腹腔镜在胆囊切除联合非腹侧肾囊肿去顶术中的应用

目的:通过腹腔镜在胆囊切除联合非腹侧肾囊肿去顶术中的运用,探讨联合手术的安全性及疗效。方法:回顾性地分析13例腹腔镜胆囊切除联合肾上极、背侧、肾盂旁囊肿去顶术的临床资料,比较分析所有患者的手术时间、术中失血量、术后恢复情况和并发症的发生率。结果:13例腹腔镜胆囊切除联合肾囊肿去顶术均获得成功,手术时间(45±20)min,出血(30±6)m L,术后拔管时间(1.5±1.0)d,平均住院时间(3.0±2.2)d,术后未发生严重不良反应,随访半年无复发。结论:腹腔镜胆囊切除联合非腹侧肾囊肿去顶术疗效肯定,严格掌握适应证,合理运用腹腔镜,手术安全可行。     

后腹腔镜手术CO_2气腹对全身麻醉病人通气功能的影响及呼吸调控效果

目的探讨后腹腔镜行泌尿外科手术中CO2气腹对全身麻醉病人通气功能的影响及呼吸调控效果。方法 82例择期行后腹腔镜手术的病人依据PaCO2监测结果分为3组。A组60例,各监测时点PaCO2〈8.00 kPa。其余22例采用随机数字表法分为B、C 2组,B组12例,气腹后PaCO2〉8.00 kPa,呼吸频率维持12次.min-1;C组10例,气腹后PaCO2〉8.00 kPa后将呼吸频率由12次.min-1调至18次.min-1。分别于气腹前（T1）,气腹后30min（T2）6、0 min（T3）、90 min（T4）时抽取动脉血1 mL行血气分析,并记录pH、PaCO2等变化情况。同时观察PETCO2、Pa-PETCO2等变化情况。结果 B、C 2组气腹时间均明显长于A组（均P〈0.01）。气腹后3组病人T2-T4的pH值均下降,PaCO2、PETCO2、Pa-PETCO2值均上升。与同组的T1时间点比较,B组在T2时间点PaCO2值明显升高（P〈0.01）,B组T4时间点PaCO2、pH、PETCO2、Pa-PETCO2与T1时间点比较差异均有统计学意义（P〈0.05或P〈0.01）,C组PaCO2值在T2、T3时间点明显升高（P〈0.05或P〈0.01）。经呼吸调整后,C组全部病人PaCO2均降至正常。皮下气肿并发症：B组5例,C组2例。结论后腹腔镜手术可导致术前既已存在通气功能障碍或肥胖的病人、术中发生皮下气肿及手术时间过长的病人出现高碳酸血症,必须通过加快呼吸频率,以增加50%通气量（MV）才能排除过多的CO2。     

后腹腔镜治疗复杂性输尿管上段结石197例体会

探讨后腹腔镜输尿管切开取石术治疗复杂性输尿管上段结石的可行性、疗效及手术技巧。回顾性分析后腹腔镜治疗的197例复杂性输尿管上段结石患者的临床资料。结果手术均取得成功,无周围器官损伤,无大出血、气胸,无感染、尿漏等并发症。随访24~36个月,除1例输尿管狭窄,予以输尿管球囊扩张治疗后好转,余均无结石复发和输尿管狭窄。所有患者术后肾功能及肾积水均不同程度改善。后腹腔镜输尿管切开取石术安全有效,具有创伤小、痛苦轻,恢复快、并发症少等优点,是处理复杂性输尿管上段结石的重要治疗手段。     

腰硬膜外联合麻醉和持续硬膜外麻醉在高龄剖宫产手术中的应用

目的探讨腰硬膜外联合麻醉和持续硬膜外麻醉在高龄剖宫产手术中的应用效果。方法回顾性分析80例高龄剖宫产手术患者资料,腰硬膜外联合麻醉(联合组)和持续硬膜外麻醉(对照组)各40例,比较两组麻醉效果。结果与麻醉前比较,麻醉后两组收缩压(SBP)、舒张压(DBP)及牵拉反应时两组心率(HR)均明显降低,且联合组较对照组明显。与对照组相比,联合组的APgar评分、血气指标(pH、PaO_2)均较高,血气PaCO_2水平,麻醉后药物不良反应总发生率显著降低。结论腰硬膜外联合麻醉在高龄剖宫产手术中较持续硬膜外麻醉有显著优势,值得推广应用。     

