妊娠合并心脏病患者流产后关爱服务的实施效果

目的探索对妊娠合并心脏病患者实施流产后关爱服务的效果。方法按照住院时间将2017年的58例妊娠合并心脏病人流术后患者作为对照组,给予常规围手术期护理;2018年的60例患者作为观察组,给予流产后关爱标准化服务,建立患者信息档案,应用微信平台进行避孕知识宣教,流产术后1、3、6个月进行电话或微信随访,给予个体化指导。结果观察组避孕认知度评分显著高于对照组,术后1、3、6个月有效避孕率显著高于同期对照组,术后6个月内未发生重复流产(P0.05,P0.01)。结论流产后关爱服务有利于提高妊娠合并心脏病患者的避孕认知度及有效避孕率,避免术后重复流产,促进女性生殖健康。     

Long-term survival of Medicare patients with head injury

BACKGROUND: An increasing number of older patients are being hospitalized with traumatic brain injury (TBI). Knowledge of their expected long-term survival may be useful in making clinical decisions. METHODS: Patients age 65 or older admitted for the first time with head injury (ICD-9 800-804 or 850-854) during 1999 were identified in a complete national sample of fee-for-service Medicare hospitalization and denominator data. Cases were categorized by age, sex, maximum Abbreviated Injury Score (AISmax), and Charlson comorbidity score. Survival was determined at hospital discharge, and (using the denominator file) at 1, 6, 12, and 24 months after the initial hospital admission. RESULTS: For all cases (n = 30,684), the hospital mortality was 14.3%, but was cumulatively 19.75%, 30.5%, 36.1%, and 44.9% at successive times up to 24 months. Long-term mortality was higher with increased age, comorbidity, or AISmax, and higher in men. These effects persisted with multivariate logistic regression analysis and were used to construct a simplified prediction score for clinical use. CONCLUSIONS: The mortality for older patients with TBI is much higher than for an uninjured control population. The relative risk for death remains elevated after hospital discharge and for at least 2 years. Awareness of the expected prognosis may help family members and health care providers make appropriate clinical decisions during acute hospitalization.     

RU486药物流产与手术流产方法的可接受性比较研究

对药物流产及手术流产的可接受性比较结果显示，１００例停经５６天以内的健康妇女接受药物流产，一次口服ＲＵ４８６６００ｍｇ，４８～５６小时内再口服米索前列醇（ＰＧＥ１）４００μｇ，完全流产率９１．Ｏ％，不全流产率５．０％，继续妊娠率４．Ｏ％。６８例停经４２～５６天的健康妇女接受手术负压吸宫术流产，完全流产率１００．Ｏ％。选择药物流产的主要原因是痛苦少（占７５．０％），选择手术流产的主要原因是流产效果好（占４１．２％）和流产时间短（占５７．４％）。药物流产的主要问题是出血时间长（占２５．Ｏ％）和出血量多（占１１．Ｏ％）。药物组９１例完全流产者流产后出血持续时间平均为１６．１±９．Ｏ天。手术组６８例完全流产者，流产后出血持续时间平均为８．９±６．１天。     

Acute renal failure in Central Anatolia.

BACKGROUND: The aetiological spectrum of acute renal failure (ARF) has changed in developed countries. It was the purpose of the study to evaluate whether similar changes have occurred in this part of the world as well. METHODS: In a prospective study a total of 439 patients with ARF were evaluated. They had been admitted to one hospital during two successive periods, i.e. 1983-1990 and 1991-1997. RESULTS: Of 439 patients with ARF, 116 were admitted in 1983-1990 (first period) and 323 in 1991-1997 (second period). The age of presentation increased from 49.8+/-6.2 years in the first period to 58.8+/-16.4 years in the second. Medical causes were present in 259 cases (59%), surgical causes in 110 cases (25%), and obstetric causes in 70 cases (16%). The frequency of surgical cases decreased from 28.4% in the first period to 23.8% in the second period. The respective figures for obstetric cases were 18.9% and 14.8%. Mortality did not change with time (33.6% in the first and 31.0% in the second period); the overall mortality was 31.7%. The mortality was higher for surgical (45.5%) than for obstetric (27.8%) and medical ARF (24.3%). CONCLUSION: In the mid-1970s, the most common causes of ARF in Turkey were obstetric complications and septic abortion. The aetiological spectrum of ARF has changed and today medical causes predominate. ARF resulting from septic abortion has become rare, possibly because of liberalization of abortion in 1983 in Turkey.     

