腹腔镜下胰体尾切除术及胰腺假性囊肿内引流术治疗经验

目的总结腹腔镜下胰体尾切除术及胰腺假性囊肿内引流术的治疗经验，探讨腹腔镜下胰体尾部手术的可行性。方法2005年2月～2006年8月分别对1例胰体尾囊性占位、2例胰岛素瘤患者施行腹腔镜下胰体尾切除术（保留脾脏1例）；对1例胰体尾部假性囊肿患者施行腹腔镜下胰腺假性囊肿-胃吻合内引流术。结果4例手术均获成功，术中出血量均在200mL以内，手术时间分别为150、210、240和120min，4例患者术后恢复顺利，术前症状明显缓解，无并发症发生。2例胰岛素瘤患者术后血糖恢复。胰腺假性囊肿患者内引流术后囊肿明显缩小。结论腹腔镜下胰体尾切除术及胰腺囊肿内引流术是安全可行的，具有创伤小、恢复快及并发症少等优点。     

慢性胰腺假性囊肿18例手术治疗体会

目的 探讨慢性胰腺假性囊肿的手术方法及效果.方法 对18例慢性胰腺假性囊肿患者的临床资料进行回顾性分析.18例患者择期行囊肿内引流术,其中16例行空肠-囊肿Roux-en-Y吻合术（6例合并胆囊结石者附加胆囊切除术）,2例行胃-囊肿吻合术.术后给予生长抑素、抗生素及加强营养支持治疗,预防吻合口漏、出血等并发症的发生.结果 行空肠-囊肿Roux-en-Y吻合的16例患者术后均恢复顺利;行胃-囊肿吻合术的2例患者术后出现吻合口出血1例,经对症保守治疗后痊愈.所有患者术后6周复查CT示囊肿已消失.随访1～5年,均无复发,无并发症发生.结论 囊肿内引流手术治疗慢性胰腺假性囊肿疗效确切、操作简单,适合基层医院开展.     

胰腺假性囊肿19例治疗分析

目的：总结胰腺假性囊肿治疗体会。方法：本组中2例保守治疗痊愈，15例行内引流手术，1例行外引流术，1例行胰腺部分切除术。结果：术后3例并发胰瘘，其余恢复良好，胰瘘经保守治疗均痊愈。结论：应根据具体情况选择术式是治疗关键。     

小儿假性胰腺囊肿的手术治疗

目的：总结小儿假性胰腺囊肿外科手术治疗的经验。方法：回顾性总结手术治疗的14例小儿假性胰腺囊肿的临床资料。本组患儿均采用手术治疗。其中行内引流术9例（64．28％），包括腹腔镜手术3例（21．42％）。外引流术5例（35．71％）。结果：14例患儿均痊愈出院，住院时间7～36d。所有病例均有术后病理检查证实为假性胰腺囊肿。结论：内引流术优于外引流术。手术治疗应尽可能行内引流术，其中囊肿胃吻合术是一种简单合理的内引流术式，可作首选。采取腹腔镜手术效果更佳。     

腹腔镜治疗急性非梗阻胆源性胰腺炎38例体会

目的探讨急性非梗阻胆源性胰腺炎的治疗方法,提高其治疗水平。方法我院2003年5月～2008年12月收治38例急性非梗阻胆源性胰腺炎,均行腹腔镜手术治疗。26例行腹腔镜胆囊切除结合胰腺被膜切开减压,12例行腹腔镜胆囊切除术、水中行胆总管造影结合腴腺被膜切开减压。结果38例均顺利完成手术,围术期无死亡者,术后住院17～25d。除2例失访外．36例随访6～20个月,术后无胆道残白、假性胰腺囊肿、胰腺炎及胆总管结石复发。结论非梗阻胆源性胰腺炎应依据症状、体征、淀粉酶值及影像学柃查制定个体化治疗方案。     

