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Clinical and renal pathological findings in children infective endocarditis

Chaoying CHEN ; Jingcheng LIU ; Li CAO ; Lina JI ; Li WANG ; Lin SHI ; Di ZHAO

Chinese Journal of General Practitioners.2015;14(1):43-46. doi:10.3760/cma.j.issn.1671-7368.2015.01.013

We retrospectively analyzed the clinical manifestations,treatments and prognosis of infective endocarditis (IE)associated with renal lesions in children.There were 23 confirmed IE cases who were admitted to the Capital Institutes of Pediatrics from 1992 to 2012.There were 6 cases (26％) with renal lesions.Renal lesions included asymptonatic microscopic hematuria(1 case),asymptomatic proteinuria (1 case) and acute nephritic syndrome (4 cases).There were 3 cases of acute renal injury (AKI) resulted from nephritis accompanied with acute heart failure.The serum level of C3 was lower in patients with renal lesions than patients without renal lesions (P ＜ 0.05),but the clinical manifestations,physical signs and other laboratory findings were the same.Patients of both groups were treated with antibiotics.All patients were recovered and discharged.The average hospital days were (39.2-± 15.2)days for patients with renal lesions and (34.9-± 19.2) days for patients without renal lesions (P ＞ 0.05).Renal lesions secondary to IE are relatively common in IE patients in children.Most of renal lesions can be improved by effective antibiotics.Prognosis of those patients accompanying with AKI is bad.

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Clinical efficacies of full-thickness suturing plus subcutaneous negative pressure drainage in the prevention of postoperative abdominal wound infection: a report of 68 cases

Xi CHEN

Chinese Journal of General Practitioners.2015;14(1):56-58. doi:10.3760/cma.j.issn.1671-7368.2015.01.017

From April 2011 to October 2013,68 patients scheduled for complex hepatobiliary and pancreatic surgery underwent full-thickness suturing of abdominal incision with subcutaneous negative pressure drainage.There was no such complications as wound dehiscence or sinus formation.Except for 2 cases of wound infection,primary healing was achieved.Two infected cases were followed up for 1 year and there was incisional hernia.The full-thickness suturing of abdominal incision plus subcutaneous negative pressure drainage could prevent postoperative wound infection and promote wound healing.And this simple and practical approach is worthy of wider clinical application.

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Haploidentical hematopoietic stem cell transplantation with supplemental umbilical cord blood infusion in treatment of malignant hematological diseases

Zhenlan DU ; Peng CHEN ; Rongmu LUO ; Quanhua LIU ; Xiaomei ZHANG ; Ya WANG ; Zhichun FENG

Chinese Journal of General Practitioners.2014;13(10):824-828. doi:10.3760/cma.j.issn.1671-7368.2014.10.011

Objective To evaluate the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) with supplemental umbilical cord blood (UCB) infusion in treatment of malignant hematological diseases.Method Clinical data of 66 patients with hematological malignancies treated with HSCT in our hospital between January 2010 and May 2013,were retrospectively analyzed.Among them 25 cases received infusion of human UCB before HSCT (experimental group) and other 41 cases had no UCB injection before HSCT (control group).Results There were no differences in age,gender,donor type,disease categories,disease status before transplant between two groups (P ＞ 0.05).There was a significant difference in conditioning regimes between two groups (P ＜ 0.05),but no clinical implication.The infused mononuclear cell (MNC) count in experimental group was higher than that in control group (9.94 ± 2.88 × 108/kg vs.7.80 ±0.82 × 108/kg,P =0.00),while there were no difference in infused CD34 + cell count (5.46 ±3.54 × 106/kg vs.3.54 ± 1.60 × 106/kg,P =0.16).Neutrophil recovery time in experimental group was shorter than that in control group (13.7 ±2.9 d vs.16.6 ±2.9 d,P =0.023).The incidences of grade Ⅲ-Ⅳ acute graft versus host disease (aGVHD,P =0.036),bacterial infection (P =0.001) and fungal infection (P =0.001)and hemorrhagic cystitis (P =0.00)in experimental group were lower than those in control group.There were no significant differences in platelet recovery time(P =0.43),the incidence of grade Ⅰ-Ⅱ aGVHD (P =0.27),implanted syndrome (P =0.24),sinusoidal obstruction syndrome (P =0.57)and viraemia (P =0.31)between two groups.Conclusion HSCT with supplemental infusion of human UCB may alleviate the degree of aGVHD,but the long-term outcome remains to be studied.

