Palliation after operation and after radiotherapy for cancer of the esophagus

Because of the negligible cure rate in cancer of the esophagus, treatment is aimed principally at providing good palliation. This paper compares the degrees of palliation achieved after the two main treatments for symptomatic carcinoma of the esophagus. The degree of palliation was measured by a grading system designed to assess only the subjective responses of each patient. The results show that palliation as defined and measured in this study is the same after radiotherapy as after surgical excision. Since the expected survival is the same after radiotherapy as after operation, the expected morbidity and mortality of radiation are lower and radiotherapy may be used where operation is not possible, the authors suggest that radiotherapy is the better primary treatment for symptomatic squamous cancer of the esophagus.     

经肝动脉化疗栓塞术后血管生成及其对策

经导管肝动脉化疗栓塞术（TACE）是无法接受手术切除的肝细胞癌患者的首选治疗方法。血管生成是影响其远期疗效的关键因素之一,对策主要有将肿瘤血供完全栓塞化和结合抗血管生成治疗。本文对TACE后血管生成及其对策进行综述。     

Reconstructing the eyelids after exenteration and trauma

. Based on 22 cases, the assessment and methods of reconstructing both the upper and lower eyelids are described. Galea and prefabricated retroauricular flaps were used in the majority of cases. When concomitant defects and deformities were present, additional procedures are discussed, with special emphasis given to shortcomings, difficulties and complications.     

Relaparotomy after operations on the rectum and colon

During 15 years 1663 intraabdominal operations on the rectum and colon were performed, relaparotomy resulting from the complications was fulfilled in 134 patients (8%). The main indication for relaparotomy was peritonitis (57 patients). Its sources were: incompetence of the colonic anastomosis suture, technical errors during the first operation, opening of the abscess into the abdominal cavity. Five types of the course of postoperative peritonitis were established: primary, atypical, artificial, perforative and necrotic types.     

Life after death--mortality statistics and the public health

The process by which mortality statistics are compiled in the RSA and the potential impact on public health are discussed. The use of the international death certificate is outlined; this is compared with the South African death certificate to illustrate the importance of establishing the chain of events leading to death. The distinction between underlying and direct causes of death in compiling mortality statistics and planning public health intervention is considered. The major part played by medical practitioners in the death certification process is emphasised, and some of the areas in which mortality data could be improved are highlighted.     

纤维胆道镜在胆道结石术中术后的应用

肝胆管结石由于病因复杂和特殊病理改变 ,术后残留结石率和再手术率高。我科 1996年 10月～ 2 0 0 2年 6月 ,应用OlympusCHF T2 0型胆道镜 ,术中、术后治疗 116例 ,效果较好 ,现报告如下。1　资料和方法1.1　一般资料　本组 116例 ,术前经B超、彩超、CT检查证实为肝内外胆管多发结石。原发性结石 10 1例 ,复发性结石15例。术中应用组 (术中组 ) :98例 ,男 4 0例 ,女 5 5例 ,年龄 34～ 78岁 ,中位年龄 4 6岁 ;术后应用组 (术后组 ) :16例 ,男 6例 ,女 10例 ,年龄 38～ 6 8岁 ,中位年龄 5 2岁 ,其中胆总管残余结石 13例 ,左肝管残余结石 3…     

Changes in the pelvis after the chiari and salter osteotomies

Summary Pelvic osteotomies were simulated on a macerated female pelvis using the techniques of Chiari and Salter. The effect of varying amounts of medial or angular displacement upon the actual and radiological displacement of the acetabulum were then measured and compared.With the Chiari osteotomy, increasing medial displacement in the range 0.5 – 2.5 cm appeared to give a wider acetabular roof but at the expense of rotating the true acetabulum to face more laterally, thereby reducing the width of articular cartilage in the weight-bearing area from that present originally. However no disturbance of the symphysis was detected.In the Salter osteotomy it was found that the radiologically determined angle was up to 50% greater than the true angle. With an increasing true osteotomy angle up to 30° steady improvement in the CE angle developed, but beyond 30% significant lateral displacement of the acetabulum, lengthening of the leg and disturbance of the symphysis pubis occured. It is concluded that the osteotomy opening should not exceed 30° in the Salter procedure.

