Subacute posttraumatic ascending myelopathy (SPAM): A potential complication of subarachnoid shunt for syringomyelia?

Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures.

Findings: The authors present the case of an 81-year-old woman who developed an unusual neurological deterioration resembling a subacute posttraumatic ascending myelopathy (SPAM) after the insertion of a syringosubarachnoid shunt for the treatment of slow-growing D10 syringomyelia.

Conclusion/Clinical Relevance: To date, no cases of SPAM secondary to the insertion of a syringosubarachnoid shunt for the treatment of syringomyelia have been reported. The potential pathogenesis related to this phenomenon is discussed.     

多囊卵巢综合征妊娠患者与非多囊卵巢综合征孕妇妊娠结局比较

目的比较多囊卵巢综合征(PCOS)妊娠患者与非PCOS孕妇的妊娠结局。方法选取200例PCOS妊娠患者作为研究组,并选取同期200例非PCOS孕妇作为对照组,比较两组孕妇的妊娠结局、新生儿情况及妊娠期并发症情况。结果研究组的先兆流产、早产、足月剖宫产发生率显著高于对照组(P <0.05);两组的先兆早产发生率比较无统计学差异(P>0.05)。两组的新生儿情况比较无统计学差异(P>0.05)。研究组的妊娠期高血压综合征、妊娠期糖尿病、羊水异常、胎儿窘迫发生率显著高于对照组(P <0.05)。结论与非PCOS孕妇相比,PCOS妊娠患者的早产风险增加,且妊娠期高血压综合征、妊娠期糖尿病、羊水异常、胎儿窘迫发生率显著升高。     

黄连解毒汤对重度颅脑损伤合并肺部感染患者血气指标和炎症因子影响分析

目的:观察黄连解毒汤对重度颅脑损伤合并肺部感染患者血气指标和炎症因子的影响,探讨其治疗效果。方法:随机抽签方式将77例重度颅脑损伤合并肺部感染患者分为两组。对照组35例接受常规治疗,研究组42例在常规治疗基础上,联合黄连解毒汤直肠灌注及全身擦浴治疗。评估两组临床效果,记录两组呼吸机使用时间、ICU入住时间及治疗费用,测定两组治疗前后血气指标和炎症因子。结果:两组临床治疗效果间差异无统计学意义(P>0.05)。与对照组比,研究组呼吸机使用时间和ICU入住时间明显缩短,ICU治疗费用显著减少(P<0.01)。治疗后两组SaO、PaO₂水平明显上升,PaCO₂及血清PCT、IL-1β、HMGB-1、CRP水平明显下降(P<0.05)。组间比较,研究组SaO、PaO₂水平高于对照组,PaCO₂及血清PCT、IL-1β、HMGB-1、CRP水平低于对照组(P<0.05)。结论:黄连解毒汤直肠灌注联合全身擦浴可明显控制重度颅脑损伤合并肺部感染患者感染病症,改善血气指标,调节炎症反应,缩短呼吸机使用时间和ICU入住时间,减少患者的治疗费用。     

A peripherally inserted central catheter misplacement into lateral thoracic vein: A case report

IntroductionCentral venous catheter applications and complications are closely related to the tip position. Previous studies have reported some rare cases of catheter misplacement. Here, we report a case of misplacement of a peripherally inserted central catheter into the lateral thoracic vein.Case reportA 56-year-old cancer patient underwent placement of a peripherally inserted central catheter through the left basilic vein under ultrasound-guided puncture. The catheterisation procedure was uneventful, so the catheter was believed to be in the superior vena cava. However, the post-anterior chest X-ray image revealed that after the catheter advanced towards the axilla, it turned downwards and outwards in the direction of the left lateral thoracic region, with the projection of the catheter tip giving the appearance of termination in the subcutaneous tissue of the lateral thoracic wall on the two-dimensional image. The catheter was then repositioned in the distal superior vena cava.DiscussionPeripherally inserted central catheters can be potentially misplaced into the lateral thoracic vein because these catheters can pass through the orifice of the lateral thoracic vein which flows into the axillary vein. Some pathological cases and clinical conditions can cause dilatation of the lateral thoracic vein, which increases the probability of catheter misplacement. Three principles were proposed to avoid this rare complication: a comprehensive review of the patients’ medical history, real-time image-guided catheterisation and routine radiographic identification of the tip position.     

Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

A retrospective study of 1058 liver transplant recipients was performed to determine: (i) the incidence, etiology, timing, clinical features and treatment of refractory ascites (RA), (ii) risk factors for RA development, (iii) predictors of RA disappearance, (iv) predictors of survival following RA and (v) the impact of RA on patient survival. Sixty-two patients (5.9%) developed RA and its disappearance occurred in 27/62 cases. Patients having hepatitis C virus (HCV) had a significantly higher hazard rate of developing RA (p < 0.00001). No other baseline characteristic was associated with RA. Cox stepwise regression analysis of the hazard rate of RA disappearance found two significant factors: HCV recurrence as the reason for developing RA implied a poorer outcome (p = 0.006), whereas an unknown reason implied a favorable outcome (p = 0.02). In addition, survival following RA was significantly poorer among patients having bacterial peritonitis or HCV recurrence. Finally, the mortality rate was significantly (nearly 8.6 times) higher in patients following RA development while it was ongoing (p < 0.00001); however, if the RA disappeared, then the additional risk of death also disappeared. This study illustrates the importance of developing an optimal treatment strategy to (i) effectively treat RA if it develops and (ii) prevent hepatitis C recurrence.     

白内障超声乳化摘除及人工晶体植入术1123例临床小结

目的本文对2004年3月9日至2004年5月13日“健康快车”短期为大批量贫困的白内障患者免费行白内障超声乳化及人工晶体植入术1123例(1136眼)进行回顾性分析总结。方法比较透明角膜切口及巩膜隧道切口二种术式的术后反应、并并症、术后视力、以及术后用药情况。结论本组病例术后三天脱盲率90.5%,脱残率70.68%,透明角膜切口植入硬性人工晶体术后反应重,易发生伤口裂开虹膜嵌顿,不宜采用。白内障术后勿需全身用药。     

A Decade of Change in Obesity Surgery

Background: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade of 1986 through 1995, as observed in the IBSR data. Methods: All data submitted to the IBSR during the decade were transferred to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (χ²) test for gender. Results: There has been a steady increase over the decade in mean patient weight. The operations used have changed from predominantly ‘simple’ operations to more frequent use of ‘complex’ operations. Within the categories of ‘simple’ and ‘complex’, an increase in the variety of operations occurred. As a group, patients with ‘simple’ operations have been heavier, more often male and public pay patients than those who have undergone ‘complex’ operations. One year weight loss was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to study the relative merits of the operations used. The reported incidence of operative mortality and serious complications (leak with peritonitis, abscess and pulmonary embolism) remained low. Conclusions: These observations and their implications can be summarized in three statements which relate to action for improved patient care in the beginning of the new century: (1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread use of both ‘simple’ and ‘complex’ operations with increased modifications of standard RGB and VBG procedures emphasizes the need for standardized long-term data and analyses regarding both weight control and postoperative side-effects.     

鹿角状肾结石开放取石的术式选择

目的:探讨鹿角状肾结石开放取石的术式选择、预防术中意外切肾和术后失肾的措施。方法:术中根据结石形态与肾脏解剖关系选择术式。对23例鹿角状肾结石患者行开放取石术治疗,左肾鹿角状结石9例,右肾10例,双肾4例。手术前后加强防治感染,术后充分引流,以预防术后失肾。结果:手术均顺利完成,结石均于术中取尽。术中无一例意外切肾。术后1个月随访全部患者的术侧肾脏功能恢复良好。结论:对鹿角结石,根据结石的形态、分布、肾盂类型、肾积水状态和肾实质厚度等因素综合判断,选择合理的术式,能保障手术安全、干净取石。     

留置超滑乳胶气囊导尿管并发症的原因分析及对策

目的探讨留置超滑乳胶气囊导尿管并发症的原因及对策。方法对586例留置超滑乳胶气囊导尿管患者进行观察,回顾分析。结果留置超滑导尿管并发症与导尿方法、规范操作、留置导尿管的时间及相关知识宣教有关。结论严格无菌操作,选择合适的导尿管、缩短留置尿管的时间是降低并发症的重要措施。