For clinicians, the correct diagnosis of the disease and timely treatment is clinical two main work. Good clinical thinking ability is very important. The book collects 100 cases of the clinical teaching hospital of Peking University nearly 10 years to come difficult cases bed, including three cases, the diagnosis of difficult cases; or diagnosis, treatment of difficult cases; or emergency case needs to make a correct and timely diagnosis and treatment of cases. Summary of the case history, clinical features, in detail, the preliminary diagnosis and diagnosis, differential diagnosis includes every case, auxiliary examination results, after treatment and the final diagnosis; expert review lessons include the diagnosis and treatment of this case in question, and finally diagnosed disease introduction. There is important value to improve the level of diagnosis and treatment of surgical physicians at all levels. The level of diagnosis and treatment of this book can reflect the Peking University Health Science Center Department of Affiliated Hospital of difficult cases, desire and domestic surgery fellow physician share.
A case 1, Department of Neurosurgery, neck and chest numbness in 10 years, 4 years, 2 cases of pain left upper extremity activities detrimental to 7 months 3 cases of intermittent abdominal pain for 3 months, dizziness, look matter geminate 2 months in case 4 the development of secondary sexual characteristics and emotional upset 15 months 5 cases postpartum headache, spirit, 6 months, two Department of thoracic surgery, 6 cases of dyspnea in 10 years 7 cases of dyspnea in 10 months, 1 months, 8 cases aggravated the left shoulder and back pain for 2 months, the CT found in the left apex occupying 1 months cough, expectoration 9 cases 1 months, chest X-ray revealed a right pulmonary occupying half a month in case 3 10 months of irritating cough, CT examination found that the right lung occupying 2 months 11 cases cough for 7 months, aggravated in 3 months, chest CT examination showed bilateral hilar mass and multiple mediastinal lymph nodes in 1 cases 12 months malaise, 2 months, physical examination revealed multiple lung nodules 2 cases 13 limbs of progressive weakness of 40 Yu Tian, CT showed bilateral pleural lesions, mediastinal tumor in 10 Yu Tian, dysphagia for 10 days 14 cases chest 3 months, cT found that anterior mediastinal cystic solid half a month, 15 cases of right upper extremity weakness of 1 years and 3 months, with drooping eyelids sometimes worse 3 month, hair The anterior mediastinal tumor 1 months three, 16 cases of cardiac surgery cardiac murmur was found 17 years 17 cases found in the area before the heart murmur 3 years, exertional dyspnea, cyanosis, 1 and a half years 18 cases from shortness of breath 7 years, accompanied with the night could not lie down for 1 months in case 19 progressive weakness over the past 10 years, accompanied with respiratory difficult 4 months 20 cases of chest pain onset of 5 months, 21 cases aggravated half month tired chest pain during the first half of the year, sudden chest 2 hours 22 cases sudden chest pain for 4 months, palpitations, chest tightness after 2 months 23 cases of chest and back sudden tearing like pain 6 hours, four Department of general surgery of 24 cases found the right breast tumor 5 months 25 cases left nipple bloody discharge 40 days 26 cases right breast cancer 9 years after surgery, left breast neoplasm, and can not walk upright half a month were 27 body pain for 1 years, 28 cases of aggravated half double lower limbs skin ecchymosis with weakness, dizziness for 1 months in 3 weeks, 29 cases of fever of acid reflux, heartburn for 1 months, gastroscope discovers gastric tumor 1 months 30 cases of recurrent vomiting every night eating 3 months 31 cases of epigastric pain for 12 years, accompanied by chills, fever, jaundice intermittent episodes of 6 years, again Episode 1 weeks 2 years 32 cases of duodenal papilla carcinoma after pancreaticoduodenectomy for intermittent melena, 9 months, 33 cases aggravated with hematochezia 4 days intermittent abdominal pain for 3 months left 34 cases of anorexia, abdominal