国产吻合器及改进荷包缝合方法行痔上黏膜环形切除术的临床疗效观察

目的 观察应用国产吻合器及改进荷包缝合方法行痔上黏膜环形切除术(PPH)的疗效.方法 对180例Ⅲ、Ⅳ度内痔患者应用国产33 mm直管型吻合器及改进荷包缝合方法行PPH.结果 手术时间30～42 min,平均36.0 min.术后住院时间4～7d,平均5.5 d.180例患者均一次吻合成功,吻合口距肛缘2～5em,切除的组织宽度为2.0～3.5(2.9± 0.4) cm.呈圆柱状,术后痔块均完全回缩.切除的标本病理检查为直肠黏膜组织及黏膜下层组织.术后常见并发症:下腹部不适20例,肛门轻度疼痛62例,尿潴留48例,术后1～3 d大便时出血30例,大便习惯改变10例.随访4周至18个月,无复发,无肛门狭窄或大便失禁及肛周感染发生.结论 应用国产吻合器及改进荷包缝合方法行PPH治疗严重脱垂性痔安全有效、操作简单、术后疼痛轻、住院时间短、恢复快、复发率低、并发症少,吻合器可反复使用,明显降低治疗费用,适于在基层医院和经济欠发达地区推广.     

吻合器痔上黏膜环切术治疗重度痔的临床疗效分析

目的探讨和分析吻合器痔上黏膜环切术(PPH)对重度痔的临床治疗效果.方法回顾性分析应用PPH治疗136例重度痔的临床资料.结果本组资料显示:平均手术时间18min,平均住院天数4.32 d;128例患者术后痔核立即完全回缩,6例患者于术后2周～2个月完全回缩,术后痔核回缩率为98.53%;1例患者因肛垫严重纤维化未完全回缩,自动出院;1例患者回缩不全.随访2个月～2.5年,无吻合口狭窄、肛周脓肿、直肠阴道瘘等,无远期大便失禁和复发.结论PPH治疗重度痔具有手术简单、疗效显著、安全可靠、术后并发症少、住院时间短、恢复快等优点;并且PPH联合手术不影响PPH手术的疗效;减少并发症的关键是手术平面为距齿线上2.5～4.0 cm直肠黏膜;荷包缝合的深度、针距及吻合器的准确操作也是影响手术效果的重要因素.     

PPH在环状混合痔治疗中的临床观察和体会

目的探讨国产吻合器痔上黏膜环切术治疗重度（Ⅲ、Ⅳ度）痔疮的临床效果。方法采用国产的环形吻合器对Ⅲ、Ⅳ度痔疮进行手术治疗,同时辅以消痔灵注射液硬化注射,以及外痔的剥切术。结果30例重度痔疮患者中,退出吻合器时吻合口有出血需用缝线结扎止血的有5例,术后疼痛者有4例,术中吻合器拔出后,大部分患者脱出的内痔、黏膜及皮赘立即回缩到肛管内,2～14d痔块基本完全萎缩,术后出血停止。外痔、皮赘一起上提,肛门恢复正常外观。无一例发生大便失禁、肛门狭窄感染或肛周脓肿形成等并发症。结论与传统手术相比,吻合器道道地地痔上黏膜环切术治疗重度脱垂痔、痔合并直肠黏膜脱垂具有安全有效、手术操作简单、住院时间短、术后痛苦小、恢复快、并发症少、治疗费用相对比较低廉等优点。     

完全保持肛垫组织手术治疗脱垂内痔的临床观察

目的探讨完全保持肛垫组织治疗脱垂内痔的可行性和安全性。方法应用完全保持肛垫的手术治疗脱垂内痔（或以内痔为主的混合痔）48例。结果47例患者术后脱垂的内痔完全回缩，1例因为肛垫严重纤维化未能完全回缩，术届再次行内痔外剥内扎手术治愈。结论完全保持完整肛垫手术治疗脱垂性内痔，具有完整保持肛门的形态和功能，彻底消除出血脱垂症状的优点，临床安全可行。     

