Laparoscopy for the Acute Abdomen in the Postoperative Urologic Patient

Objectives. Exploratory laparotomy offers the greatest diagnostic accuracy of intra-abdominal pathologic processes, but can be associated with significant morbidity. Laparoscopy provides diagnostic capabilities equivalent to that of open exploration, but with potentially less morbidity. We present 3 cases in which laparoscopy was used to diagnose and manage urologic patients with an acute abdomen in a postoperative period.Methods. Three patients underwent laparoscopy between 1 and 14 days postoperatively for an acute abdomen (fever, elevated white blood cell count, and peritoneal signs). The initial procedures included a pubovaginal sling repair with fascia lata, endoscopic placement of a percutaneous gastrostomy tube, and a laparoscopic ureterolithotomy for a distal stone.Results. In each of the 3 patients laparoscopy revealed misplacement or malfunction of a previously placed tube. In all cases, the patient was managed laparoscopically without the need for laparotomy.Conclusions. These cases demonstrate the feasibility of laparoscopy to provide diagnostic and therapeutic solutions to postoperative urologic patients presenting with an acute abdomen.     

Patient Preferences for the Disclosure of Prognosis After Esophagectomy for Cancer with Curative Intent

Introduction  The aim of this study was to determine the preferences for content, style, and format of prognostic information of patients after potentially curative esophagectomy for cancer and to explore predictors of these preferences. Patients and Methods  This multicenter study included a consecutive series of patients who underwent surgical resection for cancer in the past 2 years and who did not have evidence of cancer recurrence. A questionnaire was used to elicit patient preferences for the content, style, and format of prognostic information. Sociodemographic characteristics, clinicopathological factors, and quality of life (EORTC QLQ-30 and OES18) were explored as predictors for certain preferences. Results  Of the 204 eligible patients, 176 patients (86%) returned the questionnaire. The majority of patients desired prognostic information. Information preferences declined when information became more specific and more negative. Married patients and higher-educated patients were more likely to want all prognostic information. The majority of patients wanted their specialist to start the discussion about prognosis. However, a significant proportion of these patients wanted their specialist to first ask if they want to have prognostic information. The percentage of patients wanted a realistic and individualistic approach was 97%. Words and numbers were preferred over visual presentations. Conclusion  After potentially curative esophagectomy for cancer, the majority of patients want detailed prognostic information and want their specialist to begin the prognostic discussion. Patients prefer their doctor to be realistic; words and numbers are preferred over figures and graphs. The results of the present study were in part presented at the World organization for specialized studies on disease of the esophagus (OESO September 3-6-2006, Avignon, France).     

1例胎盘植入并存晚期产后出血患者的护理

对1例胎盘植入并存晚期产后出血患者进行化疗、输血、对症治疗及护理,结果患者阴道出血减少,各项生化指标恢复正常,宫颈管内坏死组织完全脱落,达到临床治愈.提出加强心理护理和药物治疗及对症护理是治疗成功的关键.     

l例胎盘植入并存晚期产后出血患者的护理

对1例胎盘植入并存晚期产后出血患者进行化疗、输血、对症治疗及护理，结果患者阴道出血减少，各项生化指标恢复正常，宫颈管内坏死组织完全脱落，达到临床治愈。提出加强心理护理和药物治疗及对症护理是治疗成功的关键。     

管状胃对食管癌根治术后患者预后的影响

[摘要]目的探讨管状胃代替食管对食管癌根治术后患者生活质量的影响。方法设计我院2012年6月～2013年3月行食管癌根治术患者135例,随机分为实验组（管状胃替代食管,63例）与对照组（全胃替代食管,72例）,比较两组患者手术情况、术后并发症发生率、生活质量相关指标。结果入组患者治疗均获成功,无术中死亡病例,术中相关指标比较,差异无显著性（P〉0．05）。术后并发症比较,实验组返流性食管炎与胸胃综合征的发生率明显低于对照组,差异有显著性（P〈0．05）。术后6周,两组患者生活质量比较无显著性差异（P〉0．05）,实验组术后3个月以及术后6个月生活质量改善情况较对照组好,差异有显著性（P〈0．05）。结论管状胃治疗手段对于食管癌根治术后患者生活质量的改善有着积极的作用。     

1例肝移植术后并发毛霉菌感染患者的护理

对1例肝移植术后并发背部毛霉菌感染的患者给予清创、换药、理疗以及营养支持、心理护理和饮食指导.结果感染部位7周治愈.提出密切观察患者病情、综合治疗和精心护理是治疗皮肤毛霉菌感染的关键.     

