Dual Kidney Transplantation: A Single-Center Experience in Thailand

Background

Dual kidney transplants (DKTs) from expanded criteria donors (ECDs) have been performed in our hospital since 2014. We needed to review our clinical outcome and update criteria to selected ECDs for DKTs.

肾移植术后早期急性肾功能衰竭的救治：附9例报告

为探讨肾移植术后早期急性肾功能衰竭（ＡＲＦ）的发病原因及救治方法，报告同种异体肾移植术后并发ＡＲＦ９例，其中为有效循环血容量不足所致者６例，高血磷中毒所致者３例。经过积极治疗，除１例因术后并发感染救治无效而摘除移植肾外，其余８例均恢复了肾功能，取得较好效果。并就肾移植术后早期ＡＲＦ的发病原因进行了分析，总结治疗上的一些体会。认为有效循环血容量不足和高血磷中毒为ＡＲＦ的主要病因；针对不同病因分别采取     

Experience with a program for prevention of chronic renal failure in India

BACKGROUND: For the past eight years, the Kidney Help Trust of Chennai has run a program to prevent chronic renal failure by regular screening of an entire population of 25,000, and treatment of diabetes and hypertension with the cheapest available drugs. The total cost amounts to 25 cents per capita of the study population. METHODS: The program has recently been expanded to cover the adjacent area with a population of 21,500. Both the original population and the new population are being surveyed. Persons at risk of renal failure are identified as reported earlier, and glomerular filtration rate (GFR) is estimated by the MDRD formula. The survey is as yet incomplete. Six thousand one hundred people in the new area, and 20,986 in the old, have been studied so far, and the numbers and percentage of those with GFR below normal have been compared. RESULTS: The prevalence of impaired renal function (GFR below 80 mL/min) in the original population is 8.6 per thousand, and in the new population is 13.9 per thousand (P= 0.005, RR 1.61, CI 1.15-2.24). CONCLUSION: This model provides an effective method for prevention of chronic renal failure at the community level.     

Subacromial impingement syndrome in athletes: prevention and exercise programs

The shoulder joint, the most mobile joint in the human body, is at greater risks for injuries. Several factors contribute to shoulder impingement syndrome including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. Rehabilitation and training of the shoulder in throwing and overhead athletes has dramatically improved during the last decade. There are numerous reasons for rapid return to athletic training and competition. A preventive program designed for the glenohumeral joint is mainly based on an appropriate preparation, which should include overall body conditioning, flexibility, and strengthening of the musculature around the glenohumeral joint and the scapula. Activity levels represent a helpful guide in determining an appropriate rehabilitation program for shoulder patients ranging from disabled to those competing at the highest levels of athletics. This article discusses issues related to prophylactic measures, non-operative treatment, postoperative treatment, and rehabilitation programme of impingement syndrome in athletes.     

Experience with single-dose daclizumab in the prevention of acute rejection in heart transplantation

INTRODUCTION: Daclizumab is a monoclonal antibody that binds to the interleukin-2 receptor. It has been used as induction therapy in heart transplantation with two to five repeated administrations over several weeks. The objective of our study was to estimate the efficacy and safety of induction therapy with only one dose of daclizumab in a consecutive series of patients undergoing heart transplantation. METHODS: Thirty-two consecutive heart transplants performed since July 2002, who received single-dose daclizumab as induction therapy, were compared with the 30 patients transplanted previously, who received OKT3. In both groups, maintenance immunosuppression included cyclosporine or tacrolimus, mycophenolate mofetil, and corticosteroids. Follow-up time was 1 year. RESULTS: There were no baseline differences between the two groups regarding age, gender, or etiology. In the group treated with daclizumab there were more diabetics (43% versus 10%, P = .01) and the ischemia time was longer (192 versus 156 minutes, P = .03). During the first posttransplant year, 76% of patients treated with OKT3 and 55% of those treated with daclizumab presented acute rejection > or =3A; 20% and 25%, respectively, presented infections; and 5 (17%) patients in the OKT3 group and 2 (6%) in the group treated with daclizumab died. None of these differences was statistically significant. CONCLUSIONS: Our experience suggests that induction therapy with a single-dose regimen of daclizumab seems to have an efficacy and safety profile similar to OKT3, and it is easier to administer and has a lower cost than other induction regimens.     

甲状腺手术医源性损伤的预防

对206例甲状腺良性疾病手术患者临床资料进行回顾性分析, 206例中出现喉上神经损伤5例（2.43%），喉返神经损伤3例（1.46%），甲状旁腺功能减退6例（2.92%），无死亡病例。医源性损伤与甲状腺疾病、手术方式、术中操作密切相关。提示遵循手术操作规程，提高手术技巧，减少术中出血，必要时显露喉返神经是预防医源性损伤的有效措施。     

甲状腺手术预防喉返神经损伤的体会

喉返神经损伤是甲状腺手术最严重手术并发症之一,表现为术后声音嘶哑,严重者可发生呼吸困难,甚至窒息.本文总结云南省第二人民医院普外科治疗甲状腺疾病术中行喉返神经探查的经验如下.     