Geriatric trauma: resource use and patient outcomes.

INTRODUCTION: Elderly patients who suffer trauma have a higher mortality and use disproportionately more trauma resources than younger patients. To compare these 2 groups and determine the outcomes and characteristics of elderly patients, we reviewed patients in these 2 groups admitted and treated in our tertiary care provincial trauma centre. METHODS: From the provincial trauma registry we selected a cohort of 40 geriatric patients (group 1) (> or = 65 yr of age) with an ISS of 16 or more who were admitted to and spent time in our trauma service for more than 48 hours and compared them with a similar randomly selected cohort of 44 patients (group 2) aged 20-30 years. Family physicians were contacted for follow-up of these patients 2 years after discharge. We considered length of hospital stay, complications, disposition of the patients and use of consultation services. RESULTS: Patients in group 1 had a mean age of 72.1 years (range from 65-98 yr) and a mean ISS of 27.3 (range from 17-50). Patients in group 2 had a mean age of 26.3 years (range from 22-29 yr) and a mean ISS of 26.3 (range from 17-54). Hospital stay was significantly longer in the group 1: 34.5 days (95% confidence interval [CI]: 24-44 d) versus 21.6 days (95% CI: 15-28 d). More elderly patients experienced complications (35 v. 13, p < 0.001) and required medical consultations (35 v. 26, p < 0.001). In-hospital death rates were 8% (3 of 40) and 4% (2 of 44) respectively (p = 0.3). Fewer geriatric patients could be discharged home (35% [14 of 40] v. 27% [22 of 44], p = 0.056) or to rehabilitation facilities (28% [11 of 40] v. 34% [15 of 44], p = 0.3). Five geriatric patients were discharged to nursing homes (p = 0.007). Of the geriatric patients discharged to rehabilitation facilities or home, 75% were independent 2 years after discharge. CONCLUSIONS: Aggressive care for geriatric trauma patients is warranted, and resources should be directed toward rehabilitation. Based on our findings, we expect that creating a directed care pathway for these patients, targetting complications and earlier discharge, will further improve their outcomes.     

药物流产对再次妊娠各期影响的研究

对药物流产 (药流 )后再次妊娠的孕妇观察其妊娠期、分娩期并发症的发生情况及新生儿健康状况。并与有手术流产 (术流 )史的孕妇进行比较 ,探讨药流的安全性。方法 :同期内选择年龄 2 3～ 3 5岁的药流 (2 1 2例 )或术流 (2 0 1例 )后再次妊娠的健康妇女 ,进行前瞻性研究 ,观察其妊娠期并发症 (妊高征、自然流产、前置胎盘、胎盘早剥、过期妊娠 )与分娩期并发症 (产后出血、胎盘粘连、胎盘残留、胎膜不全、胎膜早破、胎儿窘迫等 )的发生情况以及新生儿的健康状况。结果 :妊娠期并发症 ,术流组 (2 0 .9% )明显高于药流组(1 2 .3 % ) ,差异有显著意义 (P<0 .0 5) ,其中先兆流产发生率术流组 (1 3 .4 % )明显高于药流组 (3 .8% ) ,差异有非常显著意义 (P=0 .0 0 0 ) ;分娩期并发症术流组 (1 7.4 % )与药流组(1 9.3 % )无显著性差异 ;妊娠结局术流组 (3 .5% )与药流组 (3 .8% )无显著性差异。认为药流对再次妊娠分娩与术流一样都是安全的 ,并且药流再次妊娠时妊娠期并发症明显低于术流。     

Who has life-sustaining therapy withdrawn after injury?

