Risk of Respiratory Complications and Wound Infection in Patients Undergoing Ambulatory Surgery: Smokers versus Nonsmokers

Background: Smoking is considered to be a risk factor for patients undergoing surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing ambulatory surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers.

Methods: The authors studied a random selection of 489 adult patients undergoing ambulatory surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge +/- positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of surgery.

Results: Most smokers continued to smoke up until the day of surgery. Smokers had a higher rate of respiratory complications (32.8%vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84;P = 0.038) and wound infection (3.6%vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175;P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications.     

Dual Exposure to Sevoflurane Improves Anesthetic Preconditioning in Intact Hearts

Background: Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevoflurane would achieve an outcome similar to that associated with a single exposure to a higher (H) concentration.

Methods: Langendorff-prepared guinea pig hearts were exposed to 0.4 mm sevoflurane once for 15 min (H1-15; n = 8) or 0.4 mm (H2-5; n = 8) or 0.2 mm sevoflurane (L2-5; n = 8) twice for 5 min, with a 5-min washout period interspersed. Sevoflurane was then washed out for 20 min before 30 min of global no-flow ischemia and 120 min of reperfusion. Control hearts (n = 8) were not subjected to APC. Left ventricular pressure was measured isovolumetrically. Ventricular infarct size was determined by tetrazolium staining and cumulative planimetry. Values are expressed as mean +/- SD.

Results: The authors found a better functional return and a lesser percentage of infarction on reperfusion in H2-5 (28 +/- 9%) than in H1-15 (36 +/- 8%; P < 0.05), L2-5 (43 +/- 6%; P < 0.05), or control hearts (52 +/- 7%; P < 0.05).     

双眼视差视觉诱发电位与立体视觉的关系初探

作者采用双眼视差视觉诱发电位（VEP）记录了18名正常人和9名斜视患者（立体盲），结果正常人视觉刺激VEP P₁₀₀振幅明显高于非视差刺激者；斜视患者视差刺激与非视差刺激VEP P₁₀₀振幅差异无显著性；正常人视差刺激VEP P₁₀₀振幅增加的幅度值[（DSA-NDA）/NDA]明显高于斜视患者。 （中华眼底病杂志，1992，8：10-13）     

肝硬化病人的饮食管理

饮食与肝硬化疾病的痊愈、代偿期的时间、并发症的发生、节约医疗开支、减少住院次数等关系都非常密切,过去对肝硬化病人只重视治疗和护理而忽略了病人的饮食管理,而饮食不当会加重病人的临床过程、增加并发症发生甚至加重病情导致死亡等,因而做好肝硬化病人的饮食指导及护理十分重要。1临床资料我院从2003年1月至2004年10月共收住肝硬化病人1500例(因我院是治疗肝病一体化的医院),其中30%以上病人的诱因均为酗酒、暴饮暴食、不洁饮食、吸毒等,我们在对病人实施整体护理的同时,重点加强了健康教育、饮食指导,通过问卷测评,收到了良好的效果。病例1,男性,25岁,因患“肝炎后肝硬化代偿期”入院,在住院期间,遵医嘱在医护人员督促下合理调节饮食,出院后却不加节制,暴食暴饮,一人一次吃完1kg重的鸡,并大量喝酒,短时间内由于摄入大量蛋白质,肝脏负荷过重,一时不能将蛋白分解产生的氨清除,继而出现肝昏迷,再次入院抢救。病例2,女性,60岁,因“肝炎后肝硬化代偿期并上消化道出血”禁食期间,趁家属离开时,病人进食3个布郎李,进食1h后,引起消化系统症状,腹痛、腹泻,每日排水样便数十次,通过抗感染后病情才能得到控制,但已明显加重原有病情。2饮...     

Parkinson''''s Disease and Smoking: An Integral Part of PD''''s Etiological Study

INTRODUCTION Parkinson抯 disease (PD), a debilitating neurodegenerative disorder, is featured with bradykinesia, resting, muscular rigidity, gait disturbances, and postural reflex impairment[1]. PD is rare before age of 50 years, but it increases dramatically with older ages, with peak onset occurring during the age of 70-85 years. In the United States, prevalence of PD in all age groups is approximately 150 per 100 000 and is roughly 30 per 100 000 at age of less than 50 years and 800 …     

普鲁卡因、消心痛联用治疗肺结核大咯血21例

1990年5月至2003年12月，我们对21例肺结核大咯血患者用垂体后叶素治疗3天仍无效者，及时改用普鲁卡因静脉滴注及消心痛口服，并停用其他止血药，收到满意的效果．现报道如下：     

视网膜母细胞瘤SO－RB_（50）瘤细胞体外粘附晶体实验的初步报告

视网膜母细胞瘤ＳＯ－ＲＢ５０瘤细胞体外粘附晶体实验的初步报告李永平易玉珍冯官光郑健梁肿瘤细胞侵袭邻近的正常组织及转移是恶性肿瘤最基本的生物学特性之一，对肿瘤侵袭、转移的研究，多限于肺癌、肝癌、黑色素瘤、横纹肌肉瘤等［１～５］，有关视网膜母细胞瘤（ｒｅ...