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Sleep Wake Disorders*

Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.

OBJECTIVE:To standardize and improve the package inserts of Traditional Chinese medicine injections,and to guide clinical rational drug use and reduce incidences of adverse drug reactions(ADRs).METHODS:The package inserts of 34 kinds of traditional Chinese medicine injections commonly used in the clinic were subjected to an analysis.RESULTS & CONCLUSION:Part of the package inserts were not standard in writing contents in that they are unscientific and incompact,which thus remain to be improved.

3 d) were noted.CONCLUSION:The Clindamycin should be used in line with the perioperative preventive medication principle by strictly following its indications to ensure the safety and rationality of its clinical use.

Objective To investigate the efficacy of intravenous iron sucrose combined with psychological intervention in the treatment of gynecological anemia. Methods A total of 76 patients with gynecological anemia admitted in our hospital from September 2000 to March 2017 were randomly divided into study group and control group, 38 cases in each group.The control group and gynecological anemia patients were treated with intravenous sucrose iron, the study group was treated with intravenous iron sucrose, and the corresponding psychological intervention measures were used. Results There was no significant difference in HGB and SF between the two groups before treatment., the study group after treatment HGB, SF detection value is higher than that of control group (P<0.05); study group increased to HGB for normal values of time required significantly less than the control group (P<0.05); two gynecological patients with anemia treatment in the process of research the rate of adverse reactions was 13.16%, the control group is as high as 28.95% (P<0.05). Conclusion Intravenous iron sucrose based treatment combined with psychological intervention can significantly improve the index of gynecological patients with anemia effect, reduce adverse drug reactions, to ensure the effectiveness and safety of patients are of positive significance.

Objective To study the operative method for severe duodenal trauma.Methods The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.Results In 8 cases duodenal diverticulization was performed,of which 5 cases were cured,2 cases developed intestinal fistula,and one died.Of 9 cases who underwent panceaticoduodenectomy(PD),3 were cured but 6 had pancreatic leakage,and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture,13 cases cured,2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy(PD with preserved duodenum),4 cases recovered and 1 had pancreatic leakage,but 3 with wrap-type pancreaticojejunostomy had no complications.Conclusions The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma.This procedure plus removal of head of pancreas and pancreaticojejunostomy(PD with preserved duodenum) can be used for severe pancreatic injury with excellent result,but duodenal diverticulization or panceaticoduodennectomy must not be undertaken lightly.

Objective To evaluate the value and limitation of CTA, MRI and DSA in the diagnosis of the cerebral venous malformation. Methods CT angiography in 8 cases and MRI in 10 cases were performed among 12 cases of cerebral venous malformation confirmed by carotid angiography . Results All cases had typical DSA appearance and it could be seen both the number and the direction of the guide vein. The typical “Medusa-head” sign could be seen on MRI and could be more obvious after contrast enhancement.The other complications might be seen on the postcontrast. On CTA,both the lesion itself and the “caput medusae”sign could be displayed.Conclusion In diagnosis of cerebral venous malformation,DSA is the gold standard,CTA is the significant method in diagnosing and following up,while MRI is the most useful method.

The number of root canals varies most in the areas of mandibular anterior teeth, maxillary and mandibular premolars, and premolars. Generally, The mandibular anterior teeth have one root canal, but data suggest that the anatomical morphology of the root canals of mandibular incisors varies greatly, which easily leads to the neglect of root canals in endodontic treatment. This report described the case of a mother and a daughter whose mandibular anterior teeth have two symmetrical root canals.

OBJECTIVETo investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children.

METHODTotally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy.

RESULT(1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d.

CONCLUSIONPleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Biopsy ; Child ; Diagnosis, Differential ; Female ; Humans ; Infection ; diagnosis ; Male ; Pleura ; Pleurisy ; diagnosis ; etiology ; Retrospective Studies ; Tuberculosis, Pleural ; complications ; diagnosis

Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.