老年急重症胆管炎临床分析

目的：探讨重症胆管(ACST)患者的临床特点及死亡原因。方法：分析我院近十五年来收治46例ACST的治疗情况。结果：手术41例．非手术5例，死亡9例，其中手术治疗死亡6例。结论：老年ACST患者，伴发病多，死亡率高，及时就诊，早期应用大量激素，选择适宜手术方法是降低死亡率的关键。     

The Post Therapy Breast

Both systemic and local therapy, for conditions of the breast and unrelated to it, may produce manuno-graphic changes. Some of these are characteristic, such as the pattern of scarring seen in reduction mammo-plasty. In many other instances, however, the changes produced overlap features commonly seen in malignancy. A knowledge of the timing, natural history and spectrum of these changes will aid mammographic interpretation.     

脑干区占位病变的手术入路

本文报告了1990年5月以来脑干区大型、复杂占位病变15例.其中,位于脑干内3例,脚间窝2例,岩尖部4例,全岩骨区1例,全斜坡区2例,第四脑室内3例.本组采用以扩大了的岩骨入路为主的联合入路,行肿瘤全切除8例,次全切除5例.2例仅作了活检加减压术.除1例死亡外,均恢复良好.本文结合文献,对脑干区手术入路进行了讨论.     

急性出血坏死性胰腺炎手术治疗的临床观察

总结了经手术证实为急性出血坏死性胰腺炎的５３例患者的手术疗效。发现该病应早期手术。若发病４天后手术，体温在３８℃以上、脉搏超过１２０次／分、收缩压在１２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）以下、有弥漫性腹膜炎、白细胞高于１６×１０９／Ｌ和术后有重要器官功能衰竭者，术后病死率明显增高。手术方法以胰腺坏死组织清除加三造瘘、腹腔三套管持续冲洗为优。抑制胰腺分泌的药物主要选用５氟脲嘧啶。引起胰腺感染的常见病原菌依次是大肠杆菌、肺炎克雷白杆菌、肠球菌、金黄色葡萄球菌、绿脓杆菌、奇异假单胞菌、链球菌、产气肠杆菌和脆弱类杆菌９种细菌。选用抗生素应遵守３个原则：①抗生素必须能通过血胰屏障。②能在胰腺组织中形成有效的治疗浓度。③能有效地抑制引起胰腺感染的病原菌。这样，才能取得良好的治疗效果。     

自发性食管穿孔的治疗改进

报道７例自发性食管穿孔治疗经验，并对诊断和治疗和治疗新方法进行了讨论，自发性食管穿孔早期诊断的重要依据是迅速获得完整，详细的发病史。可疑时通过食道造影，胸腔穿刺刺液的分析而确诊。一经确诊应急取早期食管修补，对发病时间长，全身情况差的病人，经积极准备后仍应急取食管修补，对不宜手术者给予食管冲洗促进穿孔愈合。同时给予有效的食管腔内外引流。     

KENNETH FITZPATRICK RUSSELL: THE FIRST READER TO THE GORDON CRAIG LIBRARY

A review of the life and achievements of Kenneth Fitzpatrick Russell, whose death in his 76th year robbed us of a civilized gentleman who was at the zenith of his creative output, would be a daunting task, if only because of the breadth of his hobbies and interests: art and medical literature; reading; sinology and seal carving; numismatics, medical philately; bookbinding, collecting bookplates; carpentry; metal work, including pewter casting and silversmithing; model ship building and cooking. Yet these various interests were simply a backdrop to his public career at the University of Melbourne and the Royal Australasian College of Surgeons, where he laid the foundations of an international reputation as scholar and collector.     

