Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery

Omeprazole is a substituted benzimidazole that causes dose-dependent intracellular inhibition of gastric acid secretion in humans. This double-blind study examined the effect of omeprazole in decreasing gastric acidity and gastric residual volume in outpatient adults. Unpremedicated outpatients, ASA I-III, 18 years or older (n = 17), were randomly assigned to receive omeprazole 80 mg, or placebo by mouth the night before scheduled elective outpatient surgery. The patients were fasted for 8 h prior to surgery. After the patient was anesthetized, an orogastric tube was inserted with proper placement verified by auscultation for gastric sounds. Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1). Data were analyzed by a t-test, with P less than 0.05 considered statistically significant. Patient characteristics of both groups were similar. There was a statistically significant difference between the two groups for pH (P = 0.02), but not between the two groups for gastric volume indexed to weight (P = 0.07).     

Perioperative specific management of blood volume loss in craniosynostosis surgery

Accurate assessment and replacement of blood loss and fluid–electrolyte deficit during craniosynostosis repair is difficult owing to patient size and the diversity of surgical technique. Forty-three patients undergoing primary craniosynostosis repair over a 10-year period were studied retrospectively to determine blood loss and fluid deficit and to assess blood transfusion practices during both intraoperative and postoperative periods. Blood loss was calculated on the basis of estimated red cell mass (ERCM) and fluid-electrolyte imbalance was investigated with blood samplings. Blood transfusion was considered appropriate if the postoperative or posttransfusion ERCM was within 12% of the preoperative value. Estimated fluid requirement (EFR) was used in 4 ml kg^–1 h^–1 except for neonates. Intraoperatively, 80% of all patients were appropriately managed with respect to blood transfusion and EFR. Postoperatively only 20% of the patients receiving transfusions were transfused appropriately. In 23.3% of these patients (10/43) unexpected respiratory distress developed immediately after their recovery from the anesthesia. With the measurement of estimated blood volume and allowable blood loss, appropriate transfusion could be achieved for the successful treatment of the primary craniosynostosis. Received: 16 February 1998     

Value of digital volume tomography in patients with conductive hearing loss

Digital volume tomography (DVT) is an extension of panoramic tomography. With this diagnostic technique, characterized by high resolution, a narrow section width (0.125 mm) and three-dimensional display, small pathological processes can be well visualized. Twenty-five patients with the history of a progressive hearing loss were examined with DVT (Accu-I-tomo, Morita, Japan). The results were compared with pre- and intraoperative findings to evaluate the diagnostic value of DVT in cases of erosion of the ossicular chain. With high resolution and artifact-free demonstration of the middle ear and the ossicular chain, it was possible to define its continuity preoperatively by DVT in all 25 cases. An intact ossicular chain was found by DVT in 13 cases and was later confirmed by surgery. The predicted erosion of the ossicles was verified in 12 patients, and a tympanoplasty type III was performed. Digital volume tomography is an excellent technique to examine the middle ear cleft and inner ear, and expands the application of diagnostic possibilities in the lateral skull base. Therefore, improvement in preoperative diagnosis is achieved along with more accurate planning of the surgical procedure. Digital volume tomography delivers a small radiation dose with a high resolution and a low purchase price for the equipment.     

Three-dimensional sonographic volume measurement of the fetal spleen

AIM: The objective of this longitudinal study was to evaluate the growth of the fetal spleen in normal pregnancies, using three-dimensional ultrasound. METHODS: Three-dimensional sonographic examinations were performed on 14 appropriate-for-gestational-age fetuses. Fetal splenic volume was measured every 2-3 weeks after 20 weeks of gestational age until delivery. RESULTS: Curvilinear relationships were found between the gestational age and splenic volume (R(2) = 80.2%, P < 0.0001), and normal ranges of splenic volume measurements for estimating the growth of the fetal spleen during normal pregnancy were generated. We found that the splenic volume calculation based on the equation for the volume of the ellipsoid by conventional two-dimensional ultrasound in previous investigations is about twice as large as that using three-dimensional ultrasound in our study, whereas the present data described in this study is quite comparable with previous data from an autopsy series. CONCLUSION: Our findings suggest that the standard curve for the fetal splenic volume using three-dimensional ultrasound provides a superior means for evaluating the normal splenic growth in the fetus and for identifying splenic abnormalities in utero. However, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings.     

高脂血症患者血小板体积及有关参数的研究

本文报道242例高脂血症患者血小板(PLT)、平均血小板数(MPLT)及平均血小板体积(MPV)等参数的测定结果,其中高胆固醇并高甘油三酯患者,PLT、MPLT及巨大血小板比例(Macro-PLT)高于正常,MPV正常;而单纯高胆固醇或高甘油三酯患者,上述指标与正常人无显著性差异。提示高胆固醇并高甘油三酯患者,存在血小板生成动力学异常,其血小板的破坏增加,生成率加速、但处于一种高水平的动态平衡之中。这可能是高脂血症出现高凝状态的原因之一。同时表明此类患者使用抗血小板疗法具有一定的合理性和必要性。     

