食管切除术后病人的护理

在美国,食管癌是死亡率最高的恶性肿瘤之一,男性多于女性,其发病率随年龄增长而增加。食管癌临床表现早期食管癌临床表现不明显,吞咽困难是最常见的初始症状,但由于食管壁的柔韧性,病人到晚期才感觉到,从不能吞咽固体开始,进展到最终不能吞咽液体。此外,病人还可有吞咽时疼痛、体重减轻、营养不良和虚弱等表现。晚期表现还包括胸骨后疼痛、呃逆、呼吸困难、胃烧灼感、口臭、声音嘶哑、咳嗽、流涎过多及夜间误吸等。食管切除术后病人的护理食管切除术后24~48 h病人在重症监护室度过,通常带有气管插管等多种导管,护士应加强心肺及各方面的监护…     

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years

Objective  To compare outcomes and further operations at a minimum of 10 years following microwave endometrial ablation (MEA^TM) or transcervical resection of the endometrium (TCRE).
Design  Follow up of a randomised controlled trial using postal questionnaires and operative databank review.
Setting  Gynaecology department of a large UK teaching hospital.
Main outcome measures  Women's satisfaction with treatment, menstrual symptoms, changes in health-related quality of life, and additional treatments received.
Results  One-hundred and eighty-nine of the original 263 women returned questionnaires (72%) after a minimum of 10 years post-treatment. Those totally or generally satisfied with treatment numbered 77/129 (60%) in the microwave arm and 70/134 (52%) in the resection arm, the difference is not statistically significant. Bleeding and pain scores were highly significantly reduced and similar following both MEA^TM and TCRE, achieving amenorrhoea rates of 83 and 88% respectively. The hysterectomy rate after 10 years was significantly different with 22 (17%) in the MEA^TM and 38 (28%) in the TCRE arm (95% CI: −0.21, −0.13).
Conclusions  Both techniques achieve significant and comparable improvements in menstrual symptoms, health-related quality of life and high rates of satisfaction. With the known operative advantages, lower costs and fewer hysterectomies, it is clear that MEA™ is a more effective and efficient treatment for heavy menstrual loss than TCRE.     

What is the optimal treatment of stage IIIA-N2 non-small-cell lung cancer after EORTC 08941?

The results of a randomized trial investigating the role of local therapies after induction chemotherapy in patients with stage IIIA-N2 non-small-cell lung cancer lend themselves to a review of the available evidence and speculation about the routine and future treatment in these patients. An algorithm for future treatment is proposed.     

Penetrating keratoplasty for silicone oil keratopathy

Purpose : Penetrating keratoplasty for silicone oil keratopathy is associated with high risks and limited visual prognosis. This study examined the outcomes and factors influencing graft failure. Methods : A retrospective, non‐comparative, interventional case series of patients attending Moorfields Eye Hospital, London. Results : A total of 24 penetrating keratoplasties were performed in 17 patients (13 men and four women) from 1991 to 2000. The mean age of patients undergoing surgery was 43.6 years (range 17–84 years, SD ± 21.0). Silicone oil was removed before or during the time of initial penetrating keratoplasty in nine patients (52.9%) and left in situ in eight patients (47.1%). Ten out of 24 grafts survived (41.7%). The median duration of graft survival was 21 months (range 2 weeks–98 months) with median duration of follow up 33 months (range 2–100 months). At final follow up, the number of patients with a clear graft who had oil removed before or during the time of penetrating keratoplasty was seven out of 10 (70.0%). Risk factors for graft failure included hypotony, multiple keratoplasty, corneal neovascularization, rejection episode, silicone oil left in situ and postoperative glaucoma. Conclusions : Management of these complex patients requires a combined approach from anterior segment and vitreoretinal subspecialties. The long‐term success of the graft can be improved if silicone oil is removed prior or during the time of penetrating keratoplasty.     

Animal models of allergen‐induced tolerance in asthma: are T‐regulatory‐1 cells (Tr‐1) the solution for T‐helper‐2 cells (Th‐2) in asthma?

Non-specific anti-inflammatory medication is actually the treatment of choice for controlling the T-helper type 2 (Th-2) cell-driven airway inflammation in asthma. The induction of counterbalancing Th-1 cell clones, long considered a promising approach for immunotherapy, has failed to fulfil its promise because of potentially detrimental side-effects. This is therefore probably not a valid option for the treatment of asthma.With the increasing awareness that active immune mechanisms exist to control inflammatory responses, interest rises to investigate whether these can be exploited to control allergen-induced airway disease. The induction of antigen-specific T cells with suppressive characteristics (regulatory T cells) is therefore a potentially interesting approach. These regulatory T cells mediate tolerance in healthy, non-atopic individuals and have the potential of becoming an effective means of preventing allergen-induced airway inflammation and possibly of suppressing ongoing allergic immune responses. Here we review the available knowledge about allergen-induced suppressive immunity obtained from animal models taking into account the different developmental stages of allergic airway disease.     

Zur Haftung des Krankenhauses beim Sturz eines Patienten aus dem Rollstuhl

Abstrakt 1. Es ist Sache des Krankenhaustr?gers, darzulegen und nachzuweisen, dass der Sturz aus einem Rollstuhl nicht auf einem pflichtwidrigen Verhalten der Pflegekr?fte beruht, weil es auch hinsichtlich der Frage der Geeignetheit eines solchen Ger?tes für die Unterbindung von selbst?ndigen Gehversuchen eines Patienten um Risiken aus dem Krankenhausbetrieb geht, die von dem Tr?ger der Klinik und dem dort t?tigen Personal voll beherrscht werden k?nnen. 2. Soweit der Krankenhaustr?ger auf Antrag des Pflegepersonals nicht kurzfristig in der Lage ist, eine Sitzwache zur Vermeidung einer akuten Gef?hrdung des Patienten zur Verfügung zu stellen, handelt es sich um ein Organisationsverschulden, für das er nach x 823 BGB haftet. 3. Der Gesch?digte genügt seiner Darlegungslast sowohl hinsichtlich der objektiven Pflichtverletzung als auch des Verschuldens, indem er vortr?gt, dass er im Gefahrenbereich des Sch?digers aus dem Rollstuhl gestürzt sei. Er muss nicht nachweisen, dass der Unfall auf einem Verschulden des Pflegepersonals oder einem Organisationsverschulden des Krankenhaustr?gers beruht. Vielmehr hat der Sch?diger sich insoweit zu entlasten. (Leits?tze der Bearbeiter)     

Clinical and muscle biopsy findings in malignant hyperthermia susceptibility

Patients (155) were investigated for malignant hyperthermia susceptibility (MHS), by in vitro testing of muscle taken from the vastus medialis muscle. Histopathological and histochemical investigation of muscle was also performed. Ultrastructural investigation was performed in 13 MHS patients; 90% of the patients replied to a questionnaire concerning present or previous neuromuscular symptoms. The majority of MHS and MH negative (MHN) patients had no or only minor histopathological and histochemical abnormalities. Core-targetoid fibres were the only potentially important abnormalities found in MHS patients. There were no differences in neuromuscular symptoms between MHS, MHN and control patients, and most patients in both the MHS and MHN group were normal on clinical examination.