Fournier''s gangrene: non-clostridial gas gangrene of the perineum and diabetes mellitus.

Three successfully managed cases of Fournier's gangrene, all with diabetes, are reported. A simple bacteriological classification is offered and the importance of diabetes mellitus as a predisposing factor is stressed.     

1例会阴、阴囊气性坏疽切开引流术的手术配合

气性坏疽（gas gangrene）是厌氧菌感染的一种，即由梭状芽孢杆菌所致的肌坏死或肌炎；主要表现为患部肿胀、产气，肌肉皮肤由红肿到发紫发黑，以致坏死，蔓延快、腐肉恶臭，极易引起严重毒血症，是创伤后最严重的并发症之一［1］。此类感染发展急剧，预后较差，死亡率高［2］。本院于2011年10月收治1例会阴、阴囊气性坏疽并行急诊切开引流术的患者，现将手术配合介绍如下。     

A case for the expansion of day surgery.

The efficiency of the National Health Service (NHS) is currently under scrutiny and the problems faced by the surgical services include a shortage of financial resources, fewer beds, poor nursing recruitment and rising waiting lists. During 1984-1988 a purpose built, separate 12-bedded day surgery unit at Addenbrooke's Hospital, Cambridge operated upon 13,000 patients, with a readmission rate of less than 1%. Senior medical staff are involved and the overall surgical waiting list has been reduced by 40.9%. Nurse recruitment has been excellent, and the community medical and nursing services have not been overburdened. The results detailed in this paper suggest that day surgery deserves special consideration as one acceptable solution to some of the current NHS problems.     

Ophthalmic day case surgery: the role of a dedicated day case unit

A study was undertaken to examine all cases admitted to a new ophthalmic surgical day case unit during its first six months of operation. This paper describes the experience gained in establishing the unit, including operational management, and outlines the factors contributing to the unit's success. A quarter of the patients usually admitted as inpatients have been treated in the day unit, and day case surgery rarely results in unplanned inpatient admission, or subsequent readmission. Provided strict admission criteria are followed, the results show that this facility can accommodate a wide range of common ophthalmological procedures, and that general anaesthesia is compatible with day case management.     

Social conditions and paediatric day case tonsillectomy.

OBJECTIVE: To develop a simple method for assessing the proportion of children referred to hospital for tonsillectomy in different areas likely to be suitable for day case treatment based on their medical and social characteristics. METHODS: Four patient suitability criteria were selected based on previous experience of successful day case surgery and a literature review of the prevalence of contraindications and postoperative complications, as follows: medical contraindications (at least American Society of Anesthetists grade ASA2 to be eligible); home circumstances (no telephone, no car and single parent households were ineligible); distance from the hospital (more than 10 miles resulted in ineligibility); and likelihood of postoperative complications. Data relating to the social criteria were collected prospectively from 500 children under 12 years of age reviewed in the outpatient department and under the care of one of the authors. In addition, the electoral ward UPA8 (Jarman 8) deprivation score relevant to each child was recorded and the sample was divided into quintiles according to mean UPA8 scores. In each quintile, the percentage of children with the appropriate social criteria for day case tonsillectomy was calculated. The relationship between deprivation score and social criteria for day case tonsillectomy was determined using logistic regression. RESULTS: The proportion of children deemed socially suitable for day surgery fell continuously from 95% in the least deprived quintile to 55% in the most deprived group (proportion passing the social criteria for suitability = -1.5035 + 0.0298UPA8). Using these findings and those from the literature review on the nature and prevalence of contraindications and postoperative complications, a simple formula for realistic day case tonsillectomy targets was specified as A x B x C x D x 100%, where A is the proportion of children with no additional medical problems, B is the proportion passing the social suitability criteria, C is the proportion living within 10 miles and D is the proportion with no postoperative complications. Values for A and D would be derived from local audits. CONCLUSIONS: The formula can be used by purchasers and hospital managers to set differential day case targets for hospitals related to the characteristics of their patients referred for tonsillectomy. In principle, a similar approach could be applicable to other procedures and other age groups.     

A reversible method of vasectomy.

A method of a possible reversible vasectomy procedure is demonstrated. The basic idea of the technique is to form a loop of the vas deferens and to occlude the lumen by placing two tantalum clips 3–4 mm below the loop in a distance of 2–3 mm. In the study included are rats, rabbits and men in the reproductive age and over 60 in whom prostotectomy was done. In animals, the effectiveness of the method was proven by vasograms after clip fixation and clip removal. In young men regular spermiograms were undertaken until azoospermia occurred 8–10 weeks after the operation. In the older age group, vasograms also were done after clip fixation to demonstrate the vas occlusion and the patency again when the clips were removed after different periods of time.     

1例气性坏疽病例报告

目的通过对医院收治的1例气性坏疽患者的诊疗及其医院感染防控效果观察,探讨此类疾病的院内感染防控路径。方法某男性患者阴囊肿胀伴破溃流脓半月余于2018年2月24日入院。结合案例的具体特点,依据现有法规,采取一系列有步骤的防控措施。结果患者因阴囊肿胀伴破溃流脓就诊,当地医院抗炎治疗,效果不明显,并逐渐出现皮肤苍白、紧张发亮,破溃流脓,局部呈黑紫色,出现液体水泡,流出恶臭味液体,局部组织失去弹性,急诊来我院,以阴囊气性坏疽收入院。入院后在腰麻下接受清创术,手术过程顺利。术后无菌操作下每日换药,阴囊部感染得到控制并逐渐好转。并于3月5日在某医院创伤中心会诊,3月8日在感染控制后接受阴囊部成形术,术后恢复好。结论阴囊气性坏疽在临床上极为罕见,因而针对性的医院感染防控措施缺乏现成的经验。医院各部门配合和无缝衔接,采取主动预防,措施得力,得以保证未出现院内感染的情况。由此可见,院内感染可防可控,对于此类罕发事件,不必恐慌和过度防护。采取合理、有效的感染控制措施,是控制医院感染、保障医疗安全的关键。     

Health consequences of vasectomy in India.

Vasectomy acceptance has been declining in India during the past 20 years. Even if the risk of prostate cancer is marginally higher in vasectomized men, this risk in India has to be assessed against the immediate safety and other possible long-term benefits of this procedure. The Indian Council of Medical Research has launched a case-control study, which is unlikely to be time-consuming or beyond the available means and resources, in order to obtain definitive data on this problem. Meanwhile, vasectomy remains an excellent procedure for the couple seeking permanent methods of contraception, and specific efforts to promote its acceptance must continue in India.     

High prevalence of vasectomy in New Zealand.

The aim of this study was to examine the prevalence of vasectomy and associated factors in New Zealand, based on interviews with men. Participants were randomly selected from European men, aged between 40 and 74 years, on the general electoral roll. Telephone interviews were completed with 1225 men between 1997 and 1999. Overall, the prevalence of vasectomy was 44% (95% CI, 37-52%), adjusted to the age distribution of all New Zealand men aged 40-74 years. The prevalence ranged from 57% of men aged 40-49 years to 15% of those aged 70-74 years. Catholic men had a significantly lower odds of vasectomy, and there was a trend in increasing odds of vasectomy with increasing number of marriages and level of education of the wife. The results confirm a very high prevalence of vasectomy among New Zealand men. Comparison with earlier surveys based on interviews of women showed an increasing prevalence of vasectomy in each birth cohort from the 1920s to the 1950s. Vasectomy has been popular with men across all socioeconomic groups. New Zealand is an ideal country in which to study consequences of vasectomy.