浅析我国海上灾害医疗救援培训模式

注重平时性的灾害医疗救援训练有助于提高海上医疗救援水平。文中参照美国海上灾害医疗救援训练的先进做法,对我国海上医疗救援训练的主要现状进行深刻剖析,并对海上医疗救援培训模式提出新观点,为我国未来海上救援训练发展提供借鉴。     

Does stone dimension affect the effectiveness of ureteroscopic lithotripsy in distal ureteral stones?

Objective To investigate whether stone dimension is a restrictive factor for ureterorenoscopic procedures. Materials and methods A group of 416 patients who had undergone ureterorenoscopic pneumatic lithotripsy (URS-PL) for lower ureteral stones between January 1999 and June 2006 in our clinic had been evaluated retrospectively. Two hundred and seventy (270, 64.9%) patients were men and 146 (35.1%) were women. The mean age of the patients was 36.61 (±12.43) years. Patients were grouped according to stone dimension; 193 patients with stones smaller than 1 cm being group 1 and 223 patients with stones ≥1 cm in dimension being group 2. Stone-free rate, operative time and rate of complications of the groups were compared. Pearson’s correlation test, χ² test, Fischer’s exact test and Student’s t-test were used for the statistical analysis. The p value was accepted as being meaningful if p < 0.05. Results For group 1, the mean operative time was 39.19 (±18.33) min. Proximal stone migration in five and false passage formation in three patients was observed. Three patients were stone-free after a second session of URS-PL. The cumulative stone-free rate was 97.4% (188/193). For group 2, the mean operative time was 48.5 (±11.31) min. About 208 (93.27%) patients were stone-free after the first session and an additional eight patients became stone-free after the second session of URS-PL. False passage, ureteral perforation, ureteral avulsion and stricture were observed in four, six, one and one patients, respectively. No proximal stone migration was observed. The cumulative stone-free rate was 96.86% (216/223). Conclusions The effectiveness of ureterorenoscopy (URS) in the treatment of distal ureteral stones was independent of stone dimension. However, the operative time was longer and the rate of perforation was higher in stones with a diameter ≥1 cm. On the other hand, the migration rate was higher in stones <1 cm in diameter. Generally speaking, there was no meaningful effect of stone dimension on complication rates.     

Autologous osteochondral transplantation

The surface of diarthrodial joints is covered by hyaline cartilage whose regeneration capacity is extremely limited. Conventional surgical techniques enable repair of full-thickness articular cartilage defects only by fibrous cartilage having poor mechanical properties. Recently, new techniques have been developed to provide hyaline or hyaline-like repair tissue in the treatment of full-thickness cartilage defects. Autologous osteochondral transplantation involves press-fit implantation of both bone and cartilage obtained from healthy articular surface. The principal indication for this technique is unifocal full-thickness chondral or osteochondral defects measuring 1 to 4 square centimeters. This surgical procedure can be performed openly or arthroscopically. The graft should be placed vertically and evenly to the joint surface. Although short-term and mid-term results are satisfactory, several problems have been reported including donor site morbidity, damage to cartilage, and incongruity and incorporation of the graft. Autologous osteochondral transplantation provides viable osteochondral units at a single stage and eliminates the need for culturing chondrocytes which is quite expensive. Currently, no surgical technique or medical treatment provide complete healing of articular cartilage defects. Autologous osteochondral transplantation is an important stage worthy of improvement in this respect.     

The Predictive Factors for the Necessity of Operative Treatment in Adhesive Small Bowel Obstruction Cases

Background: The timely diagnosis of adhesive small bowel obstruction (SBO) can frequently be a clinical dilemma. The objective of this study was to evaluate the predictive factors for the necessity of operative treatment in adhesive SBO cases.

Method: The records of hospitalized adhesive SBO patients at Dicle University Hospital (DUH) between January 1998 and December 2001 were prospectively reviewed. The patients divided into two groups as a non-operative group (NOG) and an operative group (OG). The epidemiological, clinical, and laboratory features were evaluated as probable predictive factors for the timing of the surgical treatment. Predictive factors associated with the timing of the surgical treatment were determined using logistic regression models.

