腹腔镜直肠癌根治术(Dixon)

在结肠系膜与后腹膜移行处切开后腹膜,分离系膜至肠系膜下动脉根部,清扫253组淋巴结,在距腹主动脉根部1 cm处夹闭并切断血管,切断肠系膜下静脉。由内侧向外侧分离结肠系膜至结肠旁沟,切开其左侧后腹膜,将降结肠及乙状结肠系膜从后腹壁游离。沿直肠固有筋膜与盆壁筋膜的间隙按照TME原则锐性分离直肠系膜,先游离后壁,再游离两侧壁及前壁,直至盆底。在肿瘤下方2 cm处用阻断夹夹闭肠管,冲洗远端直肠,用切割缝合器切断直肠。取脐部弧形切口。提出近端肠管,于肿瘤近端15 cm处离断肠管。近端置入管型吻合器抵钉座,还纳腹腔,重建气腹。经肛置入管型吻合器,在腹腔镜直视下作乙状结肠－直肠端端吻合,冲洗腹腔,置引流管,手术结束。     

Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials

BACKGROUND AND OBJECTIVES: Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. The aim of this systematic review is to quantify beneficial and harmful effects of clonidine when used as an adjuvant to intrathecal local anesthetics for surgery. METHODS: We included data from 22 randomized trials (1,445 patients) testing a large variety of doses of clonidine, added to intrathecal bupivacaine, mepivacaine, prilocaine, or tetracaine. RESULTS: Clonidine 15 to 150 microg prolonged in a linear, dose-dependent manner, the time to 2 segment regression (range of means, 14 to 75 minutes) and the time to regression to L2 (range of means, 11 to 128 minutes). The time to first analgesic request (median 101 minutes, range 35 to 310) and of motor block (median 47 minutes, range 6 to 131) was prolonged without evidence of dose-responsiveness. Time to achieve complete sensory or motor block, and extent of cephalic spread remained unchanged. There were fewer episodes of intraoperative pain with clonidine (relative risk, 0.24; 95% confidence interval [CI], 0.09-0.64; number needed to treat, 13) but more episodes of arterial hypotension (relative risk, 1.81; 95% CI 1.44-2.28; number needed to harm, 8) without evidence of dose-responsiveness. The risk of bradycardia was unchanged. CONCLUSIONS: This study may serve as a rational basis to help clinicians decide whether or not to combine clonidine with an intrathecal local anesthetic for surgery. The optimal dose of clonidine, however, remains unknown.     

The changing causes of graft loss and death after kidney transplantation

BACKGROUND: The results of kidney transplantation have improved markedly over the last three decades. Despite this, patients still lose grafts and die. We sought to determine whether the causes of graft loss and death have changed over the last 30 years. METHODS: We reviewed patients who underwent transplantation or who died between January 1, 1970 and December 31, 1999. We compared the causes of graft loss or death for three decades: 1970 to 1979, 1980 to 1989, and 1990 to 1999. RESULTS: From January 1, 1970 to December 31, 1999, we performed 2501 kidney transplantations in 2225 patients. For the three periods, 210, 588, and 383 patients lost their grafts, respectively. Graft survival increased substantially. Graft loss occurred later after transplantation, with 36.0% losing grafts in the first year during 1970 to 1970, 22.8% during 1980 to 1989, and 11.4% during 1990 to 1999. Death with a functioning graft increased from 23.8% for 1970 to 1979 to 37.5% for 1990 to 1999. Concomitantly, rejection as a cause of graft loss fell from 65.7% for 1970 to 1979 to 44.6% for 1990 to 1999. Approximately two thirds of the patients who died after transplantation died with a functioning graft and one third died after returning to dialysis. Cardiac disease as a cause of death increased from 9.6% for 1970 to 1979 to 30.3% for 1990 to 1999. Deaths from cancer and stroke also increased significantly over the three decades from 1.2% and 2.4%, respectively, for 1970 to 1979, to 13.2% and 8.0%, respectively, for 1990 to 1999. CONCLUSIONS: The causes of graft loss and death have changed over the last three decades. By better addressing the main causes of death, cardiac disease, and stroke with better prevention, graft loss due to death with a functioning graft will be reduced.     

