Unnecessary Albumin Therapy in a Jaundiced Patient

A 40 year-old woman with obstructive jaundice due to carcinoma of the head of the pancreas is presented. Chemical determinations on the patient's jaundiced serum, using an organic dye-binding method showed a low albumin determination which led to infusion of six units of salt poor albumin. Subsequent studies of albumin by electrophoresis using the pretransfusion specimen showed a normal quantity of albumin. Caution is urged in the transfusion of albumin to jaundiced patients, since the dye-binding technique is in common use in the automated chemistry panel.     

超声引导下经皮肝穿胆道造影及胆管内置管引流在梗阻性黄疸中临床应用

本文报告１０例超声引导下经皮肝穿胆道造影，胆管内置管引流成功经验。１０例病人均为恶性梗阻性黄疸。成功９例，１例因肝内胆管畸形改变未成功。９例成功引流的病人均行手术治疗，术后无一例并发症。进行超声引导下行胆道造影，胆管内置管引流准确性及成功率高，明显减少术后并发症，是值得推广的一种方法。     

经皮肝穿刺胆道造影150例分析

目的：总结经皮肝穿刺胆道造影（PTC）的应用体会。材料与方法：回顾分析1988年1月～1997年12月收治的150例黄疸病人的临床资料和造影方法等。结果：本组PTC成功率为96％,诊断符合率达95％。结论：PTC在有经验的操作者手里是一项相当安全、有效的胆系疾病检查方法之一。     

B型超声引导经皮肝穿刺胆管造影的应用研究

应用B型超声（简称B超）引导经皮肝穿刺胆道造影（简称造影），对B超未能明确梗阻部位和病因的23例黄疸患者进行了检查。21例成功。结果表明：本方法除可确诊梗阻的具体位置外，还可依据造影后胆管阻塞端之影像特点判定梗阻的病因，为临床选择治疗方案提供可靠的依据。     

Managing the Diabetic Kidney Patient

Diabetes mellitus (DM) is the leading cause of kidney failure in the United States, and controlling DM slows kidney failure. Thus, treatment of DM with antihyperglycemic medications is vital for patients with kidney disease. However, as kidney function and medication elimination decrease, patients are at increased risk for adverse drug reactions when medication doses are not adjusted appropriately. Dosing of antihyperglycemic medications for patients with kidney disease is an important issue for nurse practitioners and other health care providers.     

B超引导经皮经肝胆道置管引流的临床价值探讨

本文回顾性总结了阻塞性黄疸患者在外科手术前及术后由B超引导的经皮经肝胆道置管引流（PTCD术）的应用效果149例，成功率为82．55％（123／149），目的在于找出在PTCD操作过程中存在的利弊因素，便于更切实有效地改进操作手法及确定适应症。以期提高PTCD的一次成功率及减少患者的痛苦。本文对PTCD成、败原因也进行了较为详细的讨论。     

经皮经肝胆管引流在恶性阻塞性黄疸治疗中的应用

选择我院2008年5月～2011年4月收治的恶性阻塞性黄疸患者45例,均采用超声引导下PTCD治疗,观察患者穿刺、置管和引流效果,并比较治疗前后患者血清总胆红素(TBIL)水平的变化。术后随访半年,观察患者并发症发生率和生存率。结果全部患者中一次穿刺成功率为97.78%;置管成功率为100.00%;术后引流量为475.21±102.58ml/d。与治疗前比较,治疗后血清TBIL水平明显较低,差异有统计学意义(P<0.05)。术后随访期间,并发症发生率为6.67%;术后6个月生存率为88.89%。     

