Maintaining patency in totally implantable venous access devices (TIVAD): A time-to-event analysis of different lock irrigation intervals

PurposeTo evaluate the effectiveness of irrigating totally implantable venous access devices (TIVADs) every eight weeks instead of every four in maintaining the patency of the device.MethodsAn explorative, pragmatic, prospective study design was conducted in two day hospital centres located in the northeast of Italy, from January 2011 to September 2012. Twenty patients who had skipped an appointment and were thus washing their TIVAD every eight weeks (exposed) were included, as were 17 patients following the typical wash regimen of every four weeks (controls). TIVAD occlusion—defined as the inability of the device to aspirate blood and/or the inability to properly irrigate the device—was the principal study end-point.ResultsA total of six occlusions were documented in six patients. Four cases were observed among the exposed group (4/20; 20.0%), while two were observed among the control group (2/17; 11.7%). No statistically significant differences were observed in the occurrence of occlusion between the groups (RR: 1.29, 95%CI: 0.67–2.50, p = 0.49). No statistically significant differences emerged between groups in the time that elapsed from study inclusion to occlusion occurrence according to the time-to-event analysis performed using the Kaplan–Meier estimation model (Log Rank [Mantel–Cox] = χ² 0.284, df 1, p = 0.594).ConclusionsWithin the limitations of the study which should be addressed with further research based on double-blinded randomised clinical trials, postponing the irrigation regimen of TIVADs to eight weeks seems to be sufficient to maintain device patency.     

不同冲洗技术去除模拟牙内吸收窝洞中氢氧化钙糊剂效果的体外研究

目的：评估不同冲洗技术去除模拟牙内吸收窝洞内氢氧化钙糊剂的效果。方法：收集110颗单根离体牙, ProTaper预备至F3。将牙根纵向劈成两半,制备标准化的模拟牙内吸收窝洞后将两半牙根复位。5颗牙齿作为阴性对照组,不向根管内导入氢氧化钙糊剂。105颗牙齿导入氢氧化钙糊剂,其中5颗作为阳性对照组不去除根管中的氢氧化钙糊剂,其余100颗牙齿根据使用的不同冲洗技术随机分成5组（n＝20）：常规冲洗针头冲洗组、主尖锉清理组、根管刷刷洗组、超声荡洗组、音波震荡组。体式显微镜下观察使用5种不同冲洗技术去除模拟牙内吸收窝洞后氢氧化钙糊剂剩余的量,使用van der Sluis 4级评分系统进行评分,Kruskal－Wallis检验以及Mann－Whitney检验（P＜0．05）对数据进行统计分析。结果：超声荡洗组、音波震荡组较其他组模拟牙内吸收窝洞内氢氧化钙糊剂剩余的量较少（P＜0．05）。超声荡洗组与音波震荡组间无明显统计学差异（P＞0．05）。常规冲洗针头冲洗组、主尖锉清理组和根管刷刷洗组间无明显统计学差异（P＞0．05）。结论：超声荡洗和音波震荡去除模拟牙内吸收窝洞内氢氧化钙糊剂效果较好。     

Rectal washout eliminates exfoliated malignant cells

PURPOSE: Irrigation of the rectal stump before anastomosis after resection for carcinoma is accepted colorectal surgical practice. However, not all surgeons perform this routinely, and it has never been established conclusively that irrigation of the rectal stump eliminates exfoliated malignant cells or even reduces local recurrence. The patients of a surgeon whose standard surgical practice involved rectal irrigation were compared with those of a surgeon who does not routinely practice rectal irrigation. METHOD: Ten patients were given rectal washout with 200 to 500 ml of normal saline introducedvia a Foley catheter per rectum. Ten patients were not given rectal washout. In both groups the anastomosis was performed with a circular stapler, and the stapler and donuts were rinsed in 200 ml of normal saline. The saline was sent for cytologic examination and classified as malignant cells seen or no malignant cells seen. The cytopathologist was blinded to the washout status. RESULTS: Of the ten patients who had rectal washout performed, none had malignant cells seen. Of the ten patients who did not have rectal washout performed, eight had malignant cells seen in the cytology (P=0.007; two-tailed Fisher's exact probability test). CONCLUSION: Rectal washout eliminates exfoliated malignant cells in the rectum in the vicinity of the anastomosis.Read at the Royal Australasian College of Surgeons Annual Scientific Meeting, Brisbane, Australia, May 7 to 13, 1997. An abstract of this study appeared in Aust N Z J Surg 1997;67:A16.     

