A, the neurosurgery medical history write a request
According to common surgery and the nerve section medical history request write, in response to the special attention following.
(A)the history and physical examination of disease
1.jot down to get hurt the then consciousness appearance in response to the point in the skull department the external injury the wound the member, have have no the near matter forget, the skull puts forth effort part and exercises a direction, harm after have already had no headache, vomit and have muscular spasms…etc..
2.pressed a sufferer who increase the Gao inside suspicious Lu, should inquire a headachy property, go into action time, part and with the relation of rest, while go into action have have no disgusted vomit, sight obstacle and deep slumber etc..Have already had no high blood pressure in the history of disease, bend the light iniquity, chronic nasosinusitis, ear to flow Nong and external injury history etc..
3.start to jot down the age in hour of disease in response to the point to the sufferer who has muscular spasms, go into action beginning part, have muscular spasms to go into action each time of keep on time, is a whole body to still keep limitting sex, is strong to keep sex or Lyuan;BE unconscious to lose, vomit white Mo, mistake to bite lips tongue and relieve nature an incontinence.In the past in the history haven’t produce inside wound, Lu brain external injury, Lu burning disease and family already have no similar go into action etc..
4.paralyze a sufferer, should start to inquire a disease slowly nasty, the part, body paralyze order of sequence and have already had no muscle to atrophy, muscle tremor and sport don’t moderate etc. circumstance.
5.the sufferer have an insensibility abnormality.To the one who feel abnormality, check its part, scope, property and develop a circumstance…etc..
6.the sufferer has already had no endocrine function obstacle, for example have fat without the excessiveness, sexual function obstacle, menstruation iniquity often and the second sex advertise for abnormality and the urine collapse etc. circumstance.
(Two)examination and other checks
1.examination in addition to the normal regulations carries on blood, wets, muck normal regulations, should make issue of blood to the important surgical operation patient, blood Ning time measurese and the blood platelets count and the liver kidney function and blood chemistry check and the guts analyze etc..Wear a taboo certificate towards doubting the infection in the Lu a patient, such as have no waist, can go a waist to wear and the brain ridge liquid normal regulations check and include sugar, egg white, chloride fixed amount and bacteriology check.Inside Lu and share a pathological changes patient inside Zhui tube, go the brain ridge liquid check, notice egg white in fixed time with the check of tumor cell.
2.should value relevant endocrine function which hangs body or other organs a check to the patient who there is endocrine obstacle, such as the serum urge a milk vegetable, growth measurements such as hormone, skin quality Chun, sex hormone, thyroid gland function and blood sugar etc..
3.the image learn a check
(1)to tumor, blood vessel inside the Lu brain external injury, Lu and infection disease patient, carry on the skull X line an even slice a check in response to the normal regulations, add to shine on special position when it’s necessary.The Zhui pathological changes inside the tube needs to shoot spinal column positive, side and Ji be some X line slices of special positions.
(2)according to condition choice cerebral build a shadow, CT, the Ci resonance check or brain room to build a shadow etc..
4.other checks can consider to go the skull super voice wave, electroencephalogram, brain stem to induct an electric potential check to the Lu brain external injury or the one who share a pathological changes inside the Lu etc..Have brain to the Yi to provide the blood the not enough patient, can go brain blood diagram, turn a neck to experiment and carotid artery many Pu Lei check etc..
Cut off specimen to the surgical operation, should describe an eye view see, and send a pathology check.The bag is swollen, abscess liquid, should notice a mirror check protozoa(amoeba, bow form insect…etc.) and wrap insect(Ji ball You), pig bag tail You, brain type lung blood bug…etc., cytology check, egg white fixed amount.In order to expel Lu to swallow tube lump, need to go cholesterol fixed amount.
Two, the neurosurgery medical history give examples
Hospitalize a record
Zheng4 Jin E2, female, 30 years old, guest sun person, Chinese of Guangxi, guest sun carton factory worker of Guangxi.Because the right eye sight carries on sex decrease, the eyeball is outstanding and becomes blind for 7 years, dysmenorrhea 2 years, hospitalize on May 8, 1991, the history of disease from oneself dictate, record on that day.
Sufferer on March 15, 1984 work medium the immodesty right eye be shoot by the asbestos piece and had no at that time obviously unwell, the sight also had no obvious obstacle.Discover after 2 weeks right eye sight suddenly decrease, see unclear, there is a pair of shadow.Discover right eye ising outstanding December, the outside be inclined, also the bulge painful feeling.Once was be a hospital to press the “the right eye saw nerve to atrophy” treatment, didn’t take effect a fruit.Become blind because of the right eye now, the companion has already had Bi milk phenomenon, dysmenorrhea for 2 years and the condition aggravates gradually and come to Hu to beg to cure especially.
Usually the body cent Jian.Once suffered from “Xiu rash” at the age of 3, deny other external injuries, surgical operation and the medicine allergic history.
Was born at the original domicile, work in the region, the non-arrival led other parts of country.Have no smoke wine habit.Menstruation 3/31~32, the blood quantity medium etc., have no a pain through the history.26 years old get married, the artificial has a miscarriage in 1984, the month of the foot produces one girl, health in 1987, end time menstruation June, 1989.The husband is still living.
