Intra-abdominal abscess due to patient non-compliance after construction of an ileal neobladder: Case report and review of the literature

PURPOSE: A case report of patient with an intra-abdominal abscess 8 weeks after radical cystectomy and construction of an ileal neobladder is presented. METHODS/RESULTS: The patient was admitted with nausea, vomiting and singultus. A perforation of the neobladder due to overdistension was assumed to be the underlying cause of the intra-abdominal abscess formation as the patient admitted infrequent voiding during the day and no emptying of the neobladder at night. The patient underwent explorative laparotomy and 4200 mL of pus was removed from the abdominal cavity. The patient made an uneventful recovery and was discharged from hospital after 5 weeks. Neobladder function remained stable and the patient was leading a normal life at 24 months follow-up. CONCLUSIONS: The present case demonstrates the need for careful patient selection prior to radical cystectomy with continent urinary diversion. Reduced compliance and mental disabilities of a patient can increase the complication rate.     

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目的探讨腹股沟疝无张力修补术后的并发症及处理。方法回顾性分析中国医科大学附属盛京医院2005年6月至2011年12月行腹股沟疝无张力修补术后发生18例并发症的临床资料。结果无张力修补术后复发8例,其中1例为腹股沟疝修补(TEP),1例网塞修补,1例Lichtenstein修补,5例腹膜前间隙置入补片修补。3例感染病人中2例为补片感染,1例为缝线感染。2例疼痛病人中1例为网塞修补,1例为聚丙烯平片Lichtenstein修补。2例术后出现严重的阴囊血清肿。1例术后出现切口下血肿。1例行TEP术后出现阴囊血肿。1例术后出现肠梗阻。结论虽然腹股沟疝无张力修补术较传统修补术并发症发生率低,但仍需注重提高临床医生的技术水平及规范化操作,降低并发症发生率。     

无缝式手术患者转运交接系统的研发及应用

目的研发手术患者转运交接系统,优化交接流程,实现无缝式交接。方法 2019年4~7月使用传统的电话沟通、口头传达方式进行手术患者转运交接;2020年4~7月研发并应用无缝式手术患者转运交接系统,通过信息化管理手段优化手术患者交接,信息同步推送,扫码识别患者身份,全流程监测患者路径信息。结果系统应用后,工勤人员接入患者用时、连台手术间隔时间、手术患者转运交接不良事件发生率显著低于应用前,护士及工勤人员满意度显著提升(均P<0.01)。结论手术患者转运交接系统的应用,优化了交接流程,确保各环节标准化、精细化、高效化。     

处女膜修补术不同术式的临床应用探讨

目的：分析处女膜修补术不同术式的优缺点，探讨各种术式的最佳适应证.方法：根据患者的诉求及处女膜的破损程度，对所采取的术式及相应的疗效进行比较.结果：环行埋线法适用于短期内将要结婚者;裂缘对合法适用于处女膜破裂为2-3处且间距较大者;裂缘对合加环行缝合法适用于处女膜破裂处较多、裂口较近，且要求保持处女膜完整较长时间者.结论：针对患者不同要求，采用合适的手术方式才能达到最佳的生理及心理疗效.     

Results of surgical treatment of synchronous multiple primary lung carcinomas

Four male patients with synchronous multiple lung carcinoma were operated on. In one patient both tumours were adenocarcinomas; both were bronchioloalveolar carcinomas in a second patient. In a third patient the tumours were adenocarcinoma and bronchioloalveolar carcinoma while in the fourth patient an adenocarcinoma and a squamous cell carcinoma were present. One patient was asymptomatic and free from carcinoma at follow-up examination 11 years and 7 months after the operation. The other three died of pulmonary carcinoma 11 months, 1 year 3 months and 9 years 8 months postoperatively.     

Considerations in the treatment of cerebral palsy patients with spinal deformities

The natural history of spinal deformities in the cerebral palsy patient is different than that in the idiopathic patient. Consequently, the approach to the patient with cerebral palsy and the surgical decision-making are different from that in the idiopathic patient. The present article gives the UTMB approach to the treatment of the cerebral palsy patient and the unique considerations that must be taken into account when treating these patients. Specific references are made to the use of L-rod instrumentation to stabilize the spinal deformity in the cerebral palsy patient.     

