Streptococcus pneumoniae serotypes: nine-year experience at a level-one trauma center

Streptococcus pneumoniae isolates from adults hospitalized with invasive pneumococcal disease (IPD) were collected at Regions Hospital in St. Paul from 2002 through 2010. Of 200 sequential, nonduplicative isolates collected and serotyped, serotypes 3, 7F and 19A were found to be the most common. Since 2008, all IPD cases have been caused by non-PCV7 serotypes. This article describes the study and its findings. It also provides an overview of the three vaccines used to protect against IPD.     

A nine-year experience of immunoprophylaxis against hepatitis B virus infection in children with cancer: results from a single institution in Poland

The results of a nine-year study of immunoprophylaxis against HBV infection in children with cancer during anticancer therapy are presented. Three hundred and fifty-three children entered the study. The preventive strategy involved three different patterns of passive and active prophylaxis. Specific anti-HBV immunoprophylaxis introduced simultaneously with anticancer therapy resulted in protection of 95.2% of children; 62% of patients produced antibodies. Long-term follow-up confirmed stable protection. Better results were obtained in children who received the last dose of vaccine after chemotherapy. The overall infection rate was 5.4% (19/353). Thirteen (68.4%) of the 19 infections occurred in patients who had not received hepatitis B immunoglobulin at the beginning of anticancer therapy. Children vaccinated before chemotherapy (during a neonatal vaccination programme) showed continuous protection after one dose of vaccine in 94% cases. In three cases, both HBsAg and anti-HBs was observed. A preventive strategy for viral hepatitis in children with cancer that includes passive and active HBV immunoprophylaxis from the beginning of chemotherapy is effective.     

Surveillance of surgical site infections after digestive surgery

Objective

The authors had for aim to monitor surgical site infections (SSI) after digestive surgery and to compare local hospital rates to those of the south-east French region. The overall rate of SSI was compared to the rate of two targeted surgeries: cholecystectomy and hernia repair (CHOL, HERN).

Method

Surveillance of all surgical procedures, following “CCLIN Sud-Est” surveillance guidelines was carried out between June and August 2006.

Results

Three hundred and thirty-eight surgeries were included. Among them, 20 SSIs (5.92%) were diagnosed and confirmed by a surgeon. The univariate analysis identified six risk factors: age, wound classes (3 or 4), ASA (3 or 4 or 5), length of surgery (greater than two hours), complexity of surgery, and carcinologic surgery. In the multivariate analysis, ASA score and length of surgery were significantly linked to SSI. SSI rates for HERN and CHOL were respectively 2.7 (2/73) and 2.9% (2/68).

Conclusion

The overall rate of infection was high compared to the “CCLIN Sud-Est” 2005 data. However, teaching hospitals accounted for only 8% of all interventions and they usually hospitalize patients at risk. Thus, the overall follow-up requires stratifying the results in homogeneous groups of patients (NNIS) to have comparable results overtime and between hospitals. In addition, this monitoring is difficult to perform because it is a very time-consuming routine. However, if CHOL and HERN are more reliable for comparison and less time-consuming, they do not reflect the overall rate of SSI.     

Functional endoscopic sinus surgery: morbidity and early results

Functional endoscopic sinus surgery is a new alternative to conventional sinus surgery as a means of managing recalcitrant sinus disease. This approach to sinus pathology focuses on the importance of the functional ostiomeatal complex and anterior ethmoid sinuses in the pathogenesis of sinus disease. In an effort to assess the morbidity and initial results of this procedure, 85 cases were reviewed. A total of 82% of the patients had bilateral maxillary and ethmoid sinusitis, and 45% had pansinusitis, frequently associated with allergic rhinitis (56%) and nasal polyps (58%). A total of 82% of the patients were operated on as outpatients under local anesthesia. There were no major complications associated with the surgery and minor complications were rare. Disease control was achieved in 88% of patients with short-term follow-up.     

