5级,双侧腱反射对称(++),病理反射未引出,深浅感觉检查正常.颅脑CT:小脑见团块状高密度影,占位效应明显,第四脑室下部受压变窄,余脑室扩大,考虑小脑出血(图1a).头颈部CTA:左侧胚胎性大脑后动脉,余未见明显异常(图1b).血生化检查:无高血脂及高胆固醇.会诊后认为:小脑出血诊断明确,出血量约13 ml,第四脑室受压,有轻度脑积水表现,手术指征明确,建议行小脑出血开颅清除术.患者及亲属3天后同意手术,全麻下以血肿为中心做后枕部旁正中直切口,颅骨铣骨瓣成型,上方暴露至横窦下缘,硬脑膜张力高,"十"字切开硬膜,皮层造瘘直达血肿腔,血肿主体为褐色血性液体,夹杂部分凝固血块,清除血肿后,见血肿腔有黄白色珍珠样新生物及钙化,有包膜,血运极不丰富,新生物及钙化约占整个血肿的1/3,清除所有新生物,并留取标本行病理检查.术后复查CT较满意(图1c).常规病理:镜下见出血坏死组织,伴钙化及胆固醇结晶形成,局部见微量短梭形细胞,细胞性质及类型待定;免疫组化结果:短梭形细胞Vimentin(+),GFAP(+),CD56(+),Syn(+), NSE(+),结合颅脑CT的出血性表现考虑为小脑陈旧性出血、坏死组织伴含铁血黄素沉着、钙化及胆固醇结晶性肉芽肿形成(图2).
目的 研究咳嗽变异性哮喘(CVA)与呼出气一氧化氮(FeNO)、胸腺基质淋巴细胞生成素(TSLP)的相关性,推测其在CVA病理生理中的可能机制.方法 收集2016年7月至2018年12月就诊于包头市中心医院呼吸科门诊及住院的病例:CVA患者67例(CVA组),嗜酸性粒细胞支气管炎(EB)患者8例(EB组).选择同期健康体检者14名(健康对照组).分别进行FeNO及血清TSLP的含量测定.采用单因素方差分析比较3组间上述资料的差异,不同组间的两两比较采用LSD-t检验法.采用Pearson相关分析分析CVA组FeNO与TSLP指标间的相关性.采用多元线性回归分析分析影响CVA组FeNO水平的因素,采用逐步法筛选变量(α入=0.10,α出=0.15)纳入合适的变量.结果 FeNO水平在CVA组、EB组和健康对照组之间差异具有统计学意义(F=7.344,P=0.001);CVA患者FeNO水平显著高于健康对照组[(60.88±42.85)×10-9 mol/L vs(17.64±4.91)×10-9 mol/L],差异具有统计学意义(t=4.35,P<0.001);EB组FeNO水平高于健康对照组[(66.50±42.35)×10-9 mol/L vs(17.64±4.91)×10-9 mol/L)],差异具有统计学意义(t=2.71,P=0.008);CVA组患者和EB组患者比较,差异无统计学意义(P>0.05).CVA组TSLP水平明显高于EB组[(421.60±111.65)ng/L vs(338.81±119.98)ng/L];EB组TSLP水平明显高于健康对照组[(338.81±119.98)ng/L vs(233.34±51.39)ng/L];CVA组血清TSLP水平显著高于健康对照组,差异均具有统计学意义(t=4.11、7.36、5.88,P均<0.001).血清总IgE浓度在CVA组、EB组和健康对照组中比较,差异均无统计学意义(P>0.05).CVA组FeNo与血清TSPL值呈正相关(r=0.258,P=0.035).TSPL值、身高对FeNO水平均有影响.结论 (1)FeNO和血清TSLP水平均与气道炎症相关.(2)单一的FeNO测定可能不能作为CVA与EB的鉴别标准.(3)血清TSLP水平参与了气道炎症的发生和发展,有助于慢性咳嗽CVA和EB的诊断和鉴别诊断.
乳腺癌的发病率占中国女性恶性肿瘤的第1位,且有逐年上升趋势.随着医学技术的进步,乳腺癌患者的生存期不断延长.乳腺癌患者的全程管理和健康教育成为提高患者生活质量不可或缺的重要保证.乳腺癌全程管理涉及筛查、诊断、手术、放疗、化疗、内分泌和靶向治疗、康复、复查随访等的多个环节,因此乳腺癌患者的健康教育应从医院专科设立开始,在基层医院和全科医生诊疗中延续,并应密切围绕诊疗长期、有效地开展.
