Penetrating wounds to the posterior chest: analysis of exigent thoracotomy and laparotomy

Most reports of penetrating chest wounds include all regions of the thoracic wall. Recent studies of abdominal wounds stratified by entrance site have demonstrated significant differences in injury pattern that influence initial assessment and management. This is an analysis of 135 consecutive patients admitted to the Denver General Hospital with penetrating injuries to the posterior chest, done in an effort to elucidate operative indications. Fifteen of these patients required emergency department (ED) thoracotomy and were excluded from the study. In the remaining 120 patients, mechanism was gunshot (GSW) in 20% and stab wound (SW) in 80%; 89% were men, and the mean age was 26 years. For analysis, the posterior chest was further divided into upper and lower at the inferior tip of the scapula line. Overall, 28 patients (23%) with posterior penetrating chest wounds required early surgical intervention; 38% following a GSW compared to 20% due to a SW. Only 9 patients (8%) required thoracotomy while 19 (15%) underwent laparotomy. The most frequent indication for thoracotomy was persistent chest hemorrhage, and for laparotomy, positive diagnostic peritoneal lavage.     

Penetrating wounds of the pelvis

While penetrating wounds of the abdomen may selectively be managed conservatively in the absence of clinical signs or symptoms, we believe that in similar injuries of the pelvic area, exploration is mandatory. Regardless of their clinical presentation, 38 consecutive patients with penetrating injury to the pelvis had exploration, which yielded positive findings in 37 (97%). Furthermore, the incidence of vascular injuries, especially in the presence of shock, was 82% (nine patients), with an associated mortality of 63% (seven patients). These data indicate that, in some cases, undue delay may be life-threatening.     

食管腺癌77例临床病理分析

目的：分析77例食管腺癌病理组织学类型。方法：采用HE不染色，进行病理形态学观察及临床资料分析。结果：单纯性腺癌48例（62．3％）、黏液表皮样癌9例（11．7％）、腺样囊性癌8例（10．4％）、黏液腺癌7例（9．1％）、鳞化腺癌3例（3．9％）、腺棘皮癌2例（2．6％）。结论：食管腺癌发病率较低，主要发病年龄在35－55岁，男性稍多于女性。单纯性腺癌的分化较高、预后较好，其5－10年生存率可达50％－75％以上，其余各类预后均差。组织分型对食管癌的治疗和估计预后有帮助。     

The management of stab wounds to the back.

The management of stab wounds to the back is controversial. There are certain clear indications for exploratory laparotomy, but most cases require a diagnostic workup and a period of observation. In this article, different diagnostic modalities are presented, including local wound exploration, diagnostic peritoneal lavage, abdominal computed tomography (CT) scan, triple-contrast abdominal CT scan, and intravenous pyelography (IVP). Recommendations for management are given, with emphasis on abdominal CT scan and observation.     

早产儿宫外生长发育迟缓77例临床分析

目的探讨早产儿发生宫外发育迟缓(EUGR)与胎龄、出生体重的关系及危险因素分析,为制定预防早产儿发生EUGR的策略提供临床依据。方法对2009年1月至12月本院NICU收治的77例胎龄37周早产儿,根据不同胎龄、不同体重的早产儿进行体重监测,比较他们住院期间EUGR的发生率并对相关危险因素进行分析。结果体重≤1500 g的早产儿组EUGR发生率为71.4%,体重1500 g的早产儿组EUGR发生率44.9%,两组比较差异有统计学意义(P0.05);胎龄34周的早产儿组EUGR发生率为66.3%,胎龄≥34周的早产儿组EUGR发生率为37.5%,两组比较差异有统计学意义(P0.05)。宫内发育迟缓(IUGR)、感染是发生EUGR的危险因素(P均0.05)。结论胎龄及出生体重越小,发生EUGR的可能性越大。导致EUGR的因素是多重的,其中IUGR及感染对EUGR影响最大,应积极预防及治疗并发症,重视早产儿早期营养是避免EUGR的关键。     

浅针配合推拿治疗情感障碍:77例疗效分析

目的:观察并分析浅针加推拿对精神障碍症候群的治疗疗效及影响疗效的相关因素,论证此治疗方法的可行性。方法:1998-09/2003-06福建中医学院国医堂门诊符合《中国精神病分类方案与诊断标准(CCMD-2-R)》中情感障碍的诊断标准患者77例,按中医病证诊断疗效标准中关于情感障碍的分型标准分为忧郁、焦虑证患者45例,情感激动、躁狂证患者32例。以浅针印堂、神庭、百会、神门、涌泉等配合推拿上穴及患者颈项部位,一周两次,1个月为1个疗程,采用自身对照的方法,于3和6个疗程后分别评定疗效。结果:治疗后所有患者精神障碍诸症候群均有明显改善,焦虑、抑郁证患者和情感激动、躁狂证患者总有效率分别为84%(40/46)和81%(26/32)。本法治疗以失眠、焦虑、情感激动、烦躁等症的治疗效果最佳。结论:浅针配合推拿是治疗情感障碍病证的有效治疗方法之一,针灸推拿穴位和手法的选用应在中医辨证论治的原则指导下进行。     

Malignant fungating wounds: an analysis of the lived experience

AIM: This paper reports upon a study that aimed to illuminate the meaning and experience of living with a malignant fungating wound. BACKGROUND: The current understanding of living with a malignant fungating wound is derived from professionals' rather than the patient's perspective. An appreciation of the lived experience may assist in the development of more empathetic support approaches. METHOD: A Heideggerian hermeneutic phenomenological approach was used as the philosophical framework. Unstructured interviews were conducted with a purposive sample of five participants. Content hermeneutic analysis was adopted to analyse the data. FINDINGS: Four themes were identified: representing the worst part of the patient's cancer; living within a body that cannot be trusted; a changing relationship with the patient's family and friends; and a loss of identity while continuously striving to be normal, yet feeling different. CONCLUSION: Health care professionals must possess a heightened awareness of: the importance of the impact of the wound upon day-to-day living, identity and purpose; the value of adopting the phrase used by the patient to describe their wound; and to focus more upon the subjective meaning of a visibly changing wound rather than objective measurement.     

