ObjectiveTo summarize the clinical features and experience of Methicillin-resistant Staphylococcus aureus (MRSA)-associated enteritis. MethodsClinical data of 21 patients with MRSA-associated enteritis who were treated in our hospital from Jan. 2003 to May. 2015 were analyzed retrospectively. ResultsAfter diagnosed or suspected of MRSA-associated enteritis, the 21 patients received a drug therapy with vancomycin instead of other antibiotic, 3 patients (14.3%) who failed to get satisfactory symptom relief received a plus therapy with biapenem; 13 patients (61.9%) received treatment which plus drugs such as Bacillus licheniformis capsules or combining Bifidobacterium to regulate intestinal microflora. Severe complications, such as intestinal fistula (8 patients, 38.1%）, toxic shock (16 patients, 76.2%）, organ system failure (14 patients, 66.7%) occurred in 17 patients (80.9%) of the 21 patients when 2-7 days (mean of 4.7 days) after diarrhea. Among 21 patients received therapy, 7 patients (33.3%) were cured and 2 patients (9.5%) were improved, whereas 11 patients died, with a total mortality of 52.4%, another 1 patient was lost to follow up (4.8%). There were 8 patients who were followed-up for 1-12 months (the median time was 3.1-month). During the followed-up period, 2 of them died and others stayed alive without occurrence. ConclusionAlthough uncommon, MRSA-associated enteritis progressed rapidly, with many complications and high mortality rate. Early diagnosis and timely targeted treatment restoring the balance of gastrointestinal microecology are the key to decrease its mortality.
Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.
Objective To reinforce the recognization of deltoid contracture inchildren and probe its causes, pathomechanism,diagnosis and treatments. Methods The Clinical data were summarized and analysed, including etiological factors, clinical situations, examinations and treatments from 9 child patients with deltoid contracture from 1992 to2004. The 9 child patients were followed up to evaluate therapeutic efficacy. Results Nine child patients with deltoid contractureincluded 4 boys and 5 girls, who aged from 5 to 14 years. The main clinical features were presented as abductive deformity,limitation of adduction of the shoulder, winging of the scapula, and dimpling of the skin with a palpable fibrous hard band in deltoid muscle. Four cases had a history of intramuscular injections in deltoid and 1 case was accompanied with bilateral gluteul contracture.Among the 9 patients, 8 cases were misdiagnosed before correct diagnosis and treatment. The misdiagnosis rate was up to 90%. All the cases received the operative treatments to release fibrous bands and were followed up for 8 months to 12 years. Abductive deformity disappeared and functions of the shoulders recovered inall patients, except 1 patient who had a lightly winged scapula. Conclusion Deltoid contracture may be caused by multiple factors,but its clinical features are conductive to correct diagnosis and excellent therapautic efficacy can be acquired by operation early.
【摘要】 目的 分析急性播散性脑脊髓炎的临床特点，提高诊疗。 方法 收集1999年1月-2010年1月住院的急性播散性脑脊髓炎患者42例，对其临床症状体征、实验室检查、影像学改变及治疗进行全面回顾性分析。 结果 42例患者中5～14岁者11例（26.19%）；15～40岁者20例（47.62%），感染后引起的23例（54.76%），无明显诱因占15例（35.71%）；脑脊液23例（23/34，67.65%）异常；脑电图异常者27例（27/32，84.38%）；CT检查阳性率26例（26/40，65.00%），MRI阳性率25例（25/28，89.29%）；糖皮质素、丙种球蛋白治疗有效。 结论 急性播散性脑脊髓炎是一组临床表现多样的免疫介导的炎性疾病，脑脊液、MRI和脑电图有重要诊断价值。急性期大剂量皮质素、静脉丙种球蛋白治疗均有较好疗效。【Abstract】 Objective To analysis the clinical features of acute disseminated encephalomyelitis so as to improve medical treatment. Methods From January, 1999 to January, 2010, 42 inpatients with acute disseminated encephalomyelitis were collected and their clinical data were analyzed retrospectively. Results Out of these 42 patients, 11 (26.19% ) were within 5 to 14 years, 20 (47.62%) ithin 15 to 40 years; 23 (54.76%) had definite infection, and 15 (35. 71%)had no any causes; 23 (23/34, 67.65%) had abnormal cerebrospinal fluid; 27 (27/32, 84.38%) had abnormal electro-encephalograph; 26 (26/40, 65.00%) were CT positive, 25 (25/28, 89.29%) MRI positive; corticosteroids and gamma globulin were effective in the treatment of disseminated encephalomyelitis. Conclusion Acute disseminated encephalomyelitis is a kind of inflammatory disease with various clinical manifestation and mediated by immune. Cerebrospinal fluid, MRI, and electro-encephalograph have important roles in its diagnosis. Large dose of corticosteroids and gamma globulin are effective in the treatment of acute disseminated encephalomyelitis.
Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive pulmonary fungal infection( IPFI) . Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases( 62. 2% ) , Cryptococcus in 18 cases( 20. 0% ) , Mucormycosis in 6 cases( 6. 7% ) , and Histoplasma in 6 cases( 6. 7% ) , etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients ( 54. 4% ) received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases( 27. 8%) , nodule lesions type in 15 cases( 16. 7% ) , lung consolidation type in 22 cases( 24. 4% ) , cavity type in 22 cases( 24. 4% ) , aspergilloma type in 6 cases( 6. 7% ) . 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2% . 31 cases ( 34. 4% ) underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases ( 62. 2% ) received systemic anti-fugal therapy, and 43 cases( 76. 8% ) were cured or significantly improved. 3 cases ( 3. 3% ) refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-termand broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.
目的 探讨绝经后宫腔积液的病因及诊治方法。 方法 对105例绝经后阴道B型超声（TVS）检查所示宫腔积液的患者进行回顾性分析。 结果 105例患者中，阴道炎患者31例，占29.52%；其余74例患者行宫腔镜检查显示，宫腔点状出血29例，占27.62%，宫腔透明粘液23例，占21.90%，另有22例宫腔镜下未见异常，占20.95%。74例接受宫腔镜检查患者因诊刮未刮出内膜组织，行宫腔细胞学涂片，病理检查结果均未见恶性肿瘤细胞，其中16例患者查见炎性细胞。 结论 绝经后无子宫内膜增厚的宫腔积液多由炎症引起，应及早明确诊断。宫腔镜现已成为宫腔内病变诊断的金标准，其作为绝经后宫腔积液的病因诊断手段具有临床实用价值。
摘要:目的: 探讨如何提高早产儿存活率和生存质量。 方法 :对我院新生儿病房收治的228例早产儿的临床资料进行了回顾分析。 结果 :引起早产的母亲因素以胎膜早破、妊娠期胆汁淤积综合征及妊娠合并高血压综合征为早产的重要因素,而引起早产儿常见疾病的是新生儿肺炎,高胆红素血症及新生儿窒息等。而呼吸衰竭、新生儿休克、多器官衰竭则是引起早产儿预后不良的重要因素。 结论 :早产原因以母体因素为主,故加强孕期保健,积极防治母亲的有关并发症,同时提高新生儿急救水平,早期干预,以提高早产儿的生存质量。Abstract: Objective: To exploere the ways of promoting the survival rate and the quality of life in premature infants. Methods :The clinical data on 228 cases of premature infants treated by neonatal wards were analyzed retrospectivelly. Results : The important factors of premature are cholestasis of pregnancy syndrome, premature rupture of membbranes, and hypertemsion in prefnancy. The commom diseases in premature infants are neonatal pnecemonia, hyperbilirubinemia and asphxia, the major factors in poor prognasis are caused by neonatal shock, multiple organ failure in premature infants. Conclusion :The main reasons of premature is maternal factors. It is important to strengthen the health care during pregnancy, control the complications of mothers actively, at the same time, improve the level of neonatal first aid, intervent early, so as to imprive the quality of life in preterm infants.
Objective To investigate the etiological and clinical characteristics of the outbreak of hand-foot-mouth disease (HFMD) in Chengdu in 2008. Methods A retrospective analysis was conducted to investigate 482 children with hand-foot-mouth disease in Chengdu from January to December 2008 in terms of epidemiology and clinical characteristics. Results Among the 482 children, 76.14% of the cases were infants, and male children numbered more than female ones. The proportion in the urban area was higher than that in the rural area. May to July was the peak epidemic period. Skin rash and fever were major clinical manifestations. Three cases were diagnosed as viral encephalitis. Conclusion The incidence of hand-foot-mouth disease is related to age and season. Effective prevention measures and isolated treatment are critical for prevention and therapy.