Extubation difficile imprévue

Complications at extubation remain an important risk factor in anaesthesia. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. We report a new case of respiratory complications associated with tracheal extubation in a 59-year-old woman. Her medical history included obesity, no criteria difficult intubation and no adverse events during her previous anesthetic procedures. At the end of surgery, immediately after extubation, the patient developed respiratory distress requiring reintubation. A second extubation performed in postoperative recovery room was complicated by a new respiratory distress with reintubation. The patient was then admitted to the ICU. The examination on admission was unremarkable. Chest X-ray and a chest CT scan were performed in search of an etiology. Both tests showed a large thyroid “goitre plongeant” (plunging goiter) and compressive. In the suites, a thyroidectomy was performed with excision of a large cervical plunging goiter para- and retropharyngeal bilateral chest, allowing extubation successfully. The postoperative course was uneventful.     

Knowledge of pelvic organ prolapse in patients and their information-seeking preferences: comparing Vienna and Moscow

Introduction and hypothesis

We hypothesized that knowledge of pelvic organ prolapse (POP) and patient information-seeking preferences are the same in the two capital cities.

Methods

First-visit patients were recruited at tertiary referral urogynaecological units in Vienna (137) and in Moscow (112). A 16-item scale was used to assess the patient knowledge of POP. The 16 items comprised 12 specific items taken from the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and four added items. The preliminary psychometric assessment of the knowledge scales in German and Russian was performed in the Vienna and in Moscow centres.

Results

The mean total knowledge scores in patients in Vienna and in Moscow were not significantly different: 9.7?±?3.5 vs. 9.8?±?2.9 (p?=?0.92). Patients in Vienna were more likely to answer questions about the pathogenesis of POP correctly. Patients in Moscow achieved higher scores for items assessing knowledge about the diagnosis of POP. Women in the two study groups equally preferred to obtain information about POP from medical specialists (72 % and 82 %; p?=?0.61), followed by friends and family for patients in Vienna (25 %), and the internet for patients in Moscow (23 %). Patients in Vienna were more likely to use printed sources (18 % and 7 %; p?=?0.001) than patients in Moscow.

Conclusions

The mean level of knowledge of POP did not differ between patients in Vienna and patients in Moscow. The differences between the specific knowledge domains might be explained by different cultural preferences for seeking health information and by the range of the information sources available.

     

不同呼吸机湿化管道系统在老年机械通气患者中的应用效果对比

目的:探讨不同呼吸机湿化管道系统在老年机械通气患者中的应用效果。方法:选取老年机械通气患者140例,随机分为3组,其中A组(n=43)使用MR410型湿化管道系统,B组(n=47)使用MR730型湿化管道系统,C组(n=50)采用MR 850型一次性双加热式、自动加水加湿湿化管道系统。观察3组湿化效果、并发症发生情况、通气时间及管道护理情况。结果:C组湿化效果适中比例最高,其次为B组,A组最低,3组间差异有统计学意义(P<0.01)。C组无导管痰痂和气道痉挛的发生,A组发生率最高,3组间差异有统计学意义(P<0.01)。C组通气时间、管道总更换次数、呼吸机管道护理时数均低于A、B组,差异有统计学意义(P<0.01)。结论:使用MR850型一次性双加热式、自动加水加湿湿化管道系统湿化效果最好,能降低并发症发生率,缩短通气时间和护理工作量。     

湖北省接受艾滋病HAART患者CD4+T淋巴细胞变化趋势及影响因素

目的 分析湖北省接受艾滋病HAART患者CD4⁺T淋巴细胞变化趋势及影响因素。 方法 筛选2012年1月1日以后接受HAART的成年患者,利用一般线性模型、重复测量方差分析来分析患者的基线、治疗后6、12个月的CD4⁺T淋巴细胞计数情况及影响因素。 结果 1 843例研究对象基线CD4⁺T淋巴细胞计数均值为(218.94±143.96)个/μl,接受HAART后6个月为(334.31±188.62)个/μl,12个月后为(382.79±204.44)个/μl,差异有统计学意义(F=6 856.98,P=0.000)。影响HAART治疗后CD4⁺T淋巴细胞计数上升的主要因素是:性别、开始治疗年龄、WHO临床分期、初始治疗方案、基线CD4⁺T淋巴细胞计数。受性别、基线CD4⁺T淋巴细胞计数、开始治疗年龄、初始治疗方案等影响,治疗后CD4⁺T淋巴细胞计数随时间推移呈线性上升趋势;其中,女性、开始治疗年龄越小、基线CD4⁺T淋巴细胞计数越高、初始治疗方案含二线药物的患者上升较快。受WHO临床分期因素影响,治疗后CD4⁺T淋巴细胞计数随时间推移上升趋势符合二次方曲线方程,WHO临床分期越靠前,上升速度较快。 结论 湖北省艾滋病患者接受HAART后CD4⁺T淋巴细胞计数上升受多种因素影响,建议针对不同的患者及早开展HAART,提高抗病毒治疗的效果和患者生命质量。     

