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find Author "张红英" 9 results
  • 老年人股骨骨折后压疮预防的护理

    目的讨论老年股骨骨折患者压疮预防的护理方法。 方法对2013年1月-6月收治的33例股骨骨折老年患者,入院后即行压疮预测评估,并根据评估情况采取使用软床垫、及时变换受压部位、保护骨隆突处等预防措施,同时对患者和家属进行个体化的健康教育及加强护士交接班预防措施,积极预防和减少压疮的发生。 结果院外带入的1例Ⅲ期压疮患者通过治疗和护理转为Ⅰ期,4例Ⅰ期、2例Ⅱ期压疮患者均治愈,住院期间无新发压疮患者。 结论积极的护理措施可预防股骨骨折老年患者压疮的发生,减轻患者的痛苦,提高护理质量和患者的满意度。

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  • 胃肠间质瘤危险度评估系统比较——从NIH共识标准到预后等高热线图

    Release date:2017-02-20 06:43 Export PDF Favorites Scan
  • Microcystic/reticular schwannoma:clinicopathologic analyses and review of literatures

    ObjectiveTo summarize the clinicopathological features of microencapsulated/reticular schwannoma.MethodsTwo cases of microencapsulated/reticular schwannoma treated in West China Hospital of Sichuan University were retrospectively collected. The histological and immunohistochemical features were summarized, and the related literatures were reviewed.ResultsTwo cases of microcystic/reticular neurilemmoma diagnosed and treated in West China Hospital of Sichuan University were male. The clinical manifestations were “dull pain in the right lower abdomen” and “mass of left index finger”. Microscopically, the characteristic reticular or cribriform structures were found in all cases, and lymphocytic sheath was seen in 1 case. Immunohistochemical staining showed S-100, glial fibrillary acidic protein (GFAP) and calretinin positive. By February 2020, only 41 cases were reported in the literatures (there were no cases of this group),there was no significant gender difference, the median age was 55 years (11–93 years), and the median size of the lesion was 2.1 cm (0.4–13.0 cm). Most of them were found by accident, without obvious symptoms and signs, and no history of neurofibromatosis type 1 or 2. Microencapsulated/reticular schwannoma in this patients mainly occurs in the viscera, especially in the gastrointestinal tract (mostly in the the colorectal of lower gastrointestinal tract ), most of them were solitary nodular masses without capsule. Microscopically, the boundary was clear, and the characteristic microcapsules and reticular structures were seen. The tumor cells were diffusely expressing S-100 protein, and GFAP and calretinin were expressed in varying degrees. Electron microscopy showed the characteristics of Schwann cells.ConclusionsMicrocystic/reticular schwannoma is a rare subtype of schwannoma, which needs to be differ-entiated from multiple benign and malignant neoplasms. The diagnosis of the tumor is a challenge for the pathologist.

    Release date:2020-10-21 03:05 Export PDF Favorites Scan
  • Experiences of the Diagnosis and Treatment of Symmetric Lipomatosis in the Neck

    【摘要】 目的 探讨颈部对称性脂肪瘤的诊断和治疗。 方法 对2004年3月-2010年10月收治的5例颈项部脂肪瘤患者,其临床症状、体征、术前术后处理及结果等临床资料进行回顾。 结果 5例均为男性,以颈、项部大量皮下脂肪堆积为主要临床表现,其中1例伴有胸部上分皮下脂肪堆积,呈对称性隆起。3例患者伴阻塞性睡眠呼吸暂停低通气综合征,2例患者有睡眠打鼾但无明显呼吸暂停。4例患者有脂肪肝和长期酗酒史,但肝功能无异常改变,其中1例(1/4)有多次乙醇中毒史。1例患者无酗酒史,但诉经常作颈部刮痧治疗。5例均行外科手术切除,术中见肿瘤为白色无包膜脂肪组织。术后随访3个月~2年,1例术后1年复发,未行再次治疗,其余未见明显复发。 结论 颈部对称性脂肪瘤是脂肪组织弥漫性、对称性沉积于颈胸部皮下浅筋膜间隙和(或)深筋膜间隙的良性疾病。患者以中年男性居多,长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助,但酗酒可能并非唯一病因。对于影响美观及功能的患者,其手术疗效较理想。【Abstract】 Objective To explore the diagnosis and treatment of symmetric lipomatosis in the neck. Methods We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010. Results All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group. Conclusions Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.

