午餐肉罐头杀菌条件的探讨

397克午餐肉传热曲线斜率f_h为66,j值为1.32。采用鲍尔公式计算的结果,若加热温度为112℃,118℃,121℃,125℃,130℃时,要使罐内中心点F值达到3,在离罐壁15mm处的F值分别为12.99,36.38,52.46,130.01,334.3,通过实罐试验,采用130℃高温短时杀菌的罐头因受热过度,有脂肪析出,弹性也差。本试验说明,午餐肉罐头采用116—118℃的杀菌条件为宜。     

PERCUTANEOUS INSERTION OF LONG-TERM VENOUS ACCESS CATHETERS VIA THE EXTERNAL ILIAC VEIN

Long-term venous access using Hickman catheters and implantable subcutaneous ports is a well established technique. These devices have customarily been inserted via the internal jugular, subclavian or cephalic veins. On occasions, these routes may be unavailable. This article reviews the outcome of 53 prolonged venous access catheters (39 Hickmans and 14 catheters attached to implantable ports) inserted percutaneously via the external iliac vein into 37 patients over a period of 5.7 years. The indications for insertion were chemotherapy (40%), total parenteral nutrition (36%), intravenous antibiotics (13%), poor venous access (7%) and bone marrow transplantation (4%). The main reasons for use of the external iliac vein were thrombosis of the subclavian veins or superior vena cava and subclavian central line sepsis. The only complication of insertion was one inadvertent puncture of the external iliac artery. Twenty-seven catheters (51%) remained complication free and functioning for the time for which they were required. Four catheters (7%) are still functioning in situ having been present for 1–5 years. Sixteen catheters (30%) became infected, with a 17% incidence of septicaemia. Venous thrombosis was associated with three catheters (6%). Catheters remained in situ for a median period of 30 days (range 5–569 days). The authors conclude that long-term venous access using percutaneous external iliac vein insertion is a useful technique when other routes are unavailable, but there is a relatively high incidence of catheter-related sepsis.     

STERILIZATION OF HIV WITH IRRADIATION: RELEVANCE TO INFECTED BONE ALLOGRAFTS

Background : Bone allograft banks commonly sterilize frozen bone by irradiation. The dose–response relationship for HIV is calculated and the dose required to inactivate the bioburden of virus that may be present in allograft bone is determined. Methods : A virus titre experiment is performed using irradiated frozen HIV. The virus is maintained on dry ice (approximately –70°C) and is exposed to a cobalt 60 source with 0–40 kGy irradiation at 5 kGy intervals. Lymphocyte cell cultures are exposed to serial dilutions of the irradiated virus. The virus titre is quantified by cytological changes of HIV infection and p24 immunofluorescence. Results : There is a linear relationship between the virus titre and the radiation dose delivered. The inactivation rate of irradiated virus was 0.1134 log₁₀ tissue culture infective doses ₅₀/mL per kGy (95% confidence intervals, 0.1248–0.1020). The irradiation dose required to inactivate the HIV bioburden in allograft bone is 35 kGy. The irradiation dose required to achieve a sterility assurance level of 10^–6 is 89 kGy. This dose exceeds current recommendations for sterilizing medical products and the current practice of many bone banks. Conclusions : It is concluded that gamma irradiation should be disregarded as a significant virus inactivation method for bone allografts.     

MICROWAVE TISSUE COAGULATOR IN LIVER RESECTION FOR CIRRHOTIC PATIENTS

The use of the microwave tissue coagulator was studied on 20 consecutive elective hepatic resections carried out for symptomatic hepatocellular carcinoma with liver cirrhosis. The mean operative blood loss (excluding one patient with hepatic vein injury) was 1132 mL. Five patients required no blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. Apart from the complications similar to those occurring in hepatic resections for cirrhotic patients, higher incidences of intra-abdominal sepsis (20%), sympathetic pleural effusion in the absence of chest or intra-abdominal sepsis (20%), and persistent fever lasting more than 1 week (40%) were encountered. It was considered that these complications were related to the coagulated tissue present in the liver remnants (mean depth of tissue coagulation = 3.8 mm) and concluded that although the hospital mortality rate of 10% and the mean operative blood loss of 1132 mL were acceptably low, microwave liver surgery carried a high morbidity rate which is a drawback in major hepatic resectional surgery.     

A LOW-POWER MAGNIFICATION TECHNIQUE FOR THE RE-ANASTOMOSIS OF THE VAS - FURTHER RESULTS IN A PERSONAL SERIES OF 125 PATIENTS

In 125 patients undergoing reversal of an earlier bilateral vasectomy, a simple technique of re-anastomosis of each divided vas, using low-power magnification (X 3.5) was used. In 51% of couples a normal pregnancy followed and 86% of the males had a sperm count greater than 20 million ml¹, These results compare quite favourably with those obtained using more sophisticated microsurgical techniques.     

TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR BENIGN PROSTATIC HYPERPLASIA: CLINICAL RESULTS AFTER A 1-YEAR FOLLOW-UP

Since September 1992, 63 patients with symptomatic benign prostatic hyperplasia (BPH) have been treated with transurethral microwave thermotherapy (TUMT) using the Prostatron device. The International Prostate Symptom Score (l-PSS) and quality of life (QOL) score were used to evaluate subjective symptoms. The mean l-PSS (total, irritative and obstructive scores) and QOL scores had decreased by 40, 38, 45 and 40%, respectively, at 12 months (p < 0.0001). While the mean peak flow rate had increased by 72% (p < 0.001). The clinical efficacy at 12 months was 42%, using a modification of the response criteria proposed at the 2nd International Consultation on Benign Prostatic Hyperplasia. There were no significant differences in the baseline and treatment parameters between those who responded favorably to TUMT and those who did not. The total thermal dose delivered to the prostate did not predict clinical response. However, there was a positive correlation between l-PSS or QOL at baseline and % reduction at 3, 6 and 12 months, and a negative correlation between peak flow rate at baseline and % increase at 3 and 6 months. There were no major complications associated with TUMT during the follow-up period. In summary, our 1-year clinical results are compatible with previous reports, suggesting that TUMT is a safe, effective and lasting non-surgical treatment for BPH. However, evaluation of efficacy should be based on uniform criteria to facilitate comparisons of different clinical trials. The most suitable patient profiles for TUMT could not be identified by retrospective analysis.     

TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR BENIGN PROSTATIC HYPERPLASIA: PATIENT CHARACTERISTICS IN GOOD AND POOR RESPONDERS

Transurethral microwave thermotherapy (TUMT) has be'en shown to produce a clinical benefit in patients with symptomatic benign prostatic hyperplasia. In order to identify the features of the ideal candidate, a retrospective analysis was conducted in 32 patients who were followed for 2 mo or more. Good responders (GR) were defined as having their Siroky peak flow rate (PFR) standard deviation (SD) increase by 0.5 or a decrease in the International Prostatic Symptom Score (l-PSS) of 10 (22 patients). Poor responders (PR) were defined as having their PFR SD increase by 0.5 and their l-PSS decrease by10 (10 patients). The prostate volume, pre-TUMT l-PSS and intravesical opening pressure were significantly greater in the GR group, while there were no significant differences between the 2 groups for the other baseline patient characteristics: age, prostate length, PFR, PFR SD, post-voiding residual volume and quality of life. Concerning the operational parameters, significantly more total energy was delivered to the prostate in the GR group (mean 131 kJ) than in the PR group (mean 101 kJ). Moreover, the 7 patients with anti-androgen therapy pre-TUMT received less total energy and 5 of the 7 were poor responders. These results suggest that patients with apparent obstructive symptoms and with moderate enlargement of prostate could benefit more from this less invasive therapy. Clinical response seems to be dose-dependent and patients with a history of recent anti-androgen treatment may have a less favorable response. The histological composition of the prostatic tissue may play an important role as far as microwave thermal interactions and treatment outcome are concerned.     

URINARY BACTERIOLOGY OF CONTINENT URINARY RESERVOIRS AND CALCULUS FORMATION

In order to investigate urinary bacteriology in relation to calculus formation in continent urinary reservoirs, a retrospective study was conducted of 19 patients with the Kock pouch and 23 patients with the Indiana pouch. Analysis of a total of 151 urine-cultures showed that asymptomatic bacteria (any bacterial count) were present in 92% of urines from the Kock pouch and 74% from the Indiana pouch. The incidence of organisms and total bacterial counts were similar for both pouches. The most prevalent organisms were Escherichia coli, Pseudomonas sp., Klebsiella sp., Proteus sp., Enterobacter sp., and Enterococcus sp. Urinary calculi developed in 42% of the Kock pouch patients and 13% of the Indiana pouch patients. More than half of the patients had multiple stone recurrence. Infectious stones developed in 32% of the Kock pouch patients, usually on the foreign materials, and 9% of the Indiana pouch patients. In general, no clear relationship was established between urinary bacteriology and calculus formation although Proteus sp. or Providencia sp. was determined to be the causative organism in some infectious stones. Furthermore, metabolic stones developed in 32% of the Kock pouch patients and 9% of the Indiana pouch patients. Because calcium phosphate was a constituent of 80% of the metabolic stones, the presence of urinary factors promoting calculus formation was suspected.     

EXPERIMENTAL STUDY OF MICROWAVE COAGULATION OF A VX-2 CARCINOMA IMPLANTED IN RABBIT KIDNEY

This paper describes the results of an experimental study of the microwave coagulation of VX-2 renal tumors implanted in rabbits. The rabbits undergoing microwave treatment exhibited a satisfactory survival rate and a complete response to treatment, as verified by histological examination. All the rabbits receiving no treatment died within 6 weeks of implantation of the VX-2 carcinoma. These results indicate that microwave coagulation may be a curative method of treatment for a relatively small renal tumor. Intraoperative real-time ultrasonic scanning permits the percutaneous microwave coagulation of renal cancer in a clinical situation.     

