聚焦超声外科手术钳减少肾部分切除术中出血的动物实验

目的:近年来高强度聚焦超声作为一种新兴的止血手段成为国内外学者研究的热点.实验拟验证聚焦超声手术钳辅助肾部分切除减少术中出血的安全性、有效性及可行性.方法:实验于2007-03/10在重庆医科大学医学超声工程研究所完成.10只南江黄羊麻醉后,使用由重庆医科大学超声研究所研制的聚焦超声手术钳(声强12 000 W/cm2,频率1.6 MHz)沿制订的预切线对肾脏进行凝固后,行右肾下极切除术.记录肾脏凝固性坏死性状、切除术中出血量和肾部分切除时间.对凝固性坏死组织行病理学检查.结果:①所有动物肾部分切除均顺利完成,聚焦超声手术钳造成整个预切线肾脏贯通性凝固性坏死,长(3.8 0.3)cm,宽(0.9±0.2)cm,厚(2.6±0.3)cm,损伤区域边界清楚.②术中肾脏凝固时间(300±10)s,肾部分切除出血量(57±7)mL,肾部分切除时间(12±3)min.③术后28 d内无实验动物死亡及并发症发生.结论:使用聚焦超声手术钳辅助肾部分切除术中出血少,安全、有效.     

Systemic effects of topical ophthalmic medications

Ophthalmic drugs topically applied have significant systemic absorption, which may result in widespread adverse side effects. All physicians involved in the care of patients receiving these drugs should be cognizant of such actions, interactions, and toxic effects. They should also be familiar with the prevention, diagnosis, and treatment of these effects, as well as the mechanisms of systemic drug absorption.     

The bipolar sealing device: reducing blood loss in orthopaedic surgery

Perioperative blood management continues to be a challenge in major orthopaedic surgical procedures. Techniques used have varied through the years, and ongoing attempts to minimize patients' exposure to allogeneic blood continue to be explored.To date, the majority of blood management options focus on either blood replacement with safe effective blood products or the preoperative stimulation of red blood cell production in the surgical patient with erythropoietin.This article describes a new device that uses thermal energy to inhibit blood loss from soft tissue and bone during orthopaedic surgery. Early clinical trials indicate that the bipolar device may reduce blood loss and decrease exposure to blood transfusions.     

Topical hemostatic agents in surgical practice

Hemostasis is of critical importance in achieving a positive outcome in any surgical intervention. Different hemostatic methods can be employed and topical hemostatic agents are used in a wide variety of surgical settings. Procoagulation agents have different hemostatic properties and the choice of a specific one is determined by the type of surgical procedure and bleeding. Hemostatic treatments include fibrin sealants, microfibrillar collagen, gelatin hemostatic agents, oxidized regenerated cellulose and cyanoacrylates adhesives. Surgeons should be familiar with topical hemostatics to ensure an appropriate use. Our purpose is to illustrate the currently available agents, their mechanism of action and their effective applications, in order to ensure an optimal use in operating room.     

Quantitative evaluation of blood loss severity in surgical practice

AIM: To develop a quantitative method of evaluation of the volume and degree of intraoperative blood loss. MATERIAL AND METHODS: Blood loss quantitation is based on maximal collection of the lost blood and its measurement by lost globular volume (GV), i.e. erythrocyte containing medium with Ht 1.0. RESULTS: The total of the components of lost GV was termed estimated blood loss (EBL). Its amount was calculated by GV deficiency from the due in the patient and volume of lost blood. The method was tried in surgical and traumatological practice in 317 operated patients (multitrauma--65, hip bone fractures -98, uterine myoma -105, aneurysm of abdominal aortic part -49). CONCLUSION: The volume of blood loss guided the physician to reestablish volume of circulating blood--the volume of infused blood exceeded EBL 1.3-1.7-fold. GV deficiency (in %) showed severity of blood loss and gave approaches to its adequate compensation.     

Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients

We studied ICU patient blood loss as a result of diagnostic testing (DBL) and the effect of two measures to reduce it. A policy of using small volumes (pediatric phlebotomy tubes, reduced syringe volumes) for the most frequent laboratory tests was implemented in our medical ICU. We prospectively studied 151 patients admitted during two consecutive 10-wk periods. During period 2, DBL was displayed on each ICU flow sheet. The DBL/day (43.6 +/- 3 [SEM] ml) was significantly lower (62.6 +/- 4 ml) than it would have been if standard volume tubes had been used. This represented an average savings of 33%. During period 1 (n = 81), eight (10%) patients with no diagnosis involving blood loss had a decrease in Hct and received transfusion. DBL was significantly higher (316 +/- 81 vs. 168 +/- 18 ml, p less than .001) for these patients and represented an average of 17% of transfusion requirements. During period 2 (n = 70), such transfusion requirements were significantly reduced (only one of 70, p less than .001), as were tests ordered/day (7.8 +/- 0.5 vs. 9.5 +/- 0.6, p less than .05). We conclude that DBL is a major health problem for the ICU patient. Routine use of small specimen volumes in this setting is warranted. Recording DBL for use in physician decision-making also significantly impacts this problem and should be considered an important part of the ICU database.     

