Unusual Hernia in a Colostomy Closure Site

This is a case report of an interstitial hernia following previous transverse loop colostomy closure. There are no reported cases in the literature of gangrenous gall-bladder as the content of an interstitial hernia. This condition can present as a diagnostic challenge. We present a case with a previous reversal of a colostomy in the right upper quadrant presenting with a short history of a right iliac fossa mass and tenderness. Clinically, the patient was septic without any peritonitis. Subsequent computed tomography scan suggested the hernial sac contained gallbladder and loops of bowel. At surgery, a gangrenous gall-bladder was found within an interstitial incisional hernia (between the external and internal oblique muscle). Retrograde cholecystectomy was performed and bowel and hernia were reduced.The hernia was repaired in layers and patient had an uneventful recovery.     

Evaluation of wound healing activity of root of Mimosa pudica

Ethno pharmacological relevance

Mimosa pudica, commonly known as touch-me-not, is used in folklore medicine in arresting bleeding and in skin diseases.

Aim

There was no scientific evidence justifying the use of Mimosa pudica, therefore the present study was aimed at evaluation of wound healing activity of the plant.

Materials and methods

In the present study the roots of Mimosa pudica were studied for wound healing activity by incorporating the methanolic and the total aqueous extract in simple ointment base B.P. in concentration of 0.5% (w/w), 1% (w/w) and 2% (w/w). Wound healing activity was studied in three types of model in rats viz. excision, incision and estimation of biochemical parameter. In case of the excision wound model wound contraction and period of epithelization was studied while in incision wound model was evaluated by determining tensile strength and hydroxyproline content in the scab.

Results

Treatment of wound with ointment containing 2% (w/w) the methanolic and 2% (w/w) the total aqueous extract exhibited significant (P < 0.001) wound healing activity. The methanolic and total aqueous extracts were analyzed for total phenols content equivalent to Gallic acid. The content of total phenols was 11% (w/w) and 17% (w/w) in methanolic and total aqueous extract respectively.

Conclusion

The methanolic extract exhibited good wound healing activity probably due to phenols constituents.     

切开旷置挂线配合中药坐浴治疗高位复杂性肛瘘疗效分析

为提高高位复杂性肛瘘的手术效果，减少并发症和后遗症，保持肛门的正常功能和形态，对60例高位复杂性肛瘘患者采用主管切开挂线引流，支管对口挂浮线或旷置引流，术后配合中药坐浴，60例均一次性治愈，肛门功能良好，肛门外观美观，疗程21—58天，平均29．5天。术后随访2～3年未见复发。提示切开旷置挂线配合中药坐浴治疗高位复杂性肛痿根治彻底，保持了肛门的正常功能和形态。     

6mm无缝线不同位置切口白内障术后散光变化

目的 研究角巩膜缘无缝线不同位置切口对白内障超声乳化摘除联合人工晶体植入术前后散光变化的影响并评价其手术效果。方法 对67例（70只眼）白内障患者根据切口位置随机分成两组，A组：上方切口组34只眼，B组：颞上侧（右眼）或鼻上侧（左眼）切口组36只眼，用钻石刀在角巩膜缘后0．5mm做隧道长1．75mm阶梯形切口行白内障超声乳化摘除人工晶体植入术。分别于术前及术后1周、1个月、3个月及6个月用Nikon自动角膜屈光曲率仪测量角膜散光度、轴向。采用Holladay矢量分析法计算手术源性散光度和轴向，比较两组术后不同时间的平均角膜散光度、平均手术源性散光度和术后裸眼视力。结果 术后1周B组平均裸眼视力明显好于A组，差异有显著性（P〈0．05），术后1、3和6个月两组差异无显著性（P〉0．05）。平均角膜散光度和平均手术源性散光度术后1周、1个月和3个月，A组明显大于B组，差异有显著性（P〈0．05）。术后散光以术前逆规性散光最甚，术后6个月两组差异无显著性（P〉0．05）。A组术后散光轴向全部为逆规性变化，B组术后散光轴向以顺规性散光变化为主。结论 颞上侧或鼻上侧切口可有效地减少切口的扩张力并且产生较小的角膜散光，早期可获得良好而稳定的裸眼视力，6mm无缝线角巩膜缘隧道切口安全、可靠。     

