小儿包皮环扎术的围术期特殊护理的效果

目的 观察小儿包皮环扎术的围术期特殊护理的效果。方法 2020 年 3 月到 2022 年 3 月于我院进行小儿包皮环扎术的幼 儿 120 名随机分为观察组和对照组。对照组进行围术期常规护理,观察组进行围术期特殊护理。对比两组患者术后并发症发生 率、术中出血情况、手术及包皮除去环脱落时间。结果 观察组术后并发症显著低于对照组（P<0.05）。观察组患者的包皮除去 环脱落时间显著短于对照组（P<0.05）。结论 小儿包皮环扎术中进行围术期特殊护理,能够缩短手术恢复时间,减少术后并发 症。     

包皮环扎术与包皮环切术治疗包茎和包皮过长的疗效比较

目的比较包皮环扎术与包皮环切术治疗包茎、包皮过长的临床效果。方法将456例包皮过长或包茎患者按随机数字表法分为2组,环扎组230例,行包皮环扎术进行治疗。环切组226例,采用包皮环切术进行治疗。对2组的手术时间、出血量、术后护理、外形及切口愈合时间进行比较。结果环扎组平均手术时间为（7.0±1.1）min,平均出血量为（0.5±0.2）mL;环切组平均手术时间为（26.3±3.4）min,平均出血量为（4.5±1.3）mL。2组比较差异均有统计学意义（均P〈0.05）。环扎组术后护理更简单,不容易创口感染,无须来院换药;环切组创口容易感染,需要无菌敷料包扎固定,定期来院换药。环扎组切缘整齐、外形美观,切口完全愈合时间为（16.0±0.6）d;环切组切缘不够平整,有针眼,术中结扎出血点出易形成皮下硬结,切口完全愈合的时间（7.6±0.6）d。2组切口完全愈合时间相比差异有统计学意义（P〈0.05）。结论包皮环扎术方法简单、并发症少、且快捷,适合各级医院应用。     

包皮环扎术512例临床分析

目的：探讨应用包皮环扎器进行包皮环扎术的疗效。方法：应用包皮环扎器进行包皮环扎术512例,随访1-2个月,观察治疗效果。结果：512例患者全部治愈,治愈率100%。手术时间3-10 min（平均6 min）;166例儿童患者的塑料环均自行脱落,而346例成人患者中,有318例塑料环自行脱落,28例2-3周未脱落或经患者要求予以拆除塑料环。512例患者术后均有轻微包皮水肿,其中496例有轻微疼痛,不需止痛药,16例术后疼痛明显,服用止痛药1-2 d。无术后继发出血,无术后感染发生,术后1-2个月随访均见切缘整齐,外观满意。结论：包皮环扎术具有操作简单、安全可靠、手术时间短、手术创伤小、出血极少、术后并发症少以及手术切缘整齐美观等优点,值得临床推广。     

阴茎根部皮肤环切术与包皮环切器包皮环切术的疗效分析

目的探讨两种全新包皮环切手术方法及治疗效果，从而最大可能地避免包皮环切术所带来的并发症。方法将155例包皮过长患者施行阴茎根部皮肤环切术，同期108例行包皮环切器包皮环切术，对两组手术时间、术中出血量、术后创口出血、水肿、疼痛及感染等并发症进行分析比较。结果根部皮肤环切组手术时间（20±5）min，包皮环切器包皮环切组（5±5）min；前组术中出血量（2±1）ml，后组为（1±0．5）ml；前组术后发生创口水肿4例，血肿2例，无局部感染；后组术后创口水肿5例，无血肿、感染病例，总共并发症发生率4％；前组术后疼痛持续（20±4）h，后组为（24±6）h。结论两组包皮环切手术方式较传统手术都具有优越性，疗效佳，临床上均有广泛的推广价值。     

