经会阴前列腺癌根治术二例报告并文献复习

目的:探讨经会阴前列腺癌根治术的初步经验。方法:对2例TMN分期为T2aN0M0、T2cN0M0期的前列腺癌患者施行经会阴前列腺癌根治术,观察并记录手术时间、术中出血量、术后尿管拔除时间、尿控恢复情况等临床数据。结果:2例手术均获得成功,无一例中转耻骨后前列腺癌根治术。两例手术手术时间分别为175 min、140 min,术中出血量分别为200 ml、150 ml,术后第7日行膀胱尿道造影检查,排除吻合口瘘后,拔除导尿管,术后病理报告前列腺包膜完整,切缘阴性。随访3个月,尿控恢复良好。结论:经会阴前列腺癌根治术在控制肿瘤和尿控方面有显著优势,是一种安全有效的前列腺癌的治疗方法。     

13例机器人辅助腹腔镜单孔经膀胱前列腺癌根治术护理体会

目的 总结机器人辅助腹腔镜单孔经膀胱前列腺癌根治术患者的手术方案及护理措施。方法 回顾分析国内某知名泌尿外科中心收治的13例行机器人辅助腹腔镜单孔经膀胱的前列腺癌根治性切除术患者的手术与护理过程。结果 按照泌尿外科严密的护理流程,对患者进行完善的术前准备、精密的手术过程和全面的术后护理,并及时总结相关护理经验,经过精心治疗与护理,13例患者平均住院4.8天,均顺利康复出院。结论 针对前列腺癌患者,创新的手术方案、高超的手术技巧、高效优质的精心护理,可以有效地提高患者的治疗和康复效果。     

机器人辅助腹腔镜下耻骨上前列腺切除术

目的 探讨机器人辅助腹腔镜下耻骨上前列腺切除术治疗良性前列腺增生(BPH)的临床疗效.方法 应用ZEUS机器人AESOP(USA)操作臂持镜机器人腹腔镜下耻骨上前列腺切除治疗BPH患者21例.前列腺平均体积90(68～160)mL,平均剩余尿110(60～300)mL.合并膀胱结石11例.结果 21例手术均获成功.手术时间90(90～210)min,平均130min;出血量70～420mL,平均210mL;术后膀胱冲洗2～6d,平均3.5d.住院时间4～9d,平均6.5d.手术前后最大尿流率分别为(4.10±3.43)(0～7.3)和(19.5±5.05)(15.2～26.8)mL/s.手术前后比较差异有显著性(P<0.05).21例随访4～15个月无尿失禁及尿潴留发生.结论 机器人辅助腹腔镜下耻骨上前列腺切除治疗良性前列腺增生使手术效率提高,操作更精确,手术更安全,疗效满意.     

前列腺癌根治术患者术后尿控功能恢复的影响因素分析

目的分析影响前列腺癌根治术患者术后尿控功能恢复的相关因素。方法收集437例前列腺癌根治术患者临床资料,分析影响患者术后尿控功能恢复的相关因素。结果 437例患者中,术后1个月尿控恢复74例(16. 93%),术后6个月尿控恢复256例(58. 58%)。BMI≥28 kg/m2、既往有经尿道前列腺电切术(TURP)史为患者术后1、6个月尿控的危险因素(P 0. 05),而机器人辅助腹腔镜手术、保留膀胱颈、保留最长尿道长度(MULP)、保留神经血管束(NVB)、后方筋膜重建、规律提肛训练是保护因素(P 0. 05)。结论尽可能保留膀胱颈、MULP、NVB及行后方筋膜重建、规律提肛训练有利于尿控功能恢复,同时采取机器人辅助腹腔镜手术也是尿控恢复的积极因素;而BMI≥28 kg/m2、既往有TURP史为患者尿控功能恢复的不利因素。     

腹腔镜前列腺癌根治术1例

目的:探讨经腹腔途径腹腔镜前列腺癌根治术的可行性.方法:采用Montsouris七步法行腹腔镜前列腺癌根治术1例.结果:手术成功,手术时间360 min,术中出血量150 mL,未输血.术后住院17 d,拔除导尿管时间14d.随访6个月,术后前列腺特异抗原(PSA)0.05 ng/mL.结论:腹腔镜前列腺癌根治术有良好的解剖影像,利于术中操作,减少术中出血,更好地保护重要解剖结构,术后恢复迅速.     