Leiomyosarcoma of the duodenum: a report of three cases.

Three cases of leiomyosarcoma of the duodenum are reported in this paper. The first patient demonstrated the development of a leiomyosarcoma from a leiomyoma, and also posed diagnostic problems as a Pólya gastrectomy had previously been performed. The second patient presented with acute pancreatitis--a hitherto unreported complication of this condition. The third patient showed that even though the primary tumour was unresectable, the patient remained well for more than a year after diagnosis.     

Two cases of congenital nephrotic syndrome

The clinical course and renal histological changes in two patients with congenital nephrotic syndrome are presented. Both patients developed edema and proteinuria at 2 days of age. Steroids and immunosuppressive drugs were not used in either patient. One patient showed gradual disappearance of nephrotic syndrome and proteinuria during the 16-month follow-up. In the other patient, the nephrotic state persisted and nephrotic complications necessitated bilateral nephrectomy when she was 12 months old. Renal biopsy showed minimal change lesions in one patient, while the nephrectomized kidneys showed mild mesangial proliferation and matrix increase in the glomeruli. No tubular dilatation or microcysts were observed in either patient.     

Patient expectations and satisfaction in orthopaedic surgery: A review of the literature

Patient expectations have been shown to be an independent predictor of outcomes in clinical medicine. In the orthopaedic literature, the majority of studies have focused on the relationship between pre-operative expectations and post-operative outcomes in patients undergoing total hip arthroplasty, total knee arthroplasty, shoulder surgery, and spine surgery. Various methodologies have been used to assess patient expectations in orthopaedic surgery, including direct questioning, short questionnaires, and validated surveys. Multiple patient factors have been associated with greater expectations prior to elective orthopaedic surgery, and greater pre-operative expectations have been shown to be associated with better subjective and objective outcomes after total hip and knee arthroplasty, shoulder surgery, and spine surgery. While there are very few validated measures of patient satisfaction after orthopaedic surgery, increased post-operative patient satisfaction is consistently associated with meeting pre-operative patient expectations. Given the relationship between pre-operative patient expectations and post-operative outcomes and patient satisfaction, understanding and defining expectations prior to elective orthopaedic surgery may optimize outcomes. In this review, we aim to summarize the current literature on patient expectations in orthopaedic surgery.     

Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection

PURPOSE: Inguinal hernia after radical retropubic prostatectomy has been reported to occur in 7% to 21% of patients. We analyzed the impact of simultaneous pelvic lymph node dissection, preoperative inguinal hernia morbidity, postoperative anastomotic stricture, duration of surgery and patient age. We also compared the detection rate of inguinal hernia events in a retrospective patient file survey to that in a prospective patient administered questionnaire. MATERIALS AND METHODS: A total of 498 patients underwent radical retropubic prostatectomy plus pelvic lymph node dissection and 166 underwent radical retropubic prostatectomy only. Mean followup was 40 months (median 37, range 3 to 85). All 664 patients were analyzed in the patient file survey. The patient administered questionnaire was mailed preoperatively, and after 3, 6, 12, 18, 24 and 36 months to 271 patients who underwent operation between 2001 and 2002. A total of 207 patients (76.4%) completed the preoperative questionnaire. RESULTS: The cumulative incidence of inguinal hernia after 24 months was 11.6% in the patient file survey and 15.7% in the patient administered questionnaire. In the patient file survey patient age was the only studied factor that significantly influenced risk. The patient file survey failed to detect half of the men with preoperative inguinal hernia morbidity and a third of post-radical retropubic prostatectomy inguinal hernias compared to the patient administered questionnaire. On patient administered questionnaire analysis preoperative inguinal hernia morbidity was a significant risk factor for postoperative inguinal hernia (log rank Mantel-Cox test p = 0.010). CONCLUSIONS: Previous inguinal hernia morbidity and age increase the risk of post-radical retropubic prostatectomy inguinal hernia. Simultaneous pelvic lymph node dissection, postoperative anastomotic stricture and duration of surgery were not significant risk factors in this study. The patient file survey is inferior to the patient administered questionnaire for detecting inguinal hernia events.     