Managing Difficult Pain Conditions in the Cancer Patient

Chronic abdominal pain is a devastating problem for patients and providers, due to the difficulty of effectively treating the entity. Both benign and malignant conditions can lead to chronic abdominal pain. Precision in diagnosis is required before effective treatment can be instituted. Celiac Plexus Block is an interventional technique utilized for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. The richly innervated plexus provides sensory input about pathologic processes in the liver, pancreas, spleen, omentum, alimentary tract to the mid-transverse colon, adrenal glands, and kidney. Chronic pancreatitis and chronic pain from pancreatic cancer have been treated with celiac plexus block to theoretically decrease the side effects of opioid medications and to enhance analgesia from medications. Historically, the block was performed by palpation and identification of bony and soft tissue anatomy; currently, various imaging modalities are at the disposal of the interventionalist for the treatment of pain. Fluoroscopy, computed tomography (CT) guidance and endoscopic ultrasound assistance may be utilized to aid the practitioner in performing the blockade of the celiac plexus. The choice of radiographic technology depends on the specialty of the interventionalist, with gastroenterologists favoring endoscopic ultrasound and interventional pain physicians and radiologists preferring CT guidance. A review is presented describing the indications, technical aspects, and agents utilized to block the celiac plexus in patients suffering from chronic abdominal pain.     

Diagnosing and Managing Spinal Stenosis in the Adult Patient

Spinal pain is one of the most common presenting complaints globally. Differentiating and determining the specific type of spinal pain is a challenge for the practicing nurse practitioner. Obtaining a thorough past medical and surgical history and performing a comprehensive spinal examination will assist in determining the appropriate diagnostics, medical management, and spinal specialty referral. The skilled and competent nurse practitioner who gains important subjective and objective findings that suggest spinal stenosis can prevent neurologic consequences and help to maintain the patient’s physical functioning and quality of life.     

Managing a Chronic Pain Patient in the Perioperative Period

ABSTRACT

The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients.

This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.     

经胆囊管胆道造影在胆囊切除术中的应用

目的：探讨经胆囊管造影在单纯性胆囊切除术中的价值。方法：对1997年1月-2000年12月,232例单纯性胆囊切除术中,经胆囊管造影的临床资料进行回顾性分析。结果：43例有胆总探查相对指针的病人,术中胆道造影有阳性发现11例,占25.58%,189例无胆总管探查相对指针的病人,术中胆道造影有阳性发现的21例,占11.1%。结论：单纯性胆囊切除术中,经胆囊管造影是种简单而有效降低胆管残余结石方法。可避免不必要的阴性胆总管探查。     

经皮肝穿胆道金属支架治疗内镜难治性恶性胆道梗阻

目的:探讨经皮肝穿胆道金属支架治疗内镜难治性恶性胆道梗阻的临床疗效。方法:12例恶性胆道梗阻患者,内镜治疗失败后,B超引导行PTC术,后置入胆道金属支架。结果:12例患者胆道置入金属支架均获成功,共置入支架13枚。术前、术后总胆红素分别为(274.5±85.1)μmol/L,(36.4±7.0)μmol/L,两者比较,有显著性差异(P<0.05);术前、术后碱性磷酸酶分别为(460.5±180.2)U/L,(118.2±36.8)U/L,两者比较,有显著性差异(P<0.05);术前、术后γ-谷氨酰转移酶分别为(1136.3±316.6)U/L,(142.5±96.7)U/L,两者比较,有显著性差异(P<0.05);不良反应:2例出现轻型急性胰腺炎。结论:恶性胆道梗阻内镜治疗失败后,PTC途径置入金属内支架是一种安全有效的姑息治疗方法。     

电话干预对经皮经肝胆道外引流术患者康复及生活质量的影响

目的探讨电话干预对经皮经肝胆道外引流术治疗恶性梗阻性黄疸患者康复及生活质量的影响。方法将某三级甲等医院经皮经肝胆道外引流术治疗恶性梗阻性黄疸患者分为对照组48例和干预组51例。干预组在接受常规健康教育的基础上,出院后3个月内接受电话干预提供的个性化健康教育;出院后3个月对两组患者带管相关知识、带管相关并发症及生活质量进行调查比较。结果患者出院后3个月除引流袋更换外,电话干预组带管相关知识均优于对照组,生活质量优于对照组,带管相关并发症低于对照组(P<0.01或P<0.05)。结论电话干预可以提高经皮经肝胆道外引流术治疗梗阻性黄疸患者的自我护理能力及生活质量。