颞叶内侧胶质瘤的显微手术治疗体会

目的:探讨颞叶内侧胶质瘤的显微手术疗效并总结经验。方法:回顾性分析23例行显微手术治疗的颞叶内侧胶质瘤患者的临床资料及手术并发症的发生情况。结果:23例患者中,20例全切除,3例次全切除术,术后术区残血1例,无手术死亡病例。术前癫痫发作18例,术后缓解16例;术前有失语8例,后缓解3例;术前8例偏盲,术后改善2例;术前偏瘫2例,术后改善1例;术后新增失语2例,术后新增偏盲3例,术后新增偏瘫1例,1年随访复发3例。结论:经侧裂入路切除颞叶内侧胶质瘤的手术疗效良好,可以最大程度切除术肿瘤,并发症较少。     

儿童意外吸入磷化铝中毒55例临床分析及文献

目的:分析儿童意外吸入磷化铝中毒的临床特点、治疗方法及死亡原因。方法:对本院儿科2014年5月～2018年8月收治的55例意外吸入磷化铝中毒患者进行回顾性分析,根据病情严重程度将其分为轻度(31例)和重度(14例),统计患儿的年龄、性别、发病季节、中毒吸入时间、中毒就诊时间、临床症状、实验室及心电图检查。结果:55例吸入磷化铝中毒患儿中,死亡10例,存活45例,死亡患者均为重度中毒者,死亡原因为循环衰竭。轻度中毒毒素吸入时间平均为25.1 h,中毒后平均就诊时间14.6 h;重度中毒毒素吸入时间平均为185.4 h,中毒后平均就诊时间38.5 h;临床表现为恶心呕吐55例(100%),头晕、面色苍白14例(25%),心悸16例(29%),呼吸衰竭14例(25%),严重的心律失常8例(14.5%),低血压、心源性休克10例(18%);心电图检查:室上性心动过速1例,室性心动过速4例,II度II型房室传导阻滞1例,窦性心律不齐5例,窦性心动过速26例;实验室检查中心肌酶升高19例(34.5%);肝功能异常12例(21.8%);肾功能异常6例(10.9%);代谢性酸中毒14例(25%)。治疗上主要为对症支持治疗。结论:儿童意外吸入磷化铝中毒以重度中毒病例死亡率高,多为循环衰竭所致,目前无特效解毒药物,早期诊断和早期综合性治疗尤为重要。     

脑囊虫的MRI 表现

目的:探讨脑囊虫不同分期、分型的磁共振表现及应用价值。方法:收集脑囊虫病例127例,行MR轴、矢、冠位扫描及增强扫描。结果:脑囊虫分型:单发小囊型44例,单发大囊型6例,多发小囊型34例,脑实质钙化型18例;脑室型11例;蛛网膜下腔型7例;混合型7例。脑囊虫分期:活动期32例,退变死亡期49例,钙化期18例,混合期28例。结论:磁共振扫描能够清晰显示各种细节,是诊断脑囊虫的有力手段。     

垂体腺瘤的临床与病理观察(附22例报告)

目的探讨垂体腺瘤(pituitary adenoma)的临床与病理特点。方法回顾性分析22例垂体腺瘤患者的临床资料。结果内分泌检查结果:22例垂体腺瘤患者中,催乳激素(PRL)值升高者8例;促性腺激素(GnH)水平改变者8例;生长激素(GH)升高者1例;出现Cushing综合症者2例;激素水平正常者3例。免疫组化结果:22例垂体腺瘤患者中8例PRL阳性;7例卵泡刺激素(FSH)/黄体生成素(LH)阳性;1例GH阳性;1例GH/PRL阳性;1例FSH/PRL阳性;无功能者4例。结论应用病理和内分泌功能分类相结合的方法,对垂体腺瘤进行分类,具有十分重要的实际应用价值。     

磁共振三维稳态进动快速成像序列诊断脑积水的临床价值

摘要 目的：分析磁共振三维稳态进动快速成像(3D-FIESTA)序列诊断脑积水的临床价值。方法：选择我院2015年3月~2016年3月收治的手术病理确诊的120例脑积水患者,术前均行磁共振常规序列及3D-FIESYA序列扫描,比较其检查结果。结果：磁共振常规序列提示有23例交通性脑积水,有73例梗阻性脑积水,其中有24例中脑导水管完全梗阻,有20例中脑导水管狭窄,有16例四脑室流出道梗阻,有13例桥前池囊肿阻塞双侧室间孔,有24例未检出。3D-FIESTA序列提示有34例交通性脑积水,有83例梗阻性脑积水,其中有34例中脑导水管完全梗阻,有19例中脑导水管狭窄,有18例四脑室流出道梗阻,有12例桥前池囊肿阻塞双侧室间孔,有3例未检出。3D-FIESTA序列对脑积水的检出率高于磁共振常规序列,差异有统计学意义(P<0.05)。结论：3D-FIESTA序列能够客观反映脑脊液循环通路的状态,利于脑积水类型的鉴别,为临床治疗提供更全面、确切的影像学参考。     

Characteristics of Hospitalized Cases of Pertussis in Catalonia and Navarra,Two Regions in the North of Spain

Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI) was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02–2.65), apnoea (aOR: 2.47; CI: 1.51–4.03) and cyanosis (aOR: 15.51; CI: 1.87–128.09) were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis.     