The father has high blood pressure for several years and the mother, elder brother, younger sister are all still living and deny the history of other diseases.
The physical examination body temperature is 37 ℃ , the pulse 80/min, breathe 80/min, the blood pressure 12.0/8.0 kpas.(90/60 mmHgs)Growth is normal and wait in the nourishment.Automatic body, the state of mind is pure, the dialogue slices, check-up cooperation.The skin color and luster is normal and have never press pain.The neck is soft, the neck vein has no Nu piece.Windpipe in the center, the thyroid gland isn’t swollen big, without the blood vessel miscellaneous sound.The chest Kuo is symmetry, breath sport be steady.The chest wall has never press pain, the breast is symmetry and have the milk method the spillage while squeeze.Two lung breath the sound be clear, smell and dry, wet sound and fricatives.The heart point pulsate at left the fifth rib the lock bone centerline seamy side 1 cm, the heart boundary doesn’t extend, heart Lyu together, the P is 2> A2s.The each petal sound area heart sound is normal, smell and miscellaneous sound, the belly tiny Long, symmetry, the stomach type breath save and have never seen a bowel type the Ji move wave.The stomach is soft and have no muscle strain, press painful and anti- jump pain, the liver Pi touched.Bowel Ming the sound be normal.The outside Yin, ass are normal.The spinal column, arms and legs has no abnormal, sport from such as, the joint have no swollen and inflamed, have no sport obstacle.
Nervous system check consciousness clear, the language be accurate, memory decrease, definite direction dint, calculation the dint all have no obstacle.Have no illusion, covet, hesitate, the Xin be quick, excited.The facial expression is melancholy.DO not force idea and emotion, thought, behavior abruption etc. performance.The sense of smell normally.Sight:The right eye become blind, left eye 0.8.The left side of the visual field is normal.Eye bottom:The right side sees dish pale, the edge is misty;The left side boundary isn’t pure, the physiology hollow disappearance, swell up, the refraction 3 Ds, move, vein comparison 1:4.The bottom of the Jian hangs on the right eye, eyeball outside Tu, fix, be placed in an outside exhibition, the Lou white 0.2 cms, to inside sport be subjected to a limit.The left eye is normal and right Tong 0.45 cms, the circular, reflect to directly and indirectly and all disappear to the light.Face felling existence, symmetry.Zhang Kou3 has no bias.The right side cornea is anti- to the muff and the left side is normal.The noodles muscle is symmetry and grin, drum cheek, listen to dint normal.Turn a neck and shrug shoulders emollient.The surd sound is hoarse and have never swallowed difficulty and drinking Qiang to cough.Stretch tongue in the center, the tongue muscle atrophied.The whole body felling exist.The arms and legs activity is free from a limit, the muscle dint V class, all independent sport.The whole body shallow and deep glint is all normal.Bahrain Si is strange to advertise for and the gram Ni space advertise for don’t derivation.Plant nerve the function be normal.
Examination and other check hemoglobin 110 gs/Ls, the red cell is 3.7 ×s 1012/L, the white cell counts 6 ×s 109/L, neutral 65%, lymphoid 30%, love sour 2%, the list checks 3% and love sour grain cell to count 88 ×s 109/L.Bleed the 2 mins in time, blood Ning time
11 min.Wet normal regulations normal, move bowels Huang2 Ruan3, the mirror check contains few tapeworm egg.
2
The skull X line even slice:See nerve bore to see right side outline faintness, close to organization piece shadow and its overlap, split the Die bone Mao outline on the right Kuang not enough clear.The right neck side artery builds a shadow:Hint the brain ex- artery to move to the side, the artery start department is press in the brain to, present arc-shaped to move.
The electroencephalogram check:Each area Mi spreads sex low medium θ wave, the companion contains a little amount δ wave, in the hint, highly excrescent electroencephalogram.
The CT check:Inside the right side Die bone Mao 1/3 meninges lumps.
Finally diagnose(1984-5-23) first step diagnosis
1.meninges lump,(fiber type) inside Die bone Mao 1/3, right 1.Meninges lump, inside Die bone Mao 1/3, right
2.the Kuang up splits comprehensive advertise for, right 2.the Kuang up splits comprehensive advertise for, right
3.hang before the body a leaf a function decrease a disease, after hair 3.hang before the body a leaf a function decrease a disease, after hair
4.bowel tapeworm disease 4.bowel tapeworm disease
Hospitalize medical history
Name Zheng4 Jin E2 work unit job don’t guest sun carton factory worker of Guangxi
Female 20th of the guest sun carton factory Tsun 3 of address Guangxi of sex
The age is 30 years old to hospitalize date 1991-5-8
The marriage denies the history of married disease to adopt date 1991-5-8
Guangxi guest sun disease historical records in the native place records date 1991-5-8
The race Han condition illustrates a sufferer
The lord tells right eye sight to carry on a decrease, eyeball outstanding, have already become blind for 7 years, the dysmenorrhea is 2 years.
