可吸收止血膜在颅脑外科手术中的应用体会

目的:研究可吸收止血膜(大清生物纸——北京大清生物)在颅脑外科手术中应用的止血效果。方法:将178例颅脑外科手术患者分成两组,术中应用可吸收止血膜联合明胶海绵者为Bio-Paper组,未用可吸收止血膜单独明胶海绵进行常规止血者为对照组,分别于手术中及术后24 h进行止血效果的观测和出血量的对比,并进行比较分析。结果:Bio-Paper组的患者即刻止血效果比对照组明显,术后24 h平均失血30mL,比对照组术后24 h的平均失血110 mL有明显降低(P<0.01)。结论:可吸收止血膜在颅脑外科手术中有良好的止血效果,并且具有很好的安全性。配合常规止血材料使用,方便易用。     

可吸收止血纱布在乳腺微创术中的应用

目的探讨可吸收性止血纱布在乳腺微创手术中的应用效果。方法 43例患者(对照组)经乳腺微创切除纤维瘤或肿块活检后,局部无任何特殊处理,只行术后弹力加压包扎;45例患者(观察组)操作相同,但改进创面处理方法,将可吸收性止血纱布(强生公司生产)填塞创面,比较以上两种方法术后血肿发生率。结果术后血肿发生率两组差异有统计学意义(χ2=3.98,P<0.05)。结论可吸收性止血纱布止血效果可靠,能有效降低术后血肿发生率,可作为乳腺微创手术时止血的理想选择。     

两种吸收性止血材料应用于眼眶手术中的护理观察

目的探讨两种吸收性止血材料(止血纱布和明胶海绵)在眼眶手术中局部创面贴敷止血的效果及术后护理方法。方法对手术中利用止血纱布(39例)或明胶海绵(50例)局部创面贴敷止血的眼眶病患者进行回顾性分析。结果止血纱布的止血成功率为100%,平均止血时间为(9.5±2.1)min,平均出血量为(112±13)ml,2例患者发现有脓肿、肿瘤样征象;明胶海绵的止血成功率为88%,平均止血时间为(21.1±4.9)min,平均出血量为(392±61)ml,4例患者出现视力检测异常。结论可吸收止血纱布组织相容性好,使用方便、安全,止血效果可靠,是眼眶手术局部止血的理想材料,且便于术后护理。     

垂体后叶素在腹腔镜肌瘤剔除术中的临床止血效果研究

目的：探讨垂体后叶素在腹腔镜肌瘤剔除术中的临床止血效果。方法：选取2013年1月～2015年10月我院诊治的90例腹腔镜子宫肌瘤剔除术患者资料进行分析,采用随机对照方法将患者分为对照组和实验组,对照组术中采用缩宫素止血,实验组术中采用垂体后叶素止血,比较两组止血效果。结果：实验组手术时间、术中出血量、血红蛋白术前与术后3d差值以及术后排气时间,显著低于对照组(P<0.05);两组患者手术前及手术后收缩压和舒张压差异不显著(P>0.05);两组患者手术后10min收缩压和舒张压出现一度上升,但是术后收缩压和舒张压差异得到下降(P<0.05)。结论：腹腔镜子宫肌瘤剔除术患者术中采用垂体后叶素止血效果理想,能够减少术中出血量,减少手术时间,值得推广应用。     

缝合止血与双极电凝止血在腹腔镜下卵巢囊肿剥除术中的应用效果

目的 比较缝合止血与双极电凝止血在腹腔镜下卵巢囊肿剥除术(LOC)中的应用效果。方法 选取2017年6月至2021年9月柘城县妇幼保健院收治的84例接受LOC治疗的卵巢囊肿(OC)患者为研究对象，按照随机数字表法分为对照组与观察组，每组42例。对照组接受双极电凝止血，观察组接受缝合止血。比较两组术前、术后3个月性激素指标[促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)]水平、卵巢动脉收缩期峰值血流速度(PSV)、基础窦卵泡数(AFC)、术前、术中创面止血时血流动力学指标[每搏量(SV)、平均动脉压(MAP)、心输出量(CO)]、血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)水平。结果 观察组术后3个月E2水平高于对照组，血清FSH、LH水平低于对照组(P<0.05);观察组术中创面止血时SV、MAP、CO低于对照组(P<0.05)。观察组术中创面止血时血清Cor、ACTH、NE水平低于对照组(P<0.05)。观察组术后3个月PSV、AFC优于对照组(P<0.05)。结论 于LOC治疗的患者术中，与应用双极电凝止血方式比较，应用...     