    Release date:2016-09-08 09:24 Export PDF Favorites Scan
  • Investigation and characteristic analysis on comorbidities in elderly patients with total hip/knee arthroplasty

    ObjectiveTo investigate and analyze comorbidities of elderly patients with total hip/knee arthroplasty, so as to provide a basis for the management of comorbidities.MethodsConvenience sampling was used to select elderly patients who underwent total hip/knee arthroplasty in the Department of Orthopedics in West China Hospital of Sichuan University from June to December 2019 as the research objects. We collected general data and comorbidity data of patients, and statistically analyzed the comorbidities of elderly patients undergoing total hip/knee arthroplasty, and the characteristics of perioperative psychology, sleep, postoperative complications, and length of hospital stay in elderly patients undergoing total hip/knee arthroplasty with comorbidities.ResultsA total of 263 patients were included, of whom 64.6% had comorbidities. The number of comorbidities in elderly patients undergoing total hip/knee arthroplasty ranged from 2 to 12. The most common comorbidity was hypertension. Between patients with comorbidities and non-comorbidities, there were statistically significant differences in age (Z=−2.225, P=0.026), preoperative Huaxi Emotion Index scores (9.6±4.6 vs. 6.4±5.0; t=5.126, P<0.001), preoperative Pittsburgh Sleep Quality Index scores (13.3±3.1 vs. 12.3±2.5; t=−2.972, P=0.003), hospital stay [(5.2±0.8) vs. (4.8±0.4) d; t=4.243, P<0.001], and incidence of postoperative complications (13.5% vs. 5.4%; χ2=4.201, P=0.040).ConclusionsComorbidities are common in elderly patients with total hip/knee arthroplasty, which may aggravate negative emotions, reduce sleep quality, increase postoperative complications and prolong length of stay. Medical staff should strengthen the management of comorbidity in elderly patients with total hip/knee arthroplasty, so as to reduce its influence on perioperative period and promote the rehabilitation of patients.

    Release date:2020-11-25 07:18 Export PDF Favorites Scan
  • 1 例伴腹膜广泛受累的肝脏上皮样 血管内皮细胞瘤报道

    目的总结 1 例伴腹膜广泛受累的肝脏上皮样血管内皮细胞瘤(epithelioid hemangioendothelioma,EHE)的临床表现、诊断与治疗经验。方法回顾性分析四川大学华西医院(简称“我院”) 2019 年诊断的 1 例伴腹膜广泛受累的肝脏 EHE 的临床、影像学、组织形态学和免疫组织化学染色特征,并回顾相关文献。结果患者为 47 岁男性,因“无明显诱因反复左下腹疼痛半年”于当地医院就诊;CT 示“肝内多发不规则稍低密度结节,腹膜增厚,以大网膜为主”,行腹腔镜下腹腔肿瘤活检术,当地医院病理诊断为“网膜恶性间叶源性肿瘤,肝脏病变定性困难”,遂送我院会诊。我院病理诊断为肝脏及网膜 EHE。患者在当地医院接受紫杉醇+顺铂化疗 4 个疗程,于活检术后 10 个月因此病死亡。结论肝脏 EHE 少见。影像学对诊断肝脏 EHE 具提示作用,但最终诊断需病理检查确诊。本例 EHE 组织学特点需与转移癌、上皮样肉瘤、间皮瘤等腹腔内常见的肿瘤相鉴别,其诊断具有挑战性。EHE 首选手术切除,对放、化疗均不敏感。近年有使用抗肿瘤血管生成的靶向药物治疗 EHE 的报道。EHE 预后需收集更多病例资料行深入、系统地研究和分析。

    Release date:2021-04-25 05:33 Export PDF Favorites Scan
  • Inter-observer Reproducibility in the Pathologic Diagnosis of Breast Intraductal Proliferative Lesions Using the Same Criteria

    Objective To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL). Methods Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis. Results Inter-observer reproducibility of the trial group was higher than that of the control group (The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group. Conclusion Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.