1例肝移植术后并发毛霉菌感染患者的护理

对1例肝移植术后并发背部毛霉茵感染的惠者给予清创、换药、理疗以及营养支持、心理护理和饮食指导。结果感染部位7周治愈。提出密切观察患者病情、综合治疗和精心护理是治疗皮肤毛霉菌感染的关键。     

高龄肠梗阻并存其他脏器疾病患者的护理

目的探讨高龄肠梗阻并存其他脏器疾病患者的护理方法。方法对70岁以上206例高龄肠梗阻并存其他疾病患者在实施手术、非手术治疗基础上，给予控制疾病后，采取基础、饮食、心理护理以及病情观察、胃肠减压、预防术后并发症等护理。结果100例患者行手术治疗，85例治愈。另106例采用非手术治疗，72例治愈。结论提高对高龄肠梗阻并存其他疾病患者，临床特点的认识，加强患者各器官功能支持和营养代谢支持，给予针对性护理，可促进患者康复。     

高龄肠梗阻并存其他脏器疾病患者的护理

目的 探讨高龄肠梗阻并存其他脏器疾病患者的护理方法.方法 对70岁以上206例高龄肠梗阻并存其他疾病患者在实施手术、非手术治疗基础上,给予控制疾病后,采取基础、饮食、心理护理以及病情观察、胃肠减压、预防术后并发症等护理.结果 100例患者行手术治疗,85例治愈.另106例采用非手术治疗,72例治愈.结论 提高对高龄肠梗阻并存其他疾病患者临床特点的认识,加强患者各器官功能支持和营养代谢支持,给予针对性护理,可促进患者康复.     

四肢骨折脱位合并血管损伤24例

我院自１９９１年３月～１９９５年３月收治四肢骨折脱位合并血管损伤２４例，除１例因创面严重感染截肢外其余均获成功，现报告如下。临床资料本组２４例均为男性，年龄８～４６岁。损伤部位：肱骨髁上伸直型骨折致肱动静脉损伤６例；股骨外科颈骨折致腋动脉损伤３例；肱骨干骨折致肱动脉损伤２例；尺桡骨中段骨折致桡动脉损伤２例；股骨干上１／３骨折致股深动脉损伤２例；股骨髁上骨折致腘动脉损伤４例；膝关节脱位致腘动静脉损伤５例。损伤类型：血管完全断裂６例，血管挫伤１４例，动静脉瘘２例，假性动脉瘤２例。修复方法：血管直接吻…     

Late Intestinal Obstruction due to an Intestinal Volvulus in a Pregnant Patient with a Previous Roux-en-Y Gastric Bypass

This is a case of a 33 weeks pregnant woman, presented 2 years after laparoscopic Roux-en-Y gastric bypass, with abdominal pain for 2 days. A laparoscopic cholecystectomy was performed 1 day earlier in another hospital, without improving the pain. She presented at our hospital with acute abdominal pain and clinical signs of intestinal obstruction, undergoing an exploratory laparotomy that revealed a volvulus and necrosis of the jejunum from the gastroenteroanastomosis through the lateral enteroenterostomy, which was resected with the reconstruction of the Roux-en-Y limb performed at the same operation. Patient and neonate presented with improvement after surgery and the patient was discharged on postoperative day 15. Internal hernias after bariatric surgery have been reported as the cause of acute abdomen problems during pregnancy, which may progress to necrosis and perforation. The delay of surgical intervention could have brought a tragic outcome for mother and neonate.     

1例骨髓移植术后并发重型肝炎患者行人工肝血浆置换术的护理

对1例骨髓移植术后在血型转换中并发重型肝炎的患者,通过人工肝支持系统进行4次血浆置换术,结果患者病情好转出院.提出做好充分的术前准备、加强血型抗体滴度的监测、选取合适血型的血浆,以及术中密切观察患者生命体征变化、预防并发症的发生,术后正确的饮食指导,是保证患者血浆置换术顺利完成的重要措施.