Management of chylous ascites following laparoscopic presacral neurectomy

Chylous ascites is an extremely rare complication of laparoscopic presacral neurectomy (LPSN), and treatment is still controversial. Four patients undergoing LPSN for dysmenorrhoea or chronic pelvic pain were complicated with chylous ascites. Two were successfully treated with bipolar cauterization and one, after the failure of initial treatment by bipolar cauterization, was then effectively managed by compression with Gelform and closure of the peritoneum of the presacral area by suture through laparoscopy. The fourth patient had persistent chyle leakage from the drainage tube after electrocauterization and was finally cured by conservative management including removal of the drainage tube and a low-fat diet for 3 weeks. Chylous ascites has not been reported in laparoscopic presacral neurectomy. Management that is quick, effective and subjects the patients to the least amount of suffering is still unresolved. Repeated laparoscopy can be considered to identify the possibility of injury to lymphatic vessels, to relieve abdominal distention due to chyle accumulation, and to apply electrocauterization or compression with Gelform and closure of the peritoneum. Conservative treatment with a low-fat diet may need a longer time. The use of a drainage tube may provide negative pressure allowing a continuous leakage of chyle. However, more controlled study is required to identify the most proper and effective management.      

Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review

To determine the risks when the primary methotrexate (MTX) treatment of cervical pregnancy has an unsatisfactory outcome, we conducted a Medline search on relevant literature published from January 1983 to June 1997. The search yielded 28 publications of 48 cases of cervical pregnancy. These and four new cases from our institutions were used in our study. A cervical pregnancy that presented with a serum beta-human chorionic gonadotrophin concentration of > or = 10,000 mIU/ml [odds ratio (OR) 10.82, 95% confidence interval (CI) 2.59, 45.14], gestational age at > or = 9 weeks (OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI 2.95, 76.92), and crown- rump length of >10 mm (OR 13.33, 95% CI 1.46, 120.48) was considered to be associated with a higher unsatisfactory rate of primary MTX treatment. A concomitant feticide was found to enhance the therapeutic effect of MTX treatment if embryonic cardiac activity was evident (OR 0.13, 95% CI 0.02, 0.68). Administration of a high dose of MTX did not seem to be more effective than a lower one. Our findings supported some previous observations and, more importantly, provided useful clinical information in selecting appropriate candidates for MTX treatment in cases of cervical pregnancy.      

Study of alpha1-antichymotrypsin (ACT) in prostatic carcinoma

10 normal prostates and 100 prostates with tumour were studied immunohistochemically. ACT was found mainly in the cells lining the ducts. Synthesis of ACT is significantly increased in carcinoma due to mainly two parallel processes: ACT production by carcinoma cells and intensification of its production by normal cells mainly at the tumour periphery. Hyperplastic structures showed not very high ACT content, adenomatous structures revealed a higher response. On the whole, there is a parallelism between the content of ACT and prostatic specific antigen (PSA) in both normal and carcinomatous prostate, however PSA is being found in a much more wider spectrum of cells. Content of ACT in seminal fluid may be used as a parameter for diagnosis and monitoring of prostate cancer.     

