When a pack becomes a plug

The authors present a case of a surgical wound that was inappropriately packed to the extent that a significant and major deterioration occurred in the expected healing by secondary intention. This is intended to alert surgeons to the fact that careful supervision is required of such seemingly simple and straightforward tasks as the topical treatment of open wounds by inexperienced caregivers.     

Nursing: a profession, a discipline, a science

The debates which drive the nursing profession often put forward the notions of profession, discipline and science to qualify nursing. It is advisable to clarify each of these concepts, as well as to highlight the importance of structuring them in order for nurses to be able to assume as best as possible the role entrusted to them within society.     

Turning a Negative into a Positive

A lack of significant difference between populations is often misinterpreted as demonstrating equivalence between the populations. I discuss how this confusion comes about and hint at a future discussion of analyses designed to show equivalence.     

做人、做事、做学问

我毕业从医已经 6 5年了 ,我常扪心自问 ,杏林行走 6 5载 ,是否让每一个经过我诊治的病人感到温暖 ,是否做到了想病人之所想 ,急病人之所急。我深感自己做得还很不够 ,在我 6 5年的外科生涯中 ,有差错、有失误 ,深夜不能入眠的时候常使我惭愧和不安。早年读春秋《左传》时 ,记得有一句话 :“太上立德 ,其次立功 ,其次立言。”立德就是做人 ,立功就是做事 ,立言就是做学问。我们做医生的 ,是做学问的 ,但是做人是最起码的要求。因此我常常思索如何做人、做事和做学问的道理。一、如何做人如何做人 ?这个问题很难回答 ,只能靠自己去感悟、去思…     

从外科医师到外科学家

一名刚完成接受外科专业培训,考试合格的外科医师,他的前面有两条路可供他选择：坏的道路和好的道路。如果向坏的道路走,他可以到达两个终点。（1）不良外科医师：这些医师以医学知识来欺骗病人钱财,或夸大病情,从中获利;（2）低劣外科医师：他们使用不达标或已淘汰的知识和技术治疗病人。另一条道路是向好的道路,但走这条道路是要不断进行终身学习和评核。最终能否成为一名合格或优秀的外科医师,主要靠的是自己的天赋和个人所付出的努力。一名优秀的外科医师如果只是通过手术,他的一生只能造福有限的病人。但是如果一名外科医师通过医学研究,找出一套新学说、新技术,就可使更多的病人受益。能够称为外科宗师,要求能把新学说发扬光大,成家成派。更要有高尚人格和品德,令人敬佩。     

Controlled induction of a pseudarthrosis: a study using a rodent model

OBJECTIVES: This study aimed to test the hypothesis that under standardized mechanical and biologic conditions, the process of indirect bone repair in a rodent species could be manipulated to form a reproducible, atrophic, fibrous pseudarthrosis. DESIGN: The model used comprised a mid-diaphyseal, transverse osteotomy in the rat femur, stabilized via a precision miniature external fixator, a constant axial fixation stiffness being defined by a specific frame geometry. MAIN OUTCOME MEASUREMENTS: The repair process for both 0.5-mm and 3.0-mm gap osteotomies was characterized using radiography, dual-energy x-ray absorptiometry, histologic assessment of standardized longitudinal sections, and postmortem mechanical testing. RESULTS: Healing of the defect was highly reproducible, bone union being attained at around 5 weeks postoperatively with a 0.5-mm gap. Increasing the gap width to 3.0 mm resulted consistently in a pseudarthrosis. CONCLUSION: These two reproducible patterns of repair can now be used to elucidate the underlying molecular mechanisms controlling the extent and progression of connective tissue differentiation in indirect bone repair without the additional variable of a nonstandardized mechanical environment.     

Prolapse of a simple ureterocele presenting as a vulval mass in a woman

A 48-year-old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single-system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.     

Sugammadex in a man with a transplanted kidney: a case report

We report the use of sugammadex to reverse a rocuronium block in a man who had received a kidney transplant 4 years earlier. The patient was admitted for gastric non-Hodgkins lymphoma and bleeding that required surgery. Arterial hypertension, tachycardia, and frequent ventricular extrasystoles were detected. Anesthetic induction was accomplished with propofol, fentanyl, and rocuronium; intubation was uneventful. We monitored pulse oximetry, capnography, heart rate, electrocardiography, arterial pressure (invasive), cardiac output, end-systolic volume, bispectral index, temperature, and neuromuscular function. Anesthesia was maintained with an infusion of propofol, fentanyl, and rocuronium guided by train-of-four (TOF) ratio. Total diuresis was 1100 mL. The operation lasted 4.5 hours. Recovery of neuromuscular response was spontaneous until the second TOF twitch, after which we injected 2 mg/kg of sugammadex. A TOF ratio of 0.94 was recorded 158 seconds after injection of the reversal agent. The patient was extubated without complications. Sugammadex can be used in patients with a transplanted kidney, provided the glomerular filtration rate has recovered sufficiently to allow full excretion of the sugammadex-rocuronium complex.     

Stability of a sufentanil-ropivacaine mixture in a glass and a PVC reservoir

BACKGROUND AND OBJECTIVE: Drug mixtures containing sufentanil may be unstable owing to absorption into the drug reservoirs of patient-controlled epidural analgesia systems that contain polyvinylchloride. The stability of sufentanil in a mixture of ropivacaine 0.2% in a 750 mL reservoir was therefore investigated. METHODS: During simulated epidural infusions of 5 mLh(-1) at 25 degrees C, sufentanil concentrations were measured for 96 h. Samples were taken from the reservoir and from the end of the epidural catheter under the following conditions: into glass or polyvinylchloride reservoirs containing ropivacaine 0.2% with sufentanil 1, 0.75 or 0.5 microg mL(-1); and into polyvinylchloride reservoirs with ropivacaine 0.2% and sufentanil 1 microg mL(-1) which were stored for 4 weeks at 8 degrees C. RESULTS: The different solutions remained stable over the observation period of 96 h. Using the same solutions, independent samples' ANOVA showed no difference in the sufentanil concentrations between the glass and polyvinylchloride reservoirs, or between the polyvinylchloride reservoirs when stored for 4 weeks. Correlations between the concentrations at the different measurement times were extremely high for the reservoir (r(min) = 0.98, r(max) = 1.00) and the catheter end (rmin = 0.86, r(max) = 1.00). CONCLUSIONS: Sufentanil citrate at 0.5-1.0 microg mL(-1) in an admixture of ropivacaine 0.29 for 5 days, which is the usual period for postoperative epidural analgesia, remains stable in a polyvinylchloride reservoir. There is no change in the drug concentration even if the reservoir is stored for 4 weeks at 8 degrees C.