ObjectiveTo investigate the clinical features,early diagnosis and therapeutic methods of primary tumor of the duodenum.MethodsThe clinical data of 130 patients of primary tumor of the duodenum who were hospitalized in Peaking University Third Hospital from 1974 to 2010 were summarized.There were 30 cases of benign tumors and 100 cases of malignancy. ResultsMore than 90％ of primary tumors of the duodenum were located at the duodenal bulb and descendent part.59％ of malignant tumors were located in the area of duodenal papilla. The mean diameter of benign tumors was less than 2 cm compared with more than 3 cm in malignancies. Upper abdominal pain,jaundice,black stool,intestinal obstruction and abdominal mass were among the most common clinical manifestations. Jaudice was most common in papilla tumors,and intestinal obstruction and palpable abdominal mass often indicate advanced stage.Duodenofiberscopy combined with air barium double contrast radiography increase the diagnosis rate.Among the 30 benign cases,11 cases underwent simple tumor resection,14 cases received endoscopic tumor resection and 3 cases underwent pancreaticoduodenectomy.Resection rate and the 5-year survival rate was 100％. Of the 100 malignant cases,56 cases underwent standard pancreaticoduodenectomy,3 cases received pylorus preserving pancreaticoduodenectomy,9 cases underwent simple tumor resection and 12 cases received segmental duodenectomy.Resection rate was 84％.The 5-year survival rate was 46％ in 59 cases receiving Whipple's procedure.ConclusionsPrimary tumor of the duodenum lacks specific clinical features. Simple tumor resection and segmental duodenectomy can be done for benign cases, while pancreaticoduodenectomy is the therapy of choice for malignant cases.

Objective:Evaluate the role of video-assisted thoracic surgery (VATS) in the treatment of bilateral synchronous multiple primary lung cancers.Methods and Results:Two paitents diagnosised as bilateral synchronous multiple primary lung cancers received one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery,performing open lobectomy to remove the larger tumor,performing wedge resection using thoracoscopy to excise the smaller one.The surgery time is short.Patients all recover smoothly without complications.To date,these two patients all alive without any sign of recurrence or metastasis of tumor,median follow-up time is 5 months (2 months+8 months).Conclusions:It is feasible to carry out one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery on patients with bilateral synchronous multiple prima-ry lung cancers,when one of the tumors of bilateral synchronous multiple primary lung cancers is classificated as T1N0M0.

Objective To investigate the nursing intervention on the effect of diagnosis and treatment of emergency patients with urolithiasis. Methods 98 patients with urolithiasis in emergency department of our hospital from January 2009 to January 2011 were randomly assigned into the observation group and the control group with 49 cases in each group. The control group received routine care, on this basis the observation group was given systemic nursing intervention. The tolerance, SAS score and satisfaction degree was compared. Results 40 patients in the observation group was well tolerated, accounting for 81.6%, significantly higher than 63.3% of the control group. SAS score and satisfaction degree of the observation group were significantly better than the control group. Conclusions Nursing intervention for emergency patients with urolithiasis can significantly reduce pain, improve the mental state and increase their satisfaction degree, which is worthy of clinical application.

Objective To summarize our experiences in the diagnosis and treatment of giant colonic lipoma,and enhance awareness of the disease and avoid misdiagnosis.Methods We retrospectively analyzed the clinical data of 5 cases of giant colonic lipoma that were mistaken for colon cancer,and evaluate the possible reasons of misdiagnosis.Results Colonic lipoma is an uncommon benign tumor.Most cases with larger tumor size were misdiagnosed as colon cancer when they suffered from the symptoms of abdominal pain,bloody stool,abdominal mass,even bowel obstruction and intussusception.Barium enema and colonoscopy are important diagnostic means.Contrast enhanced CT scan can provide definitive topographical information identifying a colonic lipoma.Surgical resection was performed in all the 5 cases.Conclusion Giant colonic lipoma with intussusception can mimic a colonic carcinoma leading to misdiagnosis.

Objective To investigate the nursing points of the mechanical ventilated patients after percutaneous endoscopic gatrostomy (PEG). Methods The nursing approaches of 28 mechanical ventilated patients after percutaneous endoscopic gatrostomy in our department was analyzed retrospectively. Results The nutritional status of the 28 patients was improved to different degree after enteral nutrition (EN) support by PEG. Thereby, the nutritional requirement of the mechanical ventilated patients was ensured effectively. Among these patients, 4 patients could take food by mouth after taking off ventilator and extubation and stoma tube was pulled out, 15 patients were discharged carrying with stoma tube and convalescent care was continued, 3 patients died of primary diseases. Conclusions The PEG is a simple,safe and cost-effective approach of nutritional support for EN of mechanical ventilated patients. The key point of insuring EN of severe patients is intensive nursing and to prevent and reduce the complication of PEG.

