缺血性脑卒中急性期神经保护治疗的研究进展

0 引言 缺血性脑卒中是脑卒中的主要类型,约占脑卒中总发病率的70%～80%.其早期治疗主要有两种途径:血管再通和神经保护治疗.溶栓治疗受限于其过窄的时间窗和对出血等并发症的担心,尚不能广泛应用.     

Training of a Minimally Invasive Bariatric Surgeon: Are Laparoscopic Fellowships the Answer?

Background: Fellowships in advanced laparoscopy with emphasis in laparoscopic gastric bypass (LGBP) are available for obtaining experience in performing LGBP. The following is the first report in the literature prospectively documenting a single surgeon's experience with LGBP outcomes following completion of an advanced laparoscopic surgical fellowship. Methods: Outcomes measured prospectively included length of stay, length of operation, complications, reduction in obesity-related co-morbidities, and percentage excess weight loss. Outcomes were analyzed by quartile to see if there was a difference over time. Complications were also compared to outcomes in the literature. Results: 175 patients (147 female, 28 male) underwent LGBP. The mean BMI was 49.2. Mean operative time was 123 minutes, and mean length of stay was 2.2 days. The percentage excess weight loss at 1 year was 73% (n = 79). One patient developed an internal hernia (0.6%) and 1 patient developed an anastomotic leak (0.6%). Postoperative transfusion rate was 4.6%. There were no deep venous thromboses or pulmonary emboli detected. There were no conversions to open, and there was no mortality. Upon quartile analysis, there was no difference in complication rates. Complication rates were comparable to published outcomes in the literature. Conclusion: Fellowships in advanced laparoscopy with emphasis on LGBP provide the optimal training environment for acquisition of skills necessary to safely and effectively perform LGBP. With fellowship training, complication rates were comparable to published outcomes in the literature without a period of higher complications (the learning curve).     

Survival after blood transfusion: a study at Rouen university hospital]

The aim of this study was to estimate short term survival rate after blood transfusion according to various criteria. PATIENTS AND METHODS: Patients admitted and transfused from January, 1 until June, 30 1996 at Rouen university hospital were retrospectively included, and their status (alive or dead) was determined. The characteristics of patients admitted and transfused were compared to the overall population of inpatients. Independent factors associated with mortality six months after blood transfusion were evaluated using Cox model. RESULTS: During the study period, 1887 patients were transfused. These patients were older, more often admitted in surgical or in intensive care units, and had a longer duration of stay, than the overall inpatients population. The survival rate at six months in transfused patients was 76.1%. Mortality rate at six months was independently higher in patients aged 75 and older, in men, in patients admitted in intensive care units, or transfused with homologous fresh-frozen plasma or packed platelet blood cells. Mortality rate was lower in patients who underwent a surgical procedure, in children under 16, and in patients whose stay was classified in "Circulatory system disorders", "Musculoskeletal system and connective tissues disorders or trauma", or "Injuries, allergy or poisoning". CONCLUSION: In this study implemented in a teaching hospital inpatients receiving blood transfusion, the survival was mainly associated with the severity and characteristics of the diseases requiring transfusion.     

Functional repair of a major necrotic palatine defect caused by chronic cocaine inhalation

INTRODUCTION: Chronic use of cocaine provokes vasoconstriction and irritation of the upper airway epithelium. These mechanisms can lead to tissue necrosis and perforations. CASE REPORT: A 37-year-old woman had major centrofacial necrosis subsequent to chronic inhalation of cocaine. The tissue loss involved the right wing of the right ala nasi, the bony and soft palate and nearly all of the lateronasal walls. A microanastomosed antebrachial fasciocutaneous flap was used for reconstruction of the nasal vault. A classical veloplasty was used to close the palate. Velar competency was improved with a second procedure with Ortricochea sphincter pharyngoplasty. Later loss of the antebrachial flap required salvage with a flap from the lateral border of the tongue which provided a satisfactory functional result. DISCUSSION: This case of extended necrosis is rare and treatment was complex. Such treatment can only be undertaken after total and definitive cessation of drug abuse, including tobacco smoking.     

Fertility Enhancing Hysteroscopic Surgery: Our Experience

690 hysteroscopies done over a period of four and a half years for infertility were evaluated. 85 therapeutic hysteroscopic procedures like hysterscopic metroplasty, lysis of intrauterine adhesions, electroresection of fibroids, removal of foreign bodies and cornual cannulation were carried out. These minimally invasive procedures were associated with satisfying results, least morbidity, shorter hospital stay and high patient satisfaction.Key Words: Cornual cannulation, Electroresection, Hysteroscopy, Intrauterine adhesions, Metroplasty, Submucus fibroids     

Clinical review of patients with fixed bridges (2). A study of deviations between observers

The authors have made a study of observer deviations in the re-examination of patients with fixed bridges. The material consisted of eighteen patients who have had their bridges for about 2 years. The total number of bridge-elements was 126, including eighty-three abutment teeth and forty-three politics. Nine observers have taken part. Of these, three have been teachers and six post-clinical students, so that it has been possible to say that the observers had more, and lesser, experience of routine observation. The recorded factors have been: (1) primary contact; (2) the general status of the marginal periodontium; (3) calculus; (4) caries; (5) periapical status; (6) attrition facet; (7) abrasion in the opposing jaw; (8) crown margin excess; (9) crown margin deficit; (10) exposed crown margin; (11) pocket formation; (12) discolouration of gold. The examinations have been carried out in a conventional milieu with the usual instruments for examination and with access to orthopantomograms. The recordings have been made after independent as well as cumulative and simultaneous examination. In the last two cases the observers have been divided into three groups. A very simple account of the results regarding the first five factors is given. It is quite clear, however, that the nine observers record different totals and that positive finds are at the same time seldom reported by all. Each of the seven remaining factors has given rise to a larger number of (positive) recordings, so that a more detailed processing has been meaningful. Within each factor (with a certain exception for abrasion) considerable deviations are found between the nine independent observers in the matter of totals. It has been possible with analysis of variance to confirm, to a great extent, these deviations as significantly systematic. In connection with the change to cumulative and simultaneous observer strategy it has been possible to note certain improvements. It has not, however, been possible to designate the agreement between the three observer groups as appreciable. On the other hand, the number of positive recordings increases most frequently in connection with the changes to (Cum) and still more with the change to (Sim). The nine observers change level in relation to one another on moving from the one factor to the other. Within a certain factor they sometimes vary also between different patients, though a certain logical pattern appears. Through comparisons in pairs and the calculation of the correlation (expressed through the coefficient r) it has been possible to show that the correlation between the recordings of two observers is not always satisfactory. However, the conventional limit + 0.70 is exceeded in the majority of cases. The two groups of observers do not differ characteristically from each other factor by factor, (the factors ‘general status of the periodontium’ and ‘crown margin excess’ constitute exceptions). Both teachers and students change position in an irregular way. Each one of the nine observers may occur alternately as a high and a low recorder. The authors recommend further studies in this field with the aim of throwing light upon the homogenization of observers and becoming better informed concerning the precise significance of utilizing different observer strategies.