经胸部乳晕入路腔镜甲状腺切除术21例分析

目的评价经胸部乳晕入路腔镜甲状腺切除术的临床应用价值。方法采用经胸部乳晕入路施行腔镜甲状腺切除术,其中单纯甲状腺结节摘除术8例,单侧甲状腺大部切除术6例,一侧甲状腺大部切除并对侧甲状腺结节摘除4例,单侧甲状腺腺叶切除术3例。结果21例全部成功,手术时间95～245min,平均(112.0±30.2)min,平均术中出血(65.8±19.5)mL,术后并发1例暂时性喉返神经损伤。结论经胸部乳晕入路腔镜甲状腺切除术具有极佳的美容效果,是安全和可行的。     

经乳晕径路腔镜甲状腺切除术临床分析

目的探讨经乳晕径路腔镜甲状腺切除术的安全性和可行性。方法采用经乳晕入路腔镜甲状腺切除术89例。术前诊断甲状腺腺瘤49例,结节性甲状腺肿24例,桥本甲状腺炎6例,甲状腺功能亢进7例,甲状腺癌3例。行甲状腺肿块切除33例,甲状腺次全切除38例,甲状腺腺叶切除18例,行颈中央区淋巴结清扫9例。结果腔镜下成功完成手术85例,4例中转开放手术,术后2～4d拔除引流管。平均手术时间(83±36.7)min,平均术中出血量(42±21.9)mL,平均术后住院(3.5±1.1)d。术后并发症3例,其中2例喉返神经损伤,1例低血钙。术后随访4～47个月,4例复发。结论经乳晕入路腔镜甲状腺手术安全,可行,美容效果满意,对合适的病例可以常规应用。     

经全乳晕入路腔镜甲状腺手术配合经验总结*

目的探讨经全乳晕入路腔镜下甲状腺手术中的配合技巧。方法回顾性分析2015年9月-2016年12月该科完成的经全乳晕入路腔镜甲状腺手术110例女患者。其中,甲亢10例,甲状腺癌26例,结节性甲状腺肿60例,甲状腺腺瘤14例。结果所有患者手术均顺利,未出现术中中转开放情况。手术时间75～240 min,平均(150.5±50.1)min,术中出血量20～180 ml,平均90 ml。术后留置引流管时间2～8 d,平均(3.5±3.4)d,术后住院时间2～14 d,平均(6.8±2.5)d。术后疼痛数字分级评分(NRS)0～4分,平均(1.5±1.2)分。无严重并发症发生,无围手术期死亡患者。与同时期进行的经胸乳入路腔镜甲状腺手术相比较,手术时间、术后疼痛评分和术后并发症的发生率,差异均无统计学意义(P0.05)。结论找准正确的筋膜层面、颈部解剖关键点、标志线以及充分的术野暴露是腔镜甲状腺手术成功的关键。     

经乳晕腔镜手术在甲状腺良性肿瘤中的应用

目的探讨经乳晕入路腔镜手术在甲状腺肿瘤患者中的临床疗效及安全性。方法选择92例甲状腺良性肿瘤患者行经乳晕入路腔镜甲状腺切除术治疗为腔镜组,另选取同期80例行开放甲状腺切除术的患者进为开放组。对比2组的手术时间、切口长度、术后住院时间、术后引流量、疼痛持续时间以及美容效果。结果 2组患者的切口长度、术后住院时间、术后引流量之间均有统计学差异(P<0.05,P<0.01);但2组手术时间、术中出血量、疼痛持续时间以及术后并发症发生率无显著差异(P>0.05)。数字分级法评价美容效果,腔镜组(8.5±1.5)分,显著优于开放组的(7.1±2.1)分(P<0.05)。结论与开放甲状腺手术相比,经乳晕入路腔镜手术是一种安全可靠的手术方式,具有切口长度小、住院时间短、术后恢复快,并发症无明显增加、且美容效果好等优点。     

完全经乳晕入路腔镜下甲状腺切除术的护理配合

[目的]总结完全经乳晕入路腔镜下甲状腺切除术的护理配合。[方法]对72例良性甲状腺疾病病人行完全经乳晕入路腔镜下甲状腺切除术,同时加强护理配合。[结果]2例病人中转改行开放手术,1例术后发生颈部皮下气肿,其余均顺利手术。[结论]加强完全经乳晕入路腔镜下甲状腺切除术的护理配合,是手术成功的保证。     