Reduced endogenous Ca2+ buffering speeds active zone Ca2+ signaling

Fast synchronous neurotransmitter release at the presynaptic active zone is triggered by local Ca²⁺ signals, which are confined in their spatiotemporal extent by endogenous Ca²⁺ buffers. However, it remains elusive how rapid and reliable Ca²⁺ signaling can be sustained during repetitive release. Here, we established quantitative two-photon Ca²⁺ imaging in cerebellar mossy fiber boutons, which fire at exceptionally high rates. We show that endogenous fixed buffers have a surprisingly low Ca²⁺-binding ratio (∼15) and low affinity, whereas mobile buffers have high affinity. Experimentally constrained modeling revealed that the low endogenous buffering promotes fast clearance of Ca²⁺ from the active zone during repetitive firing. Measuring Ca²⁺ signals at different distances from active zones with ultra-high-resolution confirmed our model predictions. Our results lead to the concept that reduced Ca²⁺ buffering enables fast active zone Ca²⁺ signaling, suggesting that the strength of endogenous Ca²⁺ buffering limits the rate of synchronous synaptic transmission.At presynaptic nerve terminals, the opening of voltage-gated Ca²⁺ channels during action potentials (APs) leads to a brief Ca²⁺ influx. The resulting microdomain Ca²⁺ signals reach several tens of micromolar amplitude near open Ca²⁺ channels and trigger neurotransmitter release at presynaptic active zones (1, 2). After Ca²⁺ channel closing, the binding to endogenous Ca²⁺ buffers and diffusion of Ca²⁺ within the cytosol lead to collapse of the microdomain, increasing the residual [Ca²⁺] in the presynaptic terminal to not more than a fraction of micromolar. During this equilibration with Ca²⁺ buffers, the majority of entering Ca²⁺ ions are bound to endogenous Ca²⁺ buffers (3). The strength of intracellular Ca²⁺ buffering can be characterized by the Ca²⁺-binding ratio defined as the ratio of buffer-bound Ca²⁺ to free Ca²⁺ (4). It is established that strong Ca²⁺ buffering limits the spread of Ca²⁺ ions at active zones and thus restricts neurotransmitter release to the vicinity of Ca²⁺ channels (5). Rapid removal of calcium from the active zone is essential to sustain synchronous release during repetitive activity. However, the mechanisms controlling the speed of active zone Ca²⁺ signaling during repetitive synaptic transmission and the clearance of Ca²⁺ from the active zone in between APs remain elusive.The cerebellar mossy fiber bouton (cMFB) to granule cell synapse is ideally suited to analyze Ca²⁺ signaling during repetitive synaptic transmission because of the synchronous neurotransmitter release at exceptionally high frequencies (6–8). Understanding rapid active zone Ca²⁺ signaling requires knowledge about the Ca²⁺ dynamics and the strength, mobility, and binding kinetics of endogenous Ca²⁺ buffers. In particular, a dissection of fixed and mobile buffers (9, 10) is needed, which is technically challenging and requires access to the presynaptic terminal.Here, we perform quantitative two-photon Ca²⁺ imaging in cMFBs, which are dialyzed with the pipette solution, and in remote cMFBs along the same axon, which are minimally perturbed, to separately characterize fixed and mobile Ca²⁺ buffers. We show that rapid active zone Ca²⁺ signaling is achieved by a low Ca²⁺-binding ratio of endogenous fixed buffers with low affinity and mobile buffers with high affinity. Our data explain how a central synapse achieves the speed of active zone Ca²⁺ signaling required for fast and synchronous transmitter release and suggest that the strength of endogenous Ca²⁺ buffering limits the precision and synchronicity of repetitive synaptic activity.     

South African hypertension practice guideline 2014

This is the sixth hypertension guideline published by the Southern African Hypertension Society (SAHS). Currently 30.4% of the adult population have hypertension (HTN),1 necessitating a simplified approach to assessment and treatment, which reflects realistic objectives that can be implemented by medical practitioners, nurse practitioners and pharmacists to diminish the impact of HTN and related cardiovascular disease (CVD) risk in this country. For full details on management not contained in this document please refer to the more detailed hypertension guideline 2011.2     

Role of Ultrasound Therapy in the Healing of Tibial Stress Fractures

Background

Stress fracture is the single most common cause for the lost number of manpower days during training. The conventional treatment options begin with rest and cessation of precipitating activity. However the demands of military training provide little tolerance for prolonged periods of rest. In the recent past ultrasound therapy (UST) has been reported to speed up healing of stress fractures.

Methods

In the present study, a total of 67 cases of stress fracture were studied for the effect of ultrasound therapy on healing time. Study protocol used was double blind placebo controlled.

Result

Study results showed that the mean number of days of incapacitation was 25.46 days in the ultrasound treatment group as compared to 39.92 in the placebo group, a difference of 14 days, which was statistically highly significant.