Objective To explore the clinical diagnosis and treatment of exertional rhabdomyolysis to improve its therapeutic effects. Methods The clinical data of 37 cases of exertional rhabdomyolysis were retrospective analyzed. All cases were given symptomatic treatments such as anti-infection, blood volume supplementation, antiemetic and antipyretic treatments, and alkalization of urine. Six patients with severe acute renal insufficiency, serum creatinine over 442 µmol/L, or hyperkalemia were treated by hemodialysis. Results The average hospitalization time was 9 (range, 4-25) days. Serum creatine phosphokinase decreased to normal in 37 patients at discharge. After hemodialysis, renal function and electrolytes returned to normal in the six patients with severe acute renal insufficiency. Conclusion The initial symptoms of exertional rhabdomyolysis are various and easy to be misdiagnosed or missed. Early detection of serum creatine phosphokinase and myoglobin is helpful for early diagnosis. Symptomatic treatments, such as blood volume supplementation, alkalization of urine, and hemodialysis, are beneficial to the prognosis of patients. Early hemodialysis can effectively improve renal function and reduce mortality in patients with severe acute renal insufficiency caused by exertional rhabdomyolysis. Key words: Rhabdomyolysis; Renal insufficiency; Acute renal injury; Hemodialysis
Objective To summarize the clinical and electromyographic features of Kennedy’s disease to provide evidence for early diagnosis. Methods A retrospective analysis was performed on five patients with Kennedy’s disease who were treated at Shengjing Hospital Affiliated to China Medical University from June 2016 to April 2019. All patients underwent electromyography. Results The patients in this group were accompanied by limb weakness at the time of presentation, but the initial symptoms were different. In most cases, the clinical symptoms at the time of presentation are mainly inability to lift, difficulty in going upstairs, difficulty in walking, and difficulty in lifting the upper limbs. Electromyographic analysis showed that in four patients, the amplitude of the sensory nerves decreased or cannot lead out in different level, and the speed was normal or slightly slowed down. There was no abnormal abnormality in sensory nerve conduction velocity and amplitude in one patient. Four patients had a decrease in motor nerve conduction amplitude, and the rate was normal or slightly slowed. In one patient, the incidence of F-waves in the median nerve and tibial nerve was reduced. Five patients had a little bit of spontaneous activity when the muscles of the limbs were at rest, and large motor unit action potentials during light contraction and heavy contraction. When the above clinical and electromyographic manifestations are present, the possibility of Kennedy’s disease should be considered. Conclusion Electromyography is a convenient and rapid examination and can play an appreciated role in the diagnosis and differential diagnosis of Kennedy’s disease. Key words: Kennedy’s disease; Electromyography; Clinical features
患儿,男性,10岁10个月,以"发热7 d、颈部包块5 d、皮疹3 d"于2018年6月30日入院.患儿于7 d前出现发热,体温38.0℃,物理降温后体温下降,当地诊所给予输液治疗2天,具体名量不详,发热反复,体温最高39.5℃,间隔12 h复升,3天前发现患儿左侧颈部包块,约豌豆大小,质软,无触痛,表面不红,2天前患儿背部及臀部出现少许淡红色片状皮疹,高出皮面,无痒感,继续原治疗,发热间隔时间较前缩短,约8 h 体温复升,患儿出现双眼球结膜充血、口唇潮红,且皮疹增多,遍及颜面部、躯干及四肢,呈淡红色片状皮疹,高出皮面,部分皮疹中间可见淡染区,颈部包块较前增大.
