Nursing care of a child with Beckwith-Wiedemann Syndrome frequent hypoglycemia / 中国实用护理杂志

Objective:To summarize the experience of blood glucose management and nursing for a newborn with repeated hypoglycemia in Beckwith-Wiedemann syndrome.Method:A multidisciplinary team was formed, and formulated an individualized care plan for a large infant with Beckwith-Wiedemann syndrome. A dynamic blood glucose monitoring system was used to closely monitor blood glucose fluctuations for this children, dynamically adjusted the amount of infusion and milk according to the blood sugar situation, detected and dealed with hypoglycemia in time, strengthened the skin care of child and implemented psychological care for the family.Results:After refined treatment and care, the child′s vital signs were stable, and his blood sugar could maintain within a normal range before being discharged from the hospital.Conclusions:The use of dynamic blood glucose monitoring system under the guidance of a multidisciplinary team can effectively monitor and control the blood glucose fluctuations of children with BWS syndrome, which can provide a basis for further treatment of children.

Effectiveness of endovascular repair with fenestration stent and branch stent assisted by 3D printing in treating thoracoabdominal aortic aneurysm involving visceral artery area / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing. Methods    The clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment. Results    All the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion    3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.

Clinic analysis of treatment for injuries of supra-arch branches / 国际外科学杂志

Objective To analyse the initial resucts in different treatment methods for the treatment of aortic arch injury.Methods A total of 23 patients (18 males and 5 females) with injuries of superior arch arteries underwent our treatment in Shandong Provincial Hospital Affiliated to Shandong University from January 2008 to May 2017.Nine patients underwent surgical procedures(surgical group),13 patients underwent endovascular procedures (endovascular group),1 patient underwent conservative treatment.The conditions of all survived patients were followed up by telephone or outpatient from one to sixty months postoperative.Mortality and complications such as rehaemorrhagia,cerebralinfarction,stenosis or blockage during the follow-up period was assessed.Operation time,hospitalization time after treatment,mortality and complications within 30 days of surgical group and endovascular group were compared by statistical methods.The data were analyzed by SPSS 16.0 software.Measurement data were expressed as ((x) ± s).The count data were expressed as frequency and percentage (％),and comparison between groups were evaluated with t test,Chi-square.Results All patients had achieved technical success.In patients treated by surgical procedures,one case of death and 2 cases of cerebralinfarction were reported within 30 days.One patient died of rehaemorrhagia during the 2nd day of open operation.Meanwhile,another two patients suffered from cerebral infarction,they recovered within 30 days.All patients treated by endovascular procedures survived without cerebralinfarction.However,blockage occurred in one patient of these patients.The operation time [(2.4 ± 1.1) hours and (1.0 ± 0.4) hours] (P ＜ 0.01) and the time of postoperative hospitalization [(8.3 ± 3.0) days and(2.5 ± 1.0) days] (P ＜ 0.05) were statistically different of the two groups.The postoperative mortality rate of the two groups undergoing open surgery and endovascular treatment within 30 days was 11.1％ and 0.0％ (P =0.41),and complication rates with 33.3％ and 7.7％ respectively (P =0.26),there has no significant difference.Overall,66.7％ (6/9) patients treated by surgical procedures and 92.3％ (12/13) patients treated by endovascular procedures and one patient treated by consewative treatment survived without any complication during the follow up period.Conclusions Initial results suggest that endovascular procedures can significantly shorten the time of operation and the time of postoperative hospitalization,and the mortality and complication rate are also slightly lower than surgical procedures.Endovascular procedures is an important method for treatment for injuries that involve superior arch arteries.It plays a special role in rescuing injuries of superior arch arteries.

The application of reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with unfavourable proximal landing zone / 中国医师杂志

Objective To explore the preliminary results of application of reserving the left subclavian artery by fenestration of domestic stent graft in the thoracic endovascular aortic repair (TEVAR) of type B dissection with unfavourable proximal landing zone.Methods From October 2015 to January 2018,a total of 13 patients with type B aortic dissection without healthy proximal landing zones underwent TEVAR using fenestration of domestic stent graft in our hospital.Computed tomography angiography (CTA) data were measured before surgery.Digital subtraction angiography (DSA) was conducted after surgery.All patients underwent CTA or ultrasound examination during follow-up.Operation success rate,survive rate,patency of left subclavian artery and complications were analyzed.Results All the patients were deployed fenestrated endografts successfully.No proximal endoleak happened during perioperative period.Delirium occurred in 1 case during 7 postoperative days and fully recovered with the medical treatment.The mean follow-up period was (9.8 ± 9.5) months (range,1-29 months).11 patients underwent CTA and 2 patients underwent ultrasound examination during follow-up.During period of following up,no patients died,no proximal endoleak appeared,and all the left subclavian arteries reserving by fenestration.Conclusions Reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with hostile proximal sealing zone is economical,safe and feasible,which expand the indication of TEVAR for aortic dissection,and the long-term outcomes of this technique need to be assessed in the future.

