腹腔镜辅助下新生儿小婴儿巨结肠根治术

目的:对腹腔镜辅助下行Soave根治术治疗新生儿、小婴儿先天性巨结肠进行探讨。方法:对18例新生儿、小婴儿先天性巨结肠病例行腹腔镜辅助下Soave根治术,术中腹腔镜辅助下腹腔内离断拟切除结肠之系膜,经肛门拖出切除肠管。结果:所有患儿均顺利完成手术,无中转开腹手术者,手术时间80~140 min(平均100 min),术中出血量20~40 mL(平均25 mL),术后恢复良好,平均住院时间7.4 d,随访1个月~2年,便秘复发2例,无便失禁、直肠脱垂等,生长发育良好。结论:腹腔镜辅助下Soave根治术治疗先天性巨结肠安全可靠,手术打击小。     

腹腔镜辅助下先天性巨结肠根治术8例手术配合

目的:探讨腹腔镜辅助下先天性巨结肠根治术的手术配合方法。方法:加强8例腹腔镜辅助下先天性巨结肠根治术患儿的术前心理护理、病情评估,术中加强手术配合。结果:8例手术均获成功,手术时间150~230min,平均198min。术中出血40ml1例,其余均少于10ml,无术后继发性出血,无术中和术后早期并发症。结论:应用腹腔镜辅助技术可有效地进行先天性巨结肠根治术,且具有创伤小、出血少、时间短、恢复快等优点,良好的手术护理配合是提高成功率的关键。     

腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的护理

[目的]总结腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的术中护理配合.[方法]对6例先天性巨结肠患儿采用腹腔镜辅助下改良Soave根治术,术前给予心理护理,术中正确安置体位、维持体温稳定、严密观察病情、防止体位性低血压发生等,同时器械护士给予密切配合.[结果]6例患儿平均住院9 d,均痊愈出院.[结论]做好腹腔镜辅助下改良Soave根治术治疗先天性巨结肠的护理,可确保患儿手术顺利,有效避免手术风险.     

腹腔镜辅助Soave术治疗先天性巨结肠32例

目的 探讨腹腔镜辅助Buav术治疗先天性巨结肠的疗效并总结经验.方法 2005年5月至2011年12月为32例先天性巨结肠患者行腹腔镜下辅助Soave术.结果 全部患者手术成功.平均手术时间130 min,术中出血30～50 ml,切除肠管长度15～35 cm,平均28 cm.术中术后无严重并发症,仅1例出现肛门湿疹,经保守治疗后痊愈.所有患者随诊1年情况良好.结论 腹腔镜辅助Soave术治疗先天性巨结肠具有创伤小、术后恢复快、术后并发症少的优点,值得推广应用.     

腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的护理

[目的]总结腹腔镜辅助下改良Soave根治术治疗小儿先天性巨结肠的术中护理配合。[方法]对6例先天性巨结肠患儿采用腹腔镜辅助下改良Soave根治术,术前给予心理护理,术中正确安置体位、维持体温稳定、严密观察病情、防止体位性低血压发生等,同时器械护士给予密切配合。[结果]6例患儿平均住院9 d,均痊愈出院。[结论]做好腹腔镜辅助下改良Soave根治术治疗先天性巨结肠的护理,可确保患儿手术顺利,有效避免手术风险。     

腹腔镜辅助Soave根治术治疗巨结肠125例的手术配合

目的 探讨腹腔镜辅助根治术治疗要幼儿先天性巨结肠手术配合.方法 回顾分析2003-2010年应用腹腔镜辅助Soave根治术治疗125例婴幼儿先天性巨结肠的手术配合经验.结果 125例手术均获成功,手术时间85～210 min,平均150min.全部患儿痊愈出院.结论 腹腔镜辅助Soave根治术治疗婴幼儿先天性巨结肠具有创伤小、恢复快、并发症少等优点,良好的手术配合,是顺利完成手术的关键.     

腹腔镜辅助先天性巨结肠根治术152例经验报告

【目的】总结腹腔镜辅助下改良Soave术治疗先天性巨结肠症的疗效。【方法】152例先天性巨结肠症患儿,在腹腔镜辅助下行改良Soave巨结肠根治术。【结果】144例在腹腔镜下完成肠系膜游离, 8例在腹部作4~5cm的切口完成手术,手术时间平均(130±30)min,平均出血40ml。术后并发腹膜后血肿1例,肛门直肠脱垂5例,肛门吻合口破裂1例。随访3个月至4年,便秘1例,粪污染4例。【结论】腹腔镜下巨结肠症根治术安全、疗效好、损伤小、术后恢复快。     

不同术式在小儿先天性巨结肠中的应用分析

目的通过临床实验探究改良Swenson术和经肛门Soave术治疗4HL先天性巨结肠的临床效果。方法2010年至2011年青岛市妇女儿童医院收治36例先天性巨结肠病的儿童，将所有患儿随机分为观察组和对照组，每组18例，分别采用改良Swenson术和经肛门Soave术对其进行治疗，比较两组患者在手术时间、手术后的并发症及术后排便功能等情况。结果观察组和对照组手术时间分别为（158．2±22．0）min、（191．2±27．6）min；术后并发症发生率分别为20．1％和36．0％，术后6—7个月排便优良率分别为94．4％和83．3％，两组患儿的手术时间、术后并发症发生率、术后6～7个月排便情况比较，差异均具有统计学意义（P均〈0．05）。结论改良Swenson术有创伤小、疗效佳、恢复迅速的特点，并且Swenson术比经肛门Soave术操作更加简单，术后并发症更少，排便优良率也更高。     

腹腔镜下巨结肠根治术34例

目的：总结腹腔镜下行拖出型直肠结肠切除斜口吻合术(改良Swenson术)治疗先天性巨结肠的经验。方法：采用气管插管全身麻醉，患儿横卧位，术者正对电视操作，脐上及脐两旁共4个切口进镜及操作器械，常规行病变及其与正常交界肠壁组织冰冻活检，确定诊断和切除肠段水平。用超声刀完成结肠系膜及直肠后壁的分离，直肠后壁达到尾骨尖水平，结合传统拖出式结直肠斜口吻合。结果：34例均经腹腔镜辅助下完成手术，平均手术时间210分钟，与传统开腹手术相近，术中1例活检时致肠穿孔，经修补和腹腔冲洗，未影响手术效果。术后疼痛轻、肠功能恢复快、腹部切口小、术后瘢痕不明显，随访2个月-3年6个月，无大便失禁和便秘复发。结论：腹腔镜下可完成巨结肠根治术腹腔部分的操作，能达到与传统手术相同的治疗效果，术后康复快，值得推广。     

腹腔镜辅助治疗先天性巨结肠的围手术期护理

目的总结腹腔镜辅助治疗先天性巨结肠患儿的围手术期护理特点与经验。方法对2006年9月2008年12月收治的34例行腹腔镜辅助下经肛改良Soave＇s术式先天性巨结肠患儿的护理资料进行回顾分析。结果本组患儿术前肠道准备7~14 d,术后6~10 d出院,无围手术期并发症发生。结论腹腔镜治疗先天性巨结肠患儿的围手术期护理,其术前充分的肠道准备,术后早期密切的监护,以及积极对症的并发症防治措施是该疾病围手术期护理及患儿获得治愈的的关键。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.