Now the history sufferer of disease on March 15, 1984 work medium the immodesty right eye be shoot by the asbestos piece and have no at that time obviously unwell, the sight also has no obvious obstacle.Discover after 2 weeks right eye sight suddenly decrease, see unclear, and have already seen into a double.Discover right eye ising outstanding December, the outside be inclined, also the bulge painful feeling.Seek medical advice at the guest sun county hospital, once diagnosed to see nerve to atrophy for the “the right eye saw nerve to atrophy” right eye, through take a medicine(medicine anonymous), needle Zhi and covered up line’s etc. is various method treatments, didn’t take effect a fruit, the sight continue decrease.The right eye becomes blind in July, 1985 and the right eyeball is obviously outstanding.The left eye sight has no obstacle.The sense of smell existence.Foot month produces one daughter baby in 1987,
1 break a milk at the age of 1, but two side mammary glandses still have the Bi milk the phenomenon, and dysmenorrhea already 2 years, disease empress tired and afraid cold, sexual appetite decrease.The outbreak expect
2
Had fever, disgusted, vomit symptom.Seek medical advice at the × × center hospital of Shanghai in the near future, after going the right side neck total artery to build a shadow, discovering inside the right side Die bone Mao 1/3 parts having already shared a sexually transmitted disease to change, through consult turn to come to this hospital.
In the past history usually body Jian, once suffered from “measles” at the age of 3, deny other infectious disease histories and skin disease history.The childhood connects to get smallpox vaccination, didn’t accept other vaccinations.
The system look back
Facial features machine:Have no jealous pain, the ear flow Nong, earache, nose to flow Nong Ti and swallow pain etc. the history of the disease.
The breath fasten:Have no chronic a cough, cough up phlegm, spit blood, the chest painful history.
Circularly fasten:Not intentional and panic, the spirit be nasty and deliver Gan, dropsy and hair a dyspnea.
The digest fasten:Have no chronic stomachache, diarrhea, vomit, throw up blood and black then history.
Blood history:Have no skin to glue a film to again and again bleed, the Yu order, the history of Yu spot, purple palace etc. disease.
The Bi urine grows to fasten:Have no urine Pin, urine nasty, urine the pain, blood in urine and row wet a difficult history.
The nerve spirit fasten:Have no headache, dizzy, faint off, have muscular spasms, consciousness obstacle and delirious history.
Sport fasten:Didn’t rove around sex joint ache and exercise obstacle, take off and bone fracture history.
External injury, surgical operation, poisoned and the medicine allergic history:Have no.
Personal history was born at guest sun county in Guangxi.After 20-year-old high school graduate, the guest sun carton factory of allotment at Guangxi works up to now.The non-arrival leads other parts of country to have no smoke wine habit.Have never once eaten to living fish and living meat.Deny touching elbow a history with animal.
3
, Through etc. in the quantity, have no a pain through history, 26 years old matrimony, the artificial has a miscarriage in 1977, next year
31~32
Foot month produces one baby girl October, still living.Don’t time menstruation June, 1989.Husband’s health.
The household history father suffers from a high blood pressure disease, mother, elder brother, each one person of younger sister all still living, deny the history of similar disease.
Physical examination
The general circumstance body temperature is 37 ℃ , the pulse 80/min, breathe 18/min, the height 15 cms of the blood pressure 12.0/80 kpas(90/60 mmHgs), , weight 50 kgs.Growth is normal, the nourishment is good, automatic body.The facial expression is melancholy, consciousness clear, the dialogue slices, check-up cooperation.
The skin color and luster is normal, the flexibility is good, have no dropsy, Huang2 Ran3, many sweat, have no skin to diagnose, purple Dian.
Poured to fawn on the whole body shallow form lymphoid knot and touch.
Head
Skull:Have no abnormal, didn’t press a pain, external injury scar formation.The hair is black, there is sheen and distribute even, do not take off hair.
Eye department:The eyebrow shed off, the 脻 hair had never pour to living, two eyelidses have no anasarca, Jian conjunctiva and ball conjunctiva have no Chong blood, sclerotic coat have no Huang2 Ran3, the cornea is transparent.Remaining is detailed to see a nervous system check.
Ear department:Two side ear department Guos have no abnormal, the external ear way didn’t overflow Nong and bleed, the milk Tu department had never press pain, listen to dint thick to measure normally.
Nose department:The nose wing instigated, have no nose to jam, didn’t flow Ti, separated and be not partial to a song in the nose, each paranasal sinus department had never press pain.
Mouth cavity:The lips has no hair Gan and pimple rash, have no Qu disease, lack Chi, the gum swelled, bleed and overflow Nong, tongue-coating Huang, the quality is red, slightly dry.The mouth cavity glues a film to have no issue of blood and Zi Yang.Swallow Houpi has no Chong blood, the tonsil isn’t swollen big, have no Nong secretion.
The neck is symmetry, the neck vein has no Nu piece, and the right side of the neck is slightly full.(once went a right side neck to move to build a shadow 3 days ago)The neck is soft, windpipe in the center, the thyroid gland isn’t swollen big, smell and afferent and miscellaneous sound.
