Techniques for difficult cases of laparoscopic cholecystectomy

Our basic techniques for the management of difficult cases of laparoscopic cholecystectomy (LC) are presented in this article. If access to Calot's triangle cannot be gained safely, dissection should be started at the fundus or body of the gallbladder (GB), rather than the neck (fundus-first method). In cases with a short and wide cystic duct, a transfixing suture should be applied for ligation instead of clipping. EndoGIA is useful for ligating and transecting this case to avoid a subsequent stricture caused by normal method of ligation. Intraoperative cholangiography should be performed near the neck of the GB in cases in which orientation is lost during dissection. More dissection should be performed in the direction of the junction of the bile ducts after orientation is regained. In cases with GB filled with stones accompanied by severe fibrosis, part of the GB is incised to remove the stones and expose the lumen of the GB. Confluence stones can be removed by placing an incision on the GB side of the junction of the duct. The incised part is closed with suture. A cystic tube (C-tube) is placed in the common bile duct through the cystic duct for decompression. In more difficult cases in which dissection cannot be started safely at any location, the body and the fundus of the GB are excised, and a drain is placed at the neck of the GB. Dissection can be carried out from the main surgeon's or the assistant's side depending on the situation, and cooperation between the two surgeons is mandatory to achieve safe LC in difficult cases. When performing the LC, one must have a low threshold for converting to open surgery if injuries cannot be managed safely.     

1 088例院前及急诊科死亡病例分析

目的通过回顾性分析急诊死亡病例，了解急危重病人死亡原因，提高院前及急诊科危重病人抢救成功率，降低死亡率。方法院前死亡和怠诊科24h内抢救无效死亡病例纳入调查内容。收集包括姓名、性别、年龄、既往史、初诊及最后诊断、院前及急诊科抢救情况、最后死因等资料，并对所有资料进行回顾性总结分析。结果院前与急诊科抢救室死亡原因及所占比例存在差异。院前死亡占同期死亡的56．62％，尤以猝死所占比例最大，而占调查急危重病人死亡前五位的主要病因是严重创伤、猝死、心血管疾病、脑血管疾病和中毒。结论加快普及提高公民的急救知识，建立健全基层与城市的急救网络，稳定急诊专职医师，加强急救知识培训，建立并完善适合本地特点的紧急创伤救治平台，是提高急诊抢救救治水平的有效措施。     

Expression of 8-hydroxy-2’-deoxyguanosine in gastric carcinomas

Reactive oxygen species may be involved in the progression of gastric carcinomas. To clarify whether the pathology of gastric carcinoma are related to oxidative DNA damage, the expression of 8-hydroxy-2＇-deoxyguanosine （8-OHdG） was examined in 30 patients with gastric carcinomas. Methods： The expression of 8-OHdG and apoptosis in the gastric carcinoma were measured using the methods of immunocytochemistry and deoxynucleartididyl transferase-mediated dUTP-biotin nick end labeling （TUNEL）, respectively. Results： Of the 30 cases, 25（83%） showed stronger immunoreactivity than normal control. The patients with poorly differentiated gastric carcinoma had a larger tumor size and higher labeling indices of TUNEL- and 8-OHdG-positive cells than those with well and moderately differentiated gastric carcinoma. Conclusion： Our findings suggest that oxidative DNA damage is increased in association with necroinflammation in chronic gastric injuries and determination of 8-OHdG is useful in assessing high-grade malignancy in gastric carcinomas.     

Treatment of herniated lumbar disc by percutaneous laser disc decompression combined with synchronous suction technique through syringe

Objective： To compare the outcomes of percutaneous laser disc decompression （PLDD） and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc（HLD）. Methods： Forty-two patients with HLD on MRI and those who did not respond to conservative treatment for 6 weeks were randomly divided into group A and group B. In group A, the patients were treated with PLDD and those in group B with PLDD and synchronous suction through syringe. GaAIAS diode laser at 810 nm was used for the ablation in both groups. The treatment effect was evaluated by modified MacNab＇s criteria on the 7^th, 30^th and 90^th day. Results： Evaluated by modified MacNab＇s criteria, the percentages of the excellent and good cases in total patients treated for group B and A were 80.95% and 57.14% on the 7^th follow-up day, 85.71% and 66.67% on the 30^th follow-up day, and 95.24% and 71.43% on the 90^th follow-up day, respectively. Conclusion： Synchronous suction technique through syringe during PLDD improves the overall outcome in the treatment of herniated lumbar disc.     