BACKGROUND: Trauma scoring systems have been developed to help surgeons predict who will die after injury. However, some patients may not actually die of their injuries but may undergo withdrawal of life-sustaining therapy (WLST). The goal of this study was to determine which factors were associated with WLST among older patients who died. We hypothesized that patients with comorbid illnesses, higher injury severity scores (ISS), complications, and existing advanced directives (AD) would be more likely to have WLST and that patients having WLST would receive more medication for symptom relief in the 24 hours before death. METHODS: Data were collected via a retrospective chart review of patients age 55 years and older admitted to the intensive care unit after injury who subsequently died. In addition to demographic and injury information, documentation of family discussions regarding care wishes and formal ADs were evaluated. Patients dying despite curative attempts were compared with those who died after WLST by Student's t test and chi test where appropriate. RESULTS: In a 3-year period, of 330 patients age 55 and older admitted to the intensive care unit, 66 (20%) died. Complete records were available for 64 patients. More than half of those who died (n = 35, 54.7%) had WLST. ADs were available for 15 patients (23.4%), and 11 (17.2%) patients had expressed to their families desires to not undergo aggressive curative care. Family discussions were documented for 50 (78%) cases. Comorbid illnesses were present in 46 (71.9%) patients and 35 (54.7%) developed at least one complication. Among people with ADs, 73% had WLST versus 49% of people without ADs (p = 0.09). WLST was independent of comorbid illnesses (p = 0.3), complications (p = 0.8), age (p = 0.5), and ISS (p = 0.2). Patients for whom there was documentation of a family discussion were more likely to have WLST than those without (91.4% versus 62.1%, p = 0.005). Morphine and benzodiazepine dosing in the 24 hours preceding death were greater in the WLST group than the curative therapy group (p = 0.02 and p = 0.05, respectively). CONCLUSIONS: Expected associations with WLST such as age, ISS, comorbidities, and complications were not present in this population. Although trends may exist regarding patient wishes and ADs, larger studies are needed to corroborate these findings. Given the percentage of patients having supportive care withdrawn, trauma registries and scoring systems should include WLST.     

A survey of obstetric complications and pregnancy outcomes in paediatric and nonpaediatric anaesthesiologists

BACKGROUND: Obstetric complications such as spontaneous abortion, preterm labour, preterm delivery, low birth weight and congenital anomalies may be associated with exposure to anaesthetic gases. We hypothesized that female anaesthesiologists practicing primarily paediatric anaesthesia, with increased exposure to trace anaesthetic agents, experience a greater prevalence of obstetric complications than female anaesthesiologists performing primarily adult anaesthesia. METHODS: Questionnaires were sent to all female Society for Pediatric Anesthesia (SPA) members and to an equal number of randomly selected female American Society of Anesthesiologists (ASA) members. Subjects were asked to answer questions regarding their pregnancy outcomes, work history and personal habits. Parametric data were analysed by unpaired t-tests. Nonparametric data were analysed by chi-square, Fisher's exact test and Mann-Whitney U-test as appropriate. RESULTS: Paediatric anaesthesiologists were defined as those having >75% paediatric practice. Paediatric anaesthesiologists were older and had greater operating room exposure during their pregnancies than nonpaediatric anaesthesiologists. There was a significantly higher prevalence of spontaneous abortion among paediatric anaesthesiologists than nonpaediatric anaesthesiologists. In an exploratory analysis, the following factors were found to be significantly associated with the development of spontaneous abortion: age >35 years, gravida >1, exercise during pregnancy, percentage of inhalational anaesthetics >75% and paediatric anaesthesia practice >75%. Independent risk factors for spontaneous abortion among anaesthesiologists included exercise (>1 time/week) and age. CONCLUSION: Our results suggest a higher prevalence of spontaneous abortion in anaesthesiologists whose practice is >75% paediatrics.     

上海市两社区初婚已分娩夫妇人工流产后开始选用避孕措施状态及影响因素的分析

对上海市两社区 71 0 1对于 1 987～ 1 988年初婚并于婚后 5～ 6年时已有孩子的夫妇进行 8年的前瞻性队列调查。结果显示 ,其中 9.3 % (6 6 3对 )的夫妇是于人工流产(人流 )术后开始选用避孕措施 (在本次调查的 2 52 7例产后至少有一次人流者中占2 6 .2 % )。在 6 3 3例产后完全暴露于妊娠危险状况的夫妇中 ,1 / 3的妻子因感避孕麻烦而原就准备于人流术后放环避孕。 51 .3 %的夫妇认为产后夫妇性生活少、哺乳期或未转经、月经量少不会受孕等而未于产后及时避孕。近 80 %未及时避孕的妻子于恢复性生活后 1年内受孕。56 .4 %未及时避孕的妻子均于人流术后放置环 ,其中 1 / 2的妻子认为于该时放环最有效。在产后非人流术后开始避孕的妻子中仅 8.1 %首选放环 ,从有效性出发首选放环的仅占 1 / 3。拟合双反应 L ogistic回归模型显示夫妇人口统计学 (妻子婚龄、宗教信仰、夫妇月收入 ) ,生育意愿 (婚后推迟生育时期 ) ,心理学因素 (产后妻子健康状况 ) ,妻子对人流的态度 ,夫妇的避孕知识 (特别丈夫在二访时 ) ,性生活状况等多种因素均显著影响到夫妇产后是否及时避孕。结果显示 :(1 )要加强对夫妇 ,特别是妻子 ,产后一旦恢复性生活及时避孕的教育 ;(2 )对有关人流后放环和人流术本身对妇女健康潜在危险性等开     

