On prognosis and treatment of acute severe pancreatitis with severe uremia

The prognosis of patients with acute pancreatitis and severe uremia is very poor. The mortality is nearly 80 per cent. In uremia requiring dialysis the mortality is 90 per cent in published materials. The slightly uremic patients, when dialysed, had a better prognosis than the severely uremic patients. The mortality in our material, consisting of cases usually dialysed at a late stage, was 100 per cent. Dialysis in these cases seems rather useless, considering the patients' severe cell damage caused by the toxic products emanating from the necrotic pancreas. It seems desirable to remove or depress the toxic focus surgically or by local irradiation as soon as possible. Attempts at a late stage to eliminate the toxic products from the pancreas and the abdominal cavity by peritoneal lavage or local radiation seem to have no effect.     

Hypothermia and severe head injury

Two patients who were deeply unconscious (GCS = 4) following head injuries, sustained whilst intoxicated with alcohol, became hypothermic due to cold exposure. Despite negative prognostic factors both underwent craniotomy and evacuation of large acute subdural haematoma. After intensive postoperative management and rehabilitation both have made satisfactory recoveries. The contribution of hypothermia to their unpredicted favourable outcome is discussed, and the importance of recording temperature in head-injured patients is emphasized.     

Anaesthesia and severe skin disease

A review of the anaesthetic management of severe skin disease is presented. Erythroderma, urticaria pigmentosa, hereditary angioedema, epidermolysis bullosa, pemphigus, pemphigoid, the Stevens-Johnson syndrome, Behcet's syndrome, scleroderma, Ehlers-Danlos syndrome and congenital anhidrotic ectodermal defect are discussed.     

重症急性胰腺炎严重并发症的预防

目的　探讨重症急性胰腺炎 (SAP)并发症的原因和预防。方法　回顾性分析 16 5例SAP的诊治情况 ,并分为三个阶段比较各阶段并发症发生与病情危重程度、手术与否和手术方式、时机之间的关系。结果　三个阶段并发症发生率分别为 72 .0 % (36 / 5 0 )、6 4 .6 % (31/ 4 8)和 34.2 % (2 3/6 7)。早期手术组、延期手术组和非手术组的并发症发生率分别为 6 2 .5 %、5 8.7%和 34.7%。结论　胰腺坏死和病情的严重程度、治疗不当是引起并发症的重要原因 ,早期不必要的手术介入会增加其发生。以非手术为主的ICU重症监护治疗 ,及正确选择手术指征、时机和方式可减少或预防其发生     

滑车成形术联合内侧髌股韧带重建术在在治疗重度髌骨不稳患者的疗效观察

目的 本研究观察分析重度髌骨不稳患者接受滑车成形术联合内侧髌骨韧带重建术(MPFLR)前后的各项指标,评估滑车成形术联合内侧髌骨韧带重建术的有效性和结局。 方法 收集2009年1月-2015年12月期间我院诊断为重度髌骨不稳患者25例,测量比较手术前后胫骨结节沟角(SA),适合角(CA),髌骨侧方移位度(LS of patella),胫骨结节股骨滑车沟(TT-TG)和Caton-Deschamps指数,患者术后疼痛状况,Lysholm膝关节功能评分及Kujala髌股关节不稳症状评分评估手术效果。 结果 本研究仅1例患者出现术后关节疼痛,无法屈膝超过25°,经过手术重新调整,有效治疗了并发症。对受试者平均3.2±1.5年的随访结果显示,24例受试者对于术后结局均非常满意,受试者术后无复发性髌骨脱位,滑车软骨移位或者是碎裂现象。基于视觉模拟评分结果显示,患者术后疼痛状况得到了明显改善(t=3.862,P＜0.001),且具有统计学意义。Tegner膝关节运动评分(t=4.093,P＜0.001),Kujala髌骨关节不稳定症状评分(t=5.396,P＜0.001),IKDC和Lysholm膝关节功能评分(t=3.974,P＜0.001)均增加,且具有统计学意义。轴位X线检查沟角(SA)(t=3.916,P＜0.001),适合角(CA)(t=4.017,P＜0.001),和髌骨侧方移位度(LS of patella)(t=2.618,P=0.015)术后均降低,且具有统计学意义。胫骨结节股骨滑车沟(TT-TG)(t=4.636,P＜0.001),Caton-Deschamps指数(t=2.892,P=0.008)在术后降低,且具有统计学意义。结论 滑车成形术联合MPFLR对于重度髌骨不稳患者是一种有效的治疗方案。滑车成形术联合MPFLR不仅应用于挽救治疗,应作为重度髌骨不稳患者治疗的首选方案。     

Urological trauma and severe associated injuries

Our experience with 212 cases of urinary tract injury in multiple trauma patients treated between 1972 and 1983 has been analysed and compared with data collected from 441 cases of isolated urinary tract injury during the same period. The following points are emphasised: (1) incidence and severity of urological trauma in multiple injured patients; (2) obstacles in diagnosis and the need for immediate radiographic assessment; (3) lower urinary tract injuries and the need for urinary diversion; (4) differences in therapeutic approach to renal injuries in multiple trauma patients. We paid special attention to the indication for surgical exploration in patients with a renal laceration and severe associated injuries.     

Pathophysiology and treatment of severe pancreatitis

The current study was designed to characterize toxic substances in hemorrhagic ascitic fluid by using in vivo dogs model and to examine the toxicity of hemorrhagic ascitic fluid by using an in vivo mice model injecting the fluid intraperitoneally. Our experiment showed that high levels of bradykinin, histamine and prostaglandin E were found in serum and in hemorrhagic ascitic fluid which reported as toxic substances during severe pancreatitis. A similar finding was also obtained clinically in four patients with severe acute pancreatitis. The mortality rate on 72 hours following the intraperitoneal injection of 2.0 and 3.0 ml of ascitic fluid were 66.0% and 89.7% respectively. Mice which died following the injection of ascitic fluid showed shock lung at autopsy. These results indicate that peritoneal lavage might be an effective method for the treatment of severe pancreatitis. We evaluated 25 patients with severe acute pancreatitis clinically. Laparotomy and drainage operations were performed in 16 patients of these patients. Twelve among 16 patient had good results. The cause of death were multiorgan failures.