急性右下肢深静脉血栓的临床治疗分析

目的:探讨右下肢深静脉血栓的临床治疗方法。方法:对我院2015年6月-2017年6月收治的63例右下肢深静脉血栓形成患者进行回顾性分析,从小腿周径差、彩超检查及造影3方面对疗效进行评价,并统计导管接触溶栓后患者复查肺部增强CT情况。结果:63例患者中,57例进行导管接触溶栓+下腔静脉滤器,6例进行导管接触溶栓+下腔静脉滤器+肺动脉碎栓、溶栓。治疗后,患者小腿周径差较治疗前明显降低,差异具有统计学意义(P0.05)。患者显效26例,有效28例,好转8例,无效1例,临床治愈率为85.7%。63例下腔静脉滤器,取出60例,3例留置为永久性滤器。新增肺栓塞12例,无致死性肺栓塞发生。结论:导管接触溶栓对右下肢深静脉血栓的治疗效果较好,但导管接溶栓时有较高肺栓塞发生率,应积极放置下腔静脉滤器。     

The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Finding medications or vaccines that may decrease the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially reduce transmission in the broader population. We developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. Simulation experiments found that reducing the average infectious period duration could avert a median of 442,852 [treating 25% of symptomatic cases, reducing by 0.5 days, reproductive number (R₀) 3.5, and starting treatment when 15% of the population has been exposed] to 44.4 million SARS-CoV-2 cases (treating 75% of all infected cases, reducing by 3.5 days, R₀ 2.0). With R₀ 2.5, reducing the average infectious period duration by 0.5 days for 25% of symptomatic cases averted 1.4 million cases and 99,398 hospitalizations; increasing to 75% of symptomatic cases averted 2.8 million cases. At $500/person, treating 25% of symptomatic cases saved $209.5 billion (societal perspective). Further reducing the average infectious period duration by 3.5 days averted 7.4 million cases (treating 25% of symptomatic cases). Expanding treatment to 75% of all infected cases, including asymptomatic infections (R₀ 2.5), averted 35.9 million cases and 4 million hospitalizations, saving $48.8 billion (societal perspective and starting treatment after 5% of the population has been exposed). Our study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.     

宫腔镜联合B超诊断异常子宫出血124例临床分析

目的：探讨宫腔镜联合B超在诊治异常子宫出血的临床价值。方法：对124例异常子宫出血的病例进行回顾性分析,所有患者作B超及宫腔镜检查,宫腔内切除物或刮出物均送病理检查。结果：124例患者经病理检查确诊为子宫内膜息肉84例（67．7％）,合并宫颈息肉10例;子宫内膜增生症16例（12．9％）,其中单纯性增生12例,复杂性增生4例;子宫内膜不典型增生1例（0．8％）;子宫粘膜下肌瘤12例（9．7％）;子宫内膜样腺癌6例（4．8％）;子宫内膜炎3例（2．4％）;胚物残留2例（1．6％）。结论：宫腔镜联合B超检查是诊断异常子宫出血最好的方法.     

A survey of the pathogenic fungi of mycotic infection of the scalp in U.A.R.

Summary 121 cases diagnosed clinically as tinea capitis were examined microscopically and culturally. In 80 cases the causative organism could be cultured.T. violaceum was the causative organism of the majority of the cases as it caused 47.5 % of the cases,T. schoenleinii 31.3 %,M. canis caused 26.1 %,T. tonsurans 1.3 %, whileM. audouinii caused none. In most of the cases ofT. violaceum infection, scaling and mild inflammation were the common clinical manifestation. The black dot or the bald patch appearance was rarely seen. Favus did not necessarily show the characteristic scutulae; in many cases ofT. schoenleinii infection, only few scales and mild inflammation were present.     