专家型患者计划在慢性病领域中的应用研究进展

本文就专家型患者计划的概念，专家型患者的招募、培训、健康教育的实施，以及专家型患者计划在国内外造口、肾病、糖尿病等慢性病患者中的应用现状进行综述，旨在深入探究专家型患者计划具体实施步骤，为国内专家型患者计划的开展提供理论依据与参考，为慢性病患者的治疗策略提供新思路。     

Successful surgical repair of an elderly patient with tetralogy of Fallot: a case report.

We report on a rare case of a 61-year-old female patient with tetralogy of Fallot who had a late radical repair. The patient had no previous surgical interventions, and her postoperative course was uneventful. One year after the repair, the patient is doing well and has no symptoms of cardiac failure. Surgical treatment greatly benefited our patient by improving her functional status and extending her life expectancy.     

A surgical perspective from two decades of breast augmentation: toward state of the art in 2001

This article summarizes the author's perspective of two decades of breast augmentation based on clinical experience using virtually every type of implant, incision location, pocket location, dissection technique and instrumentation available from 1977 to 2001. Based on this experience, the author focuses on patient education, the importance of patient choice, patient evaluation and preoperative planning, surgical techniques, patient recovery, and factors to limit reoperations.     

Analysis of Ankle Range of Motion and Functional Outcome Following Total Ankle Arthoplasty

The success of ankle joint replacement has primarily been reviewed with respect to patient morbidity and survivorship rather than patient satisfaction. A retrospective review was performed of 95 patients who had undergone a total ankle replacement and who had completed both postoperative range of motion fluoroscopy and a subjective patient score sheet. Collected data included age, body mass index, length of follow-up, presence of complications, performance of adjunctive procedures, range of motion, and the etiology of the end-stage arthritis. These variables were then compared with patient satisfaction to see if there were any predictive conditions of successful outcomes. Patients older than 60 years and those with a body mass index (BMI) less than 30 demonstrated a significant positive association with subjective satisfaction scores (P = .0023 and .0008, respectively). The amount of postoperative range of motion did not appear to correlate with patient satisfaction. Furthermore, there were no significant associations of patient satisfaction with a patient age younger than 60 years, a BMI greater than 30, additional procedures, perioperative complications, the length of time after surgery, and the presenting etiology.     

High-Dose Chemotherapy with Peripheral Blood Stem-Cell Transplantation for Hormone-Refractory Advanced Carcinoma of the Prostate: Experience of Two Cases

Two patients with hormone-refractory advanced prostate cancer were treated with high-dose chemotherapy and peripheral blood stem-cell transplantation. A satisfactory number of stem cells were collected by appropriately timed leukapheresis in these patients. The stem-cell samples collected from the first patient were positive for prostate-specific antigen messenger ribonucleic acid expression; such expression was not detected in the samples from the second patient. The first patient has remained in complete remission as of December 1995. The second patient died of the disease.     

Design of appointment systems for preanesthesia evaluation clinics to minimize patient waiting times: a review of computer simulation and patient survey studies.

