肝胆管结石的微创外科治疗进展

目的探讨肝胆管结石的微创外科治疗进展。方法对国内、外有关肝胆管结石的微创外科治疗方面的文献进行综述。结果腹腔镜肝切除术和腹腔镜下胆道探查取石可获得良好的效果，纤维胆道镜在肝胆管结石术中和术后的应用具有重要的意义。结论肝胆管结石应采取个体化的治疗方案，腹腔镜、纤维胆道镜等多路微创手术的联合应用可提高肝胆管结石的治愈率。     

Enterobacteriaceae isolated in nine general hospitals of the Ile-de-France in 1988 and 1989: susceptibility to beta-lactam antibiotics according to the length of hospitalisation

Susceptibility to beta-lactam antibiotics of strains of Enterobacteriaceae consecutively isolated in nine general hospitals during a period of 2 months (march and april) has been studied by the disk-agar diffusion method. The separation between susceptible and resistant strains was based on the measure of the inhibition zones centered by 2 disks: cephalothin and ticarcillin. Enterobacteriaceae were divided in 2 groups: strains isolated during the first 48 h of hospitalisation or isolated after. Fifty one per cent of the strains were isolated during the first 48 h: they did not belong to the residential flora of these hospitals. Klebsiella, Proteus indole positive, Providencia, Enterobacter, Serratia were more frequently isolated after 48 h of hospitalisation. Susceptible strains of Klebsiella, Proteus indole positive, Providencia, Serratia were more rarely isolated after 48 h of hospitalisation. E. coli whatever the duration of hospitalisation, is the less frequent susceptible bacterium.     

Salmonella typhimurium andSalmonella enteritidis: Changing epidemiology from 1973 until 1992

A retrospective analysis, covering a period of 20 years, of 2049 primo-isolates ofSalmonella typhimurium and 343 primo-isolates ofSalmonella enteritidis was performed at our laboratory. In 1991,S. enteritidis (43.8%) outnumberedS. typhimurium (32.1%) as the most frequently isolated Salmonella. The age group distribution ofS. enteritidis yielded peaks in the under-five and above-60 year age groups, whereasS. typhimurium only peaked in the under-five age group.S. enteritidis appeared to be twice as invasive asS. typhimurium. Both serotypes were more invasive in middle and older age groups than in under-fives.     

Ibuprofen-loaded ethylcellulose microspheres: release studies and analysis of the matrix structure through the Higuchi model

The following work deals with ibuprofen-loaded ethylcellulose microspheres. The drug exists either in a state of molecular dispersion or in crystalline form, depending on the encapsulation ratio. The in vitro release profiles have been studied and the Higuchi model applied to the experimental results. With an appropriate treatment of the results, it has been shown that the surface crystals responsible for the observed burst effect are really encapsulated by the polymer. The calculation of the tortuosity factor clearly shows that the release kinetics are controlled by the hydrophobicity of ethylcellulose and the geometry of the porous volume resulting from the dissolution of ibuprofen crystals. It thus appears that crystals are probably differently distributed in the matrix depending on the microsphere size.     

Comparison of microsurgical vasovasostomy techniques in the rat

We compared three different microsurgical vasovasostomy techniques on the rat vas deferens using absorbable and non-absorbable sutures and a fibrin adhesive technique. The best method was an extramucosal technique over a splint using vicryl. The worst results were seen using adhesive.     

Serologic evidence for human ehrlichiosis in Africa

Human ehrlichiosis is a recently recognized rickettsial disease. It is caused byEhrlichia chaffeensis, an intraleucocytic Gram-negative, obligate intracellular bacterium, grouped within the genusEhrlichiae. Most human cases of ehrlichiosis have been diagnosed in the USA. Two cases have been reported outside of the USA, one in Europe and one in Africa. From 1 January to 30 June 1992, 765 sera from blood donors or other asymptomatic subjects in 8 African countries, including Ivory Coast, Burkina Faso, Mali, Central African Republic, Angola, Zimbabwe, Mozambique and Commores Islands, were tested by indirect immunofluorescence for the presence ofE. chaffeensis antibodies. Positive sera were confirmed by Western immunoblotting. Only two of 765 sera tested were positive. One serum obtained from Burkina Faso had an IgG titer of 1:200 and one from Mozambique had an IgG titer of 1:80. Human ehrlichiosis seems to occur infrequently in Africa, although many more sera from additional African countries need to be evaluated.     

Obesity in youth and middle age and risk of colorectal cancer in men

To investigate an association between colon cancer and obesity during early adulthood—a potentially important period in the etiology of this disease—the authors assembled, by computer linkage, a population-based historical cohort of 52,539 men born between 1913 and 1927 residing in Hawaii (USA), for whom weight and height had been recorded in 1942–43 and 1972. Linkage of this cohort to the Hawaii Tumor Registry resulted in the identification of 737 incident cases of colorectal cancer for 1972–86. An average of 3.8 cancer-free controls were matched to each case on month and year of birth and ethnicity of the parents. A case-control analysis in each anatomic subsite of the large bowel revealed that both early and middle-age body mass increased the risk of sigmoid cancer in men in a dose-dependent fashion. The odds ratios (OR) for sigmoid cancer for the highest compared with the lowest tertiles of Quetelet index were: 2.1 (95 percent confidence interval [CI]=1.4–3.2) and 1.7 (CI=1.1–2.5), at ages 15–29 and in prediagnostic years, respectively. These associations were additive and idependent of socioeconomic status. Men who were above the median Quetelet index in 1942 and 1972 had an OR of 2.7 (CI=1.8–4.0), compared with those who were below the median in both periods. This study provides further evidence for an association of obesity with colon cancer in men and suggests that this association is limited to the sigmoid colon and may be related to both early and late events of colon carcinogenesis.The authors are with the Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii. Address correspondence to Dr Le Marchand, Epidemiology Program, Cancer Research Center of Hawaii, 1236 Lauhala Street, Suite 407, Honolulu, HI 96813, USA. This work was supported in part by Public Health Service grant 5-R29-CA44503 and contract NO1-CN-55424 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services.