Chlorimipramine,electroconvulsive shock and combination thereof: Differential effects of chronic treatment on apomorphine-induced behaviours and on striatal and mesocortical dopamine turnover

Summary We studied the influence of different pretreatment regimens (Chlorimipramine-Cmi, electroconvulsive shock-ECS, and Cmi+ECS all regimens being applied for either 2 or 15 days) on the open field behaviour, on the striatal and on the prefrontal dopamine-PFC DA turnover in rats injected with either apomorphine-AP 25 g/kg (stimulating presynaptic DA receptors), AP 200 g/kg (stimulating postsynaptic DA receptors), or vehicle (control).In the controls, AP 25 g/kg reduced the locomotor activity and the striatal, but not the PFC DA turnover. AP 200 g/kg increased the locomotor activity and reduced the striatal but not the PFC DA turnover.Short-term pretreatment: ECS and Cmi+ECS prevented the decrease of striatal DA turnover after AP 25 g/kg. No other influence of any pretreatment on behaviour or DA-turnover became significant.Long-term pretreatment: Chronic Cmi: marginally increased the open field behaviour and marginally decreased the PFC DA turnover; significantly increased the effect of AP (200 g/kg) on striatal DA turnover and the effect of AP (25 and 200 g/kg) on PFC DA turnover. Repeated ECS: decreased locomotion and rearing and increased PFC DA turnover; increased the effect of AP (200 g/kg) on locomotion and on striatal DA turnover; decreased the effect of AP (25 and 200 g/kg) on PFC DA turnover.Chronic Cmi+ECS: decreased locomotion and rearing and marginally decreased PFC DA turnover; increased the effect of AP on hyperlocomotion and on striatal DA turnover. No other influence of any chronic pretreatment on behaviour or on DA turnover became significant.The data support the view that chronic AD therapies increase DAergic functions related to postsynaptic rather than to presynaptic structures. It is suggested that the different effects of chronic Cmi and repeated ECS on AP-evoked PFC DA turnover help to understand the different influences exerted by both treatments on rats' behaviour.     

Culturally diverse patient--nurse interactions on acute care wards

The nurse-patient interaction is central to providing nursing care. This qualitative study explores nurses' and culturally diverse patients' experiences within nurse-patient relationships in acute care wards. Eight nurses and their respective patients volunteered to join the study and were interviewed. The three themes identified in relationships between nurses and culturally diverse patients were shared tension, perceived difference and held awareness. It is concluded from the study that relationships between nurses and culturally diverse patients in acute care wards during short episodes of hospitalization are not easy for nurses and need to receive deeper consideration as to how they can be developed more effectively. It is recommended that educational support be provided to develop more effective interactions between nurses and patients with research being carried out to investigate factors that can strengthen culturally diverse patient-nurse interactions in acute care settings.     

Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer

Background Laparoscopic resection (LR) has become increasingly popular for the management of rectal cancer. Despite a decade of experience, the safety and efficacy of LR for rectal cancer remains to be established. This report performs a meta-analysis to compare LR with conventional open resection (CR) in patients with rectal cancer.Methods Using a defined search strategy, studies directly comparing CR with LR for rectal cancer were identified. The data for patients with rectal cancer treated with both approaches were extracted and used in our meta-analysis. Open surgery and laparoscopic surgery were compared in terms of postoperative mortality, morbidity, complications, oncological clearance, operating time, and time before recovery to a normal diet.Results Compared with CR, LR is associated with lower morbidity rates [OR 0.63 (0.41, 1.96) P=0.03], longer operating times [weighted mean difference 1.59 (1.20, 1.98) P<0.00001], similar mortality rates, wound healing disorder rates, urinary disorder rates, cardiopulmony disease rates, all leakage rates, all abscess rates and a positive rate of margin.Conclusion LR is associated with less postoperative morbidity, but longer operation time. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.     

Bile Duct Injuries Associated with Laparoscopic and Open Cholecystectomy: An 11-Year Experience in One Institute

Purpose Bile duct injury (BDI) represents the most serious complication of laparoscopic cholecystectomy (LC). The aim of this retrospective single-institution study was to evaluate the real incidence of BDI during laparoscopic and open cholecystectomy (OC) in a tertiary academic center in Athens, Greece.Methods Between January 1991 and December 2001, 3 637 patients underwent cholecystectomy in our department; as LC in 2 079 patients (LC group) and as OC in 1 558 patients (OC group). All the LCs were performed or supervised by five staff surgeons and all the OCs were performed or supervised by another five staff surgeons.Results There were 13 BDIs associated with LC (0.62%) and 6 associated with OC (0.38%) (P = 0.317). There was one death associated with BDI after LC. Only two (15.4%) of the BDIs associated with LC occurred within the proposed learning curve limit of 50 LCs per individual surgeon.Conclusion Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence.     