pain, nausea and vomiting in 1 weeks, 1 days a 35 change in bowel habits of 2 years, the sigmoid colon colon tumor 1 weeks were 36 second 28 weeks of gestation, sudden onset of lower abdominal pain 7 hours 37 abdominal pain, abdominal distension were with exhaust, defecate decreases 1 weeks 2 months 38 cases mucous stool, stool with refractory fever 1 months were 39 right abdominal pain with anorexia, fatigue in 3 months and 1 months were 40 orthotopic liver after transplantation, discontinuous skin, sclera jaundice in 1 months in case 41 and case 42 black intractable bleeding 4 years 43 cases of paroxysmal abdominal pain for 3 months, CT found that pancreatic mass 2 days 44 cases of abdominal mass 40 days 45 cases of anorexia and weight loss in 2 months, left upper abdominal pain for 20 days, afternoon fever 1 weeks of 46 cases of severe abdominal pain with vomiting, diarrhea, bloody stool for 5 days, 2 cases 47 abdominal pain for 10 days, 5 days and 48 black patients intermittent melena for more than 2 years, aggravated with hematemesis 1 weeks were 49 acid reflux, heartburn 2 years, eating with choking 2 months 50 cases of recurrent upper right Abdominal pain for more than 4 years, aggravated in 1 months 51 cases found gallbladder stone in 10 years, intermittent right upper abdominal pain for 5 years, periumbilical pain with stop defecation 7 days 52 cases repeatedly left lower abdominal pain for 3 months, accompanied with blood in the stool for 6 days were 53 sporadic eating discomfort, endoscopy duodenal tumor 1 case 54 memory decline in 6 weeks, aphasia, right limb numbness, gingival bleeding, 3 weeks, 1 days, 55 cases of epilepsy after strenuous exercise 4 months left lower limb weakness, aggravation with cold 1 months 56 cases severe precordial pain for 50 minutes, five Department of Urology case 57 discontinuous left lumbar acid bilges 2 years, B Ultrasound revealed a left hydronephrosis 2 weeks were 58 on the right side of the waist bilges painful unwell for 1 months, B ultrasound revealed a right hydronephrosis in 1 months in case 59 and 1 days after the right flank pain cases 60 were injured after a collapsed wall cannot stand micturition in 2 hours and 61 cases of pelvic fracture urethral realignment with traction, 1 years after operation was 10 months, 62 cases of dysuria micturition more than 2 years, dysuria, aggravated in 5 months 63 cases found in physical examination of the right kidney stones and 1 months were 64 physical examination revealed left kidney 10 days 65 cases on the right side of the waist pain during the first half of the year, painless gross hematuria and fever 1 months 66 cases of intermittent painless Gross hematuria in 5 months in case 67 intermittent painless hematuria 2 years 68 cases of painless hematuria repeatedly with urinary frequency, urgency, 3 months, 69 cases 3 days 70 cases hematuria terminal hematuria 3 months 71 cases of left scrotal swelling for more than 1 years 7 years 72 cases of frequent micturition, dysuria 6 months, 5 days can not urinate case 73 overflow urinary 9 years, 5 years of bladder neck suspension for 1 years after the recurrence of symptoms, 74 cases found elevated blood pressure for more than 10 years, found that low blood potassium 3 years 75 cases of paroxysmal palpitation, accompanied by headache, cold sweat, sweat for 10 years, occasionally found in left upper abdominal mass in 1 months case 76 the penis cannot erect 5 years 77 cases after kidney transplantation in 3 years, 7 months and 20 days intermittent painless hematuria 78 cases with severe anemia after renal transplantation, 3 months, six cases of large area burn 79 burn patientsARDS treatment of 80 cases of large area burn late in the treatment of acute renal failure in 81 cases of severe burn complicated by multiple organ function injury cases, treatment of 82 cases of severe burn with inhalation injury, poisoning shock treatment case 83 special causes of burn treatment, seven cases on the Department of orthopedics 84 computer navigation odontoid screw fixation in the treatment of anterior teeth. Condylar fractures 85 cases of extreme lateral lumbar disc herniation 86 cases