The chest chest Kuo shape is normal, double the side be symmetry, rib flat, sport such as often, rib bow Cape about 90 ° chest wall have no lump, have never press pain and extend blood vessel, double the milk be symmetry next hang, squeeze human milk spillage.
The lung sees to diagnose:Present the chest type breath, stanza Lyu and depth normal, breathe sport double side normally.
Touch to diagnose:Speech tremor two sides stare at etc., have no friction.
The Kou diagnose:The echo is normal, the lung descend boundary Cape line under the shoulder 10, breathe ambulation degree about 4 cms.
Listen to diagnose:Breath and speech conduction double the side be symmetry, have no strengthen and turn down phenomenon, have no fricatives and stem wet sound.
The heart sees to diagnose:Have never see the heart point pulsate and the area has no Peng Long before the heart.
Touch to diagnose:The heart point pulsate the most strong have never encouraged sex to pulsate at 5 left lock bone centerline seamy side 1 cms, tremor and friction
Feeling.
The Kou diagnose:The or so heart boundary is normal, like right form:Lock the bone centerline is exact center apart from a front line 9.5 cms.
Listen to diagnose:The heart rate 80/min, Lyu together, the each petal sound area heart sound is normal, smell and miscellaneous sound, the P is 2> A2s and the not intentional pack rub
Sound.
The belly sees to diagnose:The stomach wall is symmetry and flat, have no varix, peristalsis wave and the Qi subordinate is cave.
Touch to diagnose:The stomach is soft and have never press pain and jump pain.Didn’t touch a lump and unusually pulsate and undulate.The liver descends good luck in right good luck next 1 cm
The sword Tu next 3 cmses, liver good luck Rui, soft, the surface be smooth and didn’t press pain, gall bladder, Pi and double and the kidney all touched.
The Kou diagnose:Boundary on the liver muddy sound right lock bone centerline 5, all of the top and bottom grow 11 cms.The liver, Pi area all has no Kou shot pain, belly
Have no ambulation muddy sound.
Listen to diagnose:Bowel Ming the sound be normal, 4~5/min, the stomach area didn’t flap water voice, liver Pi area have no fricatives, smell and blood vessel miscellaneous
Sound.
Outside Yin and genitals growth outside the ass are normal, the pubic hair not sparse sulphur.The ass has no external piles and the ass, place has no place hemorrhoid, the anus crack, Lou tube and skin to diagnose.
Spinal column and arms and legs spinal column have no abnormal and press pain and Kou shot pain, arms and legs have no the abnormal, Chu form point a toe, dropsy, external injury, bone fracture, varix.Muscle tension and muscle dint are normal and the muscle has never see to atrophy.The joint has no swollen and inflamed, abnormal and exercise obstacle, A bed have no the capillaries pulsate, artery and Gong artery didn’t shoot a sound, the Nao artery pulsated normally, afferent degree of hardness have no special.
The nervous system check
The spirit condition realize know, the language is accurate, apprehension normal, memory decrease, with far memory is bad, definite direction dint, calculator have no obstacle.Have no illusion, covet, suspect, the Xin be quick, easily excited.The facial expression is melancholy.Didn’t force idea and emotion, thought, behavior abruption performance.
Lu nerve
1.smell a nerve double the side the sense of smell normally and have no decrease, disappear, excrescent or allergic phenomenon.
2.see the nerve right eye to become blind, left eye far sight 0.8.Visual field:The right eye can’t measurese because of become blind and the left eye is at the normal scope.Eye bottom:The right eye sees a dish edge misty;The left side sees a dish boundary not pure, the physiology is hollow to disappear, swell up, the refraction 3 Ds, action vein comparison 1:4.
3.Move the bottom of the right and last Jian of eye, pulley, exhibition nerve hang, the eyeball obviously outside Tu, fix, be placed in an outside exhibition, the Lou white 0.2 cms, up, bottom, inside sport be subjected to a limit.The left eye eyeball activity is free from a limit.Right side eye pupil 0.45 cms.Circular respond to directly and indirectly and all disappear to the light;The left side eye pupil 0.2 cms, respond to the light directly intelligent, indirect disappearance.
4.The trigeminal nerve feel:The face pain feel, touch, cold hot feel two sides symmetry existence.Exercise:Nie muscle and chewed a muscle and atrophy, chew emollient, tension at present the Han have no bias.The cornea reflect:Right eye muff, the left eye is normal.
5.Noodles nerve two on the side department the muscle be symmetry and have no noodles to be partial to a side to atrophy and noodles muscle spasm, have no the bottom of the quarrel to hang, the nose lips ditch fit together and lift eyebrow and knit the brows, close eyes emollient and symmetry, grin, drum cheek, blow whistle the mouth have no inclined on one side, leak air.Before the tongue 2/3 sense of tastes exist.
6.Listen to the nerve ear Gua nerve the Rinne experiment a double side spirit to lead>the bone lead, the Weber experiments in the center, ex- court function normal.
