Gastroplastia de Collis robótica

The true short esophagus is an entity of controversy among surgeons. Studies have been published about its diagnosis and laparoscopic treatment, without existing to date, publication of the treatment with robotic approach. We present, as a case report, our experience in robotic surgery for hiatal hernia with true short esophagus treated with Collis gastroplasty and Toupet fundoplication. Robotic surgery on the true short esophagus can facilitate mediastinal dissection and allow a more accurate suture technique. Studies are needed to compare the long-term results of this surgical technique between the conventional laparoscopic approach and the robotic approach.     

易术心理剧治疗后抑郁症患者真实感受的质性研究

目的描述抑郁症患者参与易术心理剧治疗后的真实感受,探讨易术心理剧对抑郁症的治疗效果。方法从重庆医科大学附属第一医院精神科门诊患者中,筛选符合条件的抑郁症患者,进行易术心理剧团体干预。干预后,对16名参与研究的抑郁症患者进行真实感受的深度访谈并录音,对访谈内容进行转录、编码,描述结果并进行质性研究分析。结果易术心理剧团体干预后,抑郁症患者体验到的负性感受减少,正性感受增加;大部分患者认知发生良性改变、社会功能恢复;患者可将易术心理剧技术和经验带入生活,助人助己。结论易术心理剧团体干预有助于改善抑郁症患者的情绪、认知功能、社会功能,且能让患者在日常生活中持续获益。     

强化心理护理干预在血管神经性头痛患者中的应用效果及对负性情绪的改善作用

目的 探究强化心理护理干预在血管神经性头痛患者中的应用效果及对负性情绪的改善作用.方法 随机抽取2018年7月至2020年7月本院收治的68例血管神经性头痛患者为研究对象,依据护理方法的不同将其分为对照组和观察组,各34例.对照组予以常规护理,观察组在对照组基础上予以强化心理护理干预.比较两组的头痛症状改善情况、负性情绪及自我感受负担.结果 护理后,两组的头痛症状持续时间、头痛程度及头痛发作次数评分均低于护理前,且观察组低于对照组(P<0.05).护理后,两组的DASS-A、DASS-D、DASS-S评分均低于护理前,且观察组低于对照组(P<0.05).护理后,两组的SPBS评分均低于护理前,且观察组低于对照组(P<0.05).结论 强化心理护理干预在血管神经性头痛患者中的应用效果显著,有助于促进患者症状改善,缓解负性情绪及自我感受负担.     

Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge

INTRODUCTIONSplenic artery aneurysms are rare but clinically important entities because of their potential for life threatening rupture. They seldom exceed 3 cms in size and only a few cases of giant splenic artery aneurysms (more than 10 cm size) have been reported until now.PRESENTATION OF CASEA 58 yr old female presented with painless pulsatile progressively enlarging lump in left upper abdomen. Contrast enhanced computed tomography revealed a 10.6 × 10.38 cm aneurysm arising from distal splenic artery along with a normal pancreas. Surgical treatment in form of complete excision of the aneurysm along with spleen and distal pancreas was performed. Gross examination showed an unruptured 12.7 × 11.8 cm true aneurysm of distal splenic artery. Postoperative course was uneventful.DISCUSSIONSplenic artery aneurysms are discovered incidentally and the life time risk of rupture is 28% for giant aneurysms. Even with availability of less invasive procedures such as laproscopy or endovascular treatment, open surgery is mostly preferred.CONCLUSIONGiant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.     

自体动静脉内瘘真性动脉瘤诊治体会

目的总结维持性血液透析患者自体动静脉内瘘真性动脉瘤的发病率、临床表现和处理方法。方法选择2009年1月~2013年12月因自体动静脉内瘘并发症就诊于北京市海淀医院(北京大学第三医院海淀院区)肾内科患者中存在静脉流出道瘤样扩张且瘤样扩张直径大于2cm,除外假性动脉瘤的患者,回顾性分析其人口学特征、临床表现、体格检查联合彩色多普勒超声、血管造影了解真性动脉瘤特征(位置,直径,是否继发血栓,是否存在狭窄,是否存在流出道梗阻)及处理方法。结果真性动脉瘤接受治疗者52例,占同期因内瘘并发症住院患者的2.44%(52/2131),出现时间平均在内瘘建立后24±20个月,动脉瘤平均直径3.12±1.24cm,合并瘤内血栓者18例(34.61%);其中发生在穿刺部位者23例(44.23%),全程瘤样扩张15例(28.85%),吻合口部位14例(26.92%);7例(14.46%)患者因影响美观住院,45例(86.54%)患者存在临床症状,其中皮肤变薄存在破裂风险最常见占25.0%(13/52),其次分别为静脉高压11.54%(6/52)、高输出量心力衰竭11.54%(6/52)、血流量不足11.54%(6/52)、缺血症状9.62%(5/52)、穿刺部位受限7.69%(4/52)、继发感染5.77%(3/52)、破裂出血3.85%(2/52)。合并穿刺区域静脉狭窄者10例,非穿刺部位静脉流出道狭窄/闭塞2例,中心静脉狭窄/闭塞4例。5例患者予结扎内瘘并切除动脉瘤,30例患者行同侧肢体或对侧肢体内瘘重建或加切除动脉瘤,9例患者存在瘘体部位狭窄、3例患者存在中心静脉狭窄予血管成形,5例患者存在内瘘血流量过高予环阻法限流。手术即刻成功率98.08%,未出现严重术后并发症。结论自体动静脉内瘘后,真性动脉瘤是相对少见的晚期并发症,临床表现多样,应根据发生部位结合患者自身血管条件采取个体化治疗。     

