腹腔镜下子宫肌瘤剔除术中垂体后叶素止血效果的观察

目的 探讨腹腔镜下子宫肌瘤剔除术中垂体后叶素的作用及临床效果.方法 腹腔镜下行子宫肌瘤剔除术62例,随机分为治疗组和对照组,各31例.治疗组术前于瘤体与子宫肌层交界处注射垂体后叶素,对照组注射催产素,观察两组术中出血量、手术时间、手术前后血红蛋白的差值.结果 治疗组出血量为(134.90±38.40)mL,明显少于对照组(213.80±60.50)mL(P＜0.05),治疗组平均手术时间(74.60±38.30)min,明显短于对照组(106.70±47.20)min(P＜0.05),手术前后血红蛋白的差值也有显著性差异.结论 腹腔镜下子宫肌瘤剔除术中使用垂体后叶素可明显减少出血量,缩短手术时间,效果优于催产素.     

三种止血方法在腹腔镜子宫肌瘤剔除术中的应用效果

目的观察三种止血方法在腹腔镜子宫肌瘤剔除术中的应用效果。方法回顾性分析2016年1月至2018年12月我科收治的120例子宫肌瘤患者,所有患者入院后均行腹腔镜下子宫肌瘤剔除术。将患者根据术中止血方法分为A组(垂体后叶素)、B组(缩宫素)和C组(垂体后叶素+肌瘤蒂部套扎),每组40例。比较三组的手术时间、术中出血量、术后排气时间、术后24 h盆腔引流量、住院时间、术前与术后3 d血红蛋白下降值。结果A组的术中出血量少于B组(P=0.0207)。C组的手术时间、住院时间短于A、B组,C组的术中出血量少于A、B组,C组的术前与术后3 d血红蛋白下降值低于A、B组(P<0.05)。C组的术后排气时间短于A组,C组的术后24 h盆腔引流量少于B组(P<0.05)。结论在腹腔镜子宫肌瘤剔除术中,垂体后叶素联合肌瘤蒂部套扎的止血效果确切,值得临床推广使用。     

腹腔镜下子宫肌瘤剔除术88例临床分析

目的探讨腹腔镜下子宫肌瘤剔除术的治疗效果及止血方法。方法腹腔镜下对88例子宫肌瘤患者行子宫肌瘤剔除术,其中有蒂浆膜下肌瘤18例,阔韧带肌瘤2例。肌壁间肌瘤及无蒂浆膜下肌瘤68例,其中48例于切开浆肌层前子宫肌层注射垂体后叶素,20例未用。结果88例手术均获成功,术中失血量10～350mL,平均(90.00±65.69)mL;手术时间(120.76±42.48)min;术后肛门排气(1.84±0.30)d;术后病率0;无1例子宫肌层血肿形成;术后住院天数(7.94±1.60)d,无严重并发症。用药组出血量明显少于未用药组(P<0.05)。结论腹腔镜下子宫肌瘤剔除术具有微创手术的一切优点,是一种安全有效的保留器官的手术方法;垂体后叶素的应用是一种有效的止血方法;单针间断缝合能减少术后血肿形成。     

垂体后叶素联合缩宫素对腹腔镜子宫肌瘤剔除术止血疗效观察

145例行腹腔镜下剔除术治疗的子宫肌瘤患者随机分为三组,A组(n=47):术前于瘤体与子宫肌层交界处注射垂体后叶素,B组(n=48):术前于瘤体与子宫肌层交界处注射缩宫素,C组(n=50):术前于瘤体与子宫肌层交界处注射垂体后叶素和缩宫素。观察和比较三组的手术时间、术中出血量、住院时间和术后并发症。C组手术时间、术中出血量、出院时间和术后并发症发生率明显优于其他两组(P<0.05)。腹腔镜子宫肌瘤剔除术中应用垂体后叶素联合缩宫素可减少术中出血,缩短手术时间和住院时间,降低术后并发症,值得临床推广应用。     

腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术的临床研究(附63例报道)

目的 探讨腹腔镜下子宫肌瘤剔除术联合子宫动脉阻断术治疗子宫肌瘤的效果.方法 回顾分析子宫动脉栓塞术30例(栓塞组),腹腔镜下子宫肌瘤剔除术163例(腹腔镜A组),腹腔镜子宫肌瘤剔除联合子宫动脉阻断术63例(腹腔镜B组)的临床资料.结果 栓塞组手术时间为(93.83±25.45)min,腹腔镜A组为(86.56±38.71)min,腹腔镜B组为(78.02±29.87)min.三组间差异有统计学意义(P＜0.05).腹腔镜B组术中失血量(83.97±36.47)mL,少于腹腔镜A组(153.12±32.66)mL,差异有统计学意义(P＜0.05).术后复发率三组间差异有统计学意义(P＜0.001),腹腔镜B组复发率最低(3.17%),其次是栓塞组(20%),腹腔镜A组(27.61%)复发率最高.结论 腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术明显减少术中出血量、缩短手术时间、降低术后复发率,其术野清晰,创面电凝少,明显减少了组织坏死,术后并发症少.     