Anesthesiologists can use the science of clinic scheduling to design appointment systems for preanesthesia evaluation clinics. The principal reasons reported for inappropriately [or arguably unethically] long patient waiting times are provider tardiness, lack of patient punctuality, patient no-shows, and improperly designed appointment systems. However, the fundamental reason why anesthesia clinics have such long patient waiting times is because of their relatively long mean (and consequently standard deviation) of consultation times. If commonly applied valuations of provider idle time to patient waiting time are used in anesthesia clinics, appointment intervals will be sufficiently brief that the mean patient waiting time will be at least the mean consultation time or half an hour. Patients will be dissatisfied with this level of service. Therefore, efforts to decrease the mean patient waiting time in anesthesia clinics should focus foremost on minimizing the mean consultation time and its variability, which can most likely be achieved by assuring that providers have rapid access to relevant clinical information, including external medical records, surgical dictations, etc. Anesthesiologists managing anesthesia clinics may find it valuable to apply other interventions to decrease patient waiting times. Scheduling of preanesthesia evaluation and surgical clinics should be coordinated to assure patient punctuality. Providers should be on time for the start of their sessions. If an add-on patient cannot be seen during a scheduled clinic session, because all appointment times have been assigned to other patients, the add-on patient should be seen by a different provider or at the end of the regularly scheduled clinic session. Mean consultation times should be measured accurately for each provider. Substantial provider idle time should be expected. Appropriate values for breaks, appointment intervals, and percentage no-shows should be determined by computer simulation, using parameters appropriate for each provider and anesthesia clinic. Finally, traditional efforts at making waiting for a consultation tolerable should be made.     

泌尿外科腹腔镜手术中转开放手术的原因分析

目的:分析泌尿外科腹腔镜手术中转开放手术的原因。方法:回顾分析2004年3月至2006年1月泌尿外科腹腔镜手术81例的临床资料,其中5例(6.2%)中转开放手术。结果:中转开放手术5例包括未能辨明局部解剖关系的首例双侧肾盂输尿管连接部(UPJ)梗阻,术前未能诊断右肾上腺恶性嗜铬细胞瘤浸润肝脏,右输尿管上段结石周围粘连致密分离困难,肾窦内肾盂结石未取出,右肾输尿管结核周围粘连致密暴露困难各1例。结论:熟习腹腔镜下解剖,掌握循序渐进的原则和手术适应证,把握中转开放手术时机及良好的手术设备是提高泌尿外科腹腔镜手术成功率、减少并发症的关键。     

The relation of patient satisfaction and functional and cosmetic outcome after correction of the wrist flexion deformity in cerebral palsy

Wrist flexion deformity in cerebral palsy is treated with flexor carpi ulnaris to extensor carpi radialis brevis transfer. The aim of the study was to assess the outcome of this procedure and analyse the determining factors for patient satisfaction. Fifteen patients were reviewed after a mean follow-up of 23 months. The functional and cosmetic outcome and patient satisfaction were evaluated using patient rated scales. There was a strong and significant correlation between the cosmetic outcome and patient satisfaction, but there was no significant correlation between functional improvement and patient satisfaction. When analysing the cosmetic outcome in relation to the time since surgery, there was a decrease in the patient rated improvement over time. It seems that patient satisfaction is mainly determined by the cosmetic result, but the improvement, or the perception of it, tends to diminish over time. Fourteen out of 15 patients felt that the procedure was worthwhile and eight of them felt that the result was good or excellent.     

The impact of infection on the outcome of transplantation

The risk of infection in the transplant patient is determined by two factors: the net state of immunosuppression and the environmental exposures the patient encounters. Those infections that do occur in the transplant patient are strongly modulated by the type, intensity, duration, and sequence of immunosuppressive agents administered. A central role in the pathogenesis of all forms of infection in the transplant patient is played by the immunomodulating viruses, particularly cytomegalovirus. Prevention of infection is far better than treatment; when prevention fails and clinical disease develops, patient and allograft survival are directly related to the speed with which diagnosis is made and specific therapy instituted. In order to prevent disease, both antimicrobial prophylaxis and preemptive therapy are being increasingly employed, particularly to blunt the side effects of intensive antirejection therapy.     

实习护生患者隐私保护现状及影响因素分析

目的 了解实习护生患者隐私保护的认知与行为现状并分析其影响因素,为针对性培训提供参考.方法 对890名实习护生采用患者隐私量表(实习护生版)进行问卷调查.结果 实习护生对患者隐私保护的认知得分116.45±12.84,行为得分110.88±13.99.性别、年龄、对待护理的态度、相关法律法规了解程度、是否曾观摩患者隐私...