RIGHT ATRIAL CATHETERS: RELIABLE,IMMEDIATE AND DURABLE VASCULAR ACCESS FOR HAEMODIALYSIS AND PLASMA EXCHANGE

This paper prospectively evaluates 33 dual lumen, right atrial catheters inserted into either an external or internal jugular vein by open operation in 29 patients, of whom 15 required haemodialysis and 14 required temporary plasma exchange. The median (range) catheter survival in the haemnodialysis and plasma exchange groups was 108 days (7–334 days) and 61 days (10–116 days), respectively. Life table analysis demonstrated that overall catheter survival was 58% at 200 days. The main causes of catheter failure were infection (four cases), poor flow (three cases) and accidental removal (one case). Another nine catheters were removed electively because of maturation of alternative methods of vascular access (five cases). completion of plasma exchange treatment (three cases), or successful renal transplantation (one case). Long-term silastic catheters, inserted into the right atrium via a jugular vein. have distinct advantages over temporary subclavian vein catheters and external arteriovenous (AV) shunts; this form of access is the method of choice for hamodialysis and plasma exchange patients who require immediate and short- to medium-term vascular access.     

微波技术在肝损伤中的应用

本研究应用WGZ—Ⅰ型微波肝脏止血机对17例肝外伤实施了微波固化止血术,或在此基础上进行修补和部分切除术,取得了满意疗效。该方法具有止血迅速、确切、损伤轻微,安全方便等优点。无胆瘘、感染、腹腔脓肿等并发症出现。并探索出该机用于急性肝外伤止血的最佳条件为:功率80～100W、凝固时间40～45秒,电极直径0.9mm,长度2.0cm。     

Purple urine bag syndrome: A rare clinical entity in patients with long term indwelling catheters

An elderly gentleman, on urinary drainage catheter for 3 months developed a purple discoloration of the urinary bag with the urine inside remaining clear. He was found to have a urinary tract infection with a strain of E. coli manifesting as a rare clinical entity reported in literature as the “Purple urine bag syndrome”.     

A review of 560 Hickman catheter insertions

Indwelling, cuffed, tunnelled, central venous (Hickman) catheters are increasingly being used for venous access and the administration of chemotherapy for oncological patients. This paper reviews the technical problems associated with the percutaneous insertion of these catheters and the complications arising from their use. Five hundred and sixty catheters were inserted; 31.3% had complications at insertion, most commonly precipitation of an arrhythmia (13.9%). Arterial puncture occurred in 3.8% and pneumothorax in 1.6%. Catheters remained in place for a median period of 91 days. Forty percent of catheters were removed electively on completion of treatment; 30.2% required removal because of complications, which included sepsis, migration, thrombosis and blockage. Twenty percent of patients died with their catheter in place, 8.5% were still in situ and 1.6% were removed because of patient non compliance. Sepsis remains the commonest, long term complication, with staphylococcus epidermidis being the organism isolated most frequently. There were no catheter-related deaths.     

几丁糖凝胶预防骨感染的实验研究

为了观察几丁糖凝胶对骨感染的影响，按Ｎｏｒｄｅｎ法制作兔金黄色葡萄球菌骨髓炎模型，随机分为几丁糖组、醋酸组及对照组，观察术后动物一般情况、Ｘ线片表现、骨培养及细菌计数。结果显示：几丁糖组骨感染率与其它两组无差别，但术后动物体重增加，Ｘ线片上病变程度减轻，细菌计数减少，明显优于其它两组。证明几丁糖对骨感染有一定的缓解作用。其原因可能与几丁糖具有抑菌作用、提高动物免疫机能及体内降解缓慢有关。     

EFFECTS OF VESICOCOLIC ANASTOMOSIS ON THE PROLIFERATION OF COLONIC MUCOSA IN A RAT MODEL

The effects of diverting the urinary stream into a defunctioned segment of the distal colon has been studied in a rat model. Distal rat colon was defunctioned using the Hartmann's procedure and a vesicocolic anastomosis was performed 14 days later. The distal colon was harvested after 10 days following the administration of a vinblastine mitotic block either 1 or 3 h before death. Both the mean crypt cell proliferation and the crypt length were increased significantly in the colonic mucosa exposed to urine when compared with the control defunctioned colon or to the functional unexposed proximal colon. An active fraction was obtained from human urine by elution from a diethylaminoethyl sepharose column using 1 mol/L NaCl. This fraction was administered intraluminally to defunctioned rat colons using Alzet miniosmotic pumps. In these animals the crypt cell production rate was significantly increased compared with the control animals. Although the crypt length did not increase significantly in these animals the atrophy normally seen in defunctioned colonic mucosa did not occur. The identity of the active molecule in this urine fraction is still being determined.