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Clinical features of autoinflammatory diseases in 3 patients

Yulin GONG ; Min SHEN

Chinese Journal of General Practitioners.2014;13(10):832-834. doi:10.3760/cma.j.issn.1671-7368.2014.10.013

Patient one was a 19-year-old woman of periodic fever with urticaria during the first week of life.And there were typicalfacies,oligoarthritis and central nervous system involvement.She also exhibited a persistent elevation of acute phase reactants.The diagnosis of chronic infantile neurological cutaneous and articular syndrome was made.Short-term dosing of tumor necrosis factor-α receptor antagonist was administrated and was substituted by glucocorticoid and methotrexate.Another two males had an earlyonset of increased acute phase reactants during inflammation attacks.One of them had recurrent fever with urticaria-like rash,arthralgia and headache.Muckle-Wells syndrome was diagnosed on basis of NLRP3 gene mutation (c.92A ＞ T).And another had recurrent urticaria-like rash with conjunctivitis,oligoarthritis,hepatosplenomegaly and increased serum IgD.The clinical diagnosis was mevalonate-kinase deficiency.Autoinflammatory diseases should be suspected by physicians and diagnosed with a combination of phenotype and genotype.Biological agents,especially interleukin-1 antagonist,have broad prospects in the therapy of autoinflammatory diseases.

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Analysis of monitoring information about infant congenital heart disease in Changzhou

Lin ZHANG ; Jinxiu WANG ; Xiaoying LI

Chinese Journal of General Practitioners.2014;13(10):837-838. doi:10.3760/cma.j.issn.1671-7368.2014.10.015

Screening of CHD of infants (11 178) born from May 1st 2012 to April 30th 2013.92 infants were screening positive,68 were diagnosed.The detectable rate of CHD was 6.08‰,while boys were 3.31‰,girls were 2.77‰.68 CHD patients,the top three were VSD(2.14‰),PDA(1.34‰) and ASD (0.89‰).In these infants,detectable cardiac souffle were 61,abnormal pulse oximetry were 40.The detectable rate of CHD among infants was identical compare the average level of whole country,but the distributional characteristics was disparity.The screening of CHD was feasible,and cardiac souffle and pulse oximetry were recommended.

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Pituitary acromegalic cardiomyopathy: a report of 4 cases and literature review

Chenguang YANG ; Huiping ZHANG ; Fusui JI

Chinese Journal of General Practitioners.2014;13(10):839-841. doi:10.3760/cma.j.issn.1671-7368.2014.10.016

Four cases of pituitary acromegalic cardiomyopathy were reported and relative literature was reviewed in this article.Four patients were all males aged 45-63 y.The patients were diagnosed as pituitary adenoma,then NYHA grade Ⅲ-Ⅳ heart failure developed.One patient had both acromegaly and coronary heart disease,and all patients had arrhythmia attacks.The growth hormone levels were not under control in 3 patients,and for the remaining patient with normalized growth hormone the end-stage heart failure also developed.The onset of pituitary acromegalic cardiomyopathy is hidden; when the disease progresses to advanced heart failure,the prognosis would be poor in most cases.So early diagnosis and timely treatment is of great importance in acromegalic cardiomyopathy.

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Etiological classification of virus in adult community-acquired pneumonia in Yantai

Hongxia YU ; Yongqin CHEN ; Zenghui PU ; Maomao ZHAO

Chinese Journal of General Practitioners.2014;13(10):842-843. doi:10.3760/cma.j.issn.1671-7368.2014.10.017

To employ multiplex polymerase chain reaction (PCR) to classify the types of virus in 128 patients of community-acquired pneumonia and analyze the relationship between type of virus,age and seasons.The positive rate of viral pneumonia was 34.4％ (44/128).In 44 virus positive patients,the rates of influenza A virus,rhinovirus,adenovirus,parainfluenza type 1,human metapneumovirus virus,influenza B virus,parainfluenza type 2,parainfluenza type 3 and enterovirus were 22.7％ (10/44),15.9％ (7/44),15.9％ (7/44),9.1％ (4/44),9.1％ (4/44)6.8％ (3/44),2.3％ (1/44),2.3％ (1/44) and 2.3％ (1/44) respectively.And other 6(13.6％) patients were at least infected by one virus.The viral pneumonia had a high positive rate in spring and winter.And the age group of 20 to 29 years had a high positive rate.The major pathogen contributing to adult community-acquired pneumonia in Yantai were influenza A virus,rhinovirus and adenovirus.

