Cisapride in the treatment of post-operative ileus

The effect of cisapride on duration of post-operative ileus after surgery was investigated in a randomized, double-blind, placebo-controlled study. Patients undergoing elective upper gastrointestinal (n = 47) or colonic (n = 22) surgery were pre-operatively randomly allocated to treatment with either cisapride 30 mg t.d.s., by rectal administration, or placebo. Treatment started exactly 48 h after surgery if the patient at this time had not passed stool. Time to passage of first stool after surgery was estimated. Mean time to passage of stool was 85 (32) h (s.d.) for cisapride-treated and 91 (43) h for placebo-treated patients. No difference between the treatment groups was noted. Treatment with cisapride did not shorten the duration of postoperative ileus after either upper gastrointestinal or colonic surgery.     

术前访视及心理疏导效果观察

手术作为一种应激源 ,常使病人产生较强烈的生理和心理应激反应 ,出现紧张恐惧的心理 ,引起病人生命体征及情绪的变化 ,甚至影响麻醉和手术的正常进行。现对 80例病人给予系统的术前心理疏导 ,使病人于术前、术中获得心理支持 ,缓冲术前的应激反应 ,以最佳状态接受手术。1　对象与方法1.1　对象　选择本院外科和妇科的择期手术病人共 80例 ,男46例 ,女 34例 ;胃癌 18例 ,肝癌 3例 ,子宫癌 3例 ,子宫肌瘤 2 7例 ,胆囊及胃溃疡手术 2 9例 ;年龄 2 9岁～ 72岁 ,平均 5 0 .5岁 ,文化程度、手术类别两组差异无统计学意义。1.2　分组方法　采用随…     

T2-weighted and T1-weighted dynamic superparamagnetic iron oxide (ferucarbotran) enhanced MRI of hepatocellular carcinoma and hyperplastic nodules

BACKGROUND/PURPOSE: Iron oxide contrast medium (ferucarbotran) shortens both T1 and T2 relaxation time. We used the T2- and the T1-weighted dynamic ferucarbotran-enhanced magnetic resonance (MR) imaging to predict the histologic grade of hepatocellular carcinoma (HCC) and to distinguish HCC from hyperplastic nodules. METHODS: Forty-three patients with 48 representative hepatic lesions (13 well differentiated HCC, 19 moderately differentiated HCC, 4 poorly differentiated HCC, 12 hyperplastic nodules) were included in the study. T1-weighted image, T2-weighted turbo spin echo, and T2*EPI (echo-planar) images were obtained before and after ferucarbotran injection. The percentage T2 signal intensity loss (T2 PSIL) of the tumors was calculated at 5 minutes and 25 minutes after contrast injection. The enhancement in dynamic T1 images was interpreted by two independent radiologists. RESULTS: The T2 PSIL of well differentiated HCC was 39.5 +/- 8.23%, moderately differentiated HCC was 26.4 +/- 13.78%, poorly differentiated HCC was 4.4 +/- 9.42%, and hyperplastic nodules was 44.3 +/- 11.04%. Comparison of T2 PSIL showed significant differences in the three histologically graded HCCs (p < 0.001), but not between the well differentiated HCCs and hyperplastic nodules (p > 0.05). Delayed post-contrast (25 minutes) T2-weighted images were not necessary and shortened the examination time. In the post contrast dynamic T1 study, no significant differences between all the groups was seen. CONCLUSION: Ferucarbotran MR images help in differentiating the different histologic grades of HCC but T2 PSIL could not differentiate hyperplastic nodules from well differentiated HCC. Dynamic post contrast T1-weighted images provide no additional information.     

Novel APC-cleavage sites in FVa provide insights into mechanisms of action of APC and its cofactor protein S

Summary.  Background: Activated protein C (APC) inhibits factor Va (FVa) by cleaving at Arg306, Arg506 and Arg679. Protein S serves as cofactor, in particular for the Arg306 site, and a protein S-mediated relocation of the active site of APC closer to the membrane has been proposed as a mechanism. Recently, it was demonstrated that FVa, which was mutated at all three APC-cleavage sites (FVa-306Q/506Q/679Q), could still be cleaved by APC. These sites were close to Arg306 and Arg506 but not further defined. Objective: To identify and characterize the additional APC-cleavage sites in FVa. Methods: The cDNA for FV-306Q/506Q/679Q was used as a template to create FV variants with one or more possible cleavage sites being mutated. The FV variants were expressed and their sensitivity for APC characterized functionally and with Western blotting. Results: The additional APC-cleavage sites were located at Lys309, Arg313, Arg316, Arg317 and Arg505. FVa-306Q/309Q/313Q/316Q/317Q/505Q/506Q/679Q (denoted 8M-FVa) was APC resistant. To investigate individual sites, they were mutated back using 8M-FV as a template. The kinetics of APC-degradation of these variants demonstrated that protein S was equally efficient in enhancing the APC effect for all the novel sites. Conclusions: Multiple APC-cleavage sites close to Arg306 and a single site close to Arg506 were identified. Protein S was equally efficient as APC cofactor for all novel sites. The stimulation by protein S of the Arg505 cleavage argues against a specific protein S-mediated stimulation of cleavage at Arg306 due to relocation of the APC active site closer to the membrane.     

Gastric ulcer disease in infants: US findings

Among 600 infants examined with ultrasound for vomiting, seven (mean age, 3 months) had distinctive features that can be considered diagnostic of gastric ulcer. The findings are thickening of the mucosa (greater than 4 mm) in the antropyloric region, elongation of the antropyloric canal, persistent spasm, and delayed gastric emptying. Two of the infants had slight thickening of the pyloric muscle. Gastrointestinal series or endoscopy demonstrated thickened gastric mucosa and a deformed gastric antrum in all infants, as well as actual ulceration in five.     

临床护士心肺复苏培训技能保留的研究

[目的]研究临床护士心肺复苏(CPR)技能保留情况,寻找最佳的再培训时间间隔.[方法]抽取3所三级甲等医院的内科、外科和急诊科在职临床护士162名,分别采用传统讲授练习(A组)、多媒体指导练习(B组)和自我指导练习(C组)法进行培训,测试培训前、培训后立即、培训后3个月和培训后6个月成人单人CPR操作成绩,并进行不同阶段的比较.[结果]3组培训后CPR技能保留显著提高(P＜0.01);但在培训后3个月和培训后6个月时技能保留明显下降(P＜0.01),A组、C组在培训后3个月时不能实施有效CPR,B组培训后接近6个月时不能实施有效CPR.[结论]采用传统讲授练习和自我指导练习方法对临床护士进行CPR技能培训应在培训后3个月时即开始再培训;采用多媒体指导练习方法的再培训时间不宜超过培训后6个月.     

缺陷记录本的临床应用

医疗护理安全是医院生存和发展的基础,预防和减少护理缺陷的发生是安全护理工作的一项重要内容[1].随着医院规模的迅速扩大,许多科室以低年资护士为主,如何加强护理安全,做到零缺陷管理和无缝隙护理显得尤为重要.从2003年10月开始,我科除严格执行护理部制定的“护理缺陷登记报告“外,在科室内设计缺陷登记本,并实行班班交接,对预防缺陷的发生及缺陷发生后的及时补救起到了重要作用.……