Laparoscopic and open gastric resections for malignant lesions: A prospective comparative study

Background Whereas laparoscopy for benign diseases provides clear advantages over traditional surgery, the benefits of laparoscopic gastric resection for malignant diseases are less clear. The objectives of this study were to compare prospectively the clinical outcomes between completely laparoscopic and open total and partial gastrectomies for malignant diseases and to assess whether laparoscopic gastrectomies obtain adequate margins and follow oncologic principles.Methods Between April 1995 and March 2004, a prospective comparative study was performed comparing eight patients who underwent laparoscopic total gastrectomy with 11 patients who underwent open total gastrectomy, and 16 patients who underwent laparoscopic partial gastrectomy with 17 who patients underwent open partial gastrectomy. Stage, extent of lymphadenectomy, and long-term follow-up were examined. The intraoperative and postoperative details of the two groups were compared.Results The laparoscopic group patients had fewer intraoperative complications while the operative time was similar to that of the open group. Both ambulation and hospital stay were significantly shorter in the laparoscopic groups than in the open groups. The short-term morbidity was lower in the laparoscopic groups and there were no cases of death, whereas one case of postoperative death occurred after an open total gastrectomy. There was no need to convert to open surgery. The number of lymph nodes obtained in the laparoscopic and open procedures was not significantly different. In addition, all resected margins were tumor free in the laparoscopic group, whereas tumor involvement was presented in the margin of one specimen in the open group.Conclusions The totally laparoscopic approach to total and partial gastrectomies had good results and was proven to be a feasible and safe procedure. In addition, the laparoscopic procedures are superior to open surgeries in terms of faster postoperative recovery, shorter hospital stay, and better cosmetic outcomes. A totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.     

胫骨上段开放性骨折合并胭动脉损伤的临床观察及远期功能随访

目的:观察GustiloⅢC型胫骨开放性骨折的保肢治疗过程及功能恢复情况。方法:GustiloⅢC型胫骨开放性骨折16例共18肢,急诊行清创、骨折固定、动静脉修复术,1例双侧骨折术后24 h行双大腿下段截肢术,1例双侧骨折急诊行一侧膝下截肢术,其余15肢经4~9次(平均5次)手术保存下来,4例行游离胸脐皮瓣,2例行游离背阔肌皮瓣,其余行腓肠肌内侧头肌皮瓣或局部转移筋膜皮瓣修复软组织缺损。骨缺损取自体髂骨移植修复。术后随访12~49个月,平均19个月。修复后的小腿功能按照Puno等的标准评定。结果:15肢软组织缺损全部修复,1例已伤后72个月,骨折仍未愈合。15肢均有明显的垂足、垂趾等畸形。功能评定均为差。结论:对GustiloⅢC型胫骨开放性骨折保肢应非常慎重,特别是伴有足踝部软组织及踝关节损伤,或肢体已明显缩短,或胫神经损伤预计足底难以恢复保护性感觉,或挤压伤伴热缺血时间大于6 h,预计小腿肌肉会发生广泛的坏死和感染,应考虑一期行膝下截肢术;如经多次扩创,小腿肌肉已大部分坏死、缺失,亦应行膝下截肢术。     