The effect of UV irradiation on human-derived Giardia lamblia cysts

The effect of UV irradiation on human-derived Giardia lamblia cysts (WB isolate, cultivated using the gerbil model, and purified to homogeneity) was assessed using a 254nm collimated beam protocol. The infection kinetics of UV-exposed cysts were directly compared to the infection kinetics of control (non-UV-exposed) cysts. This demonstrated that a UV dose at 254 nm resulted in significant inactivation of the Giardia cysts. Up to 2 log (99%) inactivation was observed at a UV dose of approximately 10 mJ cm(-2) (range 9.3-11.7 mJ cm(-2)). Higher UV doses (between 20 and 40 mJ cm(-2)) resulted in up to 3 log (99.9%) inactivation of the cysts. The actual inactivation at these dose levels could be higher, but for this study the maximum quantifiable limit of cyst inactivation was up to 3 logs (99.9%). Chemical actinometry using the Rahn potassium iodide actinometer was used to confirm the UV dose delivered. No correlation between a PI/DAPI vital dye viability assay and the infectious dose assay was observed. The vital dye viability assay demonstrated no inactivation. Future work using an alternative UV delivery systems including a demonstration-scale device is recommended and more work with a variety of isolates is warranted.     

Inactivation of Naegleria gruberi cysts by chlorine dioxide

Investigations were carried out to determine the kinetics of chlorine dioxide inactivation of Naegleria gruberi cysts and the influence of pH from 5 to 9, temperature from 5 to 30°C, cyst age from 3 to 12 days, and cyst clumping. Inactivation was characterized by an initial concave downward shoulder followed by an essentially linear portion but the process obeyed Watson's Law. At 25°C and pH 7 the mean concentration time product for 99% inactivation was 5.5 mg·min l⁻¹. These products varied inversely with temperature and pH.     

Recovery of Giardia cysts from water: Centrifugation vs filtration

Methods for the recovery of Giardia cysts from large volume (1900 l.) water samples were experimentally examined in the laboratory and applied to 22 surface water supplies around Washington state. Orlon yarn-wound filters (7 and 1 μm porosity) were compared, with higher cyst recovery rates observed for 1 μm filters. For each experiment, half the recovered material was processed through a series of screens while the other half was processed through an algae (Foerst) centrifuge. Both methods recovered cysts from 1900 l. water samples containing as few as 6000 cysts, with higher recovery rates observed for the algae centrifuge. Cysts were recovered more often from surface water sources implicated in outbreaks (3 of 4) than from sources not implicated in known outbreaks (2 of 18).     

Dinoflagellate cysts and hydrographical change in Gullmar Fjord, west coast of Sweden

This high-resolution study of the latest Holocene dinoflagellate cyst record from Gullmar Fjord, on the west coast of Sweden, provides evidence for the recognition of two major dinoflagellate communities within the fjord over the last 85 years. These communities may have their origins with the history of cultural eutrophication within the region, but are more likely to be associated with the wider phenomenon of the North Atlantic Oscillation and/or the complex hydrographical response of the fjord to various changing climatic environments between 1915 and 1999. The changing dinoflagellate cyst populations are compared in detail with the many hydrographical parameters available from this well studied fjord with its long instrumental records. Indeed the dinoflagellate cysts fail to demonstrate a convincing ongoing eutrophication record for the fjord but do show a major change in the cyst assemblages at about 1969/1970 at a time when the NAO was changing from a negative phase to the present-day positive phase. Gullmar Fjord is important in the history of dinoflagellate cyst studies, being the site of the 1954 study by Erdtman in which viable cysts, produced within the phytoplankton, were first documented within the water column.     