Return-to-Sport Outcomes After Anterior Cruciate Ligament Surgical Treatment May Be Improved by Attention to Modifiable Factors and Consideration of Nonmodifiable Factors

Today, we who treat athletes are able to effect immediate, significant improvement in anterior cruciate ligament (ACL) patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport. “Prehabiliation,” bracing, time after surgery to various rehabilitation activities, time after surgery until return to sport, functional testing, strength testing including limb symmetry indices, psychological readiness, age, gender, and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable.     

Gesell在基层医院语言发育迟缓儿童中的应用

目的：探讨 Gesell 在基层医院语言发育迟缓儿童中应用效果。方法随机选取我院2007年1月～2012年12月在儿科门诊就诊的2～3岁语言发育迟缓儿童,共计52例。采用 Gesell 婴幼儿发育量表,对每个儿童进行发育评估。按运动能、应物能、语言能、应人能4个能区,将研究对象的评估结果统计对比。结果52例儿童的 Gesell 发育评估结果：按运动能、应物能、语言能、应人能4个能区,将研究对象的评估结果统计。3岁以下语言发育迟缓儿童 Gesell 检查,动作和应物能区平均 DQ 尚在正常范围内,而语言及应人能区平均 DQ 落后于正常;语言能发育落后（12.1±4.8）月,发育异常52例（100.00%）。结论 Gesell 在基层医院语言发育迟缓儿童中应用效果显著,Gesell 中应物能是小儿对外界刺激的分析和综合的能力,是预示智慧潜力的主要基础。可通过日常适应其发育水平的语言训练并定期随访即可,对于应物 DQ 低于正常的患儿,需至专门的康复治疗科室治疗。     

Clinical outcomes by age in men with hormone refractory prostate cancer: a pooled analysis of 8 Cancer and Leukemia Group B (CALGB) studies

PURPOSE: We determined if age is a prognostic factor of clinical outcomes, specifically overall survival, disease-free survival and progression-free survival in men with hormone refractory prostate cancer. MATERIALS AND METHODS: Data from 8 multi-institutional trials performed by Cancer and Leukemia Group B were combined. Eligible patients had progressive adenocarcinoma of the prostate after androgen ablation, Eastern Cooperative Oncology Group performance status 0 to 2, and adequate hematological, renal and hepatic function. The proportional hazards model stratified by study was used to assess the prognostic importance of age for predicting clinical outcomes. RESULTS: Of 1,194 men 132 (11%) were 50 to 60 years old and 120 (10%) were 80 to 89 years old. Median survival was 12.2 months (95% CI 10.6 to 13.8) in men 50 to 59 years old, 15.9 months (95% CI 14.2 to 17.6) in men 60 to 69 years old, 15.6 months (95% CI 13.8 to 16.9) in men 70 to 79 years old and 8.9 months (95% CI 6.6 to 12.1) in men 80 to 89 years old. Compared to 70 to 79-year-old men the HR for death in octogenarians was 1.3 (95% CI 1.0 to 1.6, p = 0.015). Furthermore, the HR for prostate cancer death in octogenarians was 1.3 (95% CI 1.1 to 1.7, p = 0.010) and in 50 to 59-year-old men it was 1.3 (95% CI 1.0 to 1.6, p = 0.042) compared to men 70 to 79 years old. Black men were at lower risk for death than white men (HR 0.77, 95 CI% 0.65 to 0.92, p = 0.004). CONCLUSIONS: Octogenarians and white men are at increased risk for death compared to other men with hormone refractory prostate cancer.     