蕲蛇酶治疗冠心病65例临床观察

应用蕲蛇酶治疗冠心病６５例,其中中医辨证分型属气虚血瘀１２例,气阴虚血瘀２２例,疾浊血瘀２５例,阴虚血瘀６例,经１～３疗程（每疗程７～１０ｄ）显效５３例,改善１１例,总有效率达９８．４６％。以气虚血瘀及气阴虚血瘀者疗效较佳     

Isolation of an antigen fromBlastomyces dermatitidis that is specific for the diagnosis of blastomycosis

The A antigen ofBlastomyces dermatitidis has been isolated and purified by DEAE column chromatography. In the complement-fixation test, the antigen reacted with 10 of 16 sera from patients with proven cases of blastomycosis and was negative with known positive sera from 7 cases of histoplasmosis, 5 cases of coccidioidomycosis, 5 cases of candidiasis, and 5 cases of cryptococcosis. In the enzyme-immunoassay test, 25 of 27 sera from cases of blastomycosis were positive, but all heterologous and normal sera tested were negative. The antigen gave a positive skin test with guinea pigs sensitized with killed yeast-phase cells ofB. dermatitidis and negative skin tests with guinea pigs sensitized with killed yeast-phase cells ofHistoplasma capsulatum.     

Anisakiasis: Report of 15 Gastric Cases Caused by Anisakis Type I Larvae and a Brief Review of Korean Anisakiasis Cases

The present study was performed to report 15 anisakiasis cases in Korea and to review the Korean cases reported in the literature. Total 32 Anisakis type I larvae were detected in the stomach of 15 patients by the endoscopy. Single worm was detected from 12 cases, and even 9 larvae were found from 2 cases. Epigastric pain was most commonly manifested in almost all cases, and hemoptysis and hematemesis were seen in 1 case each. Symptom manifestations began at 10-12 hr after eating fish in 73.3% cases. Endoscopy was performed 1-2 days after the symptom onset in most cases. The common conger, Conger myriaster, was the probable infection source in 7 cases. In the review of Korean anisakiasis cases, thus far, total 645 cases have been reported in 64 articles. Anisakis type I larva was the most frequently detected (81.3%). The favorable infection site of larvae was the stomach (82.4%). The common conger was the most probable source of human infections (38.6%). Among the total 404 cases which revealed the age and sex of patients, 185 (45.8%) were males, and the remaining 219 (54.2%) were female patients. The age prevalence was the highest in forties (34.7%). The seasonal prevalence was highest in winter (38.8%). By the present study, 15 cases of gastric anisakiasis are added as Korean cases, and some epidemiological characteristics of Korean anisakiasis were clarified.     

不同病理类型囊腔样肺癌的多排螺旋CT诊断

目的:分析不同病理类型囊腔样肺癌的多排螺旋CT(Multi-Detector Computed Tomography,MDCT)影像表现,以提高对该病的认识及早期诊断水平。方法:回顾性分析28例经病理证实的囊腔样肺癌的一般资料和MDCT表现,并分析不同病理类型的影像特征包括病灶大小、部位、形态分型、磨玻璃征、形态和边缘、瘤-肺界面、与支气管关系、囊腔内残留血管分隔、胸膜凹陷征、合并肺大泡等及其相关性。结果:28例囊腔样肺癌包括18例腺癌,3例微浸润腺癌,6例鳞癌,1例腺鳞癌。患者的平均发病年龄腺癌(60.56±8.03)和鳞癌(66.00±7.93岁)高于微浸润腺癌组(49.33±16.17岁)(F=3.449,P=0.048)。平均病灶大小腺癌(1.99±0.69 cm)和鳞癌(2.45±0.87 cm)大于微浸润腺癌(0.73±0.23 cm)(F=5.980,P=0.008)。磨玻璃征主要见于腺癌(14例,77.8%)或微浸润腺癌(3例,100.0%),与鳞癌(1例,16.7%)之间比较有统计学差异(P=0.012)。鳞癌(5例)与腺癌(2例)相比更容易显示支气管截断(P=0.003)。对不同病理类型囊腔样肺癌的其他影像特征之间比较无统计学差异(P0.05)。结论:不同病理类型囊腔样肺癌具有一定的典型CT影像特征,如磨玻璃征可高度提示腺癌或微浸润腺癌,鳞癌更容易出现支气管截断征象或肺门侧软组织影。对于不典型病灶,影像动态随访对确诊很重要。     

类风湿关节炎前足矫形术后跖骨痛原因分析

目的:探讨类风湿性关节炎前足矫形术后跖骨痛的病因分析,以期采取相应的应对措施,以改善类风湿性关节炎前足矫形手术的手术效果,提高患者的满意度。方法:本院自2009年6月至2014年6月5年间行类风关前足矫形术204例256足,其中术后出现跖骨痛的44例46足,随访术后出现跖骨痛的时间、部位以及处理措施的效果和预后,并分析其出现原因。结果:44例患者中11例11足接受了再次手术治疗,7例术后患者跖骨痛消失,4例患者术后仍残留疼痛,2例接受足垫治疗,2例接受了第3次手术,术后疼痛消失。32例34足未接受再次手术,行矫形足垫治疗,1例患者失随访。结论:术后残留跖骨痛是类风湿关节炎前足矫形术常见的术后并发症,大多数患者可通过矫形鞋垫缓解疼痛,少数需要再次手术治疗。     