7 .The tongue swallow, the pneumogastric nerves pronunciation have no hoarse, have never swallowed difficulty and drinking Qiang to cough.Hang the Yong hangs in the center, Mao bow twos be symmetry, swallow glint existence and deliver”” sound double the side lift Mao sport like.
8.Vice- nerve chest lock milk Tu muscle and inclined and square muscle upper part atrophied and turn a head, shrug shoulders emollient.
9.The tongue descends nerve to stretch tongue in the center and the tongue muscle atrophied and the muscle fiber vibrate.
The sport whole body muscle atrophied, fatty big, two the side body surroundings path equal, all from the aorta.The muscle tension is normal and have never increase Gao, idle and the joint excessively bend to stretch;The arms and legs muscle dint all is a V class.Total benefit sport:Point the nose experiment and alternate experiment all normal, shut eyes difficult sign to advertise for to have no dumping.Tread Tai steady, just like often.
Feel the whole body shallow felling:Pain, touch, the temperature feel existence.Feel keenly to feel:Joint sport feel and the position feel and the vibration feel and the deep department feel, press the pain feeling all exist.The skin fixed position feel and the discriminator feels at 2:00 and the sketch feel and the entity feel all and just like often.
Reflect a shallow glint:Stomach wall the glint be left and right++, the Zhi glint is left and right++the ass reflect++.Deep glint:Gong two muscle, three muscle Jian the glint be left and right++, have no Kuan Lyuan, ankle Lyuan.The pathology is anti- to:The Babinski advertise for and the Oppenheim advertise for and the Chaddock advertise for and the Gordon advertise for and the Hoffmann advertise for all feminine gender.
The meninges incitement advertises for a neck soft, the Kernig advertise for and the Brudzinski advertise for all feminine gender.
The skin color and luster of the plant nerve is normal, flexibility good, moist, the sweat gland secrete, the hair distribute, point toe AN all and just like often and perspire experiment, sign a hair glint all normal.
Examination and other checks
The Hb110 gs/Ls, the red cell is 3.7 ×s 1012/L, the white cell counts 6 ×s 109/L, neutral 65%, lymphoid 30%, love sour 3%.Bleed time
1
Min.Wet sugar and egg white feminine gender, mirror check and just like often.
3
Muck normal regulations:Huang2 Ruan3, take shape, the mirror check contains few tapeworm egg.
Love the sour grain cell counts 80 ×s 106/L, the ACTH experiment, after inject 32 ×s 106/L.Wet for 24 hours:17-the Qian steroid use before the medicine 7.97 μ mol/L(2.89 mgs)s, use the empress of the medicine 10.7 μ mol/L(3.88 mgs)s, 17-the Tong Chun use before the medicine 10.3 μ mol/L(2.98 mgs)s, after using a medicine 15.8 μ mol/Ls.(4.55 mgs)
The serum T31.54 μ mol/L(1 ng/ml), the T4411.8 μ mol/L(32 μ g/mls).
The glucose bears quantity to experiment:Empty stomach 5 mmols/l(90 mgs/dl), the 30 mins 7.4 mmols/l(133 mgs/dl), the 60 mins 8.33 mmols/L(150 mgs/dl), the 120 mins 4.25 mmols/L(76.6 mgs/dl), the 180 mins 3.89 mmols/L(70 mgs/dl),’s wetting sugar all is little.The blood urges the milk plain 3.2 nmols/L(80 ngs/ml).
The skull X line even slice:See nerve bore to see the right side see nerve bore outline unclear.
The right side carotid artery builds a shadow:The brain ex- artery to move to the side, the artery start department presents arc-shaped to move after be subjected to press upward in the brain, hint is the right side Die bone Mao(inside 1/3) meninges lump.
The electroencephalogram check:Each area Mi spreads sex low medium θ wave, hint medium to highly excrescent electroencephalogram.
The CT check:Win the top of the level of the Lu nest 2~6 cm before right side across it is thus clear that the diameter is about the 4 cms, even and consistent to build up cooking stove, it around has extensive brain dropsy.The bone window sees the Die bone Mao bone increasing to living.Take the lump possibility of the Die bone Mao meninges as big.
Summarize briefly
Sufferer female, 30 years old, worker, the right eye sight carries on sex decrease to become blind, the right eyeball be outstanding, outside inclined 7 years, and the companion have milk and dysmenorrhea of a pair of mammary glandses Bi for 2 years.The check-up discover:The right eye become blind.The eye bottom check:The right eye sees dish pale, the left eye sees dish dropsy;The bottom of the Jian hangs on the right eye, the eyeball obviously outside Tu, up, next, inside sport be subjected to a limit and be placed in an outside exhibition;The right eye pupil spreads greatly, to light glint disappear, hint Kuang top crack the Suo match to advertise for a performance.The skull X line slice, hint that the right side sees nerve bore outline not pure, split the Die bone Mao outline on the Kuang misty.The right side neck total artery builds a shadow and hint the Die bone is inside Mao 1/3 meninges lumps.The electroencephalogram show:Medium, highly excrescent electroencephalogram.The CT hint the right side Die bone Mao meninges lump’s possibility is big.