山东某三甲医院儿童急性骨髓炎致病菌及耐药性分析

目的 总结山东大学附属儿童医院儿童急性骨髓炎脓液培养及药敏结果,为临床抗生素的使用提供参考。方法 收集我院2018年1月至2023年1月诊治的115例儿童急性骨髓炎的病例资料进行回顾性分析,其中男孩71例,女孩44例,年龄19天～15岁,对脓液培养结果及药敏结果进行总结分析。结果 115例患儿中,53例为甲氧西林敏感性金黄色葡萄球菌（methicillin-susceptible Staphylococcus aureus,MSSA）,33例为耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）,2例为肺炎链球菌,1例为肠炎沙门菌,1例为流感嗜血杆菌,25例为阴性。53例MSSA中,51例对氨苄西林耐药,42例对克林霉素耐药,41例对红霉素耐药,仅1例对庆大霉素耐药,所有患儿均对青霉素耐药,均对阿莫西林、头孢西丁、苯唑西林、万古霉素和利奈唑胺敏感。33例MRSA中,27例对克林霉素耐药,27例对红霉素耐药,3例对庆大霉素耐药,所有患儿均对氨苄西林、阿莫西林、头孢西丁、苯唑西林和青霉素耐药,均对万古霉素和利奈唑胺敏感...     

Age-dependent Responses to Thermal Hyperalgesia and Mechanical Allodynia in a Rat Model of Acute Postoperative Pain

Background: Developmental differences in short- and long-term responses to pain, especially surgical pain, have received minimal attention. The purpose of the present study was to examine postoperative responses in rats of developmental ages paralleling the infant to young adult human.

Methods: The withdrawal threshold to von Frey filament testing and withdrawal latency to hind-paw radiant heating were determined before and for various times after hind-paw incision in rats 2, 4, and 16 weeks of age. Control rats of these ages were observed serially without surgery.

Results: In control animals, younger rats were more sensitive to mechanical stimulation and less sensitive to thermal stimulation. Paw incision resulted in similar changes to both types of stimulation in all age groups, peaking 4 h after surgery. However, the return to normal sensitivity to mechanical stimulation, as measured by return of threshold to 80% of normal, occurred more quickly in 2-week-old than in 4- and 16-week-old animals. In contrast, there was no age difference for time to return to normal sensitivity to thermal stimulation after surgery.     

住院患者忠诚度及其影响因素的研究

目的了解住院患者忠诚度及其影响因素,为提供更高品质的医疗服务质量提供参考。方法通过方便抽样法抽取某三甲医院住院〉5d的患者281例,采用自行设计的问卷进行调查。结果71．5％患者愿意再次购买该医疗机构医疗服务,60．1％患者愿意向亲朋好友推荐;影响住院患者再次购买意愿的因素按影响大小排列为：诊疗水平、医疗费用、医院品牌、就医环境;影响住院患者推荐意愿的因素按影响大小排列为：诊疗水平、医院品牌、他人推荐、治疗效果。结论住院患者再次购买意愿高于向他人推荐意愿,影响忠诚度的因素多样;医院应加强患者感知服务质量的管理与控制,重视品牌管理,提高住院患者忠诚度。     

Elderly trauma inpatients in New York state: 1994-1998

BACKGROUND: The aging of the population in the United States has led to an increase in geriatric trauma. This study aimed to examine the characteristics and outcomes of geriatric trauma patients in New York State. METHODS: Four groups of elderly trauma patients (ages 40-64, 65-74, 75-84, and 85+ years) were contrasted with younger adults ages 13 to 39 years with respect to mechanism of injury, discharge disposition, hospital length of stay, comorbidities, and type of hospital in which they were treated. Also, the independent association of each group with in-hospital mortality was investigated for patients with blunt injuries using logistic regression. RESULTS: There was a 17.6% increase between 1994 and 1998 in the number of traumatic injuries qualifying for the New York State Trauma Registry in the 75- to 84-year-old group and a 16.4% increase in the group ages 85 years or older, despite a decrease in traumatic injuries in other age groups. The majority of these injuries among the patients 75 years of age or older resulted from low falls (from the same level). The mortality rate rose substantially with age, from 5.1% to 5.9% to 9.4% to 12.3% to 15.8%, respectively, for the groups ages 13 to 39, 40 to 64, 65 to 74, 75 to 84, and 85 or more years. Also, fewer than 20% of the patients older than 75 years died within 1 day after admission to the hospital, as compared with 44% of the patients younger than 65 years. The groups ages 40 to 64, 65 to 74, 75 to 84, and 85 years or older were all independent (increasingly) significant predictors of mortality for all three mechanisms of injury investigated. The adjusted odds ratios for mortality relative to patients who were 13 to 39 years of age were 2.67, 8.41, 17.40, and 34.98, respectively, for the groups ages 40 to 64, 65 to 74, 75 to 84, and 85 years or older. CONCLUSIONS: Trauma is a serious and escalating problem for the elderly, and increasing age is a significant risk factor for patient mortality.     