Development of Mobile Medical Consumable Material Management System / 中国医疗器械杂志

The operation of traditional medical consumables management system depends on computer and network. The consumable material manager can't manage the consumable in time. In order to meet the convenience, flexibility, timeliness in materials management, this paper designs a mobile medical consumables management system based on Android platform and WeChat Official Accounts. The system helps the hospital manage medical consumable materials more conveniently and efficiently.

Value of ultrasonography in the persistent sciatic artery / 中华超声影像学杂志

Objective To study the clinical value of color Doppler ultrasonography in the persistent sciatic artery.Methods The ultrasonographic images of eleven patients with persistent sciatic artery diagnosed by CT angiography or digital subtraction angiography were retrospective analyzed,the ultrasonographic features were summarized.Results The sciatic artery showed the enlarged internal iliac artery,which continued into the thigh in a posterior location,the sciatic artery described a tortuous course toward the knee,slowly filling normal-appearing popliteal artery in 8 cases,there were no connection with popliteal artery in 1 cases.The common femoral artery and superficial femoral artery was dysplasia in 7 patients,which was thinner than the popliteal artery.Conclusions The ultrasonography is the effective imaging method for diagnosis of the persistent sciatic artery.

Deep venous thrombosis after greater saphenous vein ligation and stripping / 中华普通外科杂志

Objective To report deep venous thrombosis (DVT) after greater saphenous vein ligation and stripping and to evaluate diagnosis,treatment and prophylaxis. Methods The clinical characteristics, diagnosis and treatment of 12 inpatients with postoperative DVT were analyzed retrospectively. Results Of these 12 cases there were 7 cases of central type DVT,2 cases of peripheral DVT,and 3 cases of mixed type DVT.Secondary pulmonary embolism was complicated in 2 cases.Clinical symptoms in these 10 cases of proximal DVT were all severe.Catheter-directed thrombolysis(CDT) through the ipsilateral popliteal vein with protective(IV)CF was applied for these 10 cases.Of 10 cases,femoral vein was found ligated in 1 case,which was repaired under open surgery. Residual greater saphenous vein thrombus extending into deep vein was proved and managed by successful thrombolectomy in one case.Cockett syndrome were found as the causes in the other 8 cases,6 cases were treated with balloon dilatation angioplasty and endovascular stenting of the iliac vein.The 2 cases of with distal DVT were treated by anticoagulation therapy.All patients were cured. Conclusions Cockett syndrome,femoral vein injury and too long residual greater saphenous vein are common causes of DVT after greater saphenous vein ligation and tripping.Careful selection of cases,correct diagnosis,standard operative manipulation,early ambulation were all important in the prevention of DVT after great saphenous vein varix procedure.

Surgical therapy of primary leiomyosarcoma of the inferior vena cava / 国际外科学杂志

Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava(PIVCLS).Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong University.All patients underwent surgical resection,combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft.Results Surgical resection was performed successfully in all patients.The mean operation time was 166.6 min,with mean blood loss 1 560 mL.Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation.The mean size was 12 cm × 10 cm× 8 cm.The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination.All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood (BUN) and (CREA).All patients were administrated with oral warfarin therapy after discharge.No clinical relapse and pulmonary embolism was observed during the follow-up (range 3 months to 12 months).The ultrasound revealed the patency of artificial vascular grafts in all patients.Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS.Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics.The incidence of postoperative pulmonary embolism also decreases obviously.

Surgical treatment for carotid body tumors / 中华普通外科杂志

Objective To discuss the diagnosis and surgical treatment for carotid body tumors (CBT). Methods Retrospective analysis was made on 16 cases of carotid body tumors hospitalized in Shandong Provincal Hospital from January 2003 to October 2010. All patients were diagnosed by digital subtraction angiography, including 3 case of Shamblin type Ⅰ,11 cases of Shamblin type Ⅱ and 2 cases of Shamblin type Ⅲ. Three cases of type Ⅰ and 3 cases of type Ⅱ underwent carotid body tumor resection. Three cases of type Ⅱ underwent carotid body tumor plus external carotid artery resection, 3 cases underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, 2 cases did carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. One of type Ⅲ underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, and the other one underwent carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. Results Diagnosis of CBT was confirmed by pathology in all cases. There was no postoperative death、hemiplegia and blindness. The cranial nerve injury was caused in 7 cases, accounting for 43. 75%. 13 cases ( 81. 25% ) were followed up for 2 to 76 months ( mean 42 months), no tumor recurrence and metastasis was found. Conclusions Digital subtraction angiography (DSA) is important in the diagnosis and therapy of carotid body tumor. Surgical treatment is the choice of therapy for carotid body tumors.

