耻骨后前列腺摘除术

目的　减少前列腺摘除术中、术后出血及术后其他并发症。方法　对耻骨后前列腺摘除术的前列腺包膜切口进行改进,行前列腺摘除术８９ 例。结果　平均手术时间４５ ｍｉｎ ,术中出血均不足１００ ｍｌ,术后膀胱冲洗时间１ ｄ,术后随访平均２ 年,疗效满意。结论　该手术方法具有出血少、安全、手术时间短、操作简单等优点。     

课后反思

对于教师来讲,教学能力和水平的提高,更多的在于教学后的反思。教后思教是教学的延续。教师课后反思,必然在得失成败中有所收获。一次课结束后,有意识、有目的地进行反思,可起到承前启后的作用,有常教常新之功效,能不断提高教师尤其是青年教师的教学水平。     

Near-syncope after exercise

Roy C. Ziegelstein, MD

JAMA. 2004;292:1221-1226.

Syncope and near-syncope are great diagnostic challenges in medicine. On the one hand, the symptom may result from a benign condition and pose little or no threat to health other than that related to falling. On the other hand, syncope or near-syncope can be the manifestation of a serious underlying condition that poses an imminent threat to life. Patients with a cardiac cause of syncope are at far greater risk of dying in the first year after an episode of syncope or near-syncope than individuals with a noncardiac cause. A cardiac cause of syncope should be considered in every patient with syncope or near-syncope, but it is particularly common in older patients or in patients with known structural heart disease, arrhythmia, or certain electrocardiographic abnormalities. Although many diagnostic tests may be helpful in the evaluation of syncope and near-syncope, the history, physical examination, and electrocardiogram pinpoint the cause in many circumstances. Syncope after exercise may be due to left ventricular outflow tract obstruction from aortic stenosis or hypertrophic obstructive cardiomyopathy but can also suggest the diagnosis of postexercise hypotension in which an abnormality in autonomic regulation of vascular tone or heart rate results in vasodilation or bradycardia after moderate-intensity aerobic activity. The patient discussed in this case highlights the importance of the clinical history in the evaluation of this condition, since the diagnosis was revealed as the patient's story was described and eventually acted out.

     

胰管结石括约肌切开术术后护理

胰管结石是慢性胰腺炎并发症之一,常引起较严重的后果,如顽固腹痛、进行性胰腺功能损害、加重慢性胰腺炎甚至诱发胰腺癌等。随着介入治疗学的不断发展,内镜下胰管括约肌切开术(EPS)对胰管梗阻的疗效已被实践所证实,而在EPS的基础上进行取石术、机械碎石术又是治疗胰管结石的一大进步[1]。对此类患者的护理,临床资料较少,我们将近年来的经验体会报道如下。1术前准备询问患者有无碘过敏史,做碘过敏试验。术前测血、尿淀粉酶,出、凝血时间,血小板计数及分类,血型。术前对患者详细说明EPS术、取石术、机械碎石术的过程,可能出现的并发症,以取得患者主动合作,做好家属签字。检查前将内镜彻底清洗消毒,各导管附件进行灭菌。检查仪器、乳头切开刀、导丝、造影管、气囊、取石篮、碎石篮等是否完好,并将备用导管用生理盐水进行冲洗,确保管腔内无气泡。嘱患者术前禁食6h。建立静脉通路,术前30min肌肉注射哌替定50mg、阿托品1mg,根据患者情况,必要时多功能心电监护仪进行持续监护。2术中配合2.1方法常规行ERCP,了解胆管及胰管情况。确定有胰管括约肌切开适应证后深插管并置入导丝。退出造影导管,插入拉式切开电刀,沿12点~1点方向逐步将胰管括约肌切...     

Syncope after effort

A 29-year-old man developed recurrent syncope following exertion. Cardiac investigations revealed no evidence of structural heart disease, but during exercise testing, in the recovery phase, he sustained a bradycardia and then asystole for a prolonged period. Before cardiac massage could be instituted a tonic-clonic fit occurred, and this initiated a return to sinus rhythm. His symptoms were abolished following the implantation of a dual-chamber pacemaker.     

输精管吻合术后生育能力状况分析

目的 输精管结扎术后相隔一段时间内再行输精管吻合术后的生育能力状况分析.方法 分析输精管吻合术后回访的64例患者输精管结扎术后至吻合时的时间长短;输精管吻合术患者年龄;患者于输精管结扎术后至吻合术后时间段生殖系统感染等情况对生育能力影响分析.结果 输精管吻合术后的生育能力状况与患者输精管结扎术后时间段长短,患者输精管结扎术后生殖系统有无感染,患者现在吻合术后时年龄等存在相关性.结论 输精吻合术后其生育能力受多种因素影响.     

胆囊切除术后黄疸

目的：分析胆囊切除术后产生黄疸的原因及预防措施。方法：分析我院1992年8月至1998年8月1832例胆囊切除术病例。结果：经B超、CT、手术、肝功证实：①胆道损伤造成的黄疸7例;②胆道内残余结石所至黄疸8例;③引流物造成黄疸4例;④肝细胞性黄疸12例。结论：明道损伤、胆道残余结石、不恰当的引流及术前肝功不良等是胆囊切除术后黄疸常见的原因;因此,合理的手术方式、术中必要的检查、恰当的引流及围手术期保肝等是预防胆囊切除术后黄疸的措施。