真性完全性左束支阻滞情况调查分析

目的：了解完全性左束支阻滞及真性完全性左束支阻滞在不同性别与年龄的发生率情况。方法分析620888例12导联静息心电图检测结果,统计完全性左束支阻滞不同年龄、不同性别的发生率情况。结果完全性左束支阻滞发生率在不同性别之间差异无显著性(Χ2=0.6771,P=0.4106),真性完全性左束支阻滞发生率在不同性别之间差异有显著性(Χ2=15.261,P<0.05)。完全性左束支阻滞发生率与年龄存在相关性(Χ2=671.8555,P<0.05);真性完全性左束支阻滞发生率与年龄存在相关性(Χ2=299.9378, P<0.05)。结论根据本研究推断女性发生真性完全性左束支阻滞即左束支传导功能彻底丧失的概率比男性低,因此在临床工作中女性出现完全性左束支阻滞应仔细判别,是否为左束支功能完全丧失,为临床治疗提供坚实的基础。     

柏拉图分析法在阿尔茨海默病患者照顾者负性感受评价中的应用

目的：用柏拉图分析法对阿尔茨海默病（ AD）患者照顾者负性感受进行评价,对AD患者照顾者负性感受的主要问题及需求进行干预,使AD患者照顾者得到心理和情感支持,减轻负性感受。方法对46例AD患者照顾者进行回访调查,采用柏拉图分析法进行统计分析,找出照顾者需求及问题的要因,并采取针对性护理干预措施,6个月后再次调查,对比干预前后效果。结果干预前A（负担沉重感）、B（与社会分离）、C（体力上的疲倦）三项累积比为49．82％,D（家庭关系紧张）、E（缺乏社会支持）两项所占比重为28．57％（25％～75％）,F（知识的缺乏）、G（对患者感到厌恶）两项所占比重为21．61％（＜25％）。干预6个月后再次调查,A项被选例次从46次下降至30次,B项被选例次从45次下降至29次,C项被选例次从45次下降至25次,三项共计被选例次从136次降至84次。结论通过应用柏拉图分析法对AD患者照顾者负性感受进行统计分析,可发现其中的主要问题,同时也为缓解AD患者照顾者的心理压力、提高其生活质量、满足其身心需求提供了可靠依据。     

Understanding “feeling fat” and its underlying mechanisms: The importance of multimethod measurement

“Feeling fat,” the somatic sensation of being overweight that does not entirely correlate with one's actual weight, is recognized clinically as a maintenance factor in eating disorders. Occurring amidst Western internalized thin ideals and weight stigma, “feeling fat” is wide-reaching and also reported by those with subclinical and absent eating pathology. However, empirical study of “feeling fat” is limited. Regarding proposed mechanisms, “feeling fat” may (a) reflect the displacement of negative affect onto the body, (b) represent one element of a cognitive distortion related to the imagined consumption of fattening food, and/or (c) be a function of impaired interoceptive awareness. However, the relative and/or joint contributions of these mechanisms to “feeling fat” are unclear. Regarding measurement, retrospective assessment with single items has been the norm. Innovative measures of “feeling fat” will expand our understanding of this construct. Ecological momentary assessment can clarify the transitory nature of this experience, and physiological measures can allow for assessment of somatic elements of “feeling fat. Multi-method and implicit measurement strategies of ‘feeling fat’” may clarify the mechanisms underlying this experience. Further research with improved measurement techniques may also benefit eating disorder treatment by highlighting new treatment foci (e.g., cognitive distortions, interoceptive awareness).     

Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy

ObjectiveTo assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.MethodsWe examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.ResultsResection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01).ConclusionIctal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.SignificanceSuch an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.