Finally diagnose(1984-5-23) first step diagnosis
1.meninges lump,(fiber type) inside Die bone Mao 1/3, right 1.Meninges lump, inside Die bone Mao 1/3, right
2.the Kuang up splits comprehensive advertise for, right 2.the Kuang up splits comprehensive advertise for, right
3.hang before the body a leaf a function decrease a disease, after hair 3.hang before the body a leaf a function decrease a disease, after hair
4.bowel tapeworm disease 4.bowel tapeworm disease
Yang2 Zhi4 Jian/white ice white ice/allow beautiful Juan
The course of illness record
1991-5-8
The sufferer carries on a sex decrease, eyeball because of the right eye sight outstanding, become blind for 7 years, hospitalize for dysmenorrhea 2 years.Hospitalize to check a right eye to become blind, left eye sight 0.8.The eye bottom right side sees dish pale, the left side sees dish dropsy.The bottom of the Jian hangs on the right eye, eyeball sport is subjected to a limit, obviously outside Tu fix.Right eye pupil 0.45 cms disappear the light glint.Left eye pupil 0.25 cms, to light the glint directly exists, indirect disappearance.Other nervous systems check Yin Si.Squeeze the nipple contains human milk spillage.The electroencephalogram hint medium-highly excrescent electroencephalogram.The carotid artery builds the side of the right side saddle, the Die bone Mao meninges of shadow hint lump may.The CT check hint the right side Die bone Mao meninges lump may.Draw up to go a surgical operation treatment, the surgical operation contains certain risk and this has already explained toward the family members and the unit, the family members determinedly request surgical operation.
Diagnosis discuss and makes a diagnosis and treatment to plan a sufferer to be taken bad slowness, the course of illness is longer, because the pathological changes involves saddle area and right side Kuang to up split, past emergence Kuang up split comprehensive advertise for, and the examination hint to hang before the body leaf function decrease.Currently diagnose have already definitely prepared that picking a date to go tumor inside the Lu take off in addition to Shu.Check blood and wet normal regulations before the Shu, bleed, the blood Ning time, liver, kidney function and electrolyte, measurese blood sugar, red cell ratio to permit, the blood type crosses to experiment and consider to go together with blood 1000 mls.Draw blood to check liver function, the heart Mao table, immunity globulin, lymphoid cell conversion rate, rose to experiment, C3, CH50 etc. examination.Make chest clairvoyance, the electrocardiogram check, skull a super voice wave, artery guts analysis.Fill in an important surgical operation application a list, the whole sectionses discuss a research a treatment a project before the Shu.
White ice/allow beautiful Juan
1991-5-10 the various directors go around and inspect sickroom this morning, sufferer relevant diagnosis and surgical operation problem, organize whole sectionses to carry on a discussion, think:Advertise for according to the history, body of disease and cerebral build a shadow, X line special Lu slice and CT check etc., all hint the right side Die bone Mao point the sexually transmitted disease change, with meninges lump’s possibility big, clinical consider the right Die bone is inside Mao 1/3 meninges lumps.Housebound change to involve in artery inside the sponge Dou, neck and hang body area etc. important part, easily have big issue of blood in the Shu, the beard has blood before the Shu 2000 mls.Clinical up have already appeared to hang before the body a leaf function decrease to advertise for elephant, should take skin quality hormone before the Shu.The surgical operation is difficult and the risk is stronger, should work well family members a work.Speak the danger that the clear surgical operation probably appears.The relevant surgical operation detail’s problem returns beard to carry on a detailed discussion.The bowel tapeworm disease draws up a Shi treatment to the methyl benzene Mi.
White ice/allow beautiful Juan
1991-5-16 summarize briefly before the Shus
1. Diagnose the right side saddle side Die bone Mao(inside 1/3) meninges lump.
2.Diagnose a basis
(1)the history right eye sight of the disease carry on a sex decrease, the right eyeball be outstanding and become blind for 7 years, dysmenorrhea, Bi milk 2 years, the companion is tired, afraid and cold, sexual appetite decrease etc..
(2)the body advertise for a right eye to become blind, left eye sight 0.8;The right side sees nerve to break hair to atrophy and the left side eye bottom sees dish dropsy;The bottom of the right and last Jian hang, the eye crack diminish, and the eyeball fix.The right eye pupil spreads about the 0.45 cms, to light the glint disappear.Squeeze the breast contains human milk spillage and have the Bi milk the phenomenon.
(3)electroencephalogram check in the hint go to height abnormality.The skull X line even slice shows a right side to see nerve bore not pure, split the Die bone Mao outline on the right Kuang not pure, the right side is cerebral to build the shadow manifestation right side saddle side Die bone Mao to share a sexually transmitted disease to change.The CT shows the right side Die bone Mao meninges lump may.Comprehensive above see, to the right the side Die bone Mao inside 1/3 the meninges lump’s possibilities be the biggest.
3.Draw up to go surgical operation to open Lu to fish for, the tumor take off in addition to Shu.
4.anaesthesia method vein compound anaesthesia, put a tube inside windpipe.