Gastric Bypass for Morbid Obesity: a Standard Surgical Technique by Consensus

Background: The gastric bypass operation has evolved since 1966 when it was first introduced. The purpose of this study was to determine the present state of gastric bypass by consensus among the members of the American Society for Bariatric Surgery (ASBS). Method: A questionnaire was sent to all members of the ASBS. Forty-three percent responded reporting over 41,200 cases. Results: Results were analyzed by using χ² tests with a null hypothesis. Surgeons agreed on several technical aspects, preferring a vertical to a horizontal stapleline; estimating, rather than measuring, the pouch volume at an average of 22 cc. Few surgeons divide the short gastric vessels, and only 25% of surgeons polled use a restrictive ring or band proximal to the gastroenterostomy. Most surgeons calibrate the gastroenterostomy, reporting a preferred average diameter of 12.3 cm. There was no consensus regarding forming the gastroenterostomy, 58% preferring hand-sewn and 42% stapled anastomoses. There was no consensus regarding dividing the gastric pouch from the bypassed stomach: Conclusion: The preferred gastric bypass is vertical, with the pouch estimated at 20-25 cc, and the gastroenterostomy calibrated at 12 mm diameter. The short gastric vessels need not be divided, and restrictive bands or rings are not preferred. This technique of gastric bypass should be used as the control procedure when modifications are tested in future trials. Randomized prospective studies are suggested to probe the benefits of division of the stomach pouch from the bypassed stomach.     

Hygiene in Operationsabteilungen – Empfehlungen des Nationalen Referenzzentrums für Krankenhaushygiene

Zusammenfassung. Viele Hygienema?nahmen in Operationsabteilungen sind durch wissenschaftliche Untersuchungen nicht belegt. Die in dieser Arbeit vom Nationalen Referenzzentrum für Krankenhaushygiene, das 1996 vom Bundesgesundheitsministerium eingerichtet wurde, zusammengestellten Empfehlungen stützen sich auf die Ergebnisse wissenschaftlicher Untersuchungen und trennen so die unbedingt notwendigen von den weniger bzw. nicht sinnvollen Ma?nahmen.

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Summary. Many hygienic procedures performed in operation units are not supported by scientific investigations. The following recommendations by the National Reference Center for Hospital Epidemiology, founded by the German Ministry of Health in 1996, are based on the scientific literature and separate necessary from less necessary and unnecessary procedures.

     

皮肤软组织扩张器在整形外科中的应用

作者应用皮肤软组织扩张器进行软组织缺损修复１３例，全鼻再造１例，除１例皮瓣远端血运不佳外，其余病例均获满意效果。本文介绍了皮肤软组织扩张术的优点及适应症，重点讨论了下列问题：①皮肤扩张面积的估计；②扩张囊埋植层次；③注射壶、连接导管的安放位置；④纤维囊的处理；⑤扩张皮瓣的正确设计。     

Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy

The effect of thoracic (T7-8) epidural etidocaine 1.5%, 9 ml, and continuous per- and postoperative epidural infusion of etidocaine 1.5%, 4 ml/h, on early (less than 500 ms) somatosensory evoked potentials (SEPs), and cortisol and glucose in plasma during cholecystectomy, was examined in ten patients. Spread of analgesia (pin-prick) was T3 (T1-T3) to L2 (T11-L3) 35 min after injection of etidocaine, and T3 (T2-T4) to T12 (T8-L4) 3 h after surgical incision (median (range)). Before operation, epidural etidocaine had no significant effects on peak-to-peak amplitude of SEPs to electrical stimulation at the L1, T10 or T6 dermatomal level (P greater than 0.09). SEPs were abolished in only two patients at T6, and no patient had SEPs abolished at T10 or L1. The plasma concentrations of cortisol and glucose were significantly increased 20 min after surgical incision and remained increased throughout the study. No correlation was found between the block-induced decrease in the peak-to-peak amplitude at T6 or T10 and increase in plasma cortisol, except for a negative correlation at T10 and the initial increase in cortisol (Rs = 0.72, P = 0.03). In conclusion, thoracic epidural administration of 9 ml of etidocaine 1.5% does not provide total afferent somatic blockade assessed by SEP and the stress response to cholecystectomy.