PPH的操作技巧及术后并发症的预防和处理25例临床分析

目的探讨重度痔经肛门镜下吻合器痔切除术(PPH)的操作技巧及其术后并发症的预防、处理。方法回顾性分析25例重度痔的临床资料及有关文献。结果25例患者吻合一次成功,术后2～3d脱出痔或直肠黏膜完全回缩,1例术后肛周不适、里急后重感、烦躁,与压迫止血油纱卷完全进入直肠内压迫排便中枢有关,拔除后症状即刻缓解;1例术后肛周疼痛,能够耐受,2例吻合口少量渗血,无需特殊处理。手术时间平均20min,住院时间平均3d,均治愈出院。结论熟练掌握吻合器的操作技巧和丰富的临床经验是PPH成功、降低术后并发症的关键。PPH具有安全、疗效显著、手术时间短、恢复快等优点。     

PPH的操作技巧及术后并发症的预防和处理25例临床分析

目的探讨重度痔经肛门镜下吻合器痔切除术（PPH）的操作技巧及其术后并发症的预防、处理。方法回顾性分析25例重度痔的临床资料及有关文献。结果25例患者吻合一次成功，术后2—3d脱出痔或直肠黏膜完全回缩，1例术后肛周不适、里急后重感、烦躁，与压迫止血油纱卷完全进入直肠内压迫排便中枢有关，拔除后症状即刻缓解；1例术后肛周疼痛，能够耐受，2例吻合口少量渗血，无需特殊处理。手术时间平均20min，住院时间平均3d，均治愈出院。结论熟练掌握吻合器的操作技巧和丰富的临床经验是PPH成功、降低术后并发症的关键。PPH具有安全、疗效显著、手术时间短、恢复快等优点。     

柱状缝合联合消痔灵注射及肛门紧缩术治疗直肠完全脱垂11例体会

目的 总结直肠黏膜柱状缝合＋消痔灵注射＋肛门紧缩术治疗直肠完全脱垂的应用效果.方法 对行直肠黏膜柱状缝合＋消痔灵注射＋肛门紧缩术治疗完全直肠脱垂患者的临床资料进行回顾性分析.结果 全组病例手术顺利,10例治愈,1例症状改善.结论 柱状缝合＋消痔灵注射＋肛门紧缩术是治疗直肠黏膜完全脱垂的一种创伤小、并发症少、疗效确切的方法.     

吻合器痔切除手术的观察与护理

随着人们对痔病认识的进一步深入,痔病的治疗方法也发生改变.痔是人体正常的解剖结构,肛垫的病理性肥大即痔病,治疗原则主要是恢复肛垫正常的解剖结构和生理功能.进年来,对良性外科疾患的治疗均趋于采用微造方法.吻合器术(PPH)的应用与这一趋势相符合,吻合器痔切除术是用特制的吻合器,通过对直肠下端粘膜及粘膜下层组织环形切除,是治疗"Ⅲ-Ⅳ"痔的一种新方法.     

吻合器直肠黏膜环切术治疗直肠黏膜内脱垂的临床研究

目的探讨治疗直肠黏膜内脱垂新手术方法。方法采用吻合器直肠黏膜环切术治疗直肠黏膜内脱垂42例，随访2～24月。结果手术时间平均约18min，住院日期3d。术后有效的解除了临床症状，患者大便成形，排出通畅，所有患者均达到了治疗目的。9例(21.4％)在切割吻合后吻合口有搏动性出血。术后无继发出血。17例(40.5％)有尿潴留，需要导尿。6例(14.3％)术后有肛门坠胀感。无复发。也无感染、直肠阴道瘘及感觉性肛门失禁等严重并发症发生。结论吻合器直肠黏膜环切术治疗直肠黏膜内脱垂具有安全、高效、操作简便及微创等优点，是一个极具潜力的手术方法。     

柱状黏膜缝合悬吊及外剥内扎术治疗重度脱垂痔40例

目的探讨柱状黏膜缝合悬吊及外剥内扎术治疗重度脱垂痔的临床疗效。方法将40例重度脱垂混合痔患者随机分为治疗组和对照组。治疗组进行柱状黏膜缝合悬吊及外剥内扎术,对照组行传统外剥内扎术治疗,每组均为20例。观察术后伤口出血、水肿、痔核残留、肛门狭窄及治愈率情况等指标。结果治疗组在术后并发症及治愈率等方面均优于对照组。结论柱状借黏膜缝合悬吊术能最大限度地保留齿线,维持肛垫正常位置,降低了术后并发症发生率及复发率,是治疗重度脱垂痔合理有效的术式。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.