5.prepare before the Shu
(1)the blood normal regulations Hb97 gs/Ls, the WBC4.9 ×s 109/L, neutral 73%, bleeds the 1 min in time, blood Ning time 2 mins.Wet normal regulations then WBC2～4/HP.The liver, kidney function, electrolyte, guts are analytical, all in the normal scope.
(2)chest deeply, the electrocardiogram all and just like often changes.
(3)go together with the blood 2000 mls, prevent°from big issue of blood.
(4)important surgical operation application the list has been already grant, the family members comprehend a surgical operation risk, resolute approval surgical operation, and sign.The whole sectionses carry on many discussions and conference to diagnose before the Shu, the detailed research cure project.The Shu starts take to sprinkle Ni to loosen a 5 mgs the first 3 day, everyday 3 times.
6.the estimate tumor in Shu may invade and the sponge Dou artery inside the neck and right side see nerve and the tumor is hard to completely cut off;Possibility to growth inside the Kuang or see nerve revelation a difficulty;May also cut off tumor to lead long to pull artery inside the neck with to hurt and cause big issue of blood, past surgical operation ago can expose the neck total artery first, control or ligature the neck total artery when it’s necessary, then go inside Lu outside blood vessel bridging.Tumor as far as possible from the bag inside cut off, avoid harm close by important structure;Frozen cut off tumor when it’s necessary.The quiet drop hydrogen in Shu turn can of loosen 300 mgs.The on the stage set is next to closely match with.
White ice/allow beautiful Juan
The surgical operation record
Date of surgical operation May 21, 1991 start 8:00 end 11:00
The right side of the date Die bone Mao(inside 1/3) meninges before the Shu lump?
The Shu diagnoses the right side Die bone Mao(inside 1/3) meninges lump behind
The surgical operation name meninges lump big department resection
The surgical operation is various to always become the white ice of Yang2 Zhi4 Jian to allow beautiful Juan
The hemp inebriates vein compound anaesthesia and the windpipe puts a tube
Anaesthesia Liu2 De2 Bing4 Shan attend to a text English
The surgical operation has been lain evenly, expose the right side neck total artery back up first, and cut open the right side big and concealed vein, made chamber vein to put a tube.
The normal regulations disinfects area with the tincture of iodine, ether and spread to have no germ towel list, fix by suture.Take the coronal petal slices a , skin petal to inject 0.25% cards of Pu Lu because of liquid about the 200 mls(contain the adrenaline 0.5 mls), cut open skin of head to reach the bottom of the hat form Jian film, clip to stop bleeding by pliers, the rubber bands cent set fix, bluntness and Rui separate a skin petal to the double eyebrow bow.Give or get an electric shock the Ning stops bleeding, tie up by yarn mat in brine and turn over the skin petal forward square.Take the right side sum Nie department acrosses a centerline bone petal, cut open periosteum and parts of Nie muscles, the Lu bone drills a hole 6, wear to go in to lead plank, and the line saw.Starting to pry the bone petal turns over toward the Nie side and the gauze tie up.Bite together bone good luck, and to the Lu bottom extension bone window, stop bleeding by bone wax coating.The brain cotton protection bone creates good luck and slice a people’s exterior to use a treatment towel a protection.Then again wash hands.Check hard meninges tension bigger, the quality touch is hard, the brain pulsates faintly, the U form cuts open hard meninges and turn over toward the centerline side, protect by brain cotton.Notice that the brain pulsate still weak, and the brain ditch become shallow, flatten, the brain returns to change breadth and the brain dropsy is obvious.Protect brain skin a layer by brain cotton.While take the line brain cotton protection, with the brain press plank to follow the right side Die bone Mao toward the introverted juniors go into Lu bottom, rear tumor.The breeze tumor is located on the right side Die bone Mao combine to the centerline growth, occupy nest first half in Lu a department, the equal to Die bone is inside Mao 1/3, and the tumor Tu go into Kuang to up split.The tumor quality is hard and smooth, boundary still clear, but carry with sum leaf’s bottom noodles, Nie apex of leaf, the outside side crack has been already glued to connect, also the Zhui press.Tumor diameter about 4 cms.BE afferent lump respectively to clip with the silver pilers, and cut off one by one.BE well rearing with orthoptic under, give or get an electric shock Ning tumor to wrap a film, ten the forms cut open, the piece that is from the cent in the bag cut off tumor, finally cut off lump wall.Depend the seamy side has small piece to wrap a film to glue to connect close, in order to avoid wound and artery inside artery, brain inside the neck and the brain ex- artery, don’t to unwillingly cut off.Stop bleeding with a pair of oxygens waters cotton slice and electricity Ning, and stick to spread to create noodles Shen blood by clear gum sea cotton.Didn’t see movable sex issue of blood after flush, see the brain pulsate good, the brain dropsy contains decrease.A little bit pure brain cotton logarithms without any error after, put back hard meninges, but sewed up, reset a bone petal, clean the Nie side a bit of conduct and actions to float a bone petal, two sides are each to place many the bore rubber lead to flow to take care of 1 in slicing at the back of another Chuo bore derivation and interrupted to sew up layer and skin of the hat form Jian film respectively.The neck slices to also sew up and the apposition rubber leads to flow 1.A little bit pure dressing, apparatus amount without any error.Dress a wound, the Shu finish.The surgical operation is smooth, the anaesthesia is satisfied, bleed about the 800 mls and transfuse blood 1000 mls.Anne returns sickroom after the Shu.