BACKGROUND:Bone cement solidification can improve the stability, strength and mechanical support of fractured vertebrae. However, there are few studies on the effect of bone cement dispersion within the fracture line on percutaneous vertebroplasty. OBJECTIVE:To analyze the effect of bone cement dispersion within the fracture line of thoracolumbar osteoporotic vertebral compression fractures on percutaneous vertebroplasty. METHODS:Totaly 90 patients with thoracolumbar osteoporotic vertebral compression fractures were enroled, 53-80 years old, including 42 males and 48 females. Al these patients underwent percutaneous vertebroplasty with bone cement injection, and divided into two groups according to bone cement dispersion conditions: study group with good bone cement dispersion (n=60) and control group with poor bone cement dispersion (n=30). Visual analogue scale scores, Oswestry dysfunction index, Cobb's angle and adverse reactions were recordedbefore and after treatment. RESULTS AND CONCLUSION:There were no differences in the visual analogue scale score and Oswestry dysfunction index between the two groups before treatment (P > 0.05). The visual analogue scale scores were significantly lower in the study group than the control group at 3 days after treatment and at the last folow-up (P < 0.05); the Oswestry dysfunction index and Cobb's angle were also lower in the study group than the control group at 3 days after treatment (P < 0.05). However, no difference was found in the Oswestry dysfunction index, Cobb's angle and bone cement leakage between the two groups at the last folow-up. These findings indicate that the percutaneous vertebroplasty show better effects on pain relief in patients with good bone cement dispersion that those with poor bone cement dispersion, and the vertebral stability is better as wel as the short-term effect is more obvious.

Objective To explore the clinical features, diagnosis, and treatment of Kawasaki disease in neonates. Methods The diagnosis and treatment of incomplete Kawasaki disease in one case were retrospectively analyzed. The related literatures were reviewed. Results Male infant had persistent fever with rash at 26 days after birth. The anti-infective treatment was ineffective. No abnormality was found in the first coronary artery ultrasonography. However, coronary artery dilatation was confirmed by ultrasonography after skin peeling at fingertips. After the treatment of gamma globulin and aspirin, the symptoms of fever and rash were improved. The left dilated coronary artery returned to normal after 3 month. The size of coronary artery and the corresponding indexes were normal in 6-months, 1-year and 3 year follow-ups. Conclusion Neonatal Kawasaki disease is rare and atypical.

Objective:Evaluating the operative methods,complication,feasibiltity and safety of one-stage treatment by thoracoscopy for bilateral pneumothorax or pneumothorax combined with contralateral bullae.Methods:21 patients diagnosed as simultaneous bilateral pneumothorax or ipsilateral recurrent pneumothorax with contralateral bullaes received one-stage treatment by bilateral thoracoscopy.Results:all patients received VATS,postoperative complications include prolonged air leak over 4 days(2 cases), reexpansion pulmonary edema (1 case),and one patient required temporarily mechanical ventilation.There were no postoperative death.All patients recovered smoothly.Follow-up time ranges from 7 to 77 months (mean 32.7 months).Compared with the 127 thoracopcopic procedures of unilateral pneumothorax,there's no statistics difference in complications (χ2=1.7247,P＞0.05). Conclusions:one-stage VATS is a safe and effective procedure for bilateral spontaneous pneumothorax or pneumothorax combined with contralateral bullae.

10.3969/j.issn.1000-3606.2013.06.020

Abstact:Objective To study the relationship between acute mountain sickness and geographic factors in young males,and provide no-vel materials for screening susceptible population and exploring novel research ideas and methods. Methods Total 294 young men came from low altitude were randomly selected,questionnaire was conducted and military AMS standard was applied for diagnosis. Binary logistic re-gression was used to analyze the relationship between 10 different geographical factors and AMS incidence and figure out the risk factors for medical geographical differences of AMS. Results AMS incidence was 52. 04% (153 people),with most commonly seen dizziness,head-ache,shortness of breath,chest tightness and lip empurples,the occurrence was 89. 54%,84. 31%,66. 01%,65. 36% and 60. 78%,respec-tively. Binary logistic regression analysis revealed that altitude was the only geographical risk factor (OR=0. 998,P<0. 05). Conclusion Among the population who entered plateau,lower native altitude they used to live brings higher risk of AMS,therefore corresponding preven-tions should be adapted for those who come to high altitude from low altitude in order to ensure their health and safety.