lumbar kyphosis osteotomy 87 cases of comminuted humeral intercondylar fractures of distal humerus fracture were 88 cases in front of 89 elbow injury triad cases 90 Essex-Lopresti damage 91 cases of distal radius fracture with open reduction and plate screw internal fixation 92 cases improved Sauve-Kapandji operation treatment the distal radioulnar joint dislocation were 93 old scaphoid fracture with A-O cannulated screw fixation were 94 plus hollow nail in treatment of special types of femoral neck fracture femoral neck fracture: 95 cases of closed or open reduction, cannulated screw fixation of femoral neck fractures: 96 cases of closed or open reduction, photoelectric navigation system aided cannulated screw fixation cases 97 intertrochanteric PFN internal fixation 98 cases femoral bone fracture fold sense Infectious nonunion cases 99 open bone grafting in the treatment of tibial infected nonunion of fracture of talus fracture 101 cases 100 cases of old fracture of calcaneus were 102 calcaneal fractures in 103 cases and 104 cases of pelvic fractures of acetabular fracture 105 cases of pelvic fracture with femoral shaft fracture 106 cases of proximal humerus fractures 107 cases traumatic recurrent anterior shoulder dislocation 108 cases of knee anterior cruciate ligament, medial meniscus injury
1 cases of neck and chest numbness in 10 years, the pain 4 years summary female, 42 years old. "10 years because of neck and chest numbness, pain 4 years" admission. 10 years before admission without incentives in neck and chest numbness, often burn in cooking, sometimes sharp cuts do not know. In a local hospital to take interrupted compound vitamin B, Salvia and other drugs had no obvious improvement. Neck pain in the past 4 years, numbness and discomfort aggravated gradually consciously. The local hospital for x-ray report "scoliosis, cervical rigidity", "diagnosis for cervical spondylosis", give medicine (drug name unknown), such as massage therapy without improvement. 1 months ago in the treatment of neurological department of internal medicine in our hospital, physical examination revealed bilateral C5 T4 pain disappeared, tactile, hand thenar muscle atrophy, diagnosis of syringomyelia. 1 weeks ago in outside the hospital MR1 examination revealed that the left basal ganglia, brainstem left, syringomyelia (Figure 1A, B, C, D); Chiari malformation type. For further treatment of income my division. Since the illness without headache, nausea and vomiting, without limbs activity obstacle. Healthy, denied that the "draft", "sinusitis", "ear", "hypertension" history. Personal history and family history of special. Physical examination: T37 ℃, P 72 / R, 18 times / min, BP 130 / 70mmH9. The weight of 60 kg, height 1.62 meters. Skin, sclera were not yellow, systemic superficial lymph node was not enlarged. Pharyngeal tonsil not red, not less, thyroid. The neck is symmetrical, bilateral carotid artery pulse, no venous engorgement. Double lung breathes phonic Qing Dynasty, no dry Hui sound. The heart has no enlargement, heart sounds is strong, rhythm of the heart is neat, heart rate 72 beats / min. The abdomen is soft, no tenderness, without bounce painful, liver is lienal did not touch. No joint swelling, deformity of limbs. Head to the right, thoracic vertebrae convex. Sane. Comprehension, memory and computing power of normal. The time, place, people orientation normal. Good binocular vision, vision without defect. Fundus: papillary and clear boundary, the color pink; move, vein diameter ratio of 2 / 3, no hemorrhage and exudation. The left eyelid eye small, slightly invagination; double eye natural at the middle, the direction of activity fully, no diplopia and nystagmus; normal binocular accommodation and vergence eye movements.
"Surgery cases" basic diagnosis level reflect the essence of Peking University Health Science Center Science Department of the hospital pediatric difficult cases, desire and domestic surgery fellow physician share. For clinicians, the correct diagnosis of the disease and timely treatment is clinical two main work. Good clinical thinking ability is very important.
Medical Science @ 2017