Esophageal anastomotic leaks: preliminary results of treatment with balloon dilation

Disruption of a cervical esophagogastric or esophagocolonic anastomosis shortly after surgery is a common complication, and fistula drainage from the leaking anastomosis may be prolonged. Narrowing of the anastomosis apparently contributes to the development and maintenance of the fistula. Fluoroscopically guided balloon dilation of anastomotic strictures was performed in three patients with anastomotic leaks. Preliminary results suggest that the procedure is safe and promotes healing of the fistula.     

Febrile infants less than 3 months old: value of chest radiography

In the febrile infant less than 3 months old, a chest radiograph is commonly obtained to identify the cause of the fever. The purpose of this study was to evaluate the necessity of obtaining chest radiographs in this population. The clinical records and chest radiographs of 192 febrile infants (greater than 100.5 degrees F, rectal) were reviewed. Nineteen patients had signs of respiratory distress; seven had positive findings on chest radiographs. Of the 173 patients without signs of respiratory distress, five had positive findings on chest radiographs. When chest radiography was considered the gold standard for the presence or absence of pneumonia, findings of respiratory distress on physical examination had a sensitivity of 58% and a specificity of 93% for the detection of pneumonia. The prevalence of positive findings on chest radiographs in febrile infants less than 3 months old was 6%. A chest radiograph should be obtained in febrile infants only when signs of respiratory distress are present.     

Molecular and cell biologic aspects of erythropoiesis in long-term bone marrow cultures

In long-term marrow cultures, proliferation and differentiation of hemopoietic stem cells occurs for several months. Normally, only the most primitive erythroid progenitor cells are produced (the BFU-E). Following treatment with anemic mouse serum (AMS) or normal mouse serum plus erythropoietin, the BFU-E mature into CFU-E, which then go to produce mature nonnucleated red cells. This development is associated with the production of adult type hemoglobin. Furthermore, erythropoiesis and granulopoiesis occur in association with discrete cellular elements of the adherent cell layer in the long-term culture. Following treatment with AMS, erythropoiesis is enhanced while granulopoiesis is depressed, with no apparent competition at the stem cell or progenitor cell level.     

The importance of abdominal pressure during colonoscopy: techniques to assist the physician and to minimize injury to the patient and assistant.

This article outlines techniques that can be used to assist the physician's ability during colonoscopy to achieve cecal intubation in both standard situations and in specific conditions such as the obese patient. When applied properly, abdominal pressure can help shorten the length of the procedure, minimize the angle of turns in the colon, and minimize discomfort to the patient. A Mayo physician survey unanimously concluded that abdominal pressure is beneficial during colonoscopy. This article addresses the ergonomics of applying pressure and suggests techniques that minimize risk of injury to both the patient and the assistant. In addition, questions that new assistants may ask are addressed.     

经脾胰岛移植治疗糖尿病大鼠的可行性

目的:探讨经脾胰岛移植治疗糖尿病大鼠的疗效及可行性,建立稳定的胰岛移植新途径。方法:实验于2004-03/2005-03在中国医科大学附属第一医院完成。实验分组:供受鼠均采用Wistar大鼠,供鼠40只,受鼠20只。受鼠随机分为移植组、糖尿病组,每组10只。并另取10只正常大鼠作为正常组,进行对照。实验过程:①受鼠造模:移植前14d,采取链尿霉素化学灼伤法(2%链尿霉素,65mg/kg,腹腔注射)造成糖尿病大鼠模型(连续3d在非禁食情况下,血糖>16.8mmol/L为造模成功)。②供鼠胰岛分离纯化:采用明尼苏达大学改良方法,原位直接灌注消化分离大鼠胰岛。消化的胰腺组织离心,经80目不锈钢筛网过滤后,采用25%,23%,20.5%,11%Ficoll和Hank’s液梯度密度离心(4℃,3000r/min×10min),于23%,11%层交界间吸取胰岛细胞。经Hank’s液洗3次,备用。③经脾胰岛移植:移植组大鼠戊巴比妥麻醉后,经左侧肋缘下切口暴露脾脏。显微镜下手检600～800当量胰岛,以1mLCMRL1066培养液稀释,用10mL注射器直接经脾缓慢输注。糖尿病对照组大鼠注射生理盐水1mL。实验评估:①胰岛双硫腙染色与计数,计算纯化率。②体外葡萄糖刺激实验检测胰岛功能。③移植术后监测血糖、血清胰岛素水平。于术后10d行静脉糖耐量实验。④术后14d切取受体大鼠肝脏和脾脏苏木精-伊红染色及Insulin-6免疫组化染色观察组织形态学变化。结果:①每只供鼠可分离300～400当量胰岛,纯度达85%～90%。②体外葡萄糖刺激实验显示胰岛素刺激指数平均为5.59±0.62,功能良好。③受体糖尿病大鼠术后3-5d空腹血糖降至3.4～5.4mmol/L(平均4.8mmol/L)。胰岛素分泌亦达到正常水平。④移植组糖耐量曲线与正常大鼠相似,K值与正常非糖尿病大鼠差异无显著性(2.802,2.3,P>0.05)。⑤受体大鼠脾脏和肝脏内可见散在的移植胰岛。结论:①移植术后3-5d移植胰岛分泌的胰岛素可使空腹血糖达到正常水平。②经脾移植克服了门静脉直接移植引起的出血和门静脉高压的缺点,移植容量可达1mL,可用10mL注射器进行输注,避免反复离心、挤压,可减少胰岛体外损失,是胰岛移植的可行途径。     

Description of a closed plastic bag system for the collection and cryopreservation of leukapheresis-derived blood mononuclear leukocytes and CFUc from human donors

Hemopoietic stem cells were collected from blood by means of continuous- flow centrifugation. The therapeutic use of large quantities of autologous blood stem cells requires a suitable, reliable and easily practicable cryopreservation technique which prevents loss of cell number and viability. This paper describes a closed plastic bag system consisting of one part for the collection and freezing of blood-derived mononuclear cells (MNC), among them granulocyte/macrophage progenitor cells (CFUc), and of a second part for thawing the cryopreserved cells and washing them free of DMSO before transfusion to a patient. In a series of 20 leukaphereses, the average number of collected MNC and CFUc was about 11 × 10(9) and 8 × 10(5) respectively. The recovery rate of the leukapheresis derived MNC and CFUc after cryopreservation, thawing, and washing was demonstrated to be 90 per cent of better. Sequential leukaphereses in the same donor showed little effect on red and white blood cell concentration. However, there was a significant decrease in the donor's blood platelet concentration prior to the third leukapheresis.     

The management of threatened hanging and near hanging: A unique feature of remote area emergency care

Hanging is one of the commonest methods of suicide. It is an expression of despair and powerlessness. Young Australian Indigenous men from remote communities are over represented in the suicide statistics and the care provided to them when they are expressing suicide ideation or have a near hanging injury in most cases is inadequate.

Discussion

The national recommendations for the management of alcohol-related problems in Indigenous primary care do not reflect the national reality. This article proposes that Australia is developing an underclass in remote Australia where the life chances of remote Indigenous people are being compromised by the lack of access to appropriate primary health care services, education and employment opportunities and that young men are communicating their despair both in life and death.

Conclusion

Improving the rates of suicide amongst young remote Indigenous men requires more than adequate resuscitation.