消化道手术后早期肠内营养的临床研究

目的探讨消化道手术后早期进行肠内营养支持的可行性、安全性及临床效果。方法外科消化道手术后病人分成两组,肠内营养组接受能全力肠内营养,普通输液组接受以葡萄糖供能为主的治疗,共7天。术后第1天（应用前）和术后第8天测定血浆蛋白,肝肾功能、血糖、电解质、淋巴细胞计数,IgG、IgA、IgM,体重。临床观察肛门恢复排气时间,营养支持期间有无腹胀、腹痛、腹泻、恶心、呕吐等。结果肠内营养组血白蛋白,前白蛋白术后第8天明显增高,差别有统计学意义（P＜0．01）。肛门恢复排气时间,肠内营养组明显提前,两组比较差异有显著性（P＜0．01）。两组体重术后均有下降,研究组下降幅度明显小于对照组,差异有统计学意义（P＜0．01）。其它生化指标均在正常范围。肠内营养组不良反应发生率7．86％。结论术后早期肠内营养能促进胃肠功能恢复,改善营养状态,并且安全可行。     

肠道菌群在小鼠术后焦虑样行为中的作用研究

目的:探究腹部手术后焦虑与肠道菌群紊乱之间的关系.方法:将16只C57BL/6J小鼠随机分为实验组(n=8)和对照组(n=8),实验组小鼠行腹部切开,对照组小鼠无任何处理.术后第7天收取小鼠粪便,术后第15天收取小鼠肝脏,肠道等组织,期间记录两组小鼠的体质量,自主活动、认知及焦虑抑郁情况.分析肠道菌群差异,并与术后焦虑...     

Breast cancer early diagnosis experience in Florence: can a self referral policy achieve the results of service screening?

STUDY OBJECTIVE--To assess the impact of a breast clinic on a specific target population and evaluate early diagnosis performance indicators for breast cancer in the presence of a self referral policy. DESIGN--Women living in Florence between 1980 and 1989 who had undergone mammography at a self referral breast clinic were studied. Main outcome measures were the use of mammography in relation to age, symptoms, and the interval between two subsequent tests, and early diagnosis performance indicators were the detection rate (DR), the prevalence/incidence ratio, and the proportion of early detected cancers. Performance indicators were compared with those from formal screening programmes. SETTING--Florence, Italy. PATIENTS--All mammograms performed at the clinic from 1980-89 in 40-69 year old women living in Florence were examined (n = 42,226). Records included the date of birth and of the examination, the reason for testing (asymptomatic/presence of pain/presence of symptoms other than pain), and the TNM classification for breast cancer cases. MAIN RESULTS--The total number of mammograms performed per annum increased by 70% over the decade, but much of this was routine repeat mammography (54.1% in 1989). Rates of first examinations in asymptomatic women increased in the second half of the decade from 17 per 1000 in 1985 to 31 per 1000 in 1989. Mammographic coverage decreased with increasing age from 12.6% in 40-49 year olds to 6.0% in 60-69 years old. Performance indicators of the activity in asymptomatic women were comparable with those expected in service screening. The proportion of not advanced cancers detected in asymptomatic women was 62.3% with a DR of 5.3 per 1000, and the average prevalence/incidence ratio was 2.9. CONCLUSIONS--High quality mammography performed in a breast clinic in self referred asymptomatic women can achieve as good results as a formal invitation screening service. Only a few of these women will benefit, but those who do are likely to be younger (40-49 year old women).     

胃切除术后早期肠内营养的临床体会(附20例报告)

目的 :研究胃切除术后早期肠内营养的临床疗效及安全性、可行性。　方法 :将 2 0例胃切除的病人在术后2 4h给予百普素 ,待肛门排气后改为能全力 ,整个过程持续 10天时间。肠内制剂的投入均通过留置于空肠或十二指肠降部的鼻十二指肠 /空肠管。　结果 :术后第 7天均转入正氮平衡 ,前白蛋白 :术前为 (0 .2 2± 0 .0 3) g/ L,术后第7天为 (0 .2 4± 0 .0 4) g/ L;转铁蛋白 :术前为 (2 .13± 0 .33) g/ L,术后第 7天为 (2 .5± 0 .2 5 ) g/ L。血浆蛋白的术前和术后第 7天的统计学比较均无显著差别。　结论 :早期肠内营养符合生理要求、简便、经济、实用 ,避免了与胃肠外营养相关的并发症 ,并且安全有效     

