PHS 应用在腹股沟马鞍疝无张力修补术11例分析

目的 探讨PHS在腹股沟马鞍疝无张力修补术中的治疗效果和手术经验.方法 对11例使用PHS行无张力修补术的腹股沟马鞍疝患者进行分析.结果 在局麻下完成手术,手术时间25～60 min,全组留院观察24～72 h,无阴囊积液、切口感染、血肿及其它与手术有关的并发症.随访6个月～30个月,无复发,无异物感.结论 PHS修补牢靠,对于腹股沟马鞍疝的手术治疗更有针对性.重视手术的技巧是手术成功的关键.     

Cloned cellular reagents to define antigens encoded between HLA-DR and glyoxylase

Primed lymphocyte typing reagents have been used to define antigens encoded by genes of a locus (loci) mapping between HLA-DR and glyoxalase I. This locus, which we shall refer to as the third locus of the HLA-D region, has been variously referred to as D beta, PL beta, PL3, and SB. Generating discriminatory primed lymphocyte typing reagents which can be used to define these antigens, however, has been extremely difficult. Donors of responding and stimulating cells for the priming combinations have usually been matched not only for the DR, D, and MB/MT antigens but also for the HLA-A, -B, and -C antigens. Even under these very restricted conditions, not all bulk primed lymphocyte typing reagents that are generated are discriminatory enough to be useful for antigen definition. We have derived "clones" from bulk priming combinations in which stimulator and responder differed for known antigens of this third locus. Even though the bulk reagents that were prepared did not provide discriminatory results, approximately 7-12% of the clones derived from the bulk priming combination proved to be highly discriminatory. We have been able to obtain these results with regard to all three antigens of the third locus so far evaluated. The very ease of screening clones and deriving discriminatory reagents, as compared with screening responder-stimulator combinations, allows the ready derivation of cellular reagents that define the antigens of this third locus.     

Changing the paradigm of organ utilization from PHS increased‐risk donors: an opportunity whose time has come?

Approximately 8–11% of all organ donors are classified by Public Health Service (PHS) as increased‐risk. The proportion of PHS increased‐risk donors is on the rise. At the University of Washington Medical Center, in 2014, the proportion of transplants from PHS increased‐risk donors was 28% of liver transplants and 23% of kidney transplants. Nationally, transplant providers have been reluctant to use organs from PHS increased‐risk donors because of concern for transmission of HIV, HCV, or HBV. There is also patient apprehension when these organs are being offered, and thus the discard rate of these otherwise good quality organs is high. Because of the organ shortage, preventing underutilization of such organs is essential. We provide data and considerations that should be used to guide the use of organs from PHS increased‐risk donors.     

Spigelian Hernia

We report on the evolution in concept and techniques that allowed us to improve the treatment of spigelian hernia, operable in day surgery in 90% of cases and through a preperitoneal and recently a preperitoneal and subfascial prosthetic repair (PHS). Background data. We propose an innovative use of the PHS mesh for spigelian hernia repair. With this new implementation, we confront the standard surgical technique and its postoperative period. Methods. From January 1992 to March 2004, we performed 2,500 hernia surgical operations, including 32 spigelian hernia repairs (1.3% of total case series). The first surgical approach used for 20 of these 32 patients (62.5% of total spigelian hernias), all electively operated on, was a classical preperitoneal repair (Wantz), performed when possible by size of defect and weight (Body Mass Index) of the patient, under local anesthesia and on a day-surgery basis. Our new modified technique takes place through the insertion of a PHS large-type mesh, whose bottom underlay portion lies flat in the preperitoneal space with the connector obliterating the hernial orifice and with the overlay portion lying on the internal oblique muscle, covered by the aponeurosis of the external oblique muscle. Results. Our modification to the classical technique consisted only in the application of a product, such as the PHS, in a hernia defect, which presented with an orifice of the size of the connector and, therefore, was easily repairable with the use of the PHS device. This approach is easier than the preperitoneal approach, its always suitable for local anaesthesia, and it gives a more comfortable postoperative period. The surgical approach may be performed completely in day surgery. Conclusions. We believe that spigelian hernia surgical repair should always be performed by means of a preperitoneal prosthesis under local anaesthesia when the patients clinical and physical conditions allow for it, always in day surgery, and using the PHS mesh when the hernia defect size fits with the connector diameter. This last possibility seems to be easier and more comfortable for the patient in the postoperative period.     