小儿胰腺假性囊肿临床诊治体会

目的总结小儿胰腺假性囊肿的诊治体会。方法回顾性分析10例小儿胰腺假性囊肿的临床表现、诊断及治疗方法。5例行外引流术，5例行内引流术（4例行囊肿胃吻合内引流术，1例行囊肿空肠Roux—Y内引流术）。结果除行外引流术1例复发外，其余恢复良好。结论选择合适的时机和术式是治疗小儿胰腺假性囊肿的关键。     

胰腺假性囊肿56例诊治体会

目的探讨胰腺假性囊肿的临床诊治。方法对56例胰腺假性囊肿患者的临床资料进行回顾性分析。8例行非手术保守治疗;36例行内引流术,其中囊肿胃后壁吻合11例,囊肿十二指肠吻合术3例,囊肿空肠Roux-en-Y吻合术22例;5例行外引流术;7例行囊肿切除术。结果该组无死亡病例,保守治疗均痊愈;外引流术后3例出现胰瘘,2例复发;囊肿切除术后2例出现胰瘘,1例复发;内引流术后仅1例出现胰瘘,其余无严重并发症出现,恢复良好。结论根据胰腺假性囊肿的病程和病情选择合适的手术方式是治疗胰腺假性囊肿的关键,内引流术是目前较理想的手术方式。     

胰腺假性囊肿38例外科手术治疗分析

目的：探讨胰腺假性囊肿的治疗。方法：回顾性总结分析1993-01/2005-10我院收治且行外科治疗的胰腺假性囊肿38例。结果：38例采用的手术方式分别是囊肿空肠Roux-en-Y型吻合术18例，囊肿胃吻合术7例，囊肿十二指肠吻合术1例，囊肿外引流术9例，假性囊肿切除术3例，囊肿胃吻合术和囊肿空肠Roux-en-Y型吻合组术后并发症发生率均明显低于外引流组，囊肿空肠Roux-en-Y型吻合术与囊肿胃吻合术相比，术后并发症更低。结论：外引流术简单而安全，其不足之处是术后发生复发率及并发症较高，病程也较长，仅适合于假性囊肿破裂或感染的患者，故在条件允许的情况下，应尽量避免使用。囊肿胃吻合术术后并发症高于囊肿空肠Roux-en-Y型吻合术，囊肿空肠Roux-en-Y型吻合术是一种简单合理的内引流术式，应作为首选术式。     

胰腺假性囊肿的外科治疗

目的：总结胰腺假性囊肿的外科治疗方式及其经验。方法：回顾性分析我院1990年1月至2006年12月49例胰腺假性囊肿的临床资料。结果：根据囊肿部位、形成时间及囊壁厚度，采用非手术治疗7例，经皮穿刺置管引流6例，开腹手术32例（外引流7例，内引流26例，囊肿切除3例、序贯式外-内引流术6例）。全组无死亡病例，手术后并发症发生率9．5%（11／40）。结论：胰腺假性囊肿的外科治疗根据具体情况采用不同的手术方式，手术治疗尽可能行内引流术，其中囊肿胃吻合手术是一种简单合理的内引流术式，对于难以排除恶性的假性囊肿应尽量切除。     

假性胰腺囊肿并胆道梗阻的手术治疗(附18例报告)

目的：探讨假性胰腺囊肿并胆道梗阻的手术治疗方式与疗效。方法：结合文献对18例假性胰腺囊肿并胆道梗阻手术治疗的临床资料进行分析。结果：本组18例，治愈17例，死亡1例。术后出现消化道出血5例，经保守治疗痊愈4例．其中1例出现反复大量出血，导致肝、肾功能衰竭，手术后16d死亡。术后3例出现黄疸加深，肝脏功能损害，经保肝等治疗黄疸消退痊愈。术后感染发热2例，经抗炎治疗痊愈，无胰瘘、胆瘘发生。术后随访半年以上未见囊肿复发。结论：囊肿合并胆道梗阻必须同时处理，囊肿仍以外科手术内引流为主，Roux-enY空肠囊肿吻合较理想，胆道梗阻选择俄狄氏括约肌切开或胆肠吻合术。     

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.