经腋窝与经乳晕入路内镜甲状腺切除术的对比分析

目的 探讨经腋窝或经乳晕入路内镜甲状腺切除的可能性及方法。方法 6例采用经腋窝入路，200例采用经乳晕入路。结果 经腋窝组病例全部行一侧甲状腺大部切除，平均手术时间为67min(45～125min)，术中出血为16ml(8～20m1)。经乳晕组病例行甲状腺肿瘤切除、一侧腺叶和峡部切除、一侧腺叶大部分切除及两侧腺叶大部切除。平均手术时间80．5min(45～270min)，术中出血为15ml(5～28m1)。中转开放手术6例。两组病例均无喉返神经及甲状旁腺损伤，无皮下气肿的发生；无术后颈部皮肤的粘连，无感觉迟钝及感觉异常。结论 经腋窝及乳晕两种途径内镜甲状腺切除术是一种安全可行的一种方法，前者适合于单侧甲状腺手术，后者适合于单侧或双侧甲状腺手术，术后都有很好的美容效果。     

腔镜下经口腔前庭与全乳晕入路甲状腺手术的倾向得分匹配分析

目的比较经口腔前庭入路与全乳晕入路腔镜甲状腺手术的短期临床结局,初步探讨经口腔前庭入路甲状腺手术的安全性。方法收集2018年3月-2020年3月于南方医科大学附属中山市博爱医院接受经口腔前庭(n=50)和全乳晕入路(n=101)腔镜甲状腺手术患者的临床资料,经1∶1倾向评分匹配后,得到50对匹配的配对,比较两组患者临床结局。结果经口腔前庭组建腔时长[(39.9±10.0)和(32.7±7.2) min,P 0.01]和手术时间[(194.3±32.4)和(159.3±33.7) min,P 0.01]明显较经全乳晕入路组长,首日引流量明显较经全乳晕入路组少[(50.8±22.7)和(64.8±34.8) mL,P=0.019],总费用较经乳晕入路组高[(23 626.5±5 217.6)和(17 879.7±3 534.7)元,P 0.05]。两组患者术中出血量、总引流量、引流管留置时长、术后住院时长和术后并发症发生情况比较,差异均无统计学意义(P 0.05)。结论尽管经口腔前庭入路的甲状腺手术时间较经全乳晕入路长,且费用更高,但在手术并发症及住院时长方面并无明显差异。对美容有特殊要求的患者来说,经口腔前庭入路甲状腺手术是一种安全的选择。     

舒适护理在乳晕入路腔镜甲状腺切除术的应用

目的探讨在全乳晕入路腔镜甲状腺切除术围手术期应用舒适护理对患者术前准备及术后康复的影响。方法对2011年1月至2012年6月经全乳晕入路腔镜甲状腺切除术25例患者围手术期实施舒适护理。结果经术前、术后实施舒适护理对手术治疗的配合,本组25例患者术前准备充分,手术过程顺利,术后护理中未发生胸带乳晕部开窗处引出的引流管打折、扭曲;无术后出血、窒息、皮下积液、瘀斑发生;仅1例术后第2天声音嘶哑,经营养神经药物治疗,术后第6天恢复正常。平均住院时间（6.0±1.08）d。出院后随访1~6个月,患者对手术效果满意。结论通过对全乳晕入路腔镜甲状腺切除术患者实施舒适护理,明显减轻患者的心理压力,降低其痛苦和不适感,有效增加舒适度,对患者的康复具有重要意义。     

经乳晕入路腔镜甲状腺手术

目的探讨经乳晕入路腔镜甲状腺手术的可行性。方法回顾分析2007年12月-2009年4月采用经乳晕入路行腔镜甲状腺手术15例临床资料。结果术后患者均痊愈出院。手术时间90～200min,平均135min;术中出血20～60mL,平均32mL;均未出现喉返神经及甲状旁腺损伤等并发症;术后平均住院5d。随访6～20个月,均无复发,患者对伤口满意。结论经乳晕入路腔镜甲状腺手术,安全可靠、并发症少、美容效果好、住院时间短,有应用前景。     

腔镜甲状腺切除术中不同手术体位对患者及术者舒适度的影响研究

目的 观察经乳晕入路腔镜甲状腺切除手术中截石位和平卧位对患者和术者舒适度的影响.方法 回顾性分析2009年1月～2012年6月在我院行经乳晕入路腔镜下甲状腺切除手术的55例患者的临床资料,从手术时间、患者舒适度、术者操作便利性和舒适度进行比较.结果 截石位更利于术者操作,患者舒适度不受影响,术者舒适度增加,且缩短了手术时间.结论 腔镜下甲状腺切除手术采用截石位,对患者舒适度无明显影响,但更利于术者操作,术者舒适度高,手术时间缩短.     

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.     

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.     

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.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.