Clinical and Physical Evaluation of the Infertile Male: Testicular Measurement or Orchidometry/Klinische und physikalische Bewertung des infertilen Mannes: Hodenmessung oder Orchidometrie

Summary: For the quantitative determination of the testicular size or volume, two groups of apparatus are available: on the one hand, model testes, which are extremely valuable in longitudinal and cross-sectional studies during the period of pubescence, and on the other hand, measuring devices, with which the testicular dimensions can be specified. The latter instruments are helpful chiefly during the adolescent years and the diagnosis of problems surrounding fertility. The testicular volume can be calculated subsequently from the specific testicular measurements. The formula, for computing the volume of an ellipsoid, seems to be the most suitable for this purpose. Appliances also have been developed, which allow the largest (longitudinal) dimension (in mm) and the testicular volume (in cm3) to be read off simultaneously. A tonometer can be useful to quantitatively estimate the testicular consistency, which is a parameter of the testicular integrity at the level of tubular function (spermatozoa production).     

Large volume injection and infiltration system

Summary A system which can be used for injection or infiltration of large volumes of fluid is described. This consists of a syringe which fills automatically from a reservoir through an inlet/outlet valve.     

A suggested clinical score to predict the severity of adenoid obstruction in children

Chronic nasal obstruction in children is a very common disorder. Obstructing adenoid is usually the first to blame. Though the clinical assessment is essential, it is often considered unreliable or insufficient. We conducted a prospective clinical study to validate a clinical score predicting the severity of adenoid obstruction in symptomatic children. The clinical score (CS) included mouth breathing, snoring, restless sleep, frequent waking-up at night and obstructive breathing during sleep. Each item received a score of 0 or 1. The palatal airway was evaluated on a lateral nasopharyngeal x-ray. The degree of obstruction was assessed intra-operatively by a laryngeal mirror using a 3-grade scale. The volume of each adenoid specimen was measured. Eighty-six patients were enrolled, 51 boys and 35 girls, aged 13–181 months (mean 52, median 45). The CS correlated very well with the intra-operative findings (p < 0.01) and with the degree of palatal airway obstruction (p < 0.05) but not with the volume of the adenoid removed (p > 0.05). The CS was higher in children younger than 3 years (CS > 3 in 85.7% vs. 29.2%), having more frequent obstructive breathing during sleep (71.43% vs. 21.54%). A CS of three or higher, predicted severe obstruction in 96.5% of patients, as detected intra-operatively. The suggested CS is simple to use and is highly reliable in identifying children in need for adenoidectomy, in the context of normal anterior rhinoscopy and tonsils less than grade three.This work was presented at the podium of the XVIII IFOS in Rome, Italy on June 26, 2005.     

内科微创肺减容术的研究进展

传统的外科肺减容术治疗慢性阻塞性肺疾病（COPD）有严格的适应证，并且副作用大、并发症多。于是人们研究出多种基于同样原理但是采用内科微创技术的减容方法。目前常用的内科微创肺减容术有使用单向活瓣、生物蛋白胶等封堵支气管使靶肺萎陷、不张，或采用支气管内药物灌注肺泡加封堵使靶肺组织纤维化等。此外，还有人提出人工旁路增加呼出气量的方法。尽管目前还缺少大规模的随机对照临床试验结果，但是内科微创肺减容术已展现了其巨大的临床应用前景，也将为治疗COPD提供更多的选择。     

眼轴线后部眶容积增大与眼球内陷比值的测定研究

目的:通过测量眼眶爆裂性骨折伴有眼眶扩大患者的后部眼眶容积、观察眼球内陷出现的时间及程度,研究后部眶容积扩大与眼球内陷的关系比值,为病情预测和眶内填充手术提供比较精确的参考数据。方法:将96例患者按发病时间分为早期病例组(60例、受伤时间1周以内)和晚期病例组(36例、受伤时间3个月以上),早期组除进行后部眼眶容积测量外,分别于1周、2周、3周测定眼球突出度(相差>1mm为阳性),记录眼球内陷出现时间,用卡方检验进行统计学分析;晚期组测量后部眶容积增大值和眼球内陷量,对其相关性采用Pearson统计方法进行统计学分析,并得出回归方程及相关系数。结果:早期组60例患者中,(58.33%)例患者在1周内出现眼球内陷,4(880%)例在2周内出现内陷,3周时有5(388.33%)例呈现出内陷;2周时出现眼球内陷的例数与1周时有显著性差异(χ2=62.484,P<0.001),2周时出现眼球内陷例数与3周时无差异(χ2=1.563,P>0.05),1周时出现眼球内陷例数与3周时有显著差异(χ2=76.885,P<0.001),后部眶容积增大与眼球内陷的比值约为1.0,两者之间呈正相关(r=0.994,P<0.001),即后部眶容积每增加1ml,产生1.0mm的眼球内陷。结论:眼球内陷通常于伤后2周～3周出现,3个月时趋向稳定;后部眶容积增大与眼球内陷产生比值为1.0,呈正相关;后部眶容积扩大与眼球内陷比值可预测发生眼球内陷的可能性和程度,为手术矫正眼球内陷提供可靠、精确的参考,具有十分重要的临床指导意义。