腹腔镜联合结肠镜微创治疗结直肠癌60例临床观察

目的:观察腹腔镜联合结肠镜微创治疗结直肠癌的临床效果。方法:选取120例结直肠癌患者,按照手术方式分为联合组和开腹组各60例。比较两组围术期指标、术后并发症发生情况、术后恢复情况及随访情况。结果:联合组手术出血量、手术时间、术后镇痛次数、术后引流时间及术后引流量等指标均明显优于开腹组,差异有统计学意义(P<0.05);联合组术后并发症发生率为6.67%,明显低于开腹组,差异有统计学意义(P<0.05);联合组术后住院时间、排便时间、肛门排气时间及下床时间均明显短于开腹组,差异具有统计学意义(P<0.05);两组生存率、远处转移率及局部复发率对比,差异无统计学意义(P>0.05)。结论:腹腔镜联合结肠镜微创治疗结直肠癌效果明显,并发症少,创伤小,恢复快,值得推广。     

Infectivity of Giardia lamblia cysts obtained from wastewater treated with ultraviolet light

Several waterborne outbreaks of giardiasis have been linked to discharge of wastewater effluents into surface water. Little is known about the infectivity of Giardia lamblia cysts present in UV treated wastewater effluents. In this study, the infectivity of G. lamblia cysts, recovered from primary effluent and secondary effluent, both upstream and downstream of operating full-scale UV reactors at four wastewater treatment plants, was assessed using the Mongolian gerbil model. Infectivity of cysts obtained from the primary effluents was scored as either strong or moderate for induction of infection in gerbils at three out of four wastewater treatment plants. G. lamblia recovered from secondary effluent both upstream and downstream of the UV reactors caused weak infections in the gerbils. The probability of weak infections caused by inoculums of 50-1400 cysts per gerbil was, on the average, reduced by approximately 10% at the four wastewater UV installations with coliform reduction equivalent doses ranging from 6 to 18 mJ/cm². The UV systems provided considerably less inactivation of the parasite than expected based on the UV dose response of Giardia reported in the literature.     

RIFLE标准在连续性肾脏替代治疗治疗急性肾衰竭中的应用

目的 探讨以RIFLE标准分级的急性肾衰竭(ARF)患者行连续性肾脏替代治疗(CRRT)最佳时机的选择,同时评价RIFLE分级和病死率之间的关系.方法 回顾性分析2000至2007年以来103例入住ICU行CRRT治疗的ARF患者.结果 患者30 d总病死率45.6%.按RIFLE标准分级,危险性、损伤、衰竭各级30 d病死率分别为25.0%、20.0%、57.3%.结论 按RIFLE标准,衰竭之前行CRRT治疗能明显提高患者生存率.RIFLE-F组30 d病死率明显高于RIFLE-R组和RIFLE-I组.RIFLE标准适合作为ARF的定义和分级标准.     

Impact of bathers on levels of Cryptosporidium parvum oocysts and Giardia lamblia cysts in recreational beach waters

Recreational beach water samples collected on weekends and weekdays during 11 consecutive summer weeks were tested for potentially viable Cryptosporidium parvum oocysts and Giardia lamblia cysts using the multiplexed fluorescence in situ hybridization (FISH) method. The levels of oocysts and cysts on weekends were significantly higher than on the weekdays (P<0.01). Concentrations of oocysts in weekend samples (n=27) ranged from 2 to 42 oocysts/L (mean: 13.7 oocysts/L), and cyst concentration ranged from 0 to 33 cysts/L (mean: 9.1 cysts/L). For the samples collected on weekdays (n=33), the highest oocyst concentration was 7 oocysts/L (mean: 1.5 oocysts/L), and the highest cyst concentration was 4 cysts/L (mean: 0.6 cysts/L). The values of water turbidity were significantly higher on weekends than on weekdays, and were correlated with the number of bathers and concentration of C. parvum oocysts and G. lamblia cysts (P<0.04). The study demonstrated positive relationships between number of bathers and levels of waterborne C. parvum oocysts and G. lamblia cysts in recreational beach water. It is essential to test recreational waters for Cryptosporidium and Giardia when numbers of bathers are greatest, or limit the number of bathers in a recreational beach area.