Clinically relevant asymmetry of bispectral index during recovery from anaesthesia for ear-nose-throat surgery in adults and children

This study investigates the incidence of clinically relevant asymmetry in bispectral index readings from different sides of the skull (using two monitors) during ear-nose-throat surgery in 42 adults and 46 children. A unilateral increase or decrease > 10% from baseline was defined as an 'asymmetry'. Asymmetry followed by movement after stimulation was defined as a 'clinically relevant asymmetry'. Asymmetry occurred in 39 out of 42 adults (93%) and in 20 out of 46 children (44%) during surgery and in 24 out of 42 adults (57%) and in 17 out of 46 children (37%) during recovery. Clinically relevant asymmetry was observed in 5 out of 42 adults (12%) and 6 out of 46 children (13%). The incidence of asymmetry was higher in adults during surgery (p = 0.0002). In conclusion, clinically relevant bispectral index asymmetry has been observed in > 10% of paediatric and adult anaesthesia and may have clinical implications. You can respond to this article at http://www.anaesthesiacorrespondence.com.     

Effect of preoperative education on behaviour of children during induction of anaesthesia: a randomised clinical trial of efficacy

In this randomised prospective study we aimed to evaluate whether preoperative anaesthetic education delivered to children on the day of surgery reduces anxiety behaviour during induction of anaesthesia. One hundred children, six to 15 years of age, undergoing general anaesthesia for ambulatory surgery were allocated at random to a preoperative education group (n=50) or a control group (n=50). The main outcomes were behaviour score, self-reporting of satisfaction score and identification of the stage when children felt most fearful. Data from all 100 participants were analysed. There was no difference in behaviour score at induction or satisfaction score between the groups. Eighteen percent in the intervention group reported no fear preoperatively vs 10% in the control group. Intravenous induction failed in nine out of 38 children in the intervention group (23.7%) compared to five out of 40 in the control group (12.5%). When intravenous induction failed, eight out of nine (89%) of the intervention group remained co-operative during gas induction compared to two out of five (40%) of the control group. Preoperative education delivered on the day of surgery did not reduce anxiety behaviour in children during intravenous induction of anaesthesia, but did reduce anxiety during subsequent inhalational induction.     

Single-center experience of organ transplant practice during the COVID-19 epidemic

In order to safely carry out organ donation transplants during the outbreak of coronavirus disease 2019 (COVID-19), we have formulated strict procedures in place for organ donation and transplantation. We retrospectively analyzed our transplantation work from January 20 to May 5, 2020, to discuss whether organ transplantation can be carried out safely during the epidemic period. From January 20 to May 5, 43 cases of donation were carried out in our hospital, and the utilization rate of liver, kidney, heart, lung, and pancreas donations was more than 90%. Forty-one cases of liver transplantation and 84 cases of kidney transplantation were performed. No graft loss or recipient death occurred within one month after kidney transplantation, and one patient (2.4%) died after liver transplantation. There was no significant difference in the length of hospital stay compared with that during the same period in the previous three years. More importantly, COVID-19 infection did not occur among healthcare providers, donors, patients, or their accompanying families in our center. Under the premise of correct protection, it is safe and feasible to carry out organ transplantation during the epidemic period. Our experience during the outbreak might provide a clinical reference for countries facing COVID-19 worldwide.     

体外循环前后外周血单个核细胞细胞因子的差异表达

目的探讨基因芯片技术在心血管外科临床及科研中的应用价值，应用表达谱基因芯片筛选体外循环（CPB）前后外周血单个核细胞（PBMC）的差异表达基因，为CPB炎性反应的研究提供线索。方法CPB开始、CPB结束即刻抽取患者动脉血，分离PBMC，用BD Atlas^TM cDNA Expression Arrays表达谱基因芯片对比细胞因子的差异表达，应用逆转录-聚合酶链式反应（RT—PCR）对结果进行验证。结果将基因芯片技术成功应用于CPB研究，并得到CPB前后PBMC细胞因子基因表达谱，其中自细胞介素-6（IL-6）和Wnt5a差异表达较明显，但半定量RT—PCR验证结果未发现差异有统计学意义（P=0．888，0．135）。结论基因芯片技术在CPB后细胞因子变化的研究中有一定应用价值；表达谱基因芯片初步筛选出了CPB后的差异表达基因，这些基因可能参与了CPB引起的炎性反应及其他病理生理反应；PBMC可能不是CPB中细胞因子的主要来源。     