Medical and social aspects of pregnancy among adolescents. Part II. Comparative study of abortions and deliveries

Socio-medical aspects concerning 193 pregnant patients under the age of 18 were analysed. Of these patients 131 had an interruption of the pregnancy and 62 gave birth to a baby. All the abortion patients were unmarried. The mean age in the abortion group was 16.8 years and in the delivery group 17.2 years. The girls of this study had their first experience of sexual intercourse very early, 32% under the age of 15. The frequency of complications after abortion was 18.5%. In the delivery group the prematurity and prenatal mortality were at least twice as great as in the general population. The girls who gave birth to their babies often came from lower social strata and the relationships in their families were more harmonious than in those who had had abortions. The birth of the baby or the decision to have an abortion is not accidental. The different behaviour patterns have a different background regarding both the personal and the environmental characteristics. The decision of the patient whether to abort or not was influenced by the attitude of the immediate family. The relations between family members were better in the homes of the girls who had a baby than in the homes of those who belonged to the abortion group. In both groups more than 40% of the subjects had suffered the risk of being emotionally deprived because of environmental conditions, including crowded housing and limited economic means. Almost all the subjects knew about the means of prevention, although they may not have had proper instruction and sufficient knowledge of their use. The services given by the goverment to adolescent pregnant patients are insufficient and require immediate attention by society.     

Diverticulitis: A Progressive Disease?: Do Multiple Recurrences Predict Less Favorable Outcomes?

INTRODUCTION: Our understanding of complicated diverticulitis is based on outdated literature. Antecedent episodes of diverticulitis are felt to increase the risk of developing complicated diverticulitis, as well as its subsequent morbidity and mortality. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce this morbidity and mortality. METHODS: A total of 150 patients with prior episodes of diverticulitis who were hospitalized with complicated diverticulitis were retrospectively analyzed. Statistical analysis was conducted using chi and Fisher exact test tests. RESULTS: Patients were separated into 2 groups for analysis: group A = those with 1 or 2 prior diverticulitis episodes (n = 118) versus group B = patients with more than 2 prior episodes (n = 32). Characteristics of the groups were similar for age and preexistent comorbid conditions. The majority of patients presented with pericolonic abscess and inflammatory phlegmon. Perforated diverticulitis occurred more often in group A compared with patients with >2 episodes of diverticulitis. Because of the higher rate of perforation, patients in group A underwent surgical diversion more often than group B patients. No significant differences in operative complications, morbidity, or mortality rates were identified between the groups. CONCLUSION: Patients with multiple (>2) episodes of diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis. Morbidity and mortality rates are not significantly different between patients with multiple episodes of diverticulitis compared with those with 1 or 2 prior attacks. Reevaluation of the practice of elective resection as a strategy for reducing the mortality and morbidity from complicated diverticulitis is needed.     

Hypothermia on admission in patients with severe brain injury

Data from the "National Acute Brain Injury Study: Hypothermia" were examined to identify the impact of hypothermia on admission. In all patients, temperature was measured at randomization using bladder catheters with thermistors. Patients assigned to hypothermia were cooled using fluid-circulating pads. Outcome was assessed at 6 months using the dichotomized Glasgow Outcome Scale (good outcome = good recovery/moderate disability; poor outcome = severe disability/vegetative/dead). One-hundred and two patients (hypothermia, 62; normothermia, 40) were hypothermic on admission (< or =35.0 degrees C). Hypothermia-on-admission patients assigned to normothermia (n = 40) had a 78% poor outcome, and normothermia-on-admission patients assigned to normothermia had a 52% poor outcome (p < 0.004). Hypothermia-on-admission patients assigned to hypothermia had a lower percentage of poor outcomes than those assigned to normothermia (hypothermia, 61%; normothermia, 78%; p = 0.09). Patients over 45 years of age had an adverse effect of hypothermia regardless of admission temperature due to medical complications. Patients who were hypothermic on admission, age < or = 45 years (n = 81), and assigned to hypothermia had a significantly lower percentage of poor outcomes than those assigned to normothermia (hypothermia, 52%; normothermia, 76%; p = 0.02). Factors associated with hypothermia on admission were increased age, prehospital hypotension, smaller size, positive blood alcohol, larger volume of pre-hospital fluids, slightly higher injury severity, and winter enrollment The treatment effect was found in all of the four centers, which randomized the majority (80%) of the patients. It is unclear whether the improved outcome when hypothermia is maintained is a beneficial effect of very early hypothermia induction or an adverse effect of permitting the patients to rewarm passively.     