垂体后叶素在腹腔镜子宫肌瘤剔除术中的临床止血效果研究

目的:探讨垂体后叶素在腹腔镜子宫肌瘤剔除术中止血的临床效果。方法:选取2013年1月~2015年10月在我院诊治的90例腹腔镜子宫肌瘤剔除术患者资料进行分析,采用随机数字表法将患者分为两组各45例。对照组采用缩宫素止血,实验组采用垂体后叶素止血,比较两组止血效果。结果:实验组手术时间、术中出血量、血红蛋白术前与术后3 d差值以及术后排气时间均显著少于对照组(P0.05)。实验组术后10 min收缩压和舒张压均显著低于对照组(P0.05)。结论:腹腔镜子宫肌瘤剔除术患者术中采用垂体后叶素止血效果理想,值得临床推广应用。     

腹腔镜下子宫肌瘤剔除术应用垂体后叶素的止血效果分析

目的：探讨腹腔镜下子宫肌瘤剔除术垂体后叶素的止血效果。方法：子宫肌瘤剔除术80例，40例（A组）应用垂体后叶素止血，40例（B组）局部创面电凝止血或明胶海绵填压止血。结果：除1例阔韧带肌瘤靠近子宫动脉中转开腹外，其余均在腹腔镜下完成手术。两组术中出血量和手术时间相比差异有显著性（P〈0．05）。结论：应用垂体后叶素对腹腔镜下子宫肌瘤剔除术止血是安全有效的方法。     

经阴道与腹腔镜子宫肌瘤剔除术对比分析

目的:比较经阴道子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术的临床效果。方法:子宫肌瘤患者193例,分为腹腔镜子宫肌瘤剔除术组(腹腔镜组)101例,经阴道子宫肌瘤剔除术组(阴式组)92例,比较2组手术时间、术中出血量、剔除肌瘤个数、大小、术后住院时间、术后恢复情况。结果:2组肌瘤大小、剔除数目、术后病率、术后排气时间及术后住院天数比较差异无统计学意义(P>0.05);腹腔镜组手术时间(92.0±13.2)min>阴式组(53.0±16.7)min(P<0.01);腹腔镜组术中出血量(146.0±81.0)mL>阴式组(76.0±35.0)mL,二者比较差异有统计学意义(P<0.01)。结论:经阴道子宫肌瘤剔除术具有出血少,手术时间短的优点,适用于肌壁间或较深部位子宫肌瘤剔除。腹腔镜子宫肌瘤剔除术创伤小,术后粘连少,适用于浆膜下、肌瘤数目少子宫肌瘤剔除。     

垂体后叶素在腹腔镜下子宫肌瘤剔除中的作用

目的评价垂体后叶素在腹腔镜下子宫肌瘤剔除术中(LM)的止血效果。方法将100例子宫肌瘤患者随机分为治疗组和对照组各50例,LM中分别采用子宫肌层注射垂体后叶素12 U及缩宫素20 U用于止血。结果治疗组术中出血量,手术时间均显著小于对照组(P<0.01)。结论 LM术中宫体注射垂体后叶素可明显减少术中出血,缩短手术时间,不良反应小,值得推广应用。     

腹腔镜下肌壁间子宫肌瘤剔除术应用垂体后叶素联合缩宫素止血的效果

目的 探讨垂体后叶素联合缩宫素在腹腔镜下肌壁间子宫肌瘤剔除术中的应用价值。方法 选择2017年1月至2018年12月60例需行子宫肌瘤剔除术的患者作为研究对象,根据随机数字表法分为治疗组和对照组,每组30例。治疗组术中给予缩宫素20 IU及垂体后叶素6 U,对照组术中用垂体后叶素6 U。记录两组术中出血量、手术时间、术后排气时间及术后并发症。结果 治疗组与对照组的术中出血量、手术时间比较,差异有统计学意义(P 0. 05)。用药前两组血压比较差异未见统计学意义(P=0. 939);用药15 min后,治疗组收缩压水平为(151. 77±5. 58) mm Hg(1 mm Hg=0. 133 k Pa),对照组为(143. 03±5. 31) mm Hg,差异有统计学意义(P 0. 05)。而用药30 min时,两组血压比较差异未见统计学意义(P0. 05)。结论 对腹腔镜下肌壁间子宫肌瘤剔除术实施垂体后叶素联合缩宫素的临床效果较好,可减少术中出血量,缩短手术时间,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.     

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.     

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.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.