根因分析法联合流程优化降低外出检查早产儿低体温的研究

目的 探讨根因分析法联合流程优化对新生儿重症监护室早产儿外出检查体温的影响.方法 成立根因分析小组,应用根因分析法对2020年1～7月67例新生儿重症监护室外出检查早产儿进行追踪,调查导致外出检查低体温发生的原因,寻找近端原因、剖析根本原因,制订改进措施,包括对早产儿外出检查流程进行重排、合并、优化等.并于2020年8月至2021年2月在58例外出检查早产儿中实施,比较改善措施实施前后低体温发生率.结果 改善措施实施后,早产儿腹部B超、全腹B超及听诱发检查时体温显著改善(均P＜0.01);早产儿外出检查低体温发生率由实施前的37.31％下降至实施后的10.34％,差异有统计学意义(P＜0.01).结论 根因分析法联合优化早产儿外出检查流程,可有效降低早产儿外出检查低体温发生率.     

Risk factors of cerebral aneurysm re-rupture during angiography

Although re-rupture of cerebral aneurysm during angiography has been reported occasionally, we have encountered 13 such patients during eight years since 1974, the incidence corresponding to 4.4 percent of 295 consecutive aneurysm patients on whom a total of 467 angiographies were performed. Extravasation on angiogram was noticed in 10 of these patients. We carefully analyzed the following factors to determine which one is significantly related to aneurysm re-rupture during cerebral angiography. The factors we investigated were sex, age, sites of ruptured aneurysm, surgical risk grade and time interval between the latest rupture of aneurysm and angiography. Our procedures of angiography were standardized as such that contrast material was injected by means of power injector and the injection pressure was adjusted at 2.5 kg/cm2 in vertebral angiography, 3 kg/cm2 in carotid angiography and 4 kg/cm2 in retrograde brachial angiography. Volume of contrast material was 6-8 ml, 10-12 ml and 30-32 ml, respectively. An incidence of re-rupture during angiography when performed within the initial 24 hours after the latest bleeding episode was 12 out of 123 angiographies (9.8%), whereas 1 out of 344 angiographies (0.3%) which were performed later than 24 hours. This difference was significant (p less than 0.001). These data were further analyzed every one hour period. It was learned that re-rupture rate was significantly high, 9 out of 45 patients (20.0%) when angiography was done within 5 hours after the latest aneurysm rupture (p less than 0.01), particularly, 8 out of 27 patients (29.6%) within 3 hours (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Early oral feeding of patients with extensive burns

The oral administration of fluid to patients with extensive burns is usually acceptable during the first 48 h post-burn. Nutrients can be added to the drinks, whereby a hyperalimentation regimen can be reached within a few days. However, accurate monitoring through laboratory investigations needs to be carried out during this treatment.     

Interobserver variations in intra-articular evaluation during arthroscopy of the knee

We carried out a prospective study in order to establish to what extent the intra-articular evaluation undertaken during arthroscopy of the knee differed between surgeons. Two senior specialist registrars and a consultant orthopaedic surgeon with a special interest in knee surgery were involved. A total of 78 knee arthroscopies (78 patients) was studied. Arthroscopy was first carried out by the trainee and then by the senior author (ACWH). The intra-articular evaluation during the arthroscopy was recorded independently by a third person in the operating theatre. Data were collected to record variations in examination under anaesthesia, the morphology and pathology of the menisci and anterior cruciate ligament and the state of the articular surfaces. The overall interobserver variation was 20% in all categories. We question the published results of intra-articular evaluation during knee arthroscopy when surgeons of different levels of experience are involved in a single study.     

