ObjectiveTo explore the effect of precise management on life-saving equipment management in Surgical Intensive Care Unit (SICU). MethodsWe actualized precise management in the life-saving equipment management process in March 2014, including precise management control system, precise personnel training, and precise process management. ResultsAfter precise management, the knowledgement of life-saving equipment of the nurses increased from 90.2% (May, 2014) to 98.5%. The number of equipments repaired before (March-May, 2014) and after the management (June-August, 2014) was 65 and 47, respectively; the number of nonstandard management times in nurses after the equipments were used was 98 and 10, respectively. ConclusionPrecise management can drastically improve management efficiency, serviceability rate and service efficiency of life-saving equipment, obviously enhancing the degree of familiarity and using skills of clinical nurses, and ensuring quick and smooth emergency work. It plays an active role in securing severe patients' life.
Paediatric retinal disease is the most important part of paediatric ophthalmology. It usually manifests as leukocoria or yellow pupil, typically in retinopathy of prematurity, familial exudative vitreoretinopathy, persistent hyperplastic primary vitreous, Coats disease and retinoblastoma. It also can be manifested as nystamus poor visual fixation or progressive worsening of visual function, typically in Leber congenital amaurosis, Stargardt disease, Best disease and cone and rod dystrophy. Paediatric retinal diseases can be roughly divided into acquired, hereditary and congenital developmental abnormalities. With the development of gene and stem cell technologies, the advent of new medicine, equipments and new techniques, the concept of diagnosis and treatment in paediatric retinal diseases is also changing. In China, the level is improving progressively in both clinical and research areas of paediatric retinal diseases.
ObjectiveTo analyze and discuss the clinical features and management of pediatric retinal detachment (RD) associated with morning glory syndrome (MGS). MethodsThe clinical data of 49 patients (51 eyes) with RD associated with MGS were retrospectively analyzed, including 27 males (27 eyes) and 22 females (24 eyes). The age at first diagnosis ranged from 1 week after birth and 13 years old (4.2±3.2) years. There were 33 eyes of exudative RD, 3 eyes of rhegmatogenous RD and 15 eyes of RD with undetermined cause. Twenty eyes of 20 patients had other congenital ocular abnormalities, including persistent hyperplastic primary vitreous, microphthalmia, choroidal coloboma, iris coloboma. Besides retinal detachment, other complications were found, including cataract, secondary glaucoma,corneal leukoma or edema, strabismus and nystagmus. Twenty-two cases (22 eyes) received treatment. Five cases of mild exudative retinal detachment took oral methazolamide tablets. Three eyes with mild and restricted retinal detachments got retinal laser photocoagulation around the optic disc. Fourteen cases of 14 eyes underwent surgery including vitrectomy, lensectomy, and phacoemulsification. Follow-up after treatment were three months or more, with an average of (20.3±11.8) months. The visual acuity, retinal reattachment and intraocular pressure and other complications after treatment were followed up. ResultsFive patients of exudative retinal detachment were remained stable by taking methazolamide tablets. Two of the 3 eyes remained stable after laser therapy; however, the remaining one eye was not controlled after relaser. Cataract and glaucoma were resolved by lensectomy in 7 eyes and phaco-emulsification surgery in 1 eye. Retina was re-attached in 6 eyes after vitrectomy. Among those treated, 10 eyes had records of visual acuity. Visual acuity was improved in 1 eye after laser therapy and remained stable in 9 eyes. There were no drugs and surgery-related complications. ConclusionsRetinal detachment was the main complication of MGS. The high incidence and poor prognosis call for the need of close follow-up and timely treatment, including medicine, laser and surgery.