急性心肌梗死猝死者心肌细胞hsf1和HSP70改变的意义

目的探讨急性心肌梗死猝死者梗死区心肌细胞内热休克转录因子1(hsf1)和热休克蛋白70(HSP70)改变的临床意义。方法分别用RT-PCR和免疫组化法检测(IHC)18例急性心肌梗死猝死者(研究组)和15例心脏正常因车祸快速死亡者(对照组)心肌细胞中hsf1和HSP70基因的mRNA和蛋白表达量。结果急性心肌梗死猝死者心肌细胞hsf1和HSP70的mRNA表达量都显著高于正常对照组(P<0.01),且hsf1和HSP70 mRNA的表达量之间呈显著的正相关关系(P<0.001)。急性心肌梗死猝死者心肌细胞hsf1和HSP70蛋白在细胞浆和细胞核表达较对照组显著增强(P<0.01),其中hsf1蛋白主要在心肌细胞核内表达,HSP70蛋白主要在心肌细胞浆内表达。结论急性心肌梗死猝死者心肌细胞内hsf1和HSP70可能共同参与了急性心肌梗死的病理生理过程,这一过程可能是热休克反应的另一调节途径。     

46例老年死亡与用药的相关分析

目的：对药物不良反应监测期间所发生的４６例老年死亡病例进行用药相关分析。方法：由ＡＤＲ小组讨论和Ｎａｒａｎｊｏ表评分确定ＡＤＲ后,将死亡时伴发严重ＡＤＲ的病例定为与用药拟相关死亡。结果：４６例死亡病例中,有２７例共发生４３次ＡＤＲ,其中１１例为用药拟相关的死亡,主要为抗菌药物导致为肝,肾功能严重损害及不可控制的二重感染,地高辛中毒导致的严重心律失常。     

2006年度我国司法精神病鉴定状况调查

目的了解我国司法精神病鉴定的现状。方法向全国的司法精神病鉴定机构发出《2006年度司法精神病鉴定机构及业务调查表》,收集各机构年度鉴定业务信息,将资料汇总后进行统计分析。结果共发出调查表225份,收回105份。现行鉴定人员中专职鉴定人员占26.66%。在鉴定委托机构中,公安局占64.81%,法院占11.23%。鉴定案件中,刑事案件占64.57%,伤残鉴定案件占第二位(14.30%)。刑事案型分布,依次为杀人(22.07%)、伤害(18.31%)、被奸(12.75%)、盗窃(9.79%)。刑事案件中,鉴定诊断有精神疾病的依次为:精神分裂症(33.93%),精神发育迟滞(18.04%),情感性障碍(7.44%)。民事案件中,鉴定诊断为脑器质性精神障碍的比例最高,占29.55%。结论本研究一定程度上反映了当前我国司法精神病鉴定的特点,为今后提高司法精神病鉴定工作提供参考。     

Human papillomavirus prevalence in women attending routine cervical screening in South Wales, UK: a cross-sectional study

In this cross-sectional population-based study we determine human papillomavirus (HPV) prevalence in South Wales to provide comprehensive baseline data for future assessment of the impact of prophylactic HPV vaccination and to help inform future screening strategies. Liquid-based cytology samples from women attending routine cervical screening were collected (n=10 000: mean age 38 years, 93% cytology negative, and 64.8% from the 50% least deprived LSOA according to social deprivation score (SDS)). High-Risk (HR) and Low-Risk HPV screening was performed using HPV PCR-EIA with genotyping of HR positives and data correlated with age, SDS and cytology. Overall HPV prevalence was 13.5% (9.3% age standardised) and the most frequent HR types were HPV 16, 31, 18 and 58. In HR HPV-positive cases 42.4% had a single HR type and they were predominant in women with severe cytological abnormalities. Here, 66% of all HR HPV cases were in women aged 30 years of age or less and SDS had no significant effect on HPV status. HPV prevalence increased significantly with degree of dyskarosis from 7% in cytology negative samples to 80% in samples with severe cytological abnormalities (P-value <0.0001). Overall, 46% of HR HPV cases were positive for the two HR types targeted by the prophylactic vaccines (HPV 16 and HPV 18). The data presented represents the largest type-specific investigation of HPV prevalence in an unselected UK population.     

脉诊在辨证施护意识障碍者中的指导作用

通过记述临床病案凭脉指导辨证施护,指出积食、脱水、肺部积痰和大便秘结的脉象特征和相对应的护理措施,体现脉诊在指导辨证施护的重要作用,提示在中医护理队伍中开展临床脉象理论和实践的教育,对创建具有中医特色的护理理论和护理队伍大有裨益。