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Micro-traumatic surgical procedure of loose seton and cutting seton in the treatment of high anorectal fistulae of 136 cases

Chengwei YU ; Yufeng CUI ; Jingying PAN ; Xiangyu MENG ; Maowei JIANG

Chinese Journal of General Practitioners.2014;13(10):844-845. doi:10.3760/cma.j.issn.1671-7368.2014.10.018

To explore the therapeutic effect of micro-traumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistulae.Application of cutting seton (truss rubber bands) implemented the high part of fistulae and loose seton (ligation rubber band but non-fastened) for the low part of fistulae.133/136 patients undergoing micro-traumatic surgery were cured by one operation,2 cases had pseudo-healing and there was 1 recurrent case.And the curative rate was 97.8％.The microtraumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistula has such multiple advantages as small incision,minor trauma,lesser pain,faster healing and a shorter course of treatment.And it may preserve the proper anal function and the integrity of anal skin.And its clinical efficacy is satisfactory.

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Treating patients of unilateral benign thyroid disease with hemithroidectomy

Jian XU ; Yuanjiang ZHANG ; Ke JIN ; Xiaohong GU

Chinese Journal of General Practitioners.2014;13(10):846-848. doi:10.3760/cma.j.issn.1671-7368.2014.10.019

According to operative modalities,128 patients with unilateral benign thyroid disease were divided into hemithyroidectomy group (n =68) and subtotal thyroidectomy group (n =60).The operative duration of hemithyroidectomy group was (63 ± 14) min,intraoperative blood loss (54 ± 15) ml,postoperative drainage volume (64 ± 10) ml and hospitalization stay (5.9 ±0.8) days.The hospital charge of (8 335 ± 278) yuan was less than that of subtotal thyroidectomy group (P ＜ 0.05).The incidence rate of postoperative hoarseness,water bucking,low calcium and hypothyroidism had no significant inter-group difference (P ＞ 0.05).But the postoperative recurrence rate of hemithyroidectomy was significantly lower than that of subtotal thyroidectomy group (P ＜ 0.05).Treating patients of unilateral benign thyroid disease with hemithyroidectomy yield excellent efficacies.It is worthy of wider clinical application.

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Rectal carcinoid: clinical analysis of 21 cases

Tian LI ; Qian LIU ; Yi FANG ; Xiaohong MENG ; Mingfang JI ; Lu XIA

Chinese Journal of General Practitioners.2014;13(12):995-998. doi:10.3760/cma.j.issn.1671-7368.2014.12.012

Objective To analyze the clinical characteristics,pathological classification and therapy strategy of rectal carcinoid and its prognostic factors.Methods Forty four patients with rectal carcinoid were diagnosed and treated in Ruijin Hospital Shanghai Jiaotong University from January 2006 to November 2013,among whom 21 patients (19 males and 2 females) were followed-up for 1-7.5 years.The clinical data of these cases were retrospectively analyzed.Results The patients underwent colonoscopy because of changed bowel habits and/or abnormal digital rectal examination,none of them had carcinoid syndrome.Colonoscopy showed that most lesions presented yellowish in color and smooth in surface; the diameter of the tumor was ≤ 1.0 cm in 12 cases (57％) ; the tumors were located at the rectum within 8 cm from anal rim in 17cases (76％); most of them were well differentiated.Immunohistochemistry demonstrated that NSE expression was highly positive.The 1 year-and 3year-survival rate were both 100％.Among 8 cases who were followed up for over 5 year,2 relapsed.Conclusions The digital rectal examination plays a key role in detecting rectal carcinoid.Though prognosis is relatively good,we should keep close following-up to detect the recurrence.The main risk factors influencing the prognosis are tumor size,depth of invasion and clinical stage.The combination measurement of CEA,TSGF,CA19-9 and NSE will either increase the sensitivity or the specificity of early detection.

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