前列腺手术麻醉对策

前列腺手术方法分两类 :一类属开放性手术 ,有耻骨上前列腺切除术、耻骨后前列腺切除术、保留尿道前列腺切除术、前列腺联合部切开术、保存性功能的前列腺癌根治术 ;二类属尿道闭合性手术 ,有经尿道前列腺切开术 (ＴＵＩＰ)、经尿道前列腺电切术 (ＴＵＲＰ)、经尿道前列腺冷冻术、经尿道前列腺高温射频治疗、经尿道前列腺激光治疗、经尿道针刺前列腺消融术。1　重视术前准备了解前列腺手术患者的特点 :年龄大 (70岁以上并不少见 )、6 0 %～ 70 %患者合并有内科疾病 ,术前访视患者 ,了解详细病史 ,对心脏、呼吸、神经、内分泌系统及肝、肾功…     

尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术25例护理配合

目的:探讨尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术的护理配合效果。方法:对25例膀胱癌患者在尿道途径辅助下采用经脐单孔腹腔镜根治性全膀胱切除术,总结护理配合方法。结果:手术配合顺利,手术均在尿道途径辅助下于单孔腹腔镜下完成,手术时间245~530(367.0±6.7)min、出血量80~500(247.0±6.9)ml、住院时间9~83(22.0±7.8)d,无围术期死亡病例。结论:尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术安全可行,该手术方法能有效减少器械间的相互干扰,降低手术难度及风险,充分的术前准备,准确熟练的护理配合,是保证手术顺利进行的关键。     

靶向指引腹腔镜膀胱憩室切除术

目的探讨腹腔镜膀胱憩室切除术的策略及效果。方法采用经腹腔途径腹腔镜膀胱憩室切除治疗4例5个男性膀胱憩室患者,手术操作包括先行经尿道前列腺电切术处理合并有前列腺增生症、电灼憩室颈口黏膜作标记、憩室颈口小者预先导丝引导下憩室和膀胱内分别留置尿管、憩室颈口大者术中将电切镜插入憩室内指引、游离并切除憩室、缝合颈口。结果 4例手术均获成功,手术时间分别为120、150、100和90 min,腹腔镜术中出血量40~80 ml,术中、术后无明显并发症,平均术后住院时间6 d(5~7 d)。结论通过精心的手术设计,可使腹腔镜膀胱憩室切除术更加安全、可行。     

前列腺增生症术后排尿困难23例原因分析

目的：探讨前列腺增生术后排尿困难的原因,为防治提供根据。方法：回顾性分析23例前列腺增生术后出现排尿困难病例的临床资料。结果：12例耻骨上前列腺切除术出现排尿困难的病例中,膀胱颈水肿2例,膀胱颈挛缩7例,腺体残留、前尿道狭窄和前列腺癌各1例;11例TURP病例中,腺体残留6例,膀胱颈水肿、挛缩、前列腺腺癌各1例,前尿路狭窄2例。结论：膀胱颈挛缩是耻骨上前列腺切除术后排尿困难的主要原因,腺体残留是TURP术后排尿困难的主要原因。     

耻骨上前列腺切除术后膀胱出口梗阻探讨

耻骨上前列腺摘除术后膀胱出口梗阻是术后严重的并发症 ;本院自1992～2000年间共收治术后膀胱出口梗阻患者14例 ,现报告如下。1资料与方法1.1一般资料本组14例 ,年龄58～78岁 ,平均66岁。其中单纯前列腺结节性增生11例 ,合并慢性前列腺炎3例。术后留置导尿管时间7～21d。术后发生排尿困难时间1～1.5年 ,经金属尿道探子探查、尿道造影、尿道膀胱镜检查 ,发现膀胱颈口挛缩4例 ,膀胱颈后唇抬高4例 (其中1例伴腺体残留 ) ,膀胱颈前唇缩窄3例 ,膀胱颈后尿道闭锁3例(其中1例 ,后证实存在前列腺癌 )。1.2治疗方法2例膀胱颈前唇缩窄经尿道扩张后治愈…     

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.     

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.     

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.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.