ObjectiveTo observe the efficacy and safety of combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity (AP-ROP). MethodsMedical records of 70 eyes of 35 premature infants with a primary diagnosis of AP-ROP in our clinic were reviewed and analyzed retrospectively. All the lesions were located in posterior zone, with 42 eyes in zone 1 and 28 eyes in zone 2. Forty-six eyes had iris neovascularization, while 19 eyes combined with vitreous hemorrhage. All participants underwent intravitreal injection of ranibizumab as the primary treatment within 12 hours after diagnosis of AP-ROP. The systemic and ocular adverse effects were observed. The change of retinal vascular tortuosity and dilatation before and after the intravitreal injection of ranibizumab was observed one week after injection. Laser photocoagulation was used as adjuvant therapy if the plus disease persisted more than two weeks or new-onset ridge occurred after injection. The mean time interval between injection and laser therapy was (5.1±2.6) weeks (range, 1-10 weeks). Follow-up ranged from 6 to 18 months, with a mean of (10.3±3.9) months. The anatomical results and complications were evaluated after treatment. The eyes that progressed to stage 4 or 5 during the follow-ups were underwent lens-sparing vitrectomy or lensectomy combined with vitrectomy. ResultsNo major systemic or ocular complications were observed. Preretinal hemorrhages were found in 12 eyes of 8 patients (17.1%), but they were absorbed spontaneously during the follow-ups. All lens remained transparent and no iatrogenic retinal hole was occurred during the follow-ups. After the injection, the regression of iris neovascularization was observed in 46 eyes within one week, vitreous hemorrhage absorbed significantly in 16 eyes (84.2%), and plus disease disappeared completely within one week in 61 eyes (87.1%). 59 eyes (84.3%) demonstrated vascularization toward the peripheral retina after treatment. 32 out of 42 eyes (76.2%) with zone 1 demonstrated vascularization toward to zone 2, while 24 out of 28 eyes (85.7%) with zone 2 demonstrated vascularization toward to the junction of zone 2 and 3. After intravitreal injection of ranibizumab combined with laser photocoagulation, 62 of 70 eyes (88.6%) had retinal vascular ridge and plus disease regression. However, 8 eyes of 6 patients (11.4%) showed significant fibrovascular proliferation and progressed to retinal detachment after the combination treatment of intravitreal ranibizumab injection and laser photocoagulation. Four eyes underwent lens-sparing vitrectomy, while the other 4 eyes underwent vitrectomy combined with lensectomy. Five eyes achieved totally retinal reattachment after surgery, while 3 eyes achieved partially retinal reattachment. ConclusionThe combination of intravitreal injection of ranibizumab and laser photocoagulation is safe and effective in the treatment of AP-ROP.
ObjectiveTo evaluate the diagnostic value of computer tomography (CT)-guided percutaneous lung biopsy and tissue culture in pulmonary diseases. MethodsAfter the preoperative evaluation, 48 patients underwent CT-guided percutaneous lung biopsy were analyzed, and 16 patients accepted tissue culture. The clinical significance of combined diagnostic rate of histopathology and tissue culture was investigated. ResultsAll patients were punctured successfully. The pathological diagnosis confirmed 26 (54.2%) cases with malignant lesions and 16 (33.3%) cases with benign lesions. Six cases could not be pathological diagnosed. The pathological diagnostic rate was 87.5%. Sixteen patients accepted tissue culture. Among them 3 cases with benign lesions were cultured. The positive rate of tissue culture was 18.8%, and improved to 30.0% in the patients with benign lesion. The combined diagnostic rate of histopathology and tissue culture was 89.6%. In addition, the accuracy rate of pathological diagnosis in the group of lung nodules was 95.0%, higher than the others. The accuracy rate of pathological diagnosis in lung nodules of 2cm~3cm in diameter was 100.0%, and the positive rate of tissue culture in lung lump of 3cm~5cm in diameter was 25.0%. The incidence of pneumothorax and hemorrhage was 14.6%. ConclusionsCT-guided percutaneous lung biopsy is a safe and effective diagnostic method. For pulmonary infectious diseases, combination of CT-guided percutaneous lung biopsy and tissue culture can improve the early diagnostic rate.
ObjectiveTo improve the knowledge of pulmonary actinomycosis. MethodsOne case of pulmonary actinomycosis with positive blood culture diagnosed on December 2013 in North Huashan Hospital was analyzed,and related literature from CNKI and Medline after 1990 were reviewed. ResultsA 57-year-old male had recurrent fever for 24 days.Chest CT showed pneumonia in the right middle lobe.Actinomyce culture was twice positive by anaerobic blood culture.The patient's temperature was normal after large doses of penicillin and doxycycline therapy.Literature review revealed that the incidence of pulmonary actinomycesis is common in males.Poor oral hygiene is the main predisposing factors.The common clinical presentations include cough,sputum production,chest pain and hemoptysis.The peripherally progressive enhancement on CT has a certain diagnostic value for pulmonary actinomycosis.Pulmonary actinomycosis can increase FDG uptake on 18F-FDG PET scan and can mimic lung cancer.Accurate diagnosis is generally made by histopathological examination of lung biopsy or surgical samples.High-dose intravenous penicillin therapy is preferred for pulmonary actinomycosis followed by prolonged oral antibiotics for 6 to 12 months.Surgical intervention may be necessary for refractory hemoptysis or patients who do not respond to antibiotic therapy. ConclusionPulmonary actinomycosis is a rare disease.Symptoms of pulmonary actinomycosis are atypical.This patient is the first reported case of actinomyces with positive blood cultures.