Complicated colonic diverticulosis. Results of surgical treatment between 1981 and 1998 in 370 patients

AIM OF THE STUDY: The aim of this retrospective study was to analyze case reports of all the patients with complicated diverticular disease of the colon admitted in the same surgical center during an 18-year period and to report the postoperative results in patients operated on in emergency and in patients operated on electively. PATIENTS AND METHOD: From 1981 to 1998, 501 patients were admitted for complicated diverticular disease. There were 233 men and 268 women. Mean age was 66 years (range: 27-96). One hundred and thirty-one patients were only treated medically and 370 patients were operated on, either as an emergency (n = 211) or electively (n = 159). The complicated diverticular disease was located on the left colon in 362 cases and in the right colon in 8 cases. RESULTS: In the emergency group, 103 patients were operated on for pelvic (n = 24) and generalized purulent (n = 67) or stercoral (n = 12) peritonitis, mainly with Hartmann procedure (n = 80) with 14 postoperative deaths; 67 were operated on for pericolic abscess with 6 deaths, 19 for colonic obstruction with two deaths and 22 for profuse hemorrhage with 4 deaths. The overall postoperative mortality rate was 12.3%, and morbidity rate 38.7%. Intestinal continuity was restored in 74% and eventrations were present in 10%. In the elective group, there were two postoperative deaths in patients with a colic fistula (n = 30), no mortality and a 10.8% morbidity rate in the other patients (n = 129). CONCLUSION: This series of an 18-year duration emphasizes the severity of surgery for acute complications in diverticular disease of the colon and the advantages of elective surgery. Large progress in the management of peritonitis and pericolic abscesses has made possible the improvement of their prognosis.     

Predictors and outcomes of gastrointestinal complications in patients undergoing coronary artery bypass graft surgery: a prospective, nested case-control study

BACKGROUND: The aim of this study was to assess risk factors and outcomes of gastrointestinal (GI) complications in patients undergoing coronary artery bypass surgery (CABG). STUDY DESIGN: We conducted a nested case-control study from a 9-year hospitalization cohort (n = 7,345) in which data were collected prospectively. Patients developed GI complications (n = 66) and controls did not (n = 330). Cases were matched to controls 1:5 on type of surgery. We examined 16 risk factors and 14 outcomes. RESULTS: Five risk factors proved significant in predicting GI complications. Patients were more likely to be older than age 70, to be on dialysis, to have left ventricular hypertrophy, and to be on anticoagulants; the procedure was also more likely to be urgent. There was no significant difference between the cases and controls for the remaining 11 risk factors. We also computed correlation coefficients among the significant variables; using regression analysis, we found that patients undergoing CABG had a threefold increase in the risk of GI complications if they were older than age 70 (odds ratio [OR] 1.06, 95% CI 1.03 to 0.97), if they were on dialysis (OR 1.87, 95% CI 1.98 to 1.22), and if their procedure was urgent (OR 1.91, 95% CI 1.07 to 3.4). Eleven outcomes proved significant. Patients with GI complications ran a greater risk of mortality; required more additional procedures; suffered arrhythmia that required treatment; and were more likely to have neurologic, pulmonary, renal, and sternal wound complications. They also had greater length of hospitalization, intensive care unit length of hospitalization, ventilator time, and postoperative creatine phosphokinase levels. CONCLUSIONS: In patients undergoing CABG surgery, urgency of the procedure, age greater than 70 years, and dialysis all significantly increased the risk of a GI complication. Patients with GI complications also experienced more negative outcomes.     