脊柱手术后并发脑脊液漏的护理体会

目的:探讨脊柱手术后脑脊液漏的护理措施。方法:回顾分析某医院116例实施脊柱手术,并发脑脊液漏的10例患者的临床资料,观察疗效和总结护理措施。结果:经过精心护理和积极治疗,伤口愈合,脑脊液漏停止,未发生严重并发症,效果良好。结论:脑脊液漏是脊柱术后常见并发症,经严密观察病情和有效的护理措施,同时严格执行无菌操作技术,促进漏口愈合,使病人早日康复。     

Feeding stoma surgery on a nutritional support service

Thirty patients undergoing feeding stoma operation over a 2 1/2 yr period were managed by the nutritional support service. The policy of preoperative nutritional support of these generally ill and malnourished patients contributed to operative survival and discharge from the hospital for 23 patients; only one death 21 days postoperatively was directly attributable to the feeding stoma procedure. Nonfatal complications of the surgery occurred in nine cases, and required reoperation in three instances. Early stoma use was the rule, and there were 10 documented cases of long-term stoma use averaging 14 months. Three-month survival of 19 patients (63%), and six-month survival of 13 patients (43%) along with early discharge from the hospital for most patients attest to efficacy and ease of stoma use. An essential feature contributing to diminished postoperative problems was prestoma surgery nutritional support. Continuity of feeding stoma planning and patient care may be best achieved when a nutritional support service is involved through the entire course of management.     

The outpatient experience: results of a patient feedback survey

Patient surveys can be used to enable hospital management to evaluate the services they provide. This study shows high levels of patient satisfaction with the quality of their consultations and the attitude shown to them by medical staff. Patient feedback shows that despite the introduction of the Patients' Charter, waiting times from referral to appointment and delays in clinics are still identified as the main areas for improvement. Findings show that patients are, however, remarkably tolerant and understanding of the pressures and demands placed upon outpatient staff.     

肝移植术后早期肠内营养对肠黏膜屏障的保护作用

肝移植已成为各种肝终末期病人最有效的治疗方法.营养支持能够明显改善肝移植病人的预后.术后早期施行肠内营养,不仅能满足机体对营养的需求,更重要的是维持了肠道的完整性,保护了肠黏膜屏障,这对肝移植术后病人的恢复,减少肠道细菌移位及减少术后感染性并发症的发生具有重要的意义.     

Gastric reduction surgery: a dietitian's experience and perspective

Gastric reduction operations are being performed for the treatment of the morbidly obese. Loop gastric bypass, Roux-en-Y gastric bypass, horizontal gastroplasty, and vertical banded gastroplasty are the four major types of gastric reduction operations that have been performed since 1966 at the University of Iowa Hospitals and Clinics. Vertical banded gastroplasty, the procedure currently being performed, creates a small upper pouch volume (10 to 30 ml) and a small stoma diameter (10 to 12 mm). This necessitates making drastic changes in patients' eating patterns, such as taking 30 minutes to eat a small meal and not drinking liquids with the meals. The changes help eliminate such complications as disruption of the staple line, stretching of the pouch, and obstruction of the stoma. A 30-ml medicine cup and a clock are important behavior modification tools to encourage patients to eat small amounts of food and sip beverages slowly. The dietitian can play a paramount role as educator for gastric reduction operation patients and should therefore become closely involved in their perioperative and long-term care.     