The specimen has already sent a pathologic section check.Shut type inside the Lu leads to flow a tube to connect to go in to have no germ to lead to flow bag.
Various always become/white ice
1991-5-2113:00 after operation record
The sufferer fastens the right side Die bone Mao meninges lump and go meninges lump excision under the vein compound anaesthesia this morning.It Be sliced to go into road by coronal, go a right side sum a crest Nie to across a centerline petal.Surgical operation see:The hard meninges tension is higher, the brain pulsates faintly, the brain dropsy is more obvious, the brain ditch become shallow, the brain returns to flatten.The tumor is located on the right side Die bone Mao combine to the centerline growth, split place to spread all over tumor organization on the right side Kuang, the quality is harder, boundary still clear, carry with sum leaf’s bottom noodles, Nie apex of leaf, side crack outside the brain has been already glued to connect, also push to press.The tumor diameter is about the 4 cms, from bag inside cut off, overlay hard meninges not to sew up after well stopping bleeding, make float a bone petal, the bottom of the skin petal places a shut type to lead to flow to take care of 1, another Chuo bore derivation.The surgical operation is smooth, anaesthesia satisfied.Bleed about the 800 mls, transfuse blood 1000 mls.The empress of the Shu came to and sent back sickroom.
The Shu handles ① to forbid a food behind;The ② report be critically ill;The ③ measures a life body to advertise for qd;The ④ side repairs a liquid and the side dehydrate;The ⑤ big measures skin quality hormone;The ⑥ applies anti- epilepsy medicine;The ⑦ antibiotics defends an infection.The tight observation condition change.
White ice/allow beautiful Juan
After the Shu on the first day, state of mind clear, the blood pressure 14.7/9.3 kPas(110/70 mmHgs), pulse 82/min, breathe 20/min, right eye pupil 0.45 cms together before the Shu, left eye pupil 0.25 cms, exist the light glint.The body temperature is 37.5 ℃ .Repair the liquid measures a 2500 mls, add 10% chlorination potassium 20 mlses and wet to measure 1700 mls.The wound has no Shen blood, the shut type leads discharge about the 300 mls, pale red color, have already sent a normal regulations check.Heart, lung just like often, the arms and legs activity is free from a limit, also didn’t vomit phenomenon, have already drawn blood examination liver, kidney function now, electrolyte, continue to observe.
White ice/allow beautiful Juan
Hand over a class of record
The sufferer fastens inside the right side Die bone Mao 1/3 meninges lumps, after May 21 at all numbly descend going the meninges lump big department to take off in addition to Shu, Shu already 8 day, tore down wound all sutures today, slice a people Ⅰ A to heal, the patient has already can take a meal, the general circumstance is better, the life body advertise for steady, can in the bedside activity, but right side Kuang up crack comprehensive advertise for to not yet turn for the better, the eyeball is outstanding ex-er to have a little bit an amendment.Should still use to sprinkle Ni to loosen a 5 mgs, 3/d currently, remaining has no special treatment.The pathologic check reports for the fiber type meninges lump.
Bowel tapeworm disease through take orally methyl benzene Mi Shi, the row tapeworm is 4.Reexamine excrement after a week in do not see insect egg.
White ice/allow beautiful Juan
1991-5-29 take over shift duty a record
The sufferer is at May 21 oyster right side Die bone Mao inside 1/3 take off in addition to Shu, the Shu is behind already 8 day, the wound dismantle, the wound remove stitches and heal good, can get up an activity, the appetite is still good.Right eyeball’s is outstanding more before the Shu has already had an amendment, the sight not yet recovers and split on the Kuang comprehensive advertise for to still exist.The hormone has already changed to use to sprinkle Ni to loosen a 5 mgs and take orally once everyday.Currently in the process of recover in.
White ice/allow beautiful Juan
1991-6-27 hospital discharges record
The sufferer goes to become blind because of the right eye sight decrease on May 8, 1984, the companion has an outstanding eyeball, outside inclined 7 years, remainings, hospitalize for dysmenorrhea, Bi milk 2 years.Check a detection:The right eye become blind and have no light feeling, left eye 0.8, the right side sees nerve to atrophy, the left side sees dish dropsy, the right side Ⅲ , Ⅳ has damage to the Lu nerve, through cerebral build shadow and CT to confirm for the right side Die bone Mao meninges lump, through for many times discuss before the Shu, full preparation, after May 21 at all tingle descend going meninges lump a big department excision, Shu remove stitches for 8 days.The patient recovers more and quickly, aware of self a symptom amendment, the eyeball outstanding disappearance, but the sight not yet recover, menstruation as well in the future tide.The condition is stable currently and the patient request returning to original domicile rest and recuperate and get out of the hospital today.Totally go to hospital for 51 days.The day of the hospital discharge instruct:3~6 months afterwards the out-patient service reexamine
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