Clinical review: Healing in gastrointestinal anastomoses, part I

Gastrointestinal healing is a topic rarely reviewed in the literature, yet it is of paramount importance to the surgeon. Failure of anastomotic healing may lead to life-threatening complications, additional surgical procedures, increased length of stay, increased cost, long-term disability, and reduced quality of life for the patient. The goal of this article is to review the biological response to wounded tissue, to outline discrete differences between skin and gastrointestinal healing, to discuss local and systemic factors important to gastrointestinal healing, and to compare methods of measuring collagen content and strength of the newly formed anastomosis. Part II of this review will focus on techniques and therapies available to optimize anastomotic healing.     

Addressing the structural drivers of HIV: a luxury or necessity for programmes?

The social, economic, political and environmental structural factors that increase susceptibility to HIV infection and undermine prevention and treatment efforts continue to pose a challenge. The papers in this series highlight the importance of sustaining those efforts to address the structural drivers of the HIV epidemic, and that initiatives to achieve HIV elimination will only come about through a comprehensive HIV response, that includes meaningful responses to the social, political, economic and environmental factors that affect HIV risk and vulnerability. In the context of declining resources for HIV/AIDS, the papers speak to the need to integrate responses to the structural drivers of HIV/AIDS into future HIV investments, with both initiatives to integrate HIV into broader gender and development initiatives, as well as adaptations of current service models, to ensure that they are sensitive to and able to respond to the broader economic and social responsibilities that their clients face.     

Ethical and legal issues in the use of related donors for therapeutic insemination

Donor insemination involving family members can be complex. Although it may offer some advantages to the requesting individuals, to the donor, or to the family, related donation does raise a significant number of concerns. The specific circumstances of these requests should be considered carefully--in most cases more carefully than with anonymous sperm donation. Still, in the United States the freedom of couples or individuals to decide whether, when, and how to reproduce is highly valued. Respect for the autonomy of the involved family members would favor serious consideration of proposals for intrafamilial sperm donation, when all parties have freely consented to participate. Without exception, standards governing anonymous sperm donation should be followed in evaluating the proposed sperm donor for infectious and genetic diseases. The semen specimens should be frozen and quarantined for 180 days. In many cases, the 6-month delay that results from this quarantine will discourage a couple from pursuing intrafamilial sperm donation. Adequate time is essential to assess these relationships when requested. Multiple visits to physicians, nurses, counselors, and lawyers may be necessary for a thorough assessment. Programs should require prospective participants, including recipients, donors, and partners of donors, to undergo psychologic counseling by a professional knowledgeable about gamete donation. Counselors should address issues such as emotional risks, potential impact on family relationships, the donor-recipient relationship, the future role of the donor in the offspring's life, and what information will be disclosed to the offspring. The process of obtaining informed consent from the requesting individuals, the donor, and, possibly, the donor's wife should involve a thorough discussion of potential risks to all parties. Clinicians should assure that the decision to be a sperm donor has been voulntary and free from manipulative and coercive influences. Financial incentives, including direct and indirect payment and inheritance, should not be so substantial that they become inducements that may lead the prospective donor to discount the emotional risk associated with the procedure. Legal counsel should be strongly encouraged to clarify issues of disclosure, rights, and duties, as well as the donor's relationship to the resulting offspring. Any possible changes in these issues in the event of divorce or death of requesting individuals should be addressed. In certain cases, requests should be immediately denied. Gametes from consanguineous relationships should never be used to initiate a pregnancy. Because of potential parental conflicts of interest, programs should not allow minors under the age of 18 years to donate sperm. The use of a family member may not be appropriate when sperm donation is chosen to prevent genetic diseases. Careful genetic counseling should be done before intrafamilial sperm donation is allowed in this situation. If, after careful consideration of the proposed arrangement, the physician chooses to facilitate the relationship, then all precautions should be taken to prevent medical, psychologic, and legal harm to the requesting couple or individual, the potential donor, and the prospective child. Programs that offer these arrangements should make every effort to obtain long-term follow up on the outcomes of these relationships, so that programs can provide more accurate information to families considering these relationships in the future. The physician or program should not feel obligated to agree to every request for intrafamilial sperm donation. When the assessment reveals consistent concerns about coercion of the prospective donor or about unhealthy family dynamics, the physician should feel free to deny these procedures. The physician should advise the requesting couple or individual to seek alternative methods, such as anonymous sperm donation, to conceive.     

Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience

Epidural spinal cord stimulation by means of chronically implanted electrodes was carried out on 121 patients with pain of varied benign organic etiology. In 116 patients, the pain was confined to the back and lower extremities and, of these, 56 exhibited the failed-back syndrome. Most patients were referred by a pain management service because of failure of conventional pain treatment modalities. Electrodes were implanted at varying sites, dictated by the location of pain. A total of 140 epidural implants were used: 76 unipolar, 46 Resume electrodes, 12 bipolar, and six quadripolar. Patients were followed for periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months. Forty-eight patients (40%) were able to control their pain by neurostimulation alone. A further 14 patients (12%), in addition to following a regular stimulation program, needed occasional analgesic supplements to achieve 50% or more relief of the prestimulation pain. Pain secondary to arachnoiditis or perineural fibrosis following multiple intervertebral disc operations, when predominantly confined to one lower extremity, seemed to respond favorably to this treatment. Uniformly good results were also obtained in lower-extremity pain secondary to multiple sclerosis. Pain due to advanced peripheral vascular disease of the lower limbs was well controlled, and amputation below the knee was delayed for up to 2 years in some patients. Pain due to cauda equina injury, paraplegic pain, phantom-limb pain, pure midline back pain without radiculopathy, or pain due to primary bone or joint disease seemed to respond less well. Patients who responded to preliminary transcutaneous electrical nerve stimulation generally did well with electrode implants. Notable complications included wound infection, electrode displacement or fracturing, and fibrosis at the stimulating tip of the electrode. Three patients in this series died due to unrelated causes. Epidural spinal cord stimulation has proven to be an effective and safe means of controlling pain on a long-term basis in selected groups of patients. The mechanism of action of stimulation-produced analgesia remains unclear; further studies to elucidate it might allow spinal cord stimulation to be exploited more effectively in disorders that are currently refractory to this treatment modality.     

The effect of patients' noncompliance on their surgeons' obligations

Professional oaths and codes do not establish a firm basis for the obligation to treat all patients and they provide little or no clear guidance about whether patient nonadherence exempts a physician from a longstanding and still prevalent tradition in surgery supports a strong obligation to one's established patients. A personal belief in an obligation to serve those less fortunate or even less compliant could support sustained treatment and special assistance to a nonadherent patient. A collective, professional, objective, informed decision to exclude a patient who is highly likely to be nonadherent or incapable of adherence from the benefit of a scarce resource, such as a human organ, is defensible and appropriate. A surgeon's decision to deny care to an established but nonadherent patient is much less so. Adherence is as dependent on physician attitude, skill, and behavior as it is on patients' nonadherence. To the degree that it reflects less than competent management of this prevalent problem, it can be considered an error or complication that makes most surgeons feel even more obliged to mitigate or rectify the problem. This article describes the almost ubiquitous phenomenon of nonadherence; a way to reconceptualize noncompliance; and practical steps that can help predict, prevent, identify, and manage it. It is hoped that this helps surgeons reduce the frequency of nonadherence, make dealing with it less onerous, and consequently achieve better outcomes. It is reasonable to think about nonadherence in terms of three roles. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not make adherence any more difficult than it has to be. The patient's role is to make choices between value-laden alternatives. Society's role is equitably to distribute scarce medical resources to patients who can and want to adhere to the necessary regimen to benefit from them.     

BREAST LOSS AND DELAY IN BREAST CANCER DIAGNOSIS: BEHAVIOURAL SCIENCE IN SURGICAL RESEARCH1

By the use of the methods of behavioural science, a study of women's attitudes to breast cancer and to breast surgery was carried out to provide firm data which might begin to settle the argument regarding conservative surgery for breast cancer. Conscious fears, including that of mastectomy, were found to have no significant influence on the time that a woman takes to report the presence of a breast lump to her doctor, or to commence the practice of breast self-examination. The length of delay is determined by unconscious, non-rational processes, and other factors beyond her control. Rational argument, therefore, such as that earlier diagnosis will permit more conservative surgery including partial mastectomy, zmll not influence women to present any earlier or to practise breast self-examination.     