腹腔镜阑尾切除术残端荷包包埋61例

目的总结腹腔镜阑尾切除术残端荷包包埋的手术经验。方法回顾分析2009年7月至2010年6月施行的61例腹腔镜阑尾切除术,术中阑尾残端均行荷包包埋,阐述手术的经验体会。结果 61例腹腔镜阑尾切除术残端荷包包埋均成功完成,无一例发生副损伤及并发症。结论腹腔镜下阑尾残端荷包包埋是安全可行的,不增加患者的手术费用,值得推广。     

Effects of isoflurane-nitrous oxide anaesthesia on insulin secretion in female patients

In vitro studies suggest that volatile anaesthetic agents may directly inhibit insulin secretion. It is unclear if supplementation of anaesthesia with isoflurane impairs insulin secretion. We performed a 5- g i.v. glucose tolerance test in 21 patients before and during anaesthesia which was maintained with either 1 or 2 MAC of isoflurane in nitrous oxide, or no volatile agent. The study was carried out before surgery to avoid the influence of hormonal responses to trauma. A significant glycaemic response occurred during both i.v. glucose tolerance tests in all three groups of patients. Serum insulin concentrations were measured and the acute increase in insulin concentration at 3 min and area under the curve for 15 min were calculated. Both variables decreased significantly in all three groups during the tests performed under anaesthesia compared with tests carried out before anaesthesia.      

Cancer of the gallbladder

From 1976 to 1987, 1,537 operations were carried out for cholecystitis at the Ramensk District Hospital; carcinoma of the gallbladder was found in 27 patients, one case with carcinoma of the gallbladder was recognized during laparoscopy and another case during autopsy. Twenty-five patients were over 60 years of age. Concrements were discovered in 16 patients. The diagnosis of carcinoma of the gallbladder cannot be established sometimes, even during an operation. For instance, the authors were able to recognize it in 10 cases only after histological examination. Radical cholecystectomy could be carried out only in 6 of 27 patients. Three of them died having survived 360 days, on average, after the operation. Two patients were alive for more than 4 years, one patient for over 7 years. The average survival of 10 patients after laparotomy and biopsy was 46.5 days. The survival of 11 patients treated by palliative operations was 56 days on average.     

肝癌自发破裂大出血行超声刀切除术1例的护理配合

目的：探讨1例肝癌自发破裂大出血12500mL（含腹水、术前肝癌出血、术中出血）行超声刀切除术的护理配合。方法（1）配备足够的护理人员：接到手术通知单后由3组护理人员同时分工（心理护理、术前准备、手术室准备）进行。（2）手术相关配合：术前准备的同时积极做好患者心理护理,让其情绪稳定;简单、快捷的术前准备;手术仪器、器械及物品准备齐全;快速建立多处静脉通道;术中根据手术进程,及时调整,熟练配合;正确使用和调节超声刀;严格遵循无瘤原则。结果经2小时55分钟的手术抢救,患者脱离生命危险。结论针对肝癌自发性破裂大出血发病急骤、来势凶猛的特点,手术配合最好由多组护理人员同时分工进行,手术过程中用物准备齐全、娴熟的操作、沉着冷静的应对是抢救成功的保障。     

Prevention of irrigant absorption during TURP: Continuous low-pressure irrigation

Comparative studies have been carried out on bladder pressure. The pressure gradient between bladder and abdominal cavity during TURP proved to be significantly lower with continuous low-pressure irrigation than with conventional high-pressure irrigation. Absorption is reduced to a clinically insignificant rate, as shown by blood sugar determinations during TURP in 100 cases.     

The role of the vascular laboratory in the management of major lower limb amputations

Since the assumption that vascular laboratory data improves the predictability of below-knee (BK) amputation healing is largely based on retrospective studies, a comparison between the success rates of BK amputations was performed between two consecutive 50-month periods. During the first period the level of major lower limb amputations was determined by clinical judgement alone whereas during the second period analysed pressure data from a vascular laboratory was available. During the first period 16 out of 48 amputations (33%) failed whereas only 10 out of 60 amputations (17%) failed during the second period of the study. The results from this comparison suggest that vascular laboratory data can be used to improve the success rate in below-knee amputations.     