Comparison of survival in patients with breast cancer of triple-negative versus non-triple-negative / 中国医师进修杂志

Objective To assess whether survival differed among patients who had triple-negative breast cancers compared with patients who had non-triple-negative breast cancers.Methods The clinicopathologic data of 684 patients with operable breast cancer,who were treated with multimodal therapy from December 1998 to June 2007 were analyzed.Of these patients,107 cases were confirmed to have triple-negative tumor histology(triple-negative group),577 cases were confirmed to have non-triple-negative tumor histology(non-triple-negative group).The 7 years cumulative survival and disease-free survival were analyzed by Kaplan-Meier method and compared by Log-rank test.The prognosis Was analyzed by COX regression model.Results The 7 years overall survival rates for triple-negative group and non-triple-negative group were 51.4%(55/107),74.2%(428/577),respectively,there Was significant difference between the two groups(P＜0.01).However,the 7 years overall survival rates of patients with triple-negative group and those who with Her-2 positive were 51.4%(55/107)and 53.1%(43/81)respectively,there Was no significant difference between them (P＞0.05).Univariate analysis revealed that the factors affecting the disease-free survival included age,menopausal status,tumor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status.Multivariate analysis showed minor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status were independent prognostic factors.Conclusions This study has shown a trend towards a poorer outcome for patients with triple-negative breast cancer similarity to patients with Her-2 positive cancers.Triple-negative breast cancer is an independent predictor factor of survival.

Endovascular treatment for TASC C and D aortoiliac occlusive diseases / 中华普通外科杂志

Objective To evaluate the endovascular treatment of diffuse aortoiliac occlusive diseases. Methods Thirty-two patients underwent endovascular treatment in which rest pain was found in 84.38%, foot local gangrene in 15.62%. Mean age was 69.7 years (range, 52 years to 81 years) and 71.9% was male. Trans Atlantic Inter-Society Consensus C and D disease was respectively in 40.6% and 59.4% patients. Mean length of vasculopathy was (14.6 ± 1.2) cm (range, 4.5 cm to 19.5 cm) All patients had prohibitive risk for open revascularization. With the approach from femoral artery or brachial artery, combined techniques, such as recanahzation, balloon dilation, stent placement and concomitant common femoral endarterectomy were used. Results Technical success was achieved in twenty-nine patients(90.63%). The complication rate was 3.45%. Clinical status was markedly improved in eight cases (27.59%) and moderately improved in twenty-one cases(72.41%). Mean postoperative ABI was 0.73 ± 0.12, mean preoperative ABI was 0.32 ± 0.09. Significant differences were seen between postoperative ABI and preoperative ABI(P<0.05). Mean time of follow-up was (13.9±6.2) months. At 6 months, primary patency was 81.82% and secondary patency was 89.09%. At 12 months, primary patency was 63.64% and secondary patency was 80.18%. Conclusion Combined multiple endovascular technique is a safe and effective method in the treatment of poor risk diffuse aortoiliac occlusive diseases.

Creating database with Microsoft Access and its clinical application for patients with breast cancer / 中国基层医药

Objective The purpose of this study was to develop a database program based on Microsoft Access 2003 for patients with breast cancer to save and manage clinical data.This makes it easier to analyze data of the database.Methods A total of 1177 cases with breast cancer who were performed surgical treatment from December 1998 to June 2007,the clinical data collection which included regular fouow-up data of these patients after therapy,the database was designed by using Microsoft Access 2003 included the creation of tables,forms and queries according to the therapy guidelines for breast cancer.Results The clinical data for patients with breast cancer can be stored in an Access database that is both user-friendly with reliable data administration and that can be shared in network,and it is capable of recording regular updated data.Conclusion This program will not only convenient for researchers to statistic and analyze their outcome data,but also for minimizing data entry errors and reducing the time spent on data query.