Analysis on the reproductive health situation of unmarried floating young women in cities

Objective: To understand the prevalence of RTIs/STIs, the incidence of sex violence and the KAP of the sex and reproductive health among unmarried floating young women.Methods: During Ocb.2002 to Feb.2003, in the maternal and child health hospital of Beijing, Shenzhen, Nanning and Zhengzhou, 1,219 unmarried floating young women who wanted termination of pregnancy and was under 24 years old before induced abortion received gynecological and laboratory examination. At the same time, they also answered a self-questionnaire. Results: The mean age of all respondents was (22.0±1.6) years old. The respondents' average age of having first sexual activity was (20.3±1.8) years old. The rate of induced abortion history was 38.7%. 17.5% of young women had never used contraception. The incidence of sex violence was 15.6%. The prevalence of RTIs and STIs was 56.1% and 9.7%, respectively. Young women were lack of the knowledge about reproductive health care. Conclusions: The reproductive health situation of unmarried floating young women was serious, especially on sex violence and RTIs/STIs and higher rate of induced abortion.     

Occult hypoperfusion is associated with increased morbidity in patients undergoing early femur fracture fixation

BACKGROUND: The presence of persistent occult hypoperfusion (OH) is associated with higher morbidity and mortality rates after trauma. Early femur fracture fixation in trauma patients with multiple injuries is associated with decreased morbidity and mortality. Association of OH and incidence of postoperative complications after intramedullary (IM) fixation in patients with femur fractures was investigated. METHODS: A retrospective study design was used. All patients with femur fractures admitted to the trauma service of a Level I trauma center between January 1, 1995, and August 1, 1998, who were older than 18 years of age and who had IM fracture fixation within 24 hours of admission and serum lactate determinations on admission and at proscribed intervals, were included in the study. Patients with lactic acid levels > or = 2.5 mmol/L were determined to have OH. No patients had clinical signs of shock (hypotension, tachycardia, decreased urine output) on transfer to the operating room. Complete resuscitation was defined as a lactic acid level < 2.5 mmol/L. Patients were divided into two groups based on presence/absence of OH determined from the lactic acid level immediately before surgery. The incidence of all postoperative organ complications was recorded, and complication rates were compared between groups. Total hospital costs were also compared. RESULTS: One hundred seventy-seven patients with femur fractures were admitted to the trauma service during this period. Seventy-nine patients met initial criteria for inclusion in the study. Further review excluded 32 patients. Occult hypoperfusion was present in 20 patients before early IM fixation (group 2). Twenty-seven patients were completely resuscitated before early IM fixation (group 1). Injury Severity Scores were similar in both groups. Group 2 had 35 complications in 20 patients, and group 1 had 11 complications in 27 patients. A significant difference was found in incidence of postoperative complications in group 1 (20%) versus group 2 (50%). Group 2 also had a significantly higher proportion of postoperative infections than group 1 (72% vs. 28%, respectively) and higher total hospital costs ($46,469 vs. $23,139). CONCLUSION: The presence of OH in trauma patients undergoing early IM fixation of a femur fracture is associated with a twofold higher incidence of postoperative complications. Clinical judgment, not surgical dogma, should guide the timing of IM fixation in these patients. Identifying and correcting OH through relatively simple resuscitative measures may be advantageous in reducing morbidity in the patient with multiple injuries.     

Surgical treatment of anorectal complications in Crohn's disease

BACKGROUND: The purpose of our study was to elucidate features, surgical procedures, and long-term results in patients with anorectal complications of Crohn's disease. METHODS: Physical findings, surgical treatment, and long-term outcome were recorded prospectively for 224 patients who had anorectal complications of Crohn's disease between October 1984 and May 1999. RESULTS: Presenting complications included abscess (n = 36), fistula-in-ano (n = 51), rectovaginal fistula (n = 20), anal stenosis (n = 40), anal incontinence (n = 11), or a combination of features (n = 66). Twenty-four patients did not undergo surgical treatment; the remaining 200 patients underwent 284 procedures. Ultimately, 139 patients (62%) retained anorectal function; reasons for proctectomy in the remaining 85 patients included disease (n = 66), extensive fistular disease (n = 15), fecal incontinence (n = 2), and tight anal stenosis (n = 1). Patients with rectal disease had a significantly higher rate of proctectomy than patients with rectal sparing (77.6% vs. 13.6%, respectively, P<.0001). In the absence of rectal involvement, patients with multiple complications had a significantly higher rate of proctectomy than patients with single complications (23% vs. 10%, P<.05). CONCLUSIONS: A wide spectrum of surgical techniques is required for the management of the diverse anorectal complications of Crohn's disease. Complete healing and control of sepsis can be achieved in the majority of patients. Active rectal disease and multiple complications significantly increase the need for proctectomy.     