先天性肌性斜颈的两种手术方法比较

目的 探讨先天性肌性斜颈两种手术治疗的方法和效果。方法 回顾性分析86例先天性肌性斜颈患者，其中12岁以内者69例，12岁及大于12岁者17例，根据年龄及畸形严重程度的不同采用不同的治疗术式：胸锁乳突肌下端切断术和胸锁乳突肌上、下端切断术加术后牵引治疗。结果 本组86例中随访72例，随访时间1～7年，平均4．5年。从功能和外观两方面进行了术后评价：12岁以下57例，其中优52例(91．2％)，良5例(8．8％)，无劣级；12岁及大于12岁15例，其中优11例(73．3％)，良4例(26．7％)，无劣级。结论 对先天性肌性斜颈患者，应根据不同情况选择恰当的手术治疗术式，一般均可获得满意的效果。     

双抗负压引流管引流效果的观察与护理

目的　研究双抗负压引流管伤口引流的临床应用效果。方法　双抗负压引流管组 2 7例病人 ,乳胶引流管组 2 1例病人 ,采用病历回顾性分析。所有病例引流管放置手术创面由切口旁戳孔引出 ,放置时间不超过 4 8h。结果　双抗负压引流管置管时间短于乳胶引流管 (P <0 .0 5 ) ,而引流量则显著多于乳胶引流管 (P <0 .0 1) ,甲级切口愈合率的比较中也明显优于乳胶引流管 (P <0 .0 5 )。结论　双抗负压引流管置管时间短 ,引流效果好且切口甲级愈合率优于乳胶引流管 ,是一较为理想的引流装置     

沐舒坦、爱喘乐持续气道湿化在颅脑损伤气管切开患者中的应用

目的探讨湿化气道的有效方法，以保证呼吸道通畅，降低脑损伤气管切开后呼吸道并发症。方法将82例颅脑损伤气管切开后患者随机分为2组，实验组采用沐舒坦、爱喘乐加入生理盐水持续气道内滴注，对照组采用传统方法（庆大霉素、糜蛋白酶、地塞米松加入生理盐水）持续气道内滴注，比较2种方法湿化气道的效果。结果沐舒坦、爱喘乐持续气道湿化在湿化程度、预防刺激性咳嗽、气道黏膜出血和肺部感染方面显著优于传统方法（P〈0．05）。结论沫舒坦、爱喘乐持续气道涅化法优于传统方法，能达到满意湿化，减少气道并发症的发生。     

阑尾切除术美容切口与麦氏切口术后恢复效果的对比

目的 对阑尾切除术美容切口与麦氏切口的术后观察与护理进行比较分析.方法 将接受阑尾切除术的患者按手术切口的选择分成2组对照组(MC组86例)为进行传统的经麦氏口阑尾切除术的患者;实验组(MR组76例)为进行经美容切口(改良腹直肌外缘切口)的阑尾切除术的患者.对2组患者术后切口愈合情况、使用止痛剂的次数、下床活动时间、肛门排气时间进行比较分析,并通过单盲法的问卷形式比较2组患者对其切口的满意程度.结果 2组患者的切口愈合情况差别无显著性意义(P＞0.05),MR组患者术后使用止痛剂的次数少于MC组、下床活动时间及肛门排气时间早于MC组,差别有非常显著性意义(P＜0.01),问卷结果差别有显著性意义(P＜0.01).结论 阑尾切除术采用美容的改良式腹直肌外缘切口具有美观、经济、术后恢复快、患者满意,并且为临床护理带来了诸多便利.     

A randomised controlled trial of transverse skin crease vs. vertical midline incision for right hemicolectomy

Abstract.Background: A transverse skin crease incision for right hemicolectomy may result in more rapid recovery than traditional vertical midline incision. This hypothesis was tested with a prospective randomised trial.Methods: Patients from 2 centres undergoing right hemicolectomy were randomised to received a midline or transverse incision. Incision lengths were sufficient to enable unrestricted resection of the right colon. Patients and carers were blinded to the incisions using strategically placed dressings. Analgesia and oral intake were controlled by the patient. Operative details and recovery parameters were compared.Results: A total of 28 patients were randomised. Demographic data and tumour characteristics of the two treatment groups were similar. The transverse incision group had a slightly shorter median wound (10 cm vs. 11 cm, p<0.05). Operative time, analgesia requirements, recovery parameters (time to discharge, 6.5 vs. 6.5 days) and frequency of complications were otherwise comparable.Conclusions: A transverse skin crease incision for right hemicolectomy results in a slightly smaller wound but no other advantages were demonstrated compared with a traditional vertical midline incision.