血管缝合器与人工压迫止血对冠心病介入术后病人的影响

目的探讨冠状动脉介入治疗后血管缝合器与人工压迫止血对病人止血时间、制动时间、舒适度及并发症的影响。方法冠状动脉介入治疗的518例病人,随机分为经皮血管缝合器组(观察组)及人工压迫止血组(对照组),观察2组病人止血时间、制动时间、舒适度及并发症的发生率。结果血管缝合器组平均止血时间为(4.0±2.5)min,卧床制动时间为(4.0±1.0)h。人工压迫止血组平均止血时间为(16.0±5.5)min,卧床制动时间为(24.0±4.0)h。观察组止血时间及卧床制动时间均明显少于对照组(P<0.05)。4 h后观察组舒适度明显高于对照组(P<0.05)。血管缝合器组如迷走神经反射发生率明显少于人工压迫止血组(P<0.05)。结论血管缝合器用于冠心病介入术后病人安全有效。     

鼻内窥镜手术采用两种不同填塞方法的效果观察及护理

目的探讨鼻内窥镜术后采用两种不同填塞方法的效果。方法选择行鼻内窥镜手术患者100例,随机分为观察组和对照组,各50例。观察组采用Ivalon止血海绵+可吸收止血纱布填塞。对照组采用凡士林油纱条进行填塞。并观察两组填塞效果。结果术后两组头痛、鼻腔胀痛、出血量、鼻黏膜反应的比较有显著性差异(P<0.05)。结论 Ivalon止血海绵+可吸收止血纱布使用简单,分布均匀,可防止鼻腔感染,止血效果好,是较理想的填塞材料。     

Bakri子宫填塞球囊治疗产后出血的临床效果观察

探究Bakri子宫填塞球囊治疗产后出血的临床效果。对照组予以宫腔内纱条填塞治疗,观察组予以Bakri子宫填塞球囊治疗,观察对比两组治疗效果及临床预后。观察组的术中出血量、术后2h出血量、术后24h出血量及输血量均少于对照组(P<0.05),且观察组24h血红蛋白水平高于对照组(P<0.05)。观察组止血有效率为91.0%,高于对照组的66.7%(P<0.05)。两组术后均未发生产褥感染,亦无严重不适。Bakri球囊治疗产后出血的止血效果确切,减少术后出血量,有助于尽可能地保存患者的生育能力。     

卡贝缩宫素联合COOK宫腔水囊压迫止血治疗高危妊娠剖宫产术后出血的临床研究

[目的]探讨卡贝缩宫素联合COOK宫腔水囊压迫止血治疗高危妊娠剖宫产术后出血的临床疗效.[方法]回顾性分析2014年6月至2016年6月本院500例高危妊娠剖宫产术后出血的产妇,其中350例术中预防使用卡贝缩宫素止血(对照组),150例使用卡贝缩宫素+COOK宫腔水囊压迫止血(观察组),比较两组临床疗效.[结果]观察组总有效率为94.67%(142/150),明显高于对照组88%(308/350),其差异有统计学意义(χ2=5.18,P=0.023);观察组术中出血量、产后2 h内和2~24 h平均出血量分别为(687.25±157.25)mL、(284.36±42.56)mL和(168.36±24.58)mL,明显少于对照组(843.71±184.53)mL、(382.24±88.65)mL和(194.49±30.51)mL,其差异均有统计学意义(P<0.05);两组产后2 h内子宫张力状态均为硬状态,观察组持续时间(59.32±12.23)min,明显短于对照组(62.07±13.35)min,其差异均有统计学意义(P<0.05);观察组不良反应发生率为24%(36/150),与对照组27.71%(97/350)比较差异无统计学意义(P>0.05).[结论]COOK宫腔水囊联合卡贝缩宫素对高危妊娠剖宫产术后大出血产妇有较佳止血效果,且操作简便,是产后大出血产妇的较佳选择.     

子宫背带式缝合术在剖宫产术中产后出血治疗中效果观察

目的:探讨子宫背带式缝合术在剖宫产术中产后出血治疗中的临床效果。方法:以本院2016年5月至2019年5月妇产科收治的84例剖宫产术中产后出血患者为研究对象,根据入院单双号将受试者分为对照组(n=42)和研究组(n=42),对照组患者接受宫腔填纱治疗,研究组患者接受子宫背带式缝合术治疗,比较两组患者的治疗总有效率、手术情况及并发症发生率。结果:研究组患者治疗总有效率较对照组更高,两组比较差异性显著(P<0.05),研究组患者的手术时间、术中出血量、术后5min及2h出血量均显著少于对照组,两组比较差异性显著(P<0.05),研究组患者并发症发生率较对照组更低,两组比较差异性显著(P<0.05)。结论:子宫背带式缝合术止血效果安全显著,手术时间短,在剖宫产术中产后出血治疗中具有较高的应用价值。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.