ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
ObjectiveTo investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection.MethodsA retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People's Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors.ResultsA total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small cell carcinomas were located in the middle (58.5%) and lower (32.1%) segments of the esophagus. Thirty patients (56.6%) were found to have lymph node metastasis, and 7 patients (13.2%) were found to have lymphovascular invasion. According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰ disease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients (41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1- and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage (1 year survival rate: stage Ⅰ: 91.7%; stage Ⅱ: 78.9%; stage Ⅲ: 63.6%; P=0.004) and postoperative adjuvant therapy (1 year survival rate: 81.8% vs. 71.0%; P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma.ConclusionEsophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma (stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma (stage Ⅲ), chemoradiotherapy should be the preferred treatment.
目的总结肛周坏死性筋膜炎（PNF）的临床特点、诊断及治疗方法。 方法回顾性分析我院肛肠外科2007年1月至2012年12月期间收治的22例PNF患者的临床资料。 结果全部病例均行手术治疗，术中彻底清创，术后给予抗炎、对症、支持治疗。痊愈18例，死亡4例。痊愈病例随访6个月未见复发。 结论PNF早期临床表现无特异性，诊断主要依据临床表现及相关影像学检查，治疗以手术为主，早期诊断，及时治疗，是治愈PNF、降低死亡率的关键。
Objective To analyze the clinical characteristics and the treatment of 20 confirmed A/H1N1 flu cases of serious conditions. Methods The 20 confirmed A/H1N1 flu cases of serious conditions were collected and we analyzed their Clinical characteristics, treatment and prognosis. Results The 20 cases of serious conditions were given Oseltamivir, endotrachealintubation, ventilator ventilator assistant, high dose intravenous injection of Gamma-globulin/ albuminum/plasam of A/H1N1 flu rehabilitation, appropriate liquid recovery and hypothermic treatment, etc. A total of 19 of 20 confirmed A/H1N1 flu cases of serious conditions were cured and 1 case died. Conclusion The intent observation, early detection and early intervention are very helpful for A/H1N1 flu cases of serious conditions.
ObjectiveTo make a better understanding of potassium channel-complex autoimmune antibodies associated limbic encephalitis, we studied in details with patients of this autoimmune disease accompanying without tumors. MethodsDiagnosis of 3 patients were confirmed by antibody detection in serum or CSF. All the clinical data, including history, CSF data, cranial MRI, EEG, pelvic ultrasound and treatment strategy, were carefully gathered. Two to eleven months follow-up were carried out. Results3 female adult patients showed common initial manifestation of seizures, and changes of consciousness, mental disorder and cognitive impairment. Hyponatremia was found in one LGI1-Ab+ patient. Cranial MRI showed unilateral or bilateral signal changes with limbic system. Changes of CSF and EEG were nonspecific. All 3 patients became recovery in different levels after two to eleven months. ConclusionsPotassium channel-complex antibodies associated encephalitis may be a common type of limbic encephalitis in adults without tumors. Seizures may be the first sign of the disease. Hyponatremia is one of characteristics of LGI1-Ab+ patient. Patients may have a fairly good short outcome.
ObjectiveTo investigate the clinical manifestations of patients with cardiac myxoma and the factors affecting the occurrence of embolic events. Methods A retrospective study of 38 patients with cardiac myxoma diagnosed and surgically removed from January 2010 to December 2017 was performed. There were 11 males and 27 females at age of 32-75 (50.00±16.12) years. The patients were divided into a non-embolized group and an embolized group. The clinical manifestations of the patients were summarized and the factors leading to embolism were analyzed. RseultsOf the 26 patients in the non-embolized group, 22 patients (84.62%) had dyspnea, 14 patients (53.85%) had palpitations, 4 patients (15.38%) had angina pectoris, and 1 patient (3.85%) had heart failure. Of the 12 patients in the embolized group, 4 patients (33.33%) had dyspnea, 3 patients (25%) had palpitations, and 1 patient (8.33%) had angina pectoris. The mean diameter of the non-embolized group was 5.71±1.63 cm, and the maximum diameter of the tumor in the embolized group was 4.52±1.88 cm. There was no significant difference between the maximum diameter of the tumor in the embolized group and the maximum diameter of the non-embolized group (P>0.05). Atrial fibrillation occurred in 2 patients in the non-embolized group before operation. Atrial fibrillation occurred in 5 patients in the embolized group. Atrial fibrillation was more likely to occur in the embolized group (P<0.05). Conclusion Atrial fibrillation in the patients with cardiac myxoma is closely related to embolic events. The size of myxoma is not related to the occurrence of embolic events.
目的总结残胃癌的临床特点、治疗及预后情况。 方法回顾性分析笔者所在医院科室2003年1月至2008年1月期间收治的60例残胃癌患者的临床资料。 结果60例残胃癌发生于远端胃大部分切除＋BillrothⅡ式重建后48例（80.0%），发生于远端胃大部分切除＋BillrothⅠ式重建后9例（15.0%），发生于近端胃大部分切除术后3例（5.0%）。42例患者行根治性切除，其术后1、3及5年生存率分别为90.5%、57.1%及13.3%；18例行姑息性手术治疗，其术后1、3及5年生存率分别为16.7%、0及0。根治组患者的中位生存时间为36.7个月，姑息组为7.2个月，根治组的生存情况较好（χ2=76.98，P＜0.001）。 结论残胃癌不易早期诊断，对于高发人群需定期复查胃镜，积极的外科治疗可以提高患者的生存率及生活质量。
Objective To research clinical manifestations, electrophysiological characteristics of epileptic seizures arising from diagonal sulci (DS), to improve the level of the diagnosis and treatment of frontal epilepsy. MethodsWe reviewed all the patients underwent a detailed presurgical evaluation, including 5 patients with seizures to be proved originating from diagonal sulci by Stereo-electroencephalography (SEEG). All the 5 patients with detailed medical history, head Magnetic resonance (MRI), the Positron emission computered tomography (PET-CT) and psychological evaluation, habitual seizures were recorded by Video-electroencephalography (VEEG) and SEEG, we review the intermittent VEEG and ictal VEEG, analyzing the symptoms of seizures. Results 5 patients were divided into 2 groups by SEEG, group 1 including 3 patients with seizures arising from the bottom of DS, group 2 including 2 patients with seizures arising from the surface of DS, all the tow groups with seizures characterized by both having tonic and complex motors, tonic seizures were prominent in seizures from left DS, and tonic seizures may absent in seizures from right DS. Intermittent discharges with group1 were diffused, and intermittent discharges with group 2 were focal, but both brain areas of frontal and temporal were infected. Ictal EEG findings were consistent with the characteristics of neocortical seizures, the onset EEG shows voltage attenuation, seizures from bottom of DS with diffused EEG onset, and seizures from surface of DS with more focal EEG onset, but both frontal and anterior temporal regions were involved. Conclusionthe symptom of seizures arising from DS characterized by tonic and complex motor, can be divided into seizures arising from the bottom of DS and seizures from the surface of DS, with different electrophysiological characters.
目的 探讨原发性IgA肾病临床特征与病理间的关系。 方法 回顾性分析2006年1月-2008年6月经肾活检诊断为原发性IgA肾病患者109例的临床病理资料。 结果 血尿的发生及血尿的程度与肾活检病理Lee分级无关，而尿蛋白定量、症状性高血压、肾功能受损与病理学分级呈正相关，且与肾小球硬化、间质病变等病理特征呈正相关。 结论 大量蛋白尿、症状性高血压等是IgA肾病预后不良的重要因素，需要积极干预。