Osteopenia and osteoporosis of the distal forearm in menopausal females

AIM: To estimate the frequency of decreased bone mineral density (BMD) in the distal forearm of the females visiting a specialized city consultative center for menopausal pathology, by using dual energy X-ray absorptiomentry (DEX4) and to assess risk factors for osteoporosis. MATERIALS AND METHODS: The cross-sectional study included 681 females (mean age 54.8 +/- 5.81 years) who had filled in the questionnaire of the National Osteoporosis Risk Factor Study Program. The severity of the menopausal syndrome was evaluated by means of the modified menopausal index. Distal forearm BMD was diagnosed by DEXA on a DTX 200 apparatus (Denmark). RESULTS: Osteopenia and osteoporosis were detected in 187 (27.5%) and 53 (7.8%) of the examinees, respectively. The females with osteopenic syndrome had a lower body mass. Arterial hypertension was more frequently detected among the patients with OP. The distal forearm was the most common site of fractures. Irrespective of the state of BMD, the proportion of those who regularly ate dairy products was extremely low. CONCLUSION: A rapid BMD reduction is observed in menopausal females. The proportion of antihypertensive patients was significantly higher among the women with osteopenic syndrome.     

Cross-sectional analysis of the implant-abutment interface

The purpose of this study was to develop a technique to evaluate the implant-abutment gap of an external hexagon implant system as a function of radius. Six implants of 3.75 mm in diameter (Conexao Sistema de Protese Ltda, Sao Paulo, Brazil) and their respective abutments were screw connected and torqued to 20 N cm(-1). The implants were mounted in epoxy assuring an implant long-axis position perpendicular to the vertical axis. Each implant was grounded through its thickness parallel to implant long-axis at six different distance interval. Implant-abutment gap distances were recorded along the implant-abutment region for each section. Individual measurements were related to their radial position through trigonometric inferences. A sixth degree polynomial line fit approach determined radial adaptation patterns for each implant. Micrographs along implant sections showed a approximately 300 mum length implant-abutment engagement region. All implants presented communication between external and internal regions through connection gaps and inaccurate implant-abutment alignment. Average gap distances were not significantly different between implants (P > 0.086). Polynomial lines showed implant-abutment gap values below 10 mum from 0 mum to approximately 250 mum of the implant-abutment engagement region. Gap distances significantly increased from approximately 250 mum to the outer radius of the implant-abutment engagement region. The technique described provided a broader scenario of the implant-abutment gap adaptation compared with previous work concerning implant-abutment gap determination, and should be considered for better understanding mechanical aspects or biological effects of implant-abutment adaptation on peri-implant tissues.     

Laparoscopic Varicocelectomy in the Management of Chronic Scrotal Pain

Background and Objectives:

To evaluate the usefulness of laparoscopic varicocelectomy in the management of chronic scrotal pain.

Methods:

Between 2009 and 2011, 48 patients in total were treated with laparoscopic varicocelectomy for dull scrotal pain that worsened with physical activity and was attributed to varicoceles. All patients were followed up at 3 and 6 months and biannually thereafter with a physical examination, visual analog scale score, and ultrasonographic scan in selected cases.

Results:

The mean age was 38.2 years (range, 23–54 years). The mean follow-up period was 19.6 months (range, 6–26 months). Bilateral varicoceles were present in 7 patients (14.6%), and a unilateral varicocele was present in 41 (85.4%). The varicocele was grade 3 in 27 patients (56.3%), grade 2 in 20 (41.6%), and grade 1 in 1 (2.1%). The mean preoperative visual analog scale score was 4.8 on a scale from 0 to 10. The mean postoperative visual analog scale score at 3 months was 0.8. After the procedure, 42 patients (87.5%) had a significant improvement in the visual analog scale score (P < .001); 5 (10.4%) had symptom improvement, although it was not statistically significant; and 1 (2.1%) remained unchanged. During follow-up, we observed 5 recurrences (10.4%) whereas de novo hydrocele formation was identified in 4 individuals (8.3%).

Conclusion:

Laparoscopic varicocelectomy is efficient in the treatment of symptomatic varicoceles with a low complication rate. However, careful patient selection is necessary because it appears that individuals presenting with sharp, radiating testicular pain and/or a low-grade varicocele are less likely to benefit from this procedure.     

一种西地那非类似物的合成工艺研究

目的 探讨合成一种西地那非类似物的新方法.方法 设计以WG 001-01-08和五硫化二磷为原料,经过硫化得到目标化合物（一种西地那非类似物）的合成路线,并以收率和杂质为指标考察反应试剂、反应温度、加料顺序对反应的影响.结果 成功制备了目标化合物,收率为90％;较佳反应条件为以4-甲基吡啶为溶剂,120℃反应4h,先加WG001-01-08后加五硫化二磷.结论 新方法收率较高,杂质少,反应条件温和,适合工业化生产.