腹腔镜辅助下治疗小儿先天性巨结肠症:附3例报道

目的探讨腹腔镜技术辅助下治疗小儿先天性巨结肠症的手术方式,并评价其临床疗效。方法行腹腔镜辅助下治疗小儿先天性巨结肠3例(改良Soave′s法),并结合近几年来中外作者的临床资料评价其临床疗效。结果腹腔镜辅助下顺利完成先天性巨结肠根治术,无1例中转开腹手术,等同于开放手术效果,未出现并发症。结论腹腔镜辅助下行小儿先天性巨结肠根治术可行,具有直观、创伤小,在分离盆底直肠方面优于开放手术,恢复快、疗效好等优点。     

腹腔镜辅助下治疗小儿先天性巨结肠症1附3例报道

目的探讨腹腔镜技术辅助下治疗小儿先天性巨结肠症的手术方式,并评价其临床疗效。方法行腹腔镜辅助下治疗小儿先天性巨结肠3例（改良Soave’s法）,并结合近几年来中外作者的临床资料评价其临床疗效。结果腹腔镜辅助下顺利完成先天性巨结肠根治术。无1例中转开腹手术,等同于开放手术效果,未出现并发症。结论腹腔镜辅助下行小儿先天性巨结肠根治术可行,具有直观、创伤小,在分离盆底直肠方面优于开放手术,恢复快、疗效好等优点。     

腹腔镜辅助Soave根治术治疗巨结肠125例的手术配合

目的 探讨腹腔镜辅助根治术治疗要幼儿先天性巨结肠手术配合.方法 回顾分析2003-2010年应用腹腔镜辅助Soave根治术治疗125例婴幼儿先天性巨结肠的手术配合经验.结果 125例手术均获成功,手术时间85～210 min,平均150min.全部患儿痊愈出院.结论 腹腔镜辅助Soave根治术治疗婴幼儿先天性巨结肠具有创伤小、恢复快、并发症少等优点,良好的手术配合,是顺利完成手术的关键.     

电视腹腔镜巨结肠根治术8例分析

目的：探讨腹腔镜外科技术在先天性巨结肠手术中的应用。方法：经电视腹腔镜行先天性巨结肠根治术8例,结果：均获成功,无中转开腹。术后平均32．5h胃肠功能恢复。术后平均住院7．2d。无吻合口漏病例,无1例死亡,术后随访疗效满意。结论：腹腔镜巨结肠根治术损伤小、恢复快、胃肠干扰小、术后疼痛轻,值得进一步探索、开展。     

腹腔镜辅助下先天性巨结肠根治术8例手术配合

目的:探讨腹腔镜辅助下先天性巨结肠根治术的手术配合方法。方法:加强8例腹腔镜辅助下先天性巨结肠根治术患儿的术前心理护理、病情评估,术中加强手术配合。结果:8例手术均获成功,手术时间150~230min,平均198min。术中出血40ml1例,其余均少于10ml,无术后继发性出血,无术中和术后早期并发症。结论:应用腹腔镜辅助技术可有效地进行先天性巨结肠根治术,且具有创伤小、出血少、时间短、恢复快等优点,良好的手术护理配合是提高成功率的关键。     

腹腔镜辅助下新生儿小婴儿巨结肠根治术

目的:对腹腔镜辅助下行Soave根治术治疗新生儿、小婴儿先天性巨结肠进行探讨。方法:对18例新生儿、小婴儿先天性巨结肠病例行腹腔镜辅助下Soave根治术,术中腹腔镜辅助下腹腔内离断拟切除结肠之系膜,经肛门拖出切除肠管。结果:所有患儿均顺利完成手术,无中转开腹手术者,手术时间80~140 min(平均100 min),术中出血量20~40 mL(平均25 mL),术后恢复良好,平均住院时间7.4 d,随访1个月~2年,便秘复发2例,无便失禁、直肠脱垂等,生长发育良好。结论:腹腔镜辅助下Soave根治术治疗先天性巨结肠安全可靠,手术打击小。     

腹腔镜辅助Soave术治疗先天性巨结肠32例

目的 探讨腹腔镜辅助Buav术治疗先天性巨结肠的疗效并总结经验.方法 2005年5月至2011年12月为32例先天性巨结肠患者行腹腔镜下辅助Soave术.结果 全部患者手术成功.平均手术时间130 min,术中出血30～50 ml,切除肠管长度15～35 cm,平均28 cm.术中术后无严重并发症,仅1例出现肛门湿疹,经保守治疗后痊愈.所有患者随诊1年情况良好.结论 腹腔镜辅助Soave术治疗先天性巨结肠具有创伤小、术后恢复快、术后并发症少的优点,值得推广应用.     

腹腔镜辅助下先天性巨结肠根治术

目的 探讨腹腔镜辅助下先天性巨蛄肠椎话术的临床应用。方法 经电视腹腔镜行先天性巨结肠根治术18例。结果 治疗2个月～1岁的先天性巨结肠患儿，常见型16例，短段型2例。无中转开腹，无吻合口漏，亦无一例死亡。均获得满意效果。结论 腹腔镜先天性巨结肠根治术损伤小、恢复快、胃肠干扰小．术后疼痛轻，值得进一步探索开展。     

微创手术概念在儿童先天性巨结肠手术中的具体体现

目的　结合病例介绍儿童先天性巨结肠根治性手术近年来术式微创化的演变。方法　 2 0 0 0年 6月～ 2 0 0 3年 6月上海儿童医学中心共收治儿童先天性巨结肠 3 9例 ,年龄 2个月～ 13岁 ,其中短段型 11例、普通型和长段型 2 8例。手术方式有直肠肌条切除术、腹腔镜辅助下巨结肠根治术、单纯经肛门结肠拖出术。结果　所有患儿术后随访时间 1个月～ 3年 ,3 6例术后效果满意 ,3例术后仍有便秘 ,与病变肠段切除不够有关。 3年来在儿童巨结肠的手术上趋于微创化 ,即由经典的开放性手术向腹腔镜和单纯经肛门拖出演变。结论　儿童先天性巨结肠根治术近年来术式的演变是手术微创化概念在小儿外科临床的具体体现     

经肛门Ⅰ期根治手术治疗儿童先天性巨结肠临床疗效分析

【目的】探讨儿童先天性巨结肠经肛门Ⅰ期根治手术的临床应用前景。【方法】总结儿童先天性巨结肠经肛门Ⅰ期根治术病例23例,并与23例腹腔镜下巨结肠根治术及23例开腹巨结肠根治术病人的临床资料进行比较分析。【结果】经肛门Ⅰ期根治术组全部治愈,无死亡病例,1例轻度粪污,1例轻度便秘,手术打击小于其他两种术式,疗效与腹腔镜下巨结肠根治术相当,优于开腹手术。【结论】经肛门Ⅰ期巨结肠根治术是治疗儿童期先天性巨结肠的良好术式,与常规开腹手术及经腹腔镜手术组比较,微创优势明显,并发症少,值得临床推广应用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.