胰十二指肠切除术后胰瘘的防治

目的探讨胰十二指肠切除术后胰瘘发生的原因及其防治方法。方法回顾性分析2008年1月至2010年11月收治的76例胰十二指肠切除术患者的临床资料,对其术后发生胰瘘的14例患者进行临床分析。结果 76例胰十二指肠切除患者共发生术后胰瘘14例,发生率18.4%。该14例胰瘘患者中12例经保守治疗后痊愈,有效率为85.7%,2例患者经二次手术治疗,其中1例患者死亡（7.1%）。结论胰十二指肠切除术后胰瘘的发生率和病死率仍较高。术中及术后对患者的恰当处理是减少术后胰瘘的关键因素。     

胰体尾切除术后胰瘘的防治

目的探讨胰体尾切除术后胰瘘的防治。方法回顾性分析2007年1月至2014年5月间83例行胰体尾切除术病人的术前基本资料、术中操作及术后治疗等临床资料,对其中并发胰瘘的19例病人临床资料进行分析。结果行胰体尾切除术的83例病人中,术后并发胰瘘19例,发生率为22．9％,16例经保守治疗痊愈,有效率为84．2％,2例病人行放射治疗后治愈,1例死亡,死亡率为1．2％。单纯缝扎和切割闭合器处理胰腺断端后胰瘘发生率分别为21．6％和23．9％。结论胰体尾切除术后胰瘘的发生率仍然很高,术中正确处理胰腺断端及加强术后管理是预防胰体尾切除术后胰瘘的关键。胰瘘的治疗在于通畅引流、加强营养支持,并积极寻找新的治疗方法。     

移植肾输尿管并发症的防治

总结１９９０－１９９３年４年间的临床肾移植４１１例，重点探讨移植肾输尿管３种并发症的发生原因，预防及治疗方法。认为尿漏的发生与取肾，修肾过程中输尿管系膜的保护不够以及输尿管膀胱吻合的技巧有直接关系。输尿管狭窄多为粘膜下隧道缝合过紧。急性输尿管梗阻为异物所致。尿漏，输尿管狭窄应早期手术治疗，而急性梗阻则可先行局部按压或颠簸治疗，不能通畅者也应手术解除。     

新型冠状病毒肺炎疫情期间创伤显微外科病区的感染防控经验

目的总结新型冠状病毒肺炎(COVID-19)疫情期间创伤显微外科病区的感染防控经验。方法回顾性分析2019年12月31日至2020年2月14日期间武汉大学中南医院创伤与显微骨科51名医务人员和收治患者感染COVID-19的情况。2020年1月20日升级感染防控措施,包括病区的预防性消毒、终末消毒及人员消毒管理,急诊患者管理,住院患者管理,疑似患者管理,医务人员的培训、防控管理及心理干预。对比2020年1月20日前后不同感染防控措施的结果。结果2019年12月31日至2020年1月20日期间科室共有COVID-19确诊病例3例,疑似病例2例。确诊病例包括1名医师、1名技师、1名护士,疑似病例包括1例患者、1名护士。截至2020年2月14日,4名医护技人员均已治愈出院,1例患者死亡。从2020年1月20日感染防控措施升级后,科室共收治29例急诊患者,其中12例患者出现发热(体温≥37.3℃),无一例患者感染COVID-19;科室在岗的47名医务人员培训率达100%,无一名医务人员感染COVID-19和出现心理疾患。结论COVID-19疫情期间,随着疫情的变化,科室采取的感染防控措施不断调整升级,最终科学、有效地杜绝了院内感染的发生,保障了科室医务人员及患者的生命安全。     

镜下甲状腺手术无重大并发症发生的经验

目的总结预防镜下甲状腺手术并发症的经验. 方法双侧病变12例经前胸入路,单侧病变41例经腋下入路,用自制的器械做从切口到甲状腺的皮下隧道,宽约5 cm,充CO2压力4 mm Hg,用腹腔镜器械与超声刀完成病灶的分离、切除.结果腺瘤41例(单侧34例,双侧7例),结节性甲状腺肿12例(单侧7例,双侧5例).术后1例出现皮下隧道血肿,保守治愈,无神经损伤及甲状旁腺并发症发生.结论超声刀及持续系统低腔隙压是预防并发症有效方法.     

Initial experiences with telerehabilitation and contingency management programs for the prevention and management of pressure ulceration in patients with spinal cord injuries.

Two alternative treatment methods for preventive interventions for pressure ulcers, tele-rehabilitation and contingency management, are discussed. Telerehabilitation uses a videophone that transmits both audio and still images over a telephone line. Using this technology, the WOC nurse can interview a patient who cannot be present at a clinic because of physical condition or distance. Telerehabilitation allows the nurse to assess a patient's pressure ulcer, consult with appropriate caregivers, and make recommendations for treatment. Contingency management procedures are designed for patients with high rates of noncompliance in skin care. The patients are seen as outpatients and are compensated systematically for appropriate skin care (ie, the lack of pressure ulcers). Examples of each of these patient interventions is described, discussed, and contrasted.     

The impact of osteoporosis prevention programs on calcium intake: a systematic review

Little is known about the dimensions of osteoporosis prevention programs essential to changing health behaviors. The purpose of this review was to determine the impact of select characteristics of structured osteoporosis prevention programs on calcium intake in women. This systematic review included 12 experimental and quasi-experimental studies conducted internationally with adult women participants. Studies were more likely to demonstrate differences when they were conducted outside the U.W.; participants had lower baseline calcium intake; and interventions were multi-dimensional and included factual information, skill training, and social contact delivered dynamically over time. The results document extensive variability across participants, programs, and measures. There is a need to document the source (total and sub-total) of calcium intake, to provide the necessary data to calculate effect sizes to enable comparison across studies, and to identify those moderating factors (such as menopausal status) that affect the ability to determine differences between sub-groups. Results indicate health behavior change is more likely to occur when patient-centered interventions designed to increase knowledge and health beliefs, skills and abilities, and social facilitation are delivered over time. There is an urgent need for the development and testing of new health behavior change theories, prevention programs, and delivery media to support and complement health care providers in the prevention and management of this common, debilitating condition.