Basis for public health surveillance of Guillain-Barre syndrome in Sweden

We explored the basis for public health surveillance (PHS) ofGuillain-Barré syndrome (GBS) in Sweden. Time-seriesanalyses were performed by using autoregressive integrated movingaverage (ARIMA) models on GBS-related hospital-discharge data,namely monthly incidence rates in Sweden during the period 1978–1992and bimonthly numbers of new cases in Stockholm County duringthe period 1973–1992. In general, the predicted valuesfor 1993 fitted well with the observed figures. However, inline with prior analyses, the observed monthly incidence ratesfor April and May 1993 among the under 40 years age group inSweden were below the lower limit of the 95% confidence intervalsfor the corresponding predicted values. Furthermore, a seasonalpattern was detected. When the 1993 forecasts were used forretrospective examination of the data, significant variationsin GBS incidence rates were found for certain time periods.Some such signals corresponded to known high-risk periods in1978 and 1983. The results suggest that monthly or bimonthlyforecasts of GBS incidence can be obtained from ARIMA modelsapplied to registered GBS diagnostic data. PHS of GBS couldhave detected the zimeldine-induced GBS epidemic in 1983 aswell as the increases in GBS incidence with unknown cause in1978 and 1983.     

普理灵疝装置在老年复发性腹股沟疝中的应用

目的：探讨普理灵疝装置（PHS）在老年复发性腹股沟疝中的临床应用价值。方法：回顾性分析应用普理灵疝装置治疗老年复发性腹股沟疝病人28例的临床资料。结果：28例手术均成功,平均手术时间50min,随访2-30个月,无复发病例。结论：普理灵疝装置无张力疝修补术是治疗老年腹股沟复发疝的理想术式,增加可靠性,降低手术难度,创伤小,恢复快,复发率低,特别注意老年人围手术期的处理和“个体化”。     

普理灵疝装置在腹股沟疝无张力修补术中的应用观察

目的：探讨普理灵疝装置（PHS）在腹股沟疝无张力修补术中的临床应用。方法：对我院收治的96例局麻下使用PHS行腹股沟疝无张力疝修补手术的病例资料进行分析,观察手术方法及时问、术后疼痛、术后自主功能的恢复、并发症、复发率及住院时间等。结果：本组病例手术均顺利完成,平均手术时间50min;术后疼痛轻,当天即可下床活动;术后5—7d出院。随访1—12个月无复发．无伤口感染、慢性疼痛、异物感等并发症。结论：局麻下PHS补片无张力疝修补术具有操作简单、损伤轻、痛苦小及术后恢复快。并发症少,复发率低等优点,是安全有效的无张力疝修补法。     

PHS术式治疗巨大腹股沟疝的临床分析

目的:探讨PHS(polypropylene hernia system,PHS)术式治疗巨大腹股沟疝的可行性和优越性.方法:自2007年7月至2011年7月,我院采用PHS术式治疗12例巨大腹股沟疝患者,入选病例疝环缺损直径》5cm并且疝直径》20cm,通过病历资料回顾获得随访数据.结果:12例患者手术时间为80-135分钟,平均98分钟,术后住院时间(5~8)天,平均6.8天,术后2例(16.67%)出现阴囊积液,经穿刺抽液后痊愈.术后随访10个月~40个月,平均22.4个月,无复发.结论:PHS术式治疗巨大腹股沟疝安全可行,具有复发率低等优点.