    Release date:2016-09-07 02:27 Export PDF Favorites Scan
  • Analysis of metastatic sites and prognosis of newly diagnosed stage Ⅳ breast cancer patients based on SEER database

    Objective To explore the relationship between the metastatic sites and prognosis in newly diagnosed stage Ⅳ breast cancer. Methods The data of newly diagnosed female patients with stage Ⅳ invasive breast cancer with complete follow-up data from SEER database from 2010 to 2015 were grouped according to different metastatic sites, and the differences of breast cancer-specific survival (BCSS) in different metastatic sites were analyzed by univariate and multivariate Cox. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to analyze the prognostic factors of BCSS in newly diagnosed stage ⅳ breast cancer. Results A total of 8 407 patients were included in the final analysis. Among them, 5 619 (66.84%) patients were confirmed with bone metastasis only, 1 483 (17.64%) patients with lung metastasis only, 1 096 (13.04%) patients with liver metastasis only, and 209 (2.49%) patients with brain metastasis only. The median follow-up time was 22 months, with 4 180 (49.72%) breast cancer-related deaths and a median BCSS of 39 months in those patients. The location of metastasis in newly diagnosed stage Ⅳ invasive breast cancer was significantly correlated with BCSS (χ2=151.07, P<0.001). Multivariate Cox model analysis showed that the BCSS was worse in patients with liver metastasis [HR=1.34, 95%CI (1.21, 1.49), P<0.001], lung metastasis [HR=1.09, 95%CI (1.04, 1.14), P<0.001] and brain metastases [HR=1.28, 95%CI (1.20, 1.36), P<0.001] than in patients with bone metastases. Further subgroup analysis showed that the BCSS of breast cancer patients with different molecular subtypes and different metastatic sites were also significantly different (P<0.05). Patients with brain and liver metastases in the HR+/HER2– subtype had worse BCSS than those with bone metastases (P<0.001). Patients with brain metastases in the HR+/HER2+ subtype had worse BCSS than those with bone metastases (P=0.001). In HR–/HER2+ subtype, the BCSS of patients with liver metastasis, lung metastasis and brain metastasis were worse than that of patients with bone metastasis (P<0.05). In HR–/HER2– subtype, the BCSS of patients with brain metastasis and liver metastasis were worse than that of patients with bone metastasis (P<0.05) . Conclusion The prognosis of newly diagnosed stage ⅳ breast cancer patients with different metastatic sites is different, and the prognosis of different molecular subtypes and different metastatic sites is also different.

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  • Urgent recommendation protective measures of West China Hospital for medical personnel to prevent device related pressure injuries in 2019-nCoV epidemic situation

    At present, the 2019-nCoV epidemic situation is in severe and complex period. In order to prevent the virus from invading and infecting, it is very important and urgent for medical personnel to protect themselves. However, in the process of using protective equipment by medical personnel, the performance of device related pressure injuries (DRPI) caused by pain, numbness, redness, and even breakage caused by the equipment has seriously endangered the health of medical personnel. This article, based on Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019, references, and clinical experiences of wound specialists in West China Hospital of Sichuan University, summarize the preventive and protective measures of West China Hospital for medical personnel to prevent DRPI, so as to provide clinical preventive measurements for medical personnel.

    Release date:2020-08-19 03:53 Export PDF Favorites Scan
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