Objective To analyze the clinical efficacy of intravenous recombinant tissue-type plasminogen activator (rt-PA) thrombolytic therapy in stroke in young adults. Methods A retrospective study was performed on 102 young stroke patients (age≤ 45 years) admitted to Xuzhou Central Hospital from July 2010 to July 2019. All patients were treated with rt-PA after admission, and the Rankin Scale (mRS) was modified based on the 90-day clinical outcome and used to divide patients into either a good prognosis group (mRS score<2 points) or a poor prognosis group (mRS score≥ 2 points). The differences in variables were compared between the two groups using the χ2 test or the t-test. Multivariate analysis was performed to identify the prognostic factors for young stroke patients. Results All the 102 patients completed the 90-day clinical follow-up, of whom 55 had a good prognosis, accounting for 53.92% (55/102), and 47 had a poor prognosis, accounting for 46.08%(47/102). Univariate analysis demonstrated that education level, diastolic blood pressure before thrombolysis, blood homocysteine (Hcy), family genetic history, blood uric acid, and pre-thrombotic National Insitute of Health stroke scale (NIHSS) score differed significantly between the two groups (all P<0.05). Multivariate Logistic analysis confirmed that education level, pre-thrombotic systolic blood pressure, Hcy, family genetic history, blood uric acid, and pre-thrombotic NIHSS scores were related to poor prognosis of young stroke patients (P<0.05). Conclusion The poor prognosis of young stroke patients is closely related to lower education level, higher systolic blood pressure, Hcy, higher uric acid, genetic family history, and higher NIHSS score before thrombolysis. These factors should be clinically targeted to improve the prognosis of young stroke patients. Key words: Recombinant tissue-type plasminogen activator; Intravenous thrombolysis; Prognosis; Stroke, youth
目的 研究炎性乳腺癌的临床病理特征及影响预后的相关因素.方法 回顾性分析2012年1月至2018年12月北京大学第一医院乳腺疾病中心收治炎性乳腺癌患者的临床病理资料,探讨影响预后的相关因素.结果 25例临床病理资料完整的炎性乳腺癌患者纳入分析,占同期收治新发乳腺癌患者的0.89%(25/2811).临床分期Ⅲ期17例(68%),Ⅳ期8例(32%),预后分期Ⅲ期17例(68%),Ⅳ期8例(32%).Luminal B型(HER-2阴性)9例(36%),HER-2阳性型5例(20%)及三阴型11例(44%).19例患者接受手术治疗,R0切除率94.7%(18/19).中位生存时间18.2个月,预后分期ⅢB期、ⅢC期和Ⅳ期患者2年总生存率分别为72.9%,66.7%和15.6%(χ2=13.247,P<0.001),差异具有统计学意义.结论 炎性乳腺癌临床发病率不高,但是病期晚,预后差.在接受新辅助治疗后90%以上的患者可以获得局部R0切除.
目的 研究口腔颌面部锥形束CT(CBCT)检查结合牙体分割微创拔牙技术在下颌阻生第三磨牙(IMTM)拔除中的临床应用.方法 选取2018年1月至2019年5月四川省攀枝花市中心医院诊断为IMTM的97例(155颗)拔牙患者为研究对象.术前CBCT明确IMTM与周围重要组织的关系,术中采用转角高速涡轮机夹持长臂裂钻分割牙体,以微创的方式分块拔除IMTM.记录拔牙时间、患者满意度、术中及术后并发症等指标.采用t检验比较男、女间拔牙时间的差异,采用方差分析比较不同阻生牙类型及不同年龄段组间拔牙时间的差异.结果 CBCT结果显示67.7％(105/155)的下颌管位于IMTM根尖的颊侧、22.6％ 根尖下方、9.7％ 舌侧,其中24.5％<1 mm;24颗(15.5％,24/155)IMTM根尖区舌侧骨板缺如,56颗牙(36.1％,56/155)<1 mm.IMTM以近中、垂直及水平向阻生最为常见,平均拔牙时间分别是(24.3±1.1)min,(15.6±1.2)min,(29.7±1.8)min,差异有统计学意义(F=23.85,P<0.001);术中8颗牙(5.2％,8/155)下颌管暴露,无1例舌侧骨板损伤致牙根移位.术后3例少量出血,1例发生干槽症,无1例发生下唇麻木,患者满意度在95.5％ 以上.结论 CBCT应作为IMTM拔除前常规的影像学检查手段.高速涡轮机牙体分割微创拔牙技术适用于各类IMTM拔除,具有创伤小、临床效率高、并发症少、患者满意度高等优点.
