目的 探討可調壓胸腔閉式引流瓶持續負壓吸引治療自發性氣胸持續漏氣的療效觀察及護理。 方法 將2008年3月－2012年10月收治的自發性氣胸行胸腔閉式引流術后接傳統閉式引流瓶，引流達3 d胸腔仍有漏氣患者55例分為A組（治療組）、B組（對比組）。Ａ組30例更換為可調壓胸腔閉式引流瓶、Ｂ組25例繼續使用傳統閉式引流瓶。 結果 Ａ組患者平均帶管時間縮短，管腔堵塞、引流液逆流、低蛋白血癥等并發癥發生比Ｂ組減少。 結論 可調壓胸腔閉式引流瓶持續胸腔負壓吸引治療自發性氣胸持續漏氣患者治療效果優于傳統閉式引流好，患者帶管時間及平均住院時間縮短，住院費用降低，安全性高，并發癥少。
Objective To describe and compare the distributions of aminoglycosides modifying enzymes ( AMEs) in imipenem-resistant Pseudomonas aeruginosa ( IRPA) collected from5 cities in China. Methods A total of 146 strains of IRPA were collected from 5 cities of China ( Chengdu, Hangzhou, Beijing, Shanghai, and Guangzhou) . The polymerase chain reaction ( PCR) were used to amplify the genes of AMEs in IRPA. Results Six positive genotypes were amplified out of 16 genotypes of AMEs by PCR. The total positive rate of AMEs is 65. 06% . The positive rates of genes of aac( 3) -Ⅱ, aac( 6′) -Ⅰ, aac( 6′) -Ⅱ, ant( 2″) -Ⅰ, ant ( 3″) -Ⅰ and aph( 3′) -Ⅵ were 33. 6% , 15. 8% , 19. 9% , 28. 8% , 14. 4%, and 4. 8% , respectively. The genotypes of AMEs were discrepant in different areas as 6 genotypes in Huangzhou and Shanghai, 4 genotypes in Chengdu and Beijing, and 3 genotypes in Guangzhou. Conclusion The results show that the positive rate of AMEs genes is high in IRPA, and the distribution is discrepant among different areas.
ObjectiveTo summarize the experience of comprehensive treatment of parathyroid carcinoma (PTC).MethodThe clinicopathologic data of patient with PTC admitted to the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed.ResultsThe patient was a 42-year-old male, who was diagnosed with the primary hyperparathyroidism after suffering from systemic joint pain for more than 2 years. The patient accepted the first operation in a primary hospital, including the resection of the PTC and ipsilateral thyroid lobectomy, and the PTC was confirmed pathologically. The second operation was performed due to the tumor relapse within thyroid bed. The third operation was performed with the palliative resection of the recurrent tumor in the right neck and the three-dimensional conformal radiation therapy was performed. The fourth operation was performed in the left neck with lateral lymph node dissection of level Ⅲ and level Ⅳ. The lower left lung cuneiform resection was performed in the fifth operation. For the last operation, the mediastinal metastatic tumor was removed with thoracoscopy. The multiple imaging evaluation showed no evidence of recurrence in the neck, but the extensive pulmonary metastasis occurred.ConclusionsSurgery is the only effective treatment for PTC. En bloc excision consists of resection of primary tumor, ipsilateral thyroid lobectomy, other surrounding structures involved by the tumor and central neck dissection. During operation, tumor rupture should be avoided. Accessible metastatic tumor should be resected when possible. Radiotherapy should be performed in patient with local infiltration or unresectable tumor. Effect of chemotherapy for PTC is poor. Supportive medical care should be given for fatal hypercalcemia in patient when treatment failed to control tumor.