Interventional therapy for acute iliofemoral venous thrombosis / 中国微创外科杂志

Objective To investigate the clinical effect of interventional therapy in the treatment of acute iliofemoral venous thrombosis.Methods A total of 20 patients with acute iliofemoral venous thrombosis was treated by interventional therapy from February 2004 to April 2006.Under the guidance of ultrasonography,intravenous thrombolysis through the popliteal vein combined with iliac vein stenting was employed.The venous patency was assessed with angiography.Results The catheter-based thrombolysis through the ipsilateral popliteal vein was effective for all the patients.Balloon dilatation angioplasty combined with endovascular stenting was applied in 15 patients,while balloon dilatation angioplasty alone was utilized in other 5 patients.The implantation of a temporary cava filter was required in 10 patients.After intravenous thrombolysis through the popliteal vein,the recanalization rate was 30%～90%(mean,55%) in the iliac vein and 40%～80%(mean,65%) in the femoral vein.Postoperative hematuria was encountered in 1 patient.No symptomatic embolism of pulmonary artery was seen.Postoperatively,clinical symptoms on the effected limb significantly subsided or completely disappeared.The hospitalization expenditure was 52 000～81 000 yuan(mean,74 000 yuan).Follow-up observations for 1～24 months(mean,12 months) were carried out in the 20 patients.The patency rate was 100%(15/15) in 15 patients receiving iliac vein stenting.Out of 5 patients with balloon dilatation,the iliac vein was completely obstructed in 2 patients and was recanalized by 10%～20% in 3 patients.Conclusions Catheter-based thrombolysis through the popliteal vein combined with endovascular stenting is an effective therapeutic strategy for acute iliofemoral venous thrombosis,but it is very expensive.

Endovascular stenting combined with conventional surgery for treatment of lower extremity multilevel atherosclerotic occlusive disease / 中国普通外科杂志

Objective To study the treatment of multilevel atherosclerotic occlusive disease of the lower(extremity).Methods From March 2004 to January 2006,intraoperative iliac balloon angioplasty and stenting combined with simultaneous vascular bypass and profundoplasty were performed on 24 limbs in 21 patients(suffering) from lower extremity multilevel atherosclerotic occlusive disease.In 24 limbs iliac balloon angioplasty and stent placement were performed with simultaneous profundoplasty in 12 limbs and femoro-popliteal bypass in 14 limbs.Results Surgical procedures were technically successful in all patients.There were no severe postoperative morbidity or mortality.Before-operative vs postoperative ABI was 0.24?0.13 vs 0.63?(0.18)(P

Clinical study on the prevention of post-thrombotic syndrome in lower extremity deep venous thrombosis patients / 中国普通外科杂志

Objective To assess the effect of anticoagulant drugs,elastic compression stockings(ECS)and(Daflon) on the prevetion of the post-thrombotic syndrome(PTS).Methods Fifty-eight deep venous(thrombosis)(DVT) patients were divided into control group and treatment group I and II.The control group (n=15) did not take anticoagulant drugs or the time of anticoagulant drug administration was less than 1 month,and the use of(ECS) was less than 3 months.The treatment group I(n=24) took warfarin for 6 months and the ECS were used in the follow-up time;the treatment group II(n=19),besides warfarin therapy and ECS,took Daflon for 12 months.All the patients were followed up,the general conditions were assessed with clinical score,and the therapeatic results of the 3 groups were assessed.Results The rate of PTS occurrence in control group was significantly higher than that in treatment group 1 and treatment group 2.At 6 months,the clinical score of treatment groups 1 and 2 was significantly lower than that of control group.At 1 and 1.5 years after discharge,the clinical score of treatment group 2 was significantly lower than that of treatment group 1.Conclusions The long-term comprehensive and systemic therapy(including warfarin,ECS and daflon) for DVT could prevent PTS.

Clinical research of intravenous laser treatment for varicose of lower limbs / 中国普通外科杂志

ObjectiveTo evaluate the effect of varicose vein of lower limbs treated by intravenous laser treatment .MethodIntravenous laser apparatus combin ation with operation was used to treat the varicose vein of the lower extremi ties in 98 patients(all 118 legs).The change of symptoms and signs were recorded and compared before and after operation by using venous ultrasonagraphy and pa thological examination to evaluate the treatment effect.ResultsIn the 84 followed up patieats (104 compromised legs),dull,heaviness were rel ieved completely after operation in 87 legs(83.7%),decreased in 11 legs(10.6%); skin pigmentation obviously decreased in 37 of 44 legs(84.1%);superficial varic ose vein disappeared in all the patients.No blood flow signal was detected in 10 1 legs(97.1%) and slow blood flow in 3 legs(2.9%) were detected by ultrasounogr aphy.Pathological examination revealed various degeneration and necrosis in ful l layers of the vessels;and smooth muscle cells were disrupted,cell nucleus bec ame pyknotic, the internal and external elastic laminar were ruptured and no inflammatory cell infiltration in the lumen and wall of the vessels were seen .ConclusionsIntravenous laser treatment is an ideal method in the treatment of varicose vein of lower extremities .