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Résumé Des ostéotomies selon les techniques de Chiari et de Salter ont été réalisées sur des préparations cadavériques de bassins féminins. On a mesuré et comparé l'effet de divers degrés de translation interne ou d'angulation sur le déplacement réel et radiologique du cotyle.Dans l'ostéotomie de Chiari, une augmentation de la translation interne de 0,5 à 2,5 cm semble élargir le toit du cotyle, mais au prix d'une rotation du cotyle lui-même, qui regarde plus en dehors, ce qui entraîne une diminution de l'épaisseur de cartilage au niveau de la zone portante par rapport à ce qu'elle était auparavant. Par contre, il n'y a pas de retentissement défavorable sur la symphyse pubienne.Dans l'ostéotomie de Salter on a trouvé que l'angulation est de 50% supérieure radiologiquement à ce qu'elle est en réalité. En augmentant l'angle réel d'ostéotomie jusqu'à 30° on obtient une amélioration certaine de l'angle projeté CE, mais au delà de 30° on entraîne un notable déplacement externe du cotyle, un allongement du membre inférieur et des modifications au niveau de la symphyse. On en conclut que dans la technique de Salter l'ouverture de l'ostéotomie ne doit pas dépasser 30°.

     

Restoration of the jawline and the neck after bariatric surgery

Bariatric surgery can result in massive, rapid weight loss. Patients who undergo this surgery can be left with significant facial and neck skin redundancy and may request restorative facial plastic surgery. Optimal results require a thorough understanding of the unique physiologic, metabolic, and anatomic findings in these patients. Modifications of standard rhytidectomy techniques are necessary to suit the specific features of the patient after bariatric surgery.     

Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience

Purpose

The aim of this study was to explore donor and recipient outcomes from organ donation after cardiac death (DCD) in Ontario and to examine the impact of DCD on deceased donation rates in Ontario since its implementation.

Methods

Donor data were obtained from the Trillium Gift of Life Network (TGLN) TOTAL database from June 1, 2006 until May 31, 2009. All DCDs were tracked, including unsuccessful DCD attempts during that time. For the first 36 months after DCD implementation, all Ontario solid organ transplant programs that utilized organs from DCD provided clinical outcome data at one year. Total DCD activity until December 1, 2010 was also tracked. In addition, we compared organ donation and DCD rates across all Canadian jurisdictions and the USA.

Results

For the first 36 months of DCD activity in Ontario, June 1, 2006 to May 31, 2009, there were 67 successful DCDs out of 87 attempted DCDs in 18 Ontario hospitals, resulting in 128 kidney, 41 liver, and 21 lung transplants. The one-year kidney patient and death-censored allograft survivals were 96 and 97%, respectively. Mean (SD) creatinine at 12 months was 150 (108) μmol·L^?1. In 26 (20%) extended criteria donors (ECD-DCD), the one-year creatinine was 206 (158) μmol·L^?1 vs 137 (80) μmol·L^?1 in 102 standard criteria donors (SCD-DCD) (P = 0.002). The one-year liver and lung allograft survivals were 78% and 70%, respectively. Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario. In 2009, Ontario had a record number of organ donors. Of the 221 deceased donors, 37 (17%) donors were DCD. By December 1, 2010 there were 121 DCD Ontario donors resulting in > 300 solid organ transplants and accounting for 90% of all DCD activity in the country.

Conclusion

The rapid update of DCD in Ontario can be attributed to strong proponents in the critical care and transplantation communities with continued support from Trillium Gift of Life Network (TGLN). Ontario is the only province to demonstrate growth in deceased donor rates over the last decade (25% over the last four years), which can be attributed primarily to the success of its DCD activity.     

Acupressure and the prevention of nausea and vomiting after laparoscopy

The efficacy of currently available antiemetics remains poor. Concern with their side effects and the high cost of the newer drugs has led to renewed interest in non-pharmacological methods of treatment. We have studied the efficacy of acupressure at the P6 point in the prevention of nausea and vomiting after laparoscopy, in a double-blind, randomized, controlled study of acupressure vs placebo. We studied 104 patients undergoing laparoscopy and dye investigation. The anaesthetic technique and postoperative analgesia were standardized. Failure of treatment was defined as the occurrence of nausea and/or vomiting within the first 24 h after anaesthesia. The use of acupressure reduced the incidence of nausea or vomiting from 42% to 19% compared with placebo, with an adjusted risk ratio of 0.24 (95% CI 0.08-0.62; P = 0.005). Other variables were similar between groups.