Best-practice protocols: reducing harm from high-alert medications

The Institute for Healthcare Improvement challenges clinicians and administrators to raise care quality through its 5 Million Lives Campaign, a sequel to the 100,000 Lives Campaign. Here, review a case study on the importance of postoperative monitoring of opioid-naive patients who are receiving narcotics.     

个性化助产模式对减少产妇疼痛情况和出血量的应用效果

目的探讨个性化助产模式应用于产妇中对减少疼痛情况以及出血量的效果观察。方法选取110例产妇作为研究对象,按随机数字表法分为观察组和对照组,各55例。对照组采用常规产科助产模式,观察组采用个性化助产模式,评估并比较2组产妇的焦虑自评量表(SAS)和抑郁自评量表(SDS)、视觉模拟疼痛评分(VAS)以及产后出血量情况。结果观察组的SAS评分以及SDS评分均显著低于对照组(P0.05);干预后,2组的VAS评分均显著低于干预前,且观察组的VAS评分显著更低(P0.05);观察组产后出血量为(174.44±52.02)m L,显著低于对照组的(184.92±40.11)m L(P0.05)。结论个性化助产模式更能改善产妇的不良状况。     

Systemic causes of hair loss

Hair loss is both a common chief complaint by patients and a clinical challenge for physicians, especially general practitioners, yet few dermatological problems yield as much patient satisfaction when resolved as hair loss. The diagnosis is often attributed to androgen-related hair loss, while other causes, some of which are life-threatening but treatable, are overlooked. We searched for relevant literature on hair loss and supported these findings with our clinical experience to identify seven major systemic etiologies of hair loss, ranging from infectious agents to consumption of unsafe supplements. Many causes are only described in the literature through case studies, though some original articles and meta-analyses are available. Careful history taking, proper examination techniques, and judicious use of laboratory tests are essential to reach at the correct diagnosis in a cost-effective manner when performing patient work-up. Such methodical evaluation of hair loss can result in the appropriate treatment plan and provide significant patient satisfaction.

• Key messages

• Hair loss is a common chief complaint and a difficult challenge for both general practitioners and dermatology consultants.

• We identified seven major categories of systemic hair loss etiology and present a framework for their clinical evaluation.

• A methodical approach to hair loss can result in the appropriate treatment plan and provide significant patient satisfaction.

     

胶原/壳聚糖止血敷料在外科伤口中的应用

背景:壳聚糖与胶原联合可更有效地止血。目的:评价胶原/壳聚糖止血敷料的材料学性能及应用于外科伤口的生物相容性。方法:以"生物材料,止血敷料,纱布,胶原/壳聚糖,生物相容性"为中文关键词,以"biomaterial;hemostatic material;bioresorbable material;hemostasis effect;hemostatic mechanism"为英文关键词,采用计算机检索2000-01/2010-06与生物敷料、胶原/壳聚糖止血材料在伤口或创面止血过程中应用相关的文献。结果与结论:壳聚糖独特的生物学特性,具有广谱抑菌、促进上皮细胞生长及止血,促进创面愈合的作用,在体内具有良好的生物降解性与组织相容性,可用于指端损伤和肉芽创面的治疗,如制成伤口敷料、可吸收缝线、止血材料、防粘连剂、药物缓释及组织工程支架,用于平战时伤口的处理。     

Infusion-transfusion tactics in tubercular surgical patients in relation to the volume of surgical blood loss]

Infusion-transfusion tactics were studied in 71 patients with pulmonary tuberculosis during surgery and after it. Hemostasis parameters have been determined at different periods after surgery. Blood transfusion was not performed in patients with surgical blood loss below 500 g. When surgical blood loss was 500 to 1000 g hemotransfusion volume was 40-50% of blood loss. When surgical blood loss was 1000 g the volume of blood substituting solutions exceeded blood loss 2.4-4 times; in massive blood loss it was 1.5 times more. For the first 24 hours after surgery the volume of infusion-transfusion therapy was maintained at the same level, with its decrease 48 and 72 hours later. Such tactics promoted a favourable clinical course of the postoperative period and stabilization of basic homeostasis parameters.