Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy

BACKGROUND: Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress needle group (14% versus 0.9%; P <0.01), and the two major complications, gastric perforation and iliac artery laceration, were also encountered in this group. CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.     

4129例专家门诊问卷调研的启示和思考

专家门诊在各医院开设已十多年,为了解专家门诊的现况、需求,进一步做好专家门诊的管理,我们对上海交大医学院附属10所医院进行了专家门诊问卷调查,从而得到了启示和思考,为更好地做好专家门诊各方面工作提供了新的思路。     

两种十大功劳叶中生物碱成分的分析与比较

目的建立长柱十大功劳叶和阔叶十大功劳叶中药根碱、巴马汀、小檗碱的含量测定方法,比较两者的生物碱成分含量差异。方法采用反相高效液相色谱外标法同时测定。色谱柱为大连依利特Sino Chrom ODS—BP柱（250mm×4．6mm,5μm）,流动相为乙腈-0．2％磷酸（23：77）,流速为1．0mL／min,检测波长为265nm,进样量为10μL。结果上述色谱条件下,盐酸药根碱、盐酸巴马汀、盐酸小檗碱可以较好地分离,线性范围分别为0．001444—0．07076μg（r=0．9999）,0．0005152～0．02524μg（r=0．9996）,0．0009240-0．04528μg（r=0．9998）,平均回收率分别为98．74％,99．37％,99．89％,RSD分别为2．16％,1．62％,2．14％（n：9）。结论该测定方法简单,快速,专属性、重现性好,结果准确可靠。     

Early and late diagnoses of 17β-Hydroxysteroid dehydrogenase type-3 deficiency in two unrelated patients

17β-hydroxysteroid dehydrogenase type 3 deficiency is a rare cause of 46 XY disorders of sexual development. Mutations in the HSD17B3 gene result in reduced activity of the 17β-HSD3 enzyme, decreasing the conversion of androstenedione to testosterone. In this report, two cases, admitted with different clinical findings in the neonatal and adolescent periods and were decided to be raised in different genders are presented. The first case who had complete female external genitalia presented on the third postnatal day with the complaint of swelling in the groin. He was decided to be raised as a male and was treated successfully with parenteral testosterone in order to increase phallus size before surgical correction of the external genitalia. The second case was an adolescent girl who presented due to pubertal virilisation and primary amenorrhoea and chose female gender. Molecular genetic analyses of the HSD17B3 gene revealed two different previously reported homozygous variants. We emphasise that patients with 17β-hydroxysteroid dehydrogenase type 3 deficiency can present with heterogeneous clinical findings in different age groups. Early diagnosis is important to prevent future gender confusion and related problems.     

HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu’s arteritis

Clinical Rheumatology - The aim of this study was to evaluate the relationships among the disease activity, illness perception, daily life performance, anxiety and depression status as potential...     

CT-guided transthoracic biopsy: histopathologic results and complication rates

PURPOSE

We aimed to investigate the effectiveness and complications of transthoracic CT-guided biopsy techniques.

METHODS

A total of 94 CT-guided percutaneous transthoracic biopsy procedures performed in 85 patients were retrospectively evaluated. Core biopsy technique was used in 87 procedures and transthoracic fine-needle aspiration biopsy was used in seven procedures.

RESULTS

Diagnostic results were achieved in 79 of 94 biopsy procedures. Pathology results were malignant in 54 patients, suspicious for malignancy in three patients, benign in five patients, and benign nonspecific in 17 patients. Specific diagnoses were obtained in 59 patients (62.8%) using core biopsy, but no specific diagnosis could be reached with transthoracic fine-needle aspiration biopsy. Complications included pneumothorax in 27 patients (28.7%) and parenchymal hemorrhage during and after the procedure in eight patients (8.5%).

CONCLUSIONS

CT-guided percutaneous transthoracic needle biopsy is a highly accurate procedure for histopathological diagnosis of thoracic masses. In addition, percutaneous transthoracic biopsy has an acceptably low complication rate and it reduces the need for more invasive surgical procedures.Since the beginning of the 21st century, lung cancer has been cited as one of the most common causes of death (1). World Health Organization declared lung cancer as the first leading cause of death in men and second in women, among all types of cancers (2).Percutaneous transthoracic biopsies are performed either using fine-needle aspiration biopsy (transthoracic fine-needle aspiration biopsy, TTFNAB) method or using the incisional or core biopsy method. Incisional biopsy and core biopsy are used to obtain a part of tissue from the lesion for histological diagnosis. On the other hand, TTFNAB is used to obtain aspiration material, which is used for cytological examination and lesion diagnosis (3, 4).Indications of transthoracic needle biopsy include solitary and multiple pulmonary nodules, mass lesions, persistent focal infiltration, consolidation, presence of cavities and abscesses, pleural lesions, and mediastinal and hilar mass diagnosis (3, 5).The aim of this study was to investigate the technique, suitability, and complications in CT-guided transthoracic biopsy of lung masses.