The use of thromboprophylaxis in total hip replacement surgery: are the attitudes of orthopaedic surgeons changing?

We conducted a survey of all 926 active members of the British Orthopaedic Association using a postal questionnaire to find out their current attitude to thromboprophylaxis in total hip replacement surgery. Previous surveys have been performed, and with all the recent literature on the subject we wanted to see if the attitude of British orthopaedic surgeons has changed. There were 676 replies, a response rate of 73%. Fifty-five replies were excluded, those from surgeons who had retired from practice or whose practice did not include total hip replacement surgery. Of the remaining 621 surgeons, 466 (75%) use some method of thromboprophylaxis, with 367 (59%) routinely using prophylactic pharmacological agents and 99 (16%) using mechanical methods of thromboprophylaxis. Twenty-five per cent (155) of surgeons used no routine method of thromboprophylaxis. Eight-six per cent (534) of surgeons used a pharmacological method of prophylaxis in those patients thought to have a high risk of developing a deep vein thrombosis (DVT) (eg previous DVT, cardiovascular disease, obesity). Thirty-two different methods of thromboprophylaxis were used. Low molecular weight heparin is now being used by 19% of surgeons routinely and by 25% of surgeons in high risk cases, whereas 3 years ago it was not used at all. Our survey shows that although there is still a great reluctance for British orthopaedic surgeons to use pharmacological agents routinely in thromboprophylaxis. Amongst those that do, low molecular weight heparin is being increasingly used. More surgeons may want to use low molecular weight heparin routinely, but in some hospitals it is not currently available.     

双氯灭痛药膜体外透皮速率的实验研究

作者选择乙基纤维素、聚乙烯醇等高分子材料制成涂膜剂，用大鼠皮进行双氯灭痛药膜的体外透皮速率测定。结果表明，氮酮与丙二醇可以促进药物渗透。不同的高分子材料可影响药物的扩散与释放，从而影响其透皮速率。与无膜无促透剂处方相比，药物在乙基纤维素中的透皮速率没有增加，在聚乙烯醇膜中的透皮速率有显著增加。     

Retrovirus-induced immunodeficiency in mice exacerbates gastrointestinal candidiasis.

Dysfunction of neutrophils in patients infected with human immunodeficiency virus is at least partly responsible for secondary microbial diseases in these individuals, including invasive gastrointestinal (GI) candidiasis. Immunoregulatory disturbances associated with the development of AIDS in human immunodeficiency virus-infected patients exacerbates Candida albicans infection of the upper GI tract and frequently leads to oropharyngeal and esophageal candidiasis. In this article, we present the first report of a murine model of invasive GI candidiasis associated with an AIDS-related murine immunodeficiency syndrome that results from infection of C57BL/6 mice with a previously described retrovirus complex (LP-BM5). Mice of the inbred strain were infected with C. albicans by oral-intragastric inoculation as infants and with the retrovirus by the intraperitoneal route 30 days later. Control mice of the same strain were infected with C. albicans as above and subsequently infected with the avirulent, ecotropic helper virus (MBI-5). Animals were killed 90 days after retroviral challenge. Total and differential blood cell counts, CD4+ T-cell counts in the spleen, and the histopathology of the gastric mucosa of experimental and control animals were determined. The virulent LP-BM5-infected animals developed murine AIDS and showed eruptive and suppurative lesions, with associated C. albicans mainly in regions of the cardial-atrium fold of the stomach. Well-defined abscesses with entrapped C. albicans hyphae were observed in the region of the cardial-atrium fold of control mice. A significant increase in the number of C. albicans CFU in homogenized and plated segments of the GI tract was recognized in mice with murine AIDS versus the control animals. The murine model of GI candidiasis reported here permits examination of the nature of C. albicans interaction with the gastric mucosa both in the immunocompetent host under conditions in which the yeast exists predominantly as a commensal organism and in the immunosuppressed host during progressive stages of AIDS induced by a retroviral infection.     

环丙沙星与氧氟沙星注射液治疗细菌性感染的疗效观察

以乳酸环丙沙星（ＣＰＬＸ）注射液和氧氟沙星（ＯＦＬＸ）注射液随机分组治疗各种细菌性感染４０例及４２例，并以注射用头孢噻肟钠（ＣＴＸ）治疗４９例作对照。三组平均年龄、体重、疗程及病情程度相比无显著性差异，具可比性。病种分布以消化道感染最多，共８１例，占总数的６１．８％。三组１３１例病人细菌阳性率为９４．７％。一疗程ＣＰＬＸ组、ＯＦＬＸ组、ＣＴＸ组治愈率分别为８７．２％、８３．３％、７１．４％，有效率     

Surgical management of endocrine tumor of the pancreas in Japan

Endocrine tumor of the pancreas is potentially malignant. A multicenter analysis of these tumors was conducted to clarity the present status of their surgical management and the subsequent long-term surgical results. The Japan pancreatoduodenectomy (JPD) study group carried out the study; 368 patients were enrolled and variables related to tumor characteristics, surgery, and survival were retrospectively analyzed. There were 222 patients with functioning tumor and 143 patients with nonfunctioning tumor. Malignant tumor was found in 140 of 368 (38%) of the patients, and 63/140 (45%) of these patients had metastatic lesion; the most common site of the metastasis was liver 34/136 (25%), followed by regional lymph nodes 26/136 (19%). Pancreatic resection was performed in 91% of patients with nonfunctional tumor and in 83% of those with malignant tumor, and 73% of the pancreatic resections were done with lymph node dissection. The overall 5-year actuarial survival rate was 76% in patients with malignant tumor. The actuarial 5-year survival rate was 93% in the patients without metastasis and 83% in patients who received curative resection. Multivariate analysis showed that the presence or absence of synchronous metastasis was the sole significant prognostic factor. The results suggest that: (i) malignant endocrine tumor of the pancreas is a curable malignancy when pancreatic resection with lymph node dissection is adopted and (ii) that synchronous metastasis is the dominant prognostic factor. This study was carried out as a group project. The authors' institutions are as follows     

Cardiac tamponade.

Cardiac tamponade is a cardiological emergency requiring prompt treatment in order to avoid a fatal outcome. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management. These are outlined. We suggest that, with certain specific and important exceptions, percutaneous catheter pericardiocentesis is to be recommended in the management of cardiac tamponade. We include a review of 51 consecutive cases treated at our own institution. Catheter pericardiocentesis was successful in 49 (96%) cases and 36 (80%) patients did not require any further intervention. There were no major and only two minor complications which required no additional treatment. We review previous literature concerning percutaneous pericardiocentesis. Using recommended procedures, pericardiocentesis is successful in 90-100% of cases and major complications are rare.     

Active and passive surveillance for communicable diseases in child care facilities, Seattle-King County, Washington.

OBJECTIVES: The purpose of this study was to develop and evaluate models for public health surveillance of illnesses among children in out-of-home child care facilities. METHODS: Between July 1992 and March 1994, 200 Seattle-King County child care facilities participated in active or enhanced passive surveillance, or both. Reporting was based on easily recognized signs, symptoms, and sentinel events. Published criteria were used in evaluating surveillance effectiveness, and notifiable disease reporting of participating and nonparticipating facilities was compared. RESULTS: Neither surveillance model was well accepted by child care providers. Enhanced passive and active surveillance had comparable sensitivity. Reporting delays and the large amount of time needed for data entry led to problems with timeliness, especially in terms of written reporting during active surveillance. CONCLUSIONS: Widespread active public health surveillance in child care facilities is not feasible for most local health departments. Improvements in public health surveillance in child care settings will depend on acceptability to providers.