Deep Brain Stimulation Hardware Complications in Patients with Movement Disorders: Risk Factors and Clinical Correlations

Background: Deep brain stimulation (DBS) has proven to be an effective treatment for Parkinson's disease (PD) and other movement disorders, but its usefulness is limited by complications related to the hardware. Methods: We reviewed the records of all our patients treated with DBS from January 1996 to August 2010 and analyzed those with hardware complications and reasons for surgical revision. Results: A total of 512 patients underwent 856 electrode implantations during the study period. A total of 297 (58%) patients had PD, 127 (24.8%) had essential tremor (ET), 40 (7.8%) had dystonia, and 48 (9.37%) had another movement disorder. The mean age at the first electrode implantation was 57.6 ± 14 years and patients were followed for a mean of 3.9 ± 2.8 years. A total of 44 patients (8.6%) had a hardware complication or system revision. Lead fracture was the most common complication and occurred in 13 (2.5%) patients, followed by infections (n = 10, 1.9%), electrode misplacement (n = 10, 1.9%), electrode migration (n = 9, 1.75%), and other complications (n = 2 , 0.39%). Patients with ET had a higher risk of hardware complications compared to those with PD, 13 vs. 7% (OR 2.03; p = 0.042). Conclusions: DBS is a safe intervention with a relatively low rate of hardware complications.     

综合护理在深度烧伤患者实施湿润烧伤膏创面修复中的应用

目的 探讨在使用湿润烧伤膏进行创面修复的深度烧伤患者中采用综合护理的效果。方法 选取 2020年12月-2023年12月本院收治的80例深度烧伤患者为研究对象,采用随机数字表法分为对照组 （n =40）和研究组（n =40）。两组均接受湿润烧伤膏创面修复治疗,对照组给予常规护理,研究组给予 综合护理,比较两组疼痛程度、负性情绪、瘢痕情况、生活质量及并发症发生情况。结果 研究组干预 后VAS评分低于对照组（P ＜0.05）;研究组干预后SAS、SDS评分低于对照组（P ＜0.05）;研究组干预后 瘢痕厚度、色泽、血管分布、柔软度评分低于对照组（P ＜0.05）;研究组干预后躯体功能、心理功能、 社会关系、一般健康状况评分高于对照组（P ＜0.05）;研究组并发症发生率为5.00%,低于对照组的 25.00%（P＜0.05）。结论 在使用湿润烧伤膏进行创面修复的深度烧伤患者中采用综合护理的效果较好,能 够缓解患者疼痛,改善其负性情绪及瘢痕情况,进而提高其生活质量,减少并发症发生,值得临床应用。     

Complications after surgery for necrotising pancreatitis: risk factors and prognosis.

OBJECTIVE: To evaluate risk factors, results of treatment, and prognostic influence of complications on survival from acute necrotising pancreatitis. DESIGN: Retrospective study of prospectively collected data. SETTING: Tertiary referral centre, Austria. SUBJECTS: 100 consecutive patients operated on for necrotising pancreatitis confirmed by dynamic angio-computed tomography from 1988-1997. INTERVENTIONS: 77 patients were operated on acutely followed by open management, and in 23 the operations were delayed. MAIN OUTCOME MEASURES: Morbidity, mortality, factors predisposing to complications, prognostic effect of complications on survival. RESULTS: Acute operations, alcoholic origin, APACHE II scores of > or = 10 on admission, and organ dysfunction on admission were independent factors that predisposed patients to complications. Colonic necrosis (n = 17) bleeding (n = 12) and intestinal fistulisation (n = 10) predominated. The overall mortality of complicated pancreatic necrosis was higher among patients admitted with surgical complications than in those who were not, but not significantly so (12/33 compared with 7/44 p = 0.06). Colonic necrosis (mortality 53%, relative risk: 2.45, p = 0.01), however, seemed to be of prognostic relevance. CONCLUSIONS: Complications are common in severe necrotising pancreatitis leading to organ dysfunction and need for acute operations. Colonic necrosis is an independent prognostic factor for survival.