Retroperitoneal perforation of the appendix presenting as subcutaneous emphysema of the thigh

Retroperitoneal abscesses may develop insidiously, resulting in delayed diagnosis with significant morbidity and mortality. Subcutaneous emphysema of the thigh may be a late manifestation of this process, and often heralds a poor prognosis because of associated myonecrosis and fulminant sepsis. The presentation and clinical course of such a patient is summarized, and the relevant anatomy of the retroperitoneal spaces that predisposes to this condition is described.     

The neodymium-YAG laser and gastrointestinal malignancy.

Thirty-seven patients with either bleeding or obstructive metastatic gastrointestinal malignant neoplasms were treated with the neodymium-YAG laser between June 1985 and December 1988. The age range for the group was 55 to 99 years, with a mean of 71 years. There were 25 upper gastrointestinal lesions, including 22 obstructive lesions (20 esophageal and two prepyloric gastric) and three bleeding lesions (one metastatic melanoma to the stomach, one duodenal, and one pancreatic carcinoma). Of the esophageal tumors, three were proximal, eight were middle, and nine were distal third. The mean number of laser treatments was 2.6, and the overall survival ranged from 1 to 20 months, with a median of 8 months. The dysphagia grade was improved overall but depended on the site of the tumor. All bleeding lesions were successfully photocoagulated. Twelve colorectal malignant neoplasms were treated palliatively, six for obstruction (three intraperitoneal colon and three rectal) and six for bleeding (three intraperitoneal and three rectal). The mean number of treatments for the group was 1.5, and the overall survival ranged from 2 to 38 months, with a median survival of 15 months. The neodymium-YAG laser was found to be effective as a palliative mode of therapy for the management of malignant gastrointestinal lesions.     

Perioperative use of long-acting somatostatin analog (SMS 201-995) in patients with endocrine tumors of the gastroenteropancreatic axis

The clinical manifestations of hormone excess caused by functioning neuroendocrine tumors of the gastroenteropancreatic (GEP) axis can be life threatening and frequently prove refractory to conventional antisecretory drugs. Administration of a long-acting somatostatin analog (SMS 201-995) proved effective in three patients with complex management problems related to GEP tumors. A patient with an insulinoma was maintained euglycemic intraoperatively with a single 100 micrograms dose of SMS given before surgery. Gastric suction in two patients with gastrinomas caused hypochlorhydric alkalosis that was preventable with preoperative SMS. Iatrogenic pancreatic fistula occurring after resection of a benign insulinoma healed within 4 days of SMS administration. This drug may be a useful adjunct in the perioperative management of patients with GEP endocrine tumors. Caution is advised regarding potential hazards related to malabsorption and gastric dysmotility.     

Pseudolymphoma of colon

A case of pseudolymphoma of the colon is reported. Radiographically and endoscopically the lesion could not be conclusively distinguished from malignant neoplasm, particularly lymphoma or segmental colitis, thus necessitating right hemicolectomy. Careful histological examination established the diagnosis of pseudolymphoma with pathologic features identical to the focal form of pseudolymphoma more commonly observed in the stomach.     

An evaluation of a workshop for teachers of nursing by comparing the members' expectations with their opinions of the outcome

Fifty-seven teachers of nursing, who comprised 42 women and 15 men and who also comprised 12 senior tutors, 16 nurse tutors and 29 clinical teachers, participated in a study to evaluate a workshop which they attended.
The method of inquiry used was that of a survey by questionnaire. Two questionnaires were used, one being set at the beginning of the workshop and the other at the end of the proceedings. The learning objectives for the workshop were used as the questionnaire items and comprised 20 in all. When the before and after scores relating to the questionnaire items were compared through the use of t tests significant differences were found on 12 out of the 20 objectives. In the course of the paper the differences found are identified and discussed. Some of the limitations of the method of inquiry used are discussed and finally some conclusions are reached.     

Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital

A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central Hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics.     

d-生物素的立体专一性全合成研究

对confaione的d-生物素(1)全合成进行了改进,从半胱氨酸计算,总收率3.7%。5与4-溴代三苯膦丁酸甲酯进行Wittig-Schlosser缩合反应可立体专一性地转化成反式-烯(6)。以叠氮三甲基硅烷代替叠氮化锂亲核进攻9分子中C3-溴原子,可显著地提高顺式-叠氮内酰胺10的收率。     

侵及眶部脑肿瘤的临床特征与显微手术处理

目的 研究侵及眶部的脑肿瘤临床特征与显微外科手术治疗效果。方法 对58例本病经临床分析与影像学检查而获诊断，采用不同手术入路及显微外科技术切除肿瘤。全组病例中，肿瘤位于前颅凹50例，中颅窝8例，均侵及眶腔。其中39例（67．2％）有头痛、头晕等颅内压增高表现，54例（93．1％）出现视器症状。结果 本组46例肿瘤（79．3％）获手术全切除，12例（20．7％）为次全切除，无死亡。对48例经信访或门诊随访6个月-9年（平均3．6年），39例（81.3％）恢复满意，余9例（18．7％）有不同程度后遗症。结论 脑肿瘤侵及眶部多以视器改变为主要临床表现。采取不同手术入路、以显微外科技术切除本类肿瘤，预后良好。