Results: A total of 180 patients [131(72.8%) male, 49(27.2%) female] with SBO were included in this study. One hundred and twenty patients (66.7%) were diagnosed with SBO and treated medically at the hospital. Sixty patients (33.3%) were diagnosed with SBO and underwent surgery. In univariate analyses, age (P = 0.008), length of period of symptoms (P < 0.001), high fever (P < 0.001), tachicardia (P < 0.001), tachypnea (P < 0.001), intractable pain (P < 0.001), hypo-active bowel sounds (P < 0.001), presence of rebound tenderness (P < 0.001), the persisting air-fluid levels in serial the plain abdominal radiographs (P < 0.001), leukocytosis (P < 0.001) and elevated CRP (P < 0.001) were found to be significantly associated with the predictive factors for the timing of operative treatment. In multivariate analyses, the presence of rebound tenderness [Odds Ratio (OR) = 57, 95% Confidence Interval (CI) = 3.5–922.4, p = 0.004], the persisting air-fluid levels (OR = 29, CI = 1.8–466.4, p = 0.018) were found significantly important as the predictive factors for the timing of operation.

Conclusion: Presence of rebound tenderness and the persisting air-fluid levels at admission or in hospital should be considered as predictive factors for the timing of an operation in adhesive SBO cases.     

颅脑外伤迟发颅内出血与凝血异常的临床分析

目的 分析因颅脑外伤所导致的迟发性颅内出血与患者凝血功能异常之间的相关关系。方法 选择脑外伤患者共234例,发生迟发性颅内出血(出血组)34例,未发生出血(非出血组)200例,从两组凝血功能对比中总结颅内出血的危险因素。结果 出血组患者的凝血功能指标除血小板外均高于未出血组(P＜0.05),凝血异常与颅内出血存在相关性,后者是前者的危险因素。凝血指标异常达两项时,出血率明显增高。结论 凝血异常是颅脑外伤迟发颅内出血的主要影响因素之一,异常指标达两项时易导致迟发颅内出血,在临床护理工作中应对颅脑外伤患者的凝血功能变化密切观察,避免迟发性出血的发生。     

Tuberculosis despite latent infection screening and treatment in patients receiving TNF inhibitor therapy

Clinical Rheumatology - Although latent tuberculosis infection (LTBI) treatment is given before anti-tumor necrosis factor (TNF) treatment, tuberculosis (TB) still develops in these patients and...     

High-sensitivity method for the determination of LSD and 2-oxo-3-hydroxy-LSD in oral fluid by liquid chromatography‒tandem mass spectrometry

Forensic Toxicology - We have developed and validated a high-sensitivity method to quantify lysergic acid diethylamide (LSD) and 2-oxo-3-hydroxy-LSD (OH-LSD) in oral fluid samples using...     

Lack of efficacy of recombinant human thyrotropin versus thyroid hormone withdrawal for radioiodine therapy imaging in a patient with differentiated thyroid carcinoma lung metastases.

The treatment of lung metastases of thyroid cancer is nearly exclusively limited to the administration of iodine-131. For patients presented with micronodular lesions, the therapeutic response is often excellent, increasing life expectancy. Because of the necessity of multiple iodine-131 treatments in the course of this therapy, and subsequently, the lack of tolerance of hormonal withdrawal, the use of recombinant human thyrotropin (rhTSH) as a method of stimulation could represent an interesting alternative. However, as in the present case, the stimulation by rhTSH can be less effective than hormonal withdrawal, as shown in the posttherapy scan to detect metastatic lesions and thus could be detrimental to the treatment efficiency.     

Eccrine squamous syringometaplasia and cytomegalovirus infection

BACKGROUND: Eccrine squamous syringometaplasia has been reported in some cases as an Herpeviridae complication. We report a case of eccrine squamous syringometaplasia associated with a severe cytomegalovirus infection in an immunocompromised patient, and we discuss about potential viral or drug triggering factors. METHODS: A 22 years-old man was hospitalized in an intensive care unit for rejection of a renal graft associated with a disseminated cytomegalovirus infection. A papular and papulopustular eruption appeared on the trunk and the limbs. RESULTS: Histological examination of a skin sample showed eccrine squamous syringometaplasia, with evidence of cytomegalovirus genomic sequences using PCR. Two weeks later, the patient developed toxic epidermal necrolysis, with fatal issue. CONCLUSIONS: Eccrine squamous syringometaplasia is a rare condition, without specific clinical features. Numerous local affections have been reported to induce eccrine syringometaplasia (ulcer, scar, pyoderma gangrenosum, drug injection.), drugs (cytotoxic agents, non steroidal anti inflammatory therapies) and in cases of infection due to cytomegalovirus or herpes simplex virus. The potential implication of cytomegalovirus or foscarnet as triggering factors in our case is discussed. This observation and other similar reported cases lead to the conclusion that eccrine squamous syringometaplasia may be an underestimated complication of cytomegalovirus infections in immunocompromised patients.