胆道镜联合应用在腹腔镜胆总管切开取石一期缝合中的作用

目的探讨胆道镜联合应用在腹腔镜胆总管切开取石一期缝合中的应用价值。方法总结2009年1月至2013年4月,腹腔镜胆总管切开取石一期缝合术61例的临床经验,胆总管直径≥8mm,腹腔镜下胆总管切开,用纤维胆道镜联合胆道直镜行胆总管取石,先用纤维胆道镜探查胆总管、肝总管及左右肝管,吸引器接输血器管反复冲洗胆总管,大部分结石可以被冲出,再用胆道镜检查,用取石网篮取出残余结石,若遇结石嵌顿或大的结石难以用纤胆镜取出时改用胆道直镜碎石、取石。结果61例患者成功行胆总管切开取石一期缝合术,用胆道直镜碎石取石29例,占47．5％;其中17例结石在胆总管下端嵌顿,12例因结石大难以取出。少量胆漏5例,引流量每天10～50m1,术后3～12d拔除腹腔引流管;手术时间90～180（134±22）min。术后住院7～14（8．4±1．5）d,所有患者均治愈。61例中有58例获随访,随访时间4～52个月,无残余结石。结论胆道直镜可以弥补纤维胆道镜的不足,胆道镜的联合应用可以尽可能取净结石,在腹腔镜胆总管切开取石一期缝合中发挥重要的作用。     

The cost-effectiveness of a back school program in industry. A longitudinal controlled field study.

To define the cost-effectiveness of a back school program in industry, a controlled longitudinal field study was carried out in a Dutch bus company. The experimental group received a program consisting of information on back care, physical fitness, nutrition, stress, and relaxation. Objective data on absenteeism were collected and compared during a 6-year period for the control and experimental groups. Results showed that a tailor-made back school program reduced absenteeism by at least 5 days per year per employee, therefore being cost-effective to industry. A reduction was not observed in incidence, but in mean length of absenteeism. This effect turned out to be persistent during a 2-year period following the program.     

超声定位引导下注射隆乳充填物抽吸术

目的：处理聚丙烯酰胺水凝胶注射隆乳术并发症的根本方法是取出异物，为能准确、比较彻底地取出异物，同时对组织损伤小、较好地保存好乳房的形态，寻求一种定位准确、直接引导穿刺抽吸方向、动态监测抽吸效果的方法。方法：用超声探查注射隆乳术并发症患者的乳房情况，对异物定位，引导穿刺抽吸方向，动态监测抽吸状况。结果：2002年6月至2004年6月笔者用超声定位引导穿刺抽吸方向、动态观测异物抽吸情况l7例，即时取出异物，乳房硬结消失，术后随访，效果良好。结论：超声定位引导、动态监测负压抽吸注射隆乳术后异物，能够达到抽吸部位准确、异物去除彻底的目的，对乳房损伤小、效果好。     

Comparison of fine-needle aspiration biopsy and histology in human liver transplants

The findings in 50 fine-needle aspiration biopsies obtained from 27 liver transplants in 24 patients were compared with concomitant histologic findings. When histology showed rejection, rejection was diagnosed in 20 out of 29 FNAB specimens; when rejection was absent histologically, FNAB was negative in 20 out of 21 specimens (sensitivity 69%, specificity 95%). There was a statistically significant correlation between the degree of immunoactivation as reflected by total corrected increment (TCI) in FNAB specimens and the portal triad cell density during rejection, while no correlation existed between the 2 parameters in situations other than rejection. When cholestasis was demonstrated histologically, FNAB showed cholestasis in 30 out of 31 specimens. Furthermore, FNAB showed fatty change in the hepatocytes in 29 out of 43 specimens from livers with histologically evident steatosis. Histology showed necrotic areas in 40 specimens; however, only in 12 concomitant FNAB specimens were necrotic clumps observed. In conclusion, FNAB is a good method for diagnosing acute liver transplant rejection as well as for evaluating intracellular cholestasis or fatty change. Furthermore, TCI seems to reflect the severity of cellular infiltration in the portal triads during rejection.     

经尿道膀胱肿瘤电切及基底部活检：附61例报告

经尿道膀胱肿瘤电切同时行基底部活检６１例，其中７例（１１．５％）肿瘤浸润深肌层，４例再次手术时改用其他手术方法均存活２年以上。此方法对明确膀胱肿瘤分期及指导治疗，改善患者的预后均有重要意义。     

喉返神经术中监测和识别

为了在手术中更有效、准确地识别喉返神经并对其加以保护,国内外从事甲状腺外科领域的专家及医师开展了大量的研究工作,提出可运用电生理神经探测仪对喉返神经进行术中监测。目前该方法的临床应用已成为研究热点,现就喉返神经术中监测和识别的研究历史、方法、效果及存在的问题进行综述。