Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented.     

Audit-induced change reduces complications of the Ganz trochanteric flip approach

INTRODUCTION

The Ganz trochanteric flip approach aims to avoid the potential risk of avascular necrosis in hip conserving surgery and may reduce the risk of femoral neck fractures, neck thinning and femoral head implant migration in hip resurfacing. Our initial audit revealed the complications of non-union and trochanteric screw irritation to be associated with this approach. We, therefore, modified our selection criteria and re-audited our results.

SUBJECTS AND METHODS

The initial audit (IA) ran between January 2003 and November 2007 after which an age limit of 50 years was recommended. The re-audit (RA) ran between November 2007 and December 2008 where one of the senior authors stopped using the approach in the over 50 year age group whilst the other senior author continued on selected patients over 50 years.

RESULTS

There were 545 hips in the IA and 152 hips in the RA group. The incidence of non-union decreased in the RA after the change of selection criteria (6.2% [IA] vs 1.3% [RA]). In both audit groups, the incidence of non-union increased with age, and in the RA no non-unions were observed under the age of 50 years. The incidence of screw irritation and the necessity for removal remained relatively unchanged (20.7% [IA] vs 28.3% [RA]) with a combined incidence of 22.4%.

CONCLUSIONS

The trochanteric flip approach to the hip can be used safely with an acceptable complication rate in young adult impingement and resurfacing surgery. Caution must, however, be exercised in patients over 50 years of age as they have a higher incidence of trochanteric non-union. In addition, all patients should be consented for the possibility of screw removal as a second procedure.     

测定硫酸妥布霉素注射液的含量

目的: 建立旋光法测定硫酸妥布霉素注射液的含量. 方法: 根据硫酸妥布霉素具有旋光性的特点,用旋光仪进行含量测定. 结果: 硫酸妥布霉素在2.0 u～7.0 ku/L范围内呈良好的线行关系,r=0.9995. 平均回收率100.2% (n=5). 结论: 本法简单,快速,准确可行,适于半成品质量检测.     

急诊护士就当前临床实践中3个问题的非正式讨论

在急诊部使用氯胺酮(ketamine)在过去的几个月里,急诊部的很多人问我如何最有效地指导护士去掌握和使用氯胺酮以及监督病人正确使用这种止痛药。因为有很多人询问我,所以我在ENAListserv上作了一个调查。我收到了很多反馈。在我开始讨论解决方法之前,也许我首先应该概括一下解决此问题面临的困难。虽然无法指出在急诊部正在接受镇静治疗的孩子的确切数字,但是基于我已经得到的反馈信息以及我个人的临床经验,发现不同部门的数字差异甚远。一些同事指出在儿童患者中每年会临床使用中等量的镇静剂一两次。也有一些人指出,在门诊使用中等量的…