Penetrating injuries to the colon: analysis by anatomic region of injury

The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P less than .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.     

慢性伤口206例原因分析与预防对策

目的:探讨慢性伤口的发生原因及预防对策。方法:将2010年收治的206例患者作为研究对象,按年龄段分为四组,观察不同年龄段患者慢性伤口发生情况。结果:患者出现慢性伤口的原因主要为压疮(41.3%)、下肢伤口(20.4%)、腹部切口延期愈合(18.0%)、糖尿病足(9.7%)、手足感染(2.9%)、乳腺切口延期愈合(2.9%),还有个别患者(2.9%)因意外伤害、咬伤、勒伤出现慢性伤口。积极分析导致慢性伤口的原因,总结出预防措施。结论:可通过术前评估、健康教育指导、正确处理伤口、增强防范意识、采取预防措施等,使慢性伤口尽可能达到按期愈合。     

Acute appendicitis and diagnostic value of sonography: A prospective study of 77 surgically proven cases

We present the results of a prospective study on 122 patients referred for suspected acute appendicitis. In total, 77 patients had surgically proven appendicitis. Of these 77 patients, sonography showed typical signs of appendicitis and/or peri-appendicular abscess in 57 cases (true positives); in the remaining 20 patients neither the inflamed appendix nor any related abnormal finding could be detected pre-operatively (false negatives). Forty-five patients were subsequently shown to have other disorders (related to the urinary or digestive tract, or to the female reproductive system); the final diagnoses were based on surgical findings in 16 patients, and on a combination of clinical, imaging and laboratory findings in the remaining 29 patients. In all these patients, no sonographic evidence of appendicitis was detected (true negatives), whereas in 33 cases the US exam was able to detect abnormal findings related to other conditions, thus suggesting a correct diagnosis. In the authors' experience, sonography has a good accuracy in diagnosing acute appendicitis. The sensitivity (75%) and specificity (100%) values were similar among the different examiners and in overall agreement with the literature data.     

文献综述撰写要求

以某一专题为中心,查阅、收集大量国内外近期的原始医学文献,经过理解、分析、归纳、整理而写出的综述,以反映出该专题的历史、现状、最新进展及发展趋势等情况,并做出初步的评论和建议。     

Treatment of post-herpetic neuralgia. A review of 77 consecutive cases

The treatment of 77 consecutive cases of post-herpetic neuralgia is reviewed. Stellate blockade proved helpful in 75% of patients with pain of less than 1 year's duration; 40% became virtually pain free. Drug treatment and electrical counterirritation methods gave improvement in 60% of cases but only 15% became pain free. Stellate block carried out after 1 year of pain proved helpful in only 44% of patients, and only 22% became pain free. Stellate blockade carried out within 1 year of the onset of symptoms would appear to be one of the treatments of choice for post-herpetic neuralgia. It would be of interest to see the results of a controlled randomised trial.     

泌尿外科腹腔镜手术77例临床观察

目的 总结泌尿外科开展腹腔镜及后腹腔镜技术的经验.方法 泌尿外科腹腔镜手术77例,男57例,女20例;平均31.3岁,其中,采用后腹腔镜肾上腺肿块切除5例,肾囊肿切除28例,肾切除4例,输尿管切开取石3例.肾孟输尿管连接部狭窄段切除吻合5例.腹腔镜隐睾探查松解下降固定术5例,精索静脉曲张高位结扎术19例,交通性鞘膜积液内口结扎术8例.结果 77例患者中,中转开腹2例,1例因为隐睾位置较高,接近肾下极处,1例为游走肾肾囊肿,术中因体位改变,未在后腹腔内找到肾脏.其余手术均获成功,术中出血少,术后恢复快,术后第1天进食,留院1～8 d.随访2个月～4年,无并发症.结论 利用腹腔镜进行肾上腺肿块、隐睾、肾孟输尿管连接部狭窄等泌尿外科手术,手术效果与传统手术相同,值得进一步开展.     

When back pain becomes disabling: a regional analysis

Back pain is a common condition and in most cases is not disabling. We have investigated disabling back pain that leads to health care utilization, time lost from work, and high costs. Disabling back pain remains of obscure origin because the focus in studying it has been too narrow. Our indicator of disability is the industrial insurance claim rate for back sprain by county (N = 39) in the State of Washington. After controlling for the size of the labor force and the proportion of workers in occupations that are particularly at risk of back sprain, we determined the effect of 3 socioeconomic factors on the claim rate: the unemployment rate, percentage receiving food stamps, and per capita income. For 2 of the 3 years studied, socioeconomic factors accounted for about one-third of the variance in the claim rate. Even though claimants of industrial insurance are employed, the unemployment rate was significantly related to the claim rate in the 3 years studied. Our interpretation is that disability is a symptom of distress. Where there is a rise in job insecurity and an attendant rise in economic insecurity, there is a greater likelihood that back pain will become disabling.