基层医院开展腹腔镜胆囊切除术治疗急性大结石胆囊炎66例的临床报告

目的总结基层医疗单位开展腹腔镜胆囊切除术治疗急性大结石胆囊炎的经验。方法回顾性分析我科于2009年9月～2011年5月运用腹腔镜胆囊切除术治疗急性大结石胆囊炎66例患者的临床资料。结果 59例均成功完成腹腔镜手术,成功率89.39%。7例中转开腹,其中3例因为胆囊三角区出血中转;2例胆囊三角区发现异常管道改开腹,最后证实均为变异的血管;1例粘连紧密无法解剖胆囊三角区遂中转;1例术中考虑Mirrizi综合症中转。手术平均时间（92±9.6）min,手术中失血量平均（144±56）ml,平均住院时间（3.5±5.5）d。所有病例未发现并发症,随诊1～28个月,平均17个月,无黄疸及腹痛。结论腹腔镜胆囊切除术治疗急性大结石胆囊炎安全可行,只要正确娴熟地掌握腹腔镜技术,易于在基层医疗单位推广且对患者有益。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎的手术方式讨论

目的急性结石性胆囊炎行腹腔镜胆囊切除术（laparoscopie cholecystectomy,LC）的手术经验总结。方法对2001年10月～2010年1月期间158例急性结石性胆囊炎行腹腔镜胆囊切除术的临床资料进行总结分析。结果147成功完成腹腔镜胆囊切除术,11例中转开腹,元死亡病例,无术后大出血、胆漏。结论急性结石件胆囊炎行腹腔镜胆囊切除术是可行的,关键在于提高腹腔镜操作技术,掌握手术原则。     

腹腔镜胆囊切除术治疗急性胆囊炎85例

目的 探讨腹腔镜胆囊切除术在急性胆囊炎治疗中的临床应用.方法 回顾性分析2006年5月至2010年4月在我院施行腹腔镜胆囊切除术治疗急性胆囊炎85例患者的临床资料.结果 81例均成功施行腹腔镜胆囊切除术,成功率95.3％.手术时间35～100min.置腹腔引流管74例,占91.4％,术后5～9d拔除,住院时间4～15d,平均6.4d.中转开腹4例,严重组织炎症水肿2例,周围组织粘连1例,较多瘢痕组织者1例,手术时间较腹腔镜胆囊切除术延长,72～120min.所有患者无腹腔出血、胆漏、死亡等严重并发症.结论 腹腔镜胆囊切除术在急性胆囊炎治疗中的临床应用创伤小、并发症少,安全可靠.     

急诊腹腔镜胆囊切除42例手术体会

目的总结急诊腹腔镜胆囊切除术(ALC)的临床体会.方法对我院42例结石性胆囊炎急性发作期患者行ALC的临床资料进行回顾性总结分析.结果42例急诊腹腔镜胆囊切除术操作,除3例中转开腹外,其余均在腹腔镜下完成.术后并发胆漏2例,急性胰腺炎1例,剑突下戳孔感染伴结石残留2例.术后住院时间3～29d.结论合理选择ALC的病例、提高腹腔镜操作技术、适时中转,可降低ALC并发症发生率及中转开腹率.     

55例急性结石充满性胆囊炎行腹腔镜胆囊切除术治疗体会

目的探讨急性结石性胆囊炎采用腹腔镜胆囊切除术治疗的适应证及同手术期处理方法。方法通过对55例急性结石充满性胆囊炎实行腹腔镜胆囊切除术治疗临床资料的回顾性分析，并结合传统开腹手术实际情况做对比，总结了手术时机的选择和实际操作体会。结果发病时间在3～8d的55例急件结石件胆囊炎患者全部顺利完成腹腔镜胆囊切除术手术，无中转开腹。结论发病时间〉5d的急性结石充满性胆囊炎仍适于行腹腔镜胆囊切除术治疗，而且无需常规放置引流管。     

腹腔镜胆囊切除术治疗急性胆囊炎85例

目的探讨腹腔镜胆囊切除术在急性胆囊炎治疗中的临床应用。方法回顾性分析2006年5月至2010年4月在我院施行腹腔镜胆囊切除术治疗急性胆囊炎85例患者的临床资料。结果81例均成功施行腹腔镜胆囊切除术,成功率95．3％。手术时问35-100min。置腹腔引流管74例,占91．40,术后5—9d拔除,住院时间4～15d,平均6．4d。中转开腹4例,严重组织炎症水肿2倒,周围组织粘连1倒,较多疲痕组织者1例,手术时间较腹腔镜胆囊切除术延长,72-120min。所有患者无腹腔出血、胆漏、死亡等严重并发症。结论腹腔镜胆囊切除术在急性胆囊炎治疗中的临床应用创伤小、并发症少,安全可靠。     

急性结石性胆囊炎腹腔镜胆囊切除术122例临床分析

目的:探讨腹腔镜胆囊切除术采用急性结石性胆囊炎治疗临床效果。方法:选取急性结石性胆囊炎患者122例,均为我院普外科2013年9月至2016年2月收治,均采用腹腔镜胆囊切除术治疗,回顾临床效果。结果:本次选取的普外科急性结石性胆囊炎病例,腹腔镜手术均成功完成,达100%成功率,未出现围术期死亡事件,无中转开腹情况。术中出血量为(167.4±21.9)ml,胃肠功能恢复时间(21.9±8.1)h,平均住院时间(6.5±1.7)d,无严重并发症发生。结论:针对临床收治的急性结石性胆囊炎患者,采用腹腔镜胆囊切除术治疗,把握操作要点,可取得理想的手术效果,具较高安全性,对改善患者预后意义显著。     

腹腔镜下急性结石性胆囊炎手术的临床体会

目的 分析急性结石性胆囊炎在腹腔镜下行胆囊切除术的可行性.方法 对85例急性结石胆囊炎进行回顾性分析.结果 80例成功施行腹腔镜胆囊切除术(LC),中转开腹5例,全部病例痊愈出院,无术后并发症和死亡病例.结论 只要选择好手术时机、熟练腹腔镜操作技术,急性结石性胆囊炎LC手术是安全可行的.     

腹腔镜治疗急性胆囊炎120例临床分析

目的探讨急性胆囊炎行腹腔镜手术的手术方式及临床疗效。方法回顾分析2001年6月～2009年6月对入住笔者所在医院的120例急性结石性胆囊炎患者的临床资料与手术方式。结果120例急性胆囊炎患者中,均行腹腔镜胆囊切除术,其中手术成功117例,其中3例行中转开腹。结论腹腔镜下胆囊切除术是治疗急性胆囊炎一种安全有效的方法,可以减少患者身心痛苦,降低并发症的发生率,值得临床推广。     

腹腔镜胆囊切除术180例临床分析

目的总结腹腔镜胆囊切除术的经验,分析腹腔镜胆囊切除术的手术适应症,并发症及对策.方法对我院2001年9月～2005年4月施行180例腹腔镜胆囊切除术临床资料进行回顾性分析.结果180例均治愈.其中中转开腹6例,并发肝外胆管损伤1例,胆瘘1例.手术时间为25～180分钟,平均住院日(6±1.5)d.结论腹腔镜胆囊切除术是慢性胆囊炎治疗的金标准[1],对于急性胆囊炎早期以及有下腹部手术史病人也并非腹腔镜胆囊切除术的禁忌症,正确处理胆囊三角区是腹腔镜胆囊切除术成功的关键,正确把握中转开腹是腹腔镜胆囊切除术的重要措施.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.