Breast loss and delay in breast cancer diagnosis: behavioural science in surgical research.

By the use of the methods of behavioural science, a study of women's attitudes to breast cancer and to breast surgery was carried out to provide firm data which might begin to settle the argement regarding conservative surgery for breast cancer. Conscious fears, including that of mastectomy, were found to have no significatn influence on the time that a woman takes to report the presence of a breast lump to her doctor, or to commence the practice breast self-examination. The length of delay is determined by unconscious, non-rational processes, and other factors beyond her control. Rational argument, therefdore, such as that earlier diagnosis will permit more conservative surgery including partial mastectomy, will not influence women to present any earlier or to practise breast self-examination.     

Developing evidence-based standards for diagnosis and management of lower urinary tract or pelvic floor dysfunction

The International Continence Society (ICS) has a key role in standardizing terminology related to lower urinary tract and pelvic organ dysfunction. The ICS Standardization Steering Committee (SSC) presents the new structure and process by which future ICS Standards will be developed. The new processes aim to meet present-day evidence-based practice requirements, and to foster unbiased, inclusive, and transparent development. For each new ICS Standard, the SSC will oversee a dedicated ad hoc Working Group (WG). Applications to chair or contribute to a WG will be invited from the ICS membership. The SSC will select the Chairperson, and work with him or her to select the WG composition, balanced to represent key disciplines, stakeholders, and regions. Consultants can be invited to contribute to the WG where specific need arises. Every WG will review current knowledge, adhering to evidence-based medicine requirements. Progress reports will be reviewed by the SSC, and amendments recommended, culminating in a first draft. The draft will be offered to the ICS membership and additional relevant experts for comment. Further revision, if needed, will result in a document, which the SSC will submit to the ICS Trustees, as arbiters of whether the document should be adopted as an ICS Standard. The SCC will then coordinate with the WG to ensure that the new ICS Standard is published and disseminated. Implementation strategies, such as education, audit, accreditation, and research initiatives will be linked to the Standards where appropriate. Revisions of ICS Standards will be undertaken to maintain contemporaneous relevance.     

Common pathogens in burn infection and changes in their drug sensitivity]

This paper reports common pathogens in burn infection and changes in their drug sensitivity from 1985 to 1988. Gram negative rods constituted 55.7% of all pathogens, while 40.5% were gram positive cocci. The former group consisted of 173 strains of Pseudomonas aeruginosa (28.5%), 55 Proteus (9.1%), 33 Serratia (5.4%), 23 Klebsiella (3.8%) 19, Acinetobacter (3.1%), 18 Enterobacter (3.0%) and 17 E. coli (2.8%). Among gram-positive cocci, Staphylococcus aureus accounted for 32.8%, Staphylococcus epidermidis accounted for 5.6%, and Streptococcus faecalis accounted for 2.1%. All the gram-negative rods and gram-positive cocci showed more resistance against various antibiotics. Ps. aeruginosa were resistant to 24 commonly used antibiotics. However, ciprofloxacin, ceftaztdime and piperacillin were comparatively effective, the sensitivity rates were 92.9%, 91.5% and 78.3%, respectively. Ps. aeruginosa showed a sensitivity rate of 92.5% and 86.1% to amikacin and polymyxin-B, respectively, from 1980 to 1984, but the rates were lowered to 65.9% and 17.3%, respectively, from 1985 to 1988. Staphylococcus aureus showed a sensitivity rate of 88.9% to ciprofloxacin, 76.1% to ceftazidime, 71.4% to amikacin, 48.5% to piperacillin, 63.1% to cefuroxime. This organism showed a sensitivity rate of 87.3%, 83.9%, 81.7% and 82.8% to amikacin, cefoperozone, leucomycin and lincomycin, respectively, from 1980 to 1984, but the sensitivity rates declined to 71.4%, 56.8%, 60.8% and 43.7%, respectively, from 1985 to 1988.