Rules for allocation of livers for transplantation

Previous rules of allocation of livers for transplantation were based mainly on local priorities, with final management left to the local team. This created substantial regional disparities. A prospective survey of waiting list deaths and dropouts due to aggravation of liver disease (2003-2005) validated the MELD (Model for End-stage Liver Disease) score on French data. A new allocation score (Liver Score) for liver transplants, based on specific variables for each liver disease, was introduced in March 2007. An initial evaluation, based on the first 5 months of practice, clearly shows that the Liver Score reduces the rates of deaths, dropouts, and futile transplantations; it also accelerates access to transplantation for the sickest patients. Several points remain unresolved: both the MELD and Liver scores may be improved. The variability of the MELD score related to different laboratory assay methods requires harmonization between laboratories.     

Survey of arrangements for anaesthesia for interventional neuroradiology for aneurysmal subarachnoid haemorrhage

The management of patients with subarachnoid haemorrhage following rupture of an intracranial aneurysm is changing. The recent introduction of endovascular occlusion of the aneurysm using detachable coils offers an alternative to craniotomy and clipping of the aneurysm for the prevention of recurrent aneurysmal haemorrhage. The aim of this survey was to evaluate the current provision of peri-operative care for patients with an aneurysmal subarachnoid haemorrhage in the United Kingdom and Republic of Ireland. A survey was conducted of the 34 neuroscience centres which provide an adult neurosurgery service in the United Kingdom and Republic of Ireland. Most centres reported an increasing role for coiling, and a decreasing role for clipping in the management of aneurysmal subarachnoid haemorrhage. The provision of peri-operative care for patients undergoing interventional neuroradiology procedures varied greatly between centres. Neurovascular services in the UK are being reorganised and adequate staff and facilities should be available for the peri-operative care of patients undergoing interventional neuroradiology procedures.     

Risk factors for osteoporosis for residents of Kiwa

We evaluated 207 individuals (49 men and 158 women) living in a small town in central Japan to identify the risk factors for, and the etiology of, osteoporosis. Female sex, advanced age, short stature, low body weight, and deficiencies in calcium and protein intake were associated with an increased risk of osteoporosis. Nutrition appeared to be strongly related to a decrease in bone mass, because subjects who lived solitary lives were more likely to have decreased bone mass and bone mass was similar between husbands and wives.     

Criteria for selection of patients for bariatric surgery

Because of the high prevalence of co-morbid conditions and poor life expectancy a Body Mass Index (BMI) of 40 kg/m(2) or more is an indication for surgery in a fully informed, consenting adult in optimal medical condition to tolerate general anaesthesia. Patients with BMI of 35-40 kg/m(2) and the existence of one or more serious obesity-related conditions ameliorated by weight loss, such as hypertension, pulmonary insufficiency, non-insulin-dependent diabetes mellitus etc., are also candidates for surgical treatment. The bariatric surgeon should use these international criteria as guidelines only, not strict rules. Attempts on the part of internists and more frequently insurance carriers to require documented failure of previous non-operative treatment is not meaningful.     

昏迷患者气管切开术后气管套管的选择

目的探讨昏迷患者气管切开术后应用不同类型气管套管预防肺部感染的效果。方法将102例昏迷气管切开患者按入院时间分为对照组（50例）和观察组（52例），对照组采用不带气囊的金属气管套管；观察组采用一次性低压气囊气管套管，均予气管切开术后常规护理。两组分别在气管切开后第3天、第15天，从气管套管内留取痰标本进行细菌培养。结果两组气管切开术后第15天细菌阳性率比较，差异有显著性意义（P〈0．01）；观察组气管切开术后15d总菌株少于对照组（P〈0．01）；第3天与第15天总菌株比较，对照组差异有显著性意义（P〈0．01），观察组差异无显著性意义（P〉0．05）。观察组肺部感染率显著低于对照组（P〈0．05）。结论采用一次性低压气囊气管套管能有效降低昏迷气管切开术患者的肺部感染率。     

输液胶贴回收的管理

目的 保持住院环境整洁、舒适,减少医院感染.方法 将82例输液患者随机分为干预组(40例)和对照组(42例).对照组给予常规静脉输液健康教育;干预组在此基础上,对患者及陪护实施规范输液胶贴回收的教育,于病房设置胶贴回收容器.结果 两组不同时段胶贴规范回收率比较,差异有显著性意义(均P<0.01).结论 加强医疗垃圾回收教育,提供胶贴回收专用设施,能提高输液胶贴规范回收率,为患者提供环保、安全、整洁、舒适的住院环境,从而消除医院感染隐患.     

Guidelines for consideration for surgical repair of vesicoureteral reflux

Vesicoureteral reflux (VUR) is a risk factor for acute pyelonephritis, which can result in renal scarring (reflux nephropathy), hypertension, end-stage renal disease (ESRD) and complications during pregnancy, In deciding whether to recommend surgical correction of VUR, factors that should be considered include the previous and potential future morbidity of VUR in that individual, the risk of uncorrected VUR, the likelihood of spontaneous resolution or significant reduction in VUR, the efficacy and complications of medical therapy, the morbidity and discomfort associated with serial screening for VUR, the benefits and risks of surgical therapy, and economic factors. Currently, surgical correction is recommended for those who fail medical therapy, or if the child has grade V VUR, bilateral grade IV VUR, moderate VUR associated with a complete duplication anomaly, severe renal scarring, or persistent VUR associated with an ectopic ureterocele, posterior urethral valves or a neuropathic bladder. The current perioperative management of children undergoing ureteroneocystostomy is detailed. In the future, the less invasive alternative of endoscopic therapy will need to be balanced against the changing understanding of the risk of VUR to the individual.     

Use of LMA for awake intubation for Caesarean section

Purpose

This case report describes the use of a Laryngeal Mask Airway in a morbidly obese parturient with the H.E.L.L.P. syndrome. An urgent Caesarean section was required because of vaginal bleeding and fetal distress.

Clinical features

The patient was a 32 year old G3, T1, P1, L1 who presented with epigastric pain, headache, vomiting, and diarrhoea. She was hypertensive (180/110 mmHg) and thrombocytopaenic (18 × 10^?9 · L^?1). Examination of the airway revealed a short neck, receded jaw, full dentition, large breasts and she was considered to be a potential intubation problem. The patient required an awake intubation using a technique that minimized hypertension, aspiration risk, airway trauma, and hypoxia. A laryngeal mask was used to facilitate tracheal intubation, and the patient tolerated the procedure with no adverse outcome.

Conclusion

The LMA has a place to facilitate potentially difficult awake tracheal intubation with the pregnant patient.     

昏迷患者气管切开术后气管套管的选择

目的 探讨昏迷患者气管切开术后应用不同类型气管套管预防肺部感染的效果.方法 将102例昏迷气管切开患者按入院时间分为对照组(50例)和观察组(52例),对照组采用不带气囊的金属气管套管;观察组采用一次性低压气囊气管套管,均予气管切开术后常规护理.两组分别在气管切开后第3天、第15天,从气管套管内留取痰标本进行细菌培养.结果 两组气管切开术后第15天细菌阳性率比较,差异有显著性意义(P＜0.01);观察组气管切开术后15d总菌株少于对照组(P＜0.01);第3天与第15天总菌株比较,对照组差异有显著性意义(P＜0.01),观察组差异无显著性意义(P＞0.05).观察组肺部感染率显著低于对照组(P＜0.05).结论 采用一次性低压气囊气管套管能有效降低昏迷气管切开术患者的肺部感染率.