儿童包皮环扎术与包皮环切术的效果比较

目的比较包皮环扎术和包皮环切术治疗儿童包皮过长、包茎的效果。方法随机抽取2000年1月～2008年9月接受包皮环切术及包皮环扎术的患儿各100例,比较2组的术后并发症、平均住院时间及平均费用、家长满意度等。结果包皮环扎术较包皮环切术术后并发症少、费用低、家长满意度高（p〈0．05）,差别有统计学意义。结论包皮环扎术及其相关护理措施效果好,可以推广应用。     

几种包皮环切术式的临床观察比较

目的:探讨不同方法行包皮环切术的临床效果.方法:回顾性分析2008年1月至2011年8月采用不同方法行包皮环切术的临床资料1 247例.其中传统包皮环切术982例、激光袖套状包皮环切术123例、包皮环环扎术142例,并对其手术平均耗时、水肿消退期时间、术后并发症如术后创口出血、术后感染、术后线头反应、术后伤口裂开、再次手术率,进行临床观察比较.结果:传统包皮环切术组的手术时间(26.8±5.9) min及术后水肿消退时间(13.8±4.5)d分别介于激光袖套状包皮环切术组和包皮环环扎术组之间,3组比较差异均有统计学意义(P＜0.05).在术后并发症发生率和再次手术情况方面,传统包皮环切术组分别是0.7％(7/982)和0.2％ (2/982),激光袖套状包皮环切术组分别是4.9％(6/123)和0.8％(1/123),包皮环环扎术组分别是12.9％(16/142)和4.2％(6/142),3组手术方式对比差异也具有统计学意义(P＜0.05),传统包皮环切术组并发症及再次手术的发生率均最小.结论:激光袖套状包皮环切术手术耗时长、术后恢复期长、术后并发症多.包皮环环扎术手术耗时短、术后恢复快、不残留线头、外形美观,但感染率高,一旦感染伤口易裂开,必须控制感染后重新清创缝合.传统包皮环切术比较包皮环环扎术手术耗时、术后水肿消退期虽长,但术后并发症少,再次手术率低,较为安全可靠.     

包皮环扎术治疗包茎和包皮过长1420例分析

目的：探讨包皮环扎术治疗包茎和包皮过长的方法和效果。方法：对2000-10/2005-12采用包皮环扎术治疗包茎和包皮过长的1 420例进行分析。结果：本组手术平均时间8 min,结扎环平均脱落时间12 d,外观满意率99.5%,无并发症发生。结论：包皮环扎术治疗包茎和包皮过长是一种简单易行且效果良好的新方法,值得临床推广应用。     

新型包皮环切器在包皮环切术中的临床应用

目的观察新型包皮环切器行包皮环切术的临床应用效果。方法对103例包皮过长及包茎患者应用新型包皮环切器行包皮环切术。结果 103例患者手术时间4～18 min,平均8 min,出血量0～5 mL,术中无须结扎止血,无血肿发生。2例腹侧包皮外板保留稍长,1例包皮左右侧长度不一致,影响外观,其余100例均外型美观,伤口整齐。结论应用新型包皮环切器行包皮环切术手术操作简单、时间短、疼痛轻、术后外形美观。     

一次性包皮环切吻合器行包皮环切220例分析

目的 观察一次性包皮环切吻合器行包皮环切术的疗效.方法 对220例门诊包皮过长及包茎的患者采用“圣环”一次性包皮环切吻合器行包皮环切术.结果 220例均为门诊手术,手术时间平均6.5 min,术中无出血,所有患者未发生包皮环脱落、感染,伤口愈合后整齐、美观.结论 应用一次性包皮环切吻合器行包皮环切术,手术操作简单、时间短,易于掌握、普及,术后效果好,切缘无癜痕,外形美观.     

包皮环扎术治疗包皮龟头炎的临床价值探析

选取2013年4月~2015年1月我院收治的100例包皮龟头炎患者。随机分为对照组和观察组各50例。对照组行包皮环切术治疗,观察组行包皮环扎术治疗,对比两组的临床效果。结果观察组手术时间、术中出血量及并发症发生率均明显少于对照组,差异有统计学意义(P0.05)。包皮环扎术治疗包皮龟头炎,手术时间短,术中无出血,术后并发症发生率低,可促使患者早日痊愈,值得推广。     

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.