尿道下裂术后远期疗效的比较研究

目的 比较尿道下裂术后的远期治疗效果,分析其影响因素.方法 64例尿道下裂患者(病例组)术后接受随访调查,通过调查表比较患者本人和外科医师对治疗效果评价的差异,尿流率测定检查患者的排尿功能,以勃起功能国际问卷-5(IIEF-5)评估患者的性功能.另设35例健康成年人作为对照组.结果 随访时间3～11(7.5±2.3)年.患者和外科医师对治疗效果的评价存在较大差异,主要集中在术后外生殖器的外观方面,患者的术后满意度评分明显低于医师(P＜0.05或＜0.01).病例组的最大尿流率(23.37±2.92)ml/s、平均尿流率(16.84±1.75)ml/s,与对照组的(24.41±2.94)、(17.34±2.14)ml/s比较差异无统计学意义(P＞0.05).病例组阴茎勃起功能评分(22.31±1.94)分,与对照组的(22.80±1.73)分比较差异无统计学意义(P＞0.05).病例组术后阴茎松弛时长度(5.93±1.06)cm、阴茎松弛时周径(6.17±0.83)cm,与对照组的(7.38±0.79)、(7.53±0.75)cm比较差异有统计学意义(P＜0.01).手术完成时的年龄越大、尿道下裂程度越重、手术次数越多以及有并发症的患者对治疗效果的总体满意度越低.结论 注重阴茎矫正的美学效果、早期手术、减少手术次数和并发症的发生可提高尿道下裂术后的远期治疗效果.     

Stroke severity and early recovery after first-ever ischemic stroke: results of a hospital-based study in Taiwan

OBJECTIVE: To assess the relationship between admission stroke severity and outcomes of acute hospitalization in patients with first-ever ischemic stroke in Taiwan. METHODS: Data were prospectively collected from 360 first-ever ischemic stroke patients admitted to a medical center within 48h of stroke onset. Stroke severity was evaluated with NIH stroke scale (NIHSS) and categorized as mild (0-6), moderate (7-15), or severe (16-38). We studied three prespecified discharge outcomes: (1) status based on a combination of NIHSS and modified Barthel index (MBI), (2) subsequent change in neurologic impairments, and (3) subsequent change in functional status. For each outcome, a separate polytomous logistic regression model with least favorable category as the reference group was constructed, controlling confounding factors. RESULTS: Patients (58% male) had mean age 64.9+/-12.5 (range 18-90), median NIHSS 6 and median MBI 12 on admission. Median length-of-stay was 7 (range 1-122) days; in-hospital deaths 8%. Twenty-two percent patients had excellent status outcome, 33% good. For subsequent change in neurologic impairments, 22% of patients had better outcomes; for sequent change in functional status, better outcomes were noted in 14% of patients. The NIHSS score at admission was strongly associated with outcomes of acute hospitalization after multivariate adjustment. The odds ratio (OR) for moderate (versus mild) stroke patients to achieve excellent status was 0.04 (95% CI, 0.02-0.10), and for severe stroke the OR was less than 0.01 (95% CI, 0-0.05). The OR (95% CI) for moderate stroke patients to have good or improved outcome was 0.19 (0.10-0.36), for severe stroke 0.04 (0.01-0.13). The ORs for moderate and severe (versus mild) stroke patients to have better subsequent change in neurologic impairments were 5.18 (1.94-13.85) and 4.12 (1.38-12.30); to remain stationary 0.43 (0.19-0.96) and 0.15 (0.06-0.36), respectively. CONCLUSIONS: In patients with first-ever ischemic stroke in Taiwan, admission NIHSS is predictive of outcome of acute hospitalization.     

去甲肾上腺素在成人心脏手术后的早期应用

目的 探讨去甲肾上腺素在体外循环心脏手术后的早期应用对循环、肾脏功能方面的影响.方法 选择2008年1月～2010年6月成人心脏手术后早期应用去甲肾上腺素的病例43例,临床表现为容量依赖,常有短时尿量多,和（或）引流液多,末梢温暖,但积极补充血容量,循环仍难维持等情况,应用去甲肾上腺素前后对心率、平均动脉血压、中心静脉压、尿量、血清肌酐值等方面进行比较.结果 应用后心率较应用前有显著性下降（P〈0.01）,应用后血压较前有显著性升高（P〈0.01）,中心静脉压和平均每小时尿量在应用前后均无显著性变化（P=0.437〉0.05;P=0.063〉0.05）,血清肌酐浓度在应用去甲肾上腺素后较前有显著性升高（P〈0.01）,但无一例出现急性肾功能衰竭.结论 在成人心脏手术后早期出现血管扩张性（或麻痹性）休克,应用去甲肾上腺素能支持循环功能,保证肾灌注,是可行和安全的.