ABSTRACT
Objective To explore the effect of discharge planning mode on growth and development in prematures.Methods 62 premature cases were randomly divided into the control group and the observation group with 31 cases in each group respectively.The control group accepted routine nursing care,the observation group was given comprehensive detailed discharge planning mode on basis of conventional premature nursing.All the research objects were monitored about the height and body weight,and also the Bayley Infant Development Scale was adopted to evaluate the psychological behavior development when their corrected gestational age was 3,6,12 months respectively.Results The height,weight and Mentality Development Index (MDI),Psychomotor Development Index(PDI) of the prematures in the observation group when their corrected gestational age was 3,6,12 months respectively were all higher than those of the control group.Conclusions Application of discharge planning mode in premature infants is helpful to the physical and mental developmental of them.
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Objective To evaluate the diagnosis and surgical treatment of primary retroperitoneal extraadrenal pheochromocytoma(PREAP). Methods Clinical data of 17 cases with PREAP from 1976 to 2006 were analyzed retrospectively. Results It was not difficult for the diagnosis of PREAP based on the primary symptoms, including paroxysmal hypertension or persistent hypertension. PREAP is usually deep, large and invading on adjacent organs. B-uhrasound was used for preliminary screening. CT and MRI with high soft tissue resolution and multi directional imaging are of great value for correct diagnosis and determination of exact extent of the tumor in diagnosis of PREAP. 24 h urinary VMA output imcreased in 12 cases (92. 3%) and urinary catecholamine level was up to 526. 1 μg- Precise location of PREAP by 123I-MIBG is superior to that by 131I-MIBG. The diagnosis was tentative in 4 cases and definite in 13 cases. Complete tumor resection was achieved in 15 cases, among them 2 cases died on table due to inadequate preparation before surgery in 1970's. In the remaining 2 cases with huge tumors partial resection, silver clips were put in during operation to locate the extent of the tumors for further management after operation. Conclusions Locating and qualitative diagnosis before operation are valuable and once the patients are diagnosed as PREAP, they should receive exploratory laparotomy after an adequate preparation.
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Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple's triad. Accurate preoperative localization rate of B ultrasonography, CT and enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail;while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in 13 cases, resection of pancreatic body and tail plus splenectomy in 6 cases, resection of pancreatic tail in 8 cases, resection of pancreatic tail plus splenectomy in 4 cases, laparoscopic resection of insulinoma in 1 case, piecewise resection of pancreas from left to right (blind resection) in 2 cases, pancreaticoduodenectomy in 1 case. The tumor was benign in 62 cases, and malignant in 2 cases. Pancreatic fistula developed after operation in 3 cases, acute pancreatitis in 4 cases, and in these cases, they healed after non-operative treatment. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 62 cases, 2 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor, 2 malignant tumors cases, recurred and died of hepatic metastasis in 3 years and 4 years after operation. Conclusions Whipple's triad and IRI/G>0.3 are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Resection of insulinoma is the best mode of surgical treatment of insulinoma.