Conclusion

The results of the study convincingly prove that ultrasound treatment is effective in cases of stress fracture.Key Words: Stress fracture, Ultrasound therapy     

人工建立褪黑素节律对妇科手术后病人睡眠质量的影响

目的 评价人工建立褪黑素节律对妇科手术后病人睡眠质量的影响.方法 择期行妇科手术病人18例,年龄25～50岁,体重45～80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为3组(n=6):空白对照组(C组)、安慰剂对照组(P组)和褪黑素组(M组).分别于术前1d、手术当天和术后第1天的21:00熄灯前10 min时,M组口服褪黑素胶囊6mg;P组口服安慰剂.术中采用连续硬膜外麻醉,术后采用病人硬膜外自控镇痛.分别于手术当天和术后第1天的6:00、10:00、14:00、16:00、18:00、20:00、22:00、0:00、3:00时,留取尿液,采用放射免疫法测定褪黑素浓度.分别于术前1d、手术当天和术后第1天的21:00至次日6:00时,监测多导睡眠图,计算总睡眠时间、睡眠潜伏期、Ⅰ期睡眠时间、Ⅱ期睡眠时间、Ⅲ期睡眠时间、Ⅳ期睡眠时间、快速眼动睡眠时间、慢波睡眠时间和总清醒次数.记录病人对术前1d、手术当天和术后第1天的夜间睡眠质量评分(0分为基本无睡眠,10分为睡眠良好).结果 与C组和P组比较,M组手术当天和术后第1天的6:00、0:00和3:00时尿液褪黑素浓度升高,手术当天的总睡眠时间和Ⅰ期睡眠时间延长,手术当天和术后第1天的夜间睡眠质量评分升高(P＜0.05).结论 人工建立褪黑素节律可改善妇科手术后病人的睡眠质量.     

Organization of medical support U.S. Armed Forces

The article describes the structure of the medical service of the U.S. Army, presented by seven corps,principles of planning of capabilities of medical services and their management, personnel policy of the Medical Service, that focuses on the staffing of the medical service of the officers of the possibilities. Organization of medical care during the combat theater provided by 4 echelons is represented. The first echelon "battlefield-Battalion", the second--"brigade combat team", the third is the rear of the theater of operations, the fourth--stationary hospitals outside the theater of operations. The basic direction of reducing the medical costs of all the troops: military personnel, their families, civilian employees of the Ministry of Defence, members of their families, veterans of military service and their families.     

肝移植术后患者血清胆汁酸代谢的检测及临床意义

目的:评价肝移植术后患者血清总胆汁酸水平、胆酸/鹅脱氧胆酸比值在肝移植术后发生排斥反应及肝功能延迟恢复时的变化规律。方法:选择2004-01/2004-12在大连医科大学器官移植中心进行肝移植手术的患者28例,同时收集大连医科大学附属二院门诊健康体检者和肝硬化患者血清学标本各12例作为对照,所有观察对象均知情同意。采用高效液相色谱检测肝移植术后患者血清中不同种类胆汁酸及总胆汁酸水平,也与常规肝功能监测指标谷草转氨酶和总胆红素加以比较,对肝移植术后患者血清指标与肝功能恢复之间的关系进行综合评价。结果:所有观察对象均进入结果分析,无脱落。①肝硬化组、肝移植组术前患者的血清总胆汁酸水平显著高于正常对照组(P<0.05)。②肝移植患者术后发生排斥反应或肝功能延迟恢复时,血清总胆汁酸水平较术前明显升高(P<0.05),胆酸/鹅脱氧胆酸比值明显降低(P<0.05),且比谷草转氨酶、总胆红素的变化提前发生,随着供肝功能的恢复它们将逐渐恢复正常。结论:总胆汁酸及胆酸/鹅脱氧胆酸比率可以作为肝移植术后发生排斥反应及肝功能延迟恢复的早期诊断指标,其对于肝移植术后急性排斥反应的早期诊断、早期治疗有重大意义。     

Hypoxic hepatitis in children after cardiac surgery

<正>To the Editor: Hypoxic hepatitis(HH), also known as ischemic hepatitis or shock liver, is a liver injury characterized by necrosis of centrilobular hepatocytes with a rapid increase in serum aminotransferase levels. The incidence rate of HH among patients in the intensive care unit(ICU) was found to be 0.9%-11.9% [1]. Occurrence of HH appears to have a significant impact on the clinical outcome.