利用无线局域网实现无纸化查房

无线局域网络作为对现有覆盖整个医院信息系统的拓展，具有灵活、方便的特点，因而广泛应用于医疗卫生领域；中山市人民医院充分利用无线局域网实现了无纸化查房。     

不同等级环境对大、小鼠及其应用的影响

目的了解不同等级环境（屏障环境和普通环境）对实验大小鼠的一般生理表现和抗应激能力以及对药物反应的影响，初步判定严格的微生物控制是否影响实验动物的人类模型作用。方法将40只SPF级Wistar大鼠和200只SPF级BALB／c小鼠分别饲养于屏障环境和普通环境内，通过以下实验对比观察不同等级环境对实验大、小鼠及其应用的影响：每周测量动物的体重增长情况；饲养35d后，测定大鼠15项血液学指标、14项血液生化指标和9个脏器的相对重量；以抗缺氧实验和游泳实验判断对小鼠体质和抗应激能力的影响；以5．氟尿嘧啶急性毒性实验和戊巴比妥钠麻醉实验测试其对药物作用的异同。结果在5周观察期内，屏障环境饲养小鼠和大鼠的体重增长均明显快于普通环境的对照动物（P〈0．05）；普通环境饲养大鼠的血液RBC、WBC、PCT、PLT、GOT、GGT、GPT、CK、TB值高于屏障环境大鼠（P〈0．05），而CHO、LDL-C和HDL-C值低于屏障环境大鼠（P〈0．05）；不同微生物环境条件饲养小鼠的游泳耐力和抗缺氧实验结果接近，但是屏障环境组动物所获数据的变异较小；不同等级环境条件饲养小鼠的戊巴比妥钠麻醉反应和5-氟尿嘧啶中毒反应相似，而屏障环境组动物的麻醉维持时间较短，LD50较低，95％可信限狭窄。结论饲养于屏障环境和普通环境的实验大、小鼠在一般生理表现上出现部分差异，动物的抗应激能力和对药物的反应未发生显著变化；在屏障环境条件中，动物的药物反应更敏感、所获数据更稳定，因此，初步认为严格微生物控制条件下的SPF级动物可以作为生活在自然环境中的人类的模型动物。     

A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs

Background: Although ventral hernia repair is increasingly performed laparoscopically, complication rates with this procedure are not well characterized. For this reason, we performed a prospective study comparing early outcomes after laparoscopic and open ventral hernia repairs. Methods: We identified all the patients undergoing ventral (including incisional) hernia repair at a single tertiary care center between September 1, 1999 and July 1, 2001 (overall n = 257). To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, nonelective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. Postoperative complications (in-hospital or within 30-days) were assessed prospectively according to standardized definitions by trained nurse clinicians. Results: Of the 136 ventral hernia repairs that met the study criteria, 65 (48%) were laparoscopic repairs (including 3 conversions to open surgery) and 71 (52%) were open repairs. The patients in the laparoscopic group were more likely to have undergone a prior (failed) ventral hernia repair (40% vs 27%; p = 0.14), but other patient characteristics were similar between the two groups. Overall, fewer complications were experienced by patients undergoing laparoscopic repair (8% vs 21%; p = 0.03). The higher complication rate in the open ventral hernia repair group came from wound infections (8%) and postoperative ileus (4%), neither of which was observed in the patients who underwent laparoscopic repair. The laparoscopic group had longer operating room times (2.2 vs 1.7 h; p = 0.001), and there was a nonsignificant trend toward shorter hospital stays with laparoscopic repair (1.1 vs 1.5 days; p = 0.10). Conclusions: The patients undergoing laparoscopic repair had fewer postoperative complications than those receiving open repair. Wound infections and postoperative ileus accounted for the higher complication rates in the open ventral hernia repair group. Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair. Drs. Birkmeyer and Finlayson were supported by Career Development Awards from the VA Health Services Research and Development program. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.     

A comparative study of the audiological outcomes with Retro-X (semi-implantable hearing aid system) and conventional open fitting hearing aids

The objective of this study was to compare the results of hearing augmentation with the Retro-X semi-implantable hearing aid to a conventional non-implantable open canal hearing aid using the same software technology (Titan-X, auric Hearing Systems, HiKaNo.:13.20.03.0047). Nineteen subjects (20 ears) with mild to moderate high-frequency sensory-neural hearing loss were included in this clinical study. All the subjects were first fitted with a conventional open canal hearing aid (Titan-X). After a period of 4-6 weeks audiological evaluations were performed using standardized speech tests in quiet and noise. Subjective evaluation was performed with the help of standardized questionnaires. After this phase the patients received the semi-implantable Retro-X device under local anaesthesia and 4 weeks later were fitted with a hearing module with the same software technology as the conventional Titan-X hearing aid. Four weeks following the first fitting the same audiological evaluations were performed under similar conditions and the patients were evaluated again using the same questionnaires in order to compare the results of the Retro-X semi-implantable system with the conventional open canal hearing aid. Audiological evaluations revealed better results with the semi-implantable Retro-X in the adaptive speech in noise test; however, the results of the monosyllabic word test in quiet were similar for the Retro-X and conventional open canal hearing aid. The patients subjectively preferred the improved wearing comfort of the semi-implantable device. The Retro-X semi-implantable hearing aid provides better speech perception in noise and higher wearing comfort in comparison to the conventional open canal hearing aids. Considering the simple implantation procedure under local anaesthesia with low complication rate, Retro-X is an alternative to the conventional open canal hearing aids in patients with mild to moderate high frequency sensory-neural hearing loss.