Epidemiology of Leprosy in Spain: The Role of the International Migration

BackgroundAlthough incidence of leprosy in Spain has declined steadily over the years, the fivefold increase in immigration since the turn of the century—much of it from countries where leprosy is still prevalent—has been linked to an uptick in registered cases.ObjectiveTo describe the epidemiologic trends of incident leprosy cases detected in Spain among Spanish- and foreign-born population groups.MethodsObservational, retrospective study of suspected leprosy cases in Spain, as reported through the System of Compulsory Notification of Diseases from 2003 to 2013, with results disaggregated by country of birth. We collected statistical data on leprosy burden for other countries from WHO to estimate the expected number of imported cases.ResultsOf the 168 leprosy cases registered during the study period, 40 (24.6%) were in Spanish patients, while 128 (76.2%) were detected in legally resident immigrants. We identified a significantly higher number of imported leprosy cases during the 2008–2010 and 2011–2013 trienniums compared to the reference biennium 2003–2004 (OR 5.38, 95% CI 1.83–14.88 and OR 4.80, 95% CI 1.41–16.33, respectively). Most imported cases were diagnosed in Latin American immigrants (71.9%), especially Brazilians, but also Paraguayans, Bolivians and other nationalities from South and Central America. However, registered incidence was lower than expected for each year. For example, in 2003, the expected new cases in immigrants was 47.12, compared to only four cases that were actually detected (a 91% difference). Likewise, we expected to find 49.6 incident cases among immigrants in 2009, but only 15 new cases were reported (60% fewer than expected).ConclusionImported cases of leprosy are responsible for most leprosy incidence in Spain, and we cannot rule out some under-diagnosis. Clinicians should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

双胎妊娠一胎宫内死亡的临床分析

目的:探讨双胎妊娠一胎宫内死亡的原因及处理方法。方法:对本院2013年1月～2017年6月住院分娩的双胎妊娠一胎宫内死亡的病例进行回顾性分析。结果:双胎妊娠一胎宫内死亡28例,占同期双胎分娩的1.63%,占同期双胎胎盘送检的4.33%。6例孕28周,14例孕28～34周,8例孕周34周。全部孕产妇均无出血倾向或发生凝血功能障碍。产妇年龄23～45周岁,平均31.3周岁;初产妇23人,经产妇5人。应用辅助生殖技术受孕5例,自然受孕23例;剖宫产7例,顺产21例;确诊一胎儿死亡时间为孕12周余～34周余。主要致死原因为脐带因素13例次(46.43%),胎盘因素12例次(42.86%),双胎输血综合征及纸样胎共5例次(17.86%),胎儿畸形4例次(18.18%)。结论:孕中晚期双胎之一胎儿宫内死亡妊娠不足34周,应在密切监护母胎情况下行期待治疗,单绒毛膜囊双胎34周后可以分娩,双绒毛膜囊双胎可妊娠至36周。     

Brucellacapt、RBT、SAT、iELISA四种血清学检测方法对布鲁氏菌病检测价值的比较研究

目的:探讨布鲁氏菌病血清学试验(Brucellacapt)、虎红平板凝集试验(RBT)、试管凝集试验(SAT)、间接酶联免疫吸附试验(i ELISA)四种血清学检测方法对布鲁氏菌病检测价值的比较研究。方法:收集近两年110例布鲁氏菌病疑似病例人员的静脉血分离得到血清后进行Brucellacapt、RBT、SAT、i ELISA四种血清学检测,以卫生部制定的《布鲁氏菌病诊疗指南》中布鲁氏菌病确诊方法为诊断金标准,将检测结果与其确诊结果进行比较,评价比较各组血清检测方法对布鲁氏菌病的检测价值。结果:110例疑似人员中确诊为布鲁氏菌病阳性91例、阴性19例。Brucellacapt试验阳性89例、阴性21例;RBT试验阳性79例、阴性31例;SAT试验阳性71例、阴性39例;i ELISA检验阳性82例、阴性28例。Brucellacapt试验的灵敏度、符合率、Kappa值、ROC曲线下面积均最大,i ELISA试验、RBT试验、SAT试验依次减小;i ELISA试验的ROC曲线下面积最大,Brucellacapt试验次之,其次为RBT试验,SAT试验的ROC曲线下面积最小。结论:Brucellacapt、RBT、SAT、i ELISA四种血清学检测方法对于布鲁氏菌病检测均有一定的检测价值,对于常规普通患者可采用RBT试验、SAT试验进行检查,而对于疑似病例人员可采用灵敏度更高的Brucellacapt试验、i ELISA试验。