患者男性,19岁,因"自服阿米替林200片后意识不清2 h"于2019年1月30日被送入常德市第一人民医院急诊科.患者服药后出现意识不清、呼之不应,被发现时无抽搐、无口吐白沫,阿米替林每片25 mg,共服用5 g.患者既往有抑郁症,无其他特殊病史.查体:体温36.5 ℃,脉 搏 138 次 /min, 呼 吸 20 次 /min, 血 压 112/69 mmHg (1 mmHg=0.133 kPa),中度昏迷,瞳孔等大等圆约4 mm,对光反射灵敏.心率138 次/min,节律整齐.脑膜刺激征阴性,双侧巴宾斯基征阴性.服药2.5 h ECG 为宽QRS 波(约160 ms)心动过速,报告:阵发性室性心动过速(图1).诊断:(1)急性阿米替林中毒;(2)心律失常:室性心动过速.立即予以洗胃、血液灌流及血液滤过等处理,并分别予以双相100焦耳、150焦耳及200焦耳同步电复律共3 次,均失败.患者服药10 h 复查ECG 仍为宽QRS波心动过速,但QRS 波宽度缩窄为142 ms,且QRS 波前可见清晰窦性P波,报告:窦性心动过速,不定型室内传导阻滞(图2).患者服药20 h后复查ECG示QRS波形态恢复正常,QRS波宽度为114 ms,额面电轴+50°,报告:窦性心动过速(图3).头部CT未见明显异常.肺部CT示双肺炎症,胸腔少量积液.患者服药24 h 左右被送入重症监护室继续诊治,心肌酶、心肌肌钙蛋白正常.患者服药后30 h 查ECG 为窦性心动过速,QRS 波宽度100 ms,额面电轴+66°.继续血液灌流、血液滤过、头部亚低温、促醒护脑、抑酸护胃、静滴碳酸氢钠及维持内环境平衡等治疗.2 月1 日患者可睁眼及四肢活动.24 h 动态ECG、心脏彩色多普勒超声未见明显异常,头部MRI平扫及扩散加权成像均未见明显异常.
患者,男性,75岁,以"上腹部不适伴返酸6个月,间断呕血10 d,再发1 d"为主诉于2017 年6 月25 日入鞍钢集团总医院治疗.患者于6个月前无明显诱因出现上腹部不适伴返酸,进食后无缓解,于当地医院行胃镜检查提示在胃小弯胃窦后壁靠近幽门口有隆起型肿物,约1.5 cm×1.5 cm,边界清楚,病理提示胃黏膜腺体增生,间质炎细胞浸润.初步诊断:胃窦部黏膜下占位,考虑间质瘤可能性大,建议行超声胃镜检查,患者拒绝并出院自行口服"胃药治疗",期间仍间断上腹部不适.10 d 前患者无明显诱因出现呕血,共4 次,暗红色,总量约400 ml,伴有返酸、胸闷、胸骨后疼痛等不适,血红蛋白尚处于正常范围,急诊来鞍钢集团总医院消化内科就诊,给予抑酸、止血治疗,患者病情稳定后不同意胃镜、CT检查及进一步治疗,自动出院.1 d 前患者再次呕血,量约100 ml,再次以"消化道出血"入院.入院查体:体温36.5 ℃,脉搏72次/min,呼吸19次/min,血压111/66 mmHg(1 mmHg=0.133 kPa),神清语明,皮肤巩膜无黄染,球结膜无水肿,口唇无发绀,非贫血貌,颈无强直,颈静脉无怒张,未触及浅表肿大淋巴结,呼吸平稳,肋间隙均等,双肺呼吸音清,未闻及干湿性啰音,心律齐,无杂音,腹平坦,上腹部深压痛,无反跳痛及肌紧张,肝脾肋下未触及,移动性浊音(-),肠鸣音正常,双下肢无水肿.患者入院后给予禁食水、抑酸、止血、补液治疗,腹部CT检查(图1)提示:胃窦部扩张积液.增强CT(图2)提示:胃窦部囊性病变,考虑胃窦壁囊肿.胃镜(图3)提示:胃窦部小弯侧后壁见一隆起,约5.0 cm×5.0 cm,表面有一凹陷性溃疡,大小0.6～0.8 cm, 表面覆厚苔,呈类圆形,表面黏膜充血肿胀,考虑胃隆起样病变伴表面溃疡,病理提示胃黏膜慢性炎症.内镜超声(图4)提示:胃窦部小弯侧起源于固有肌层的囊性肿物,考虑胃囊肿.心电图、胸片、血常规、肝功能、肾功能、血糖、离子均未见明显异常,入院诊断:胃囊肿壁溃疡出血.患者择期在全麻下行腹腔镜腹腔探查术,术中见胃窦部小弯侧囊性包块,位于浆膜下,表面光滑,边界清楚,胃周淋巴结略肿大,无融合,考虑性质为良性.