鼻内镜下经咽鼓管注药治疗慢性分泌性中耳炎

目的　探讨电视监视鼻内镜下经欧氏管注药治疗慢性分泌性中耳炎的疗效。方法　采用随机分组设计 ,对门诊确诊为慢性分泌性中耳炎的 6 2例患者随机分为两组 ,一组为电视监视鼻内镜下欧氏管注药 ,另一组为额镜照明下欧氏管通气法。记录两组所见 ,分析临床疗效的差异 ,以判定各自方法的优劣。结果　电视监视鼻内镜下欧氏管注药组有效率 87% ,额镜照明下欧氏管通气组疗效为 5 4 8%。两者相比有显著性差异 (P <0 0 5 )。结论　电视监视鼻内镜下欧氏管注药治疗慢性分泌性中耳炎疗效显著 ,有临床推广价值。     

Suction/irrigation for deep wound infection after spinal instrumentation: a case study

Deep wound infection after spinal instrumentation is a serious complication that is difficult to treat without removing the instruments and bone graft. Debridement and suction/irrigation is an effective method of treatment in these cases. It was performed on six patients in our department who developed this complication between 1985 and 1994. Four patients with early post-operative infection were cured by this method without removing the instruments and bone graft, and two patients with delayed post-operative infection were cured by this method with instrument removal. Debridement and suction/irrigation is a useful method of treatment for both groups of deep wound infection and gives good results when performed soon after infection onset together with additional antibiotic therapy.     

腹腔镜手术中腹腔冲洗引流的原则和方法

目的:探讨腹腔镜手术中腹腔冲洗引流的原则和方法。方法:总结腹腔镜胆囊切除术(LC)1 200例,腹腔镜阑尾切除术(LA)356例(肝脏功能异常和急性化脓性炎症病例除外),术中冲洗422例,引流101例的临床资料。结果:术后除2例延期拔管外,余均于术后1~2d拔管。未发生与腹腔冲洗引流有关的并发症。结论:准确掌握腹腔镜术中腹腔冲洗引流的原则和方法,可以缩短手术时间,术后加快患者恢复,减少手术并发症的发生。     

丝裂霉素对于腺性膀胱炎术后膀胱灌注的疗效分析(附60例报告)

目的:提高腺性膀胱炎综合治疗效果。方法:腺性膀胱炎患者60例,膀胱镜检表现为滤泡状或绒毛状40例、乳头瘤样16例、慢性炎症4例。术前活检病理报告腺性膀胱炎。行经尿道电切加气化术,术后丝裂霉素20mg膀胱灌注,规律治疗2年,方案为每周1次共8次,其后每月1次共2年。定期做膀胱镜检查,并行组织学观察。结果:随访6￣70个月,平均25个月。55例痊愈,膀胱黏膜逐渐恢复为移行上皮覆盖;4例复发;1例腺癌变。结论:经尿道电切加气化,术后丝裂霉素灌注治疗腺性膀胱炎,有助于膀胱上皮的组织学转归。     

不同灌洗液对经尿道前列腺等离子体双极电切术病人血糖、电解质的影响

目的 :观察经尿道前列腺等离子体双极电切 (PKRP)术中 5 %葡萄糖与 0 .9%生理盐水作为灌洗液对病人血糖、电解质的影响。方法 :5 8例ASAⅠ～Ⅱ级 ,术前无糖尿病 ,肝、肾功能无异常患者。 5 %葡萄糖组 (组Ⅰ ) 2 9例 ;0 .9%生理盐水组 (组Ⅱ ) 2 9例。手术均采用英国佳乐等离子体双极电切系统。结果 :组Ⅰ手术 30、6 0min及术后 6 0min血糖均较术前明显增高 (P <0 .0 1) ,且手术 6 0min较 30min亦明显升高 (P <0 .0 5 )。手术 6 0min及术后 6 0min血钠明显低于基础值 (P <0 .0 1)。血氯无显著性差异。术后 6 0min血钾明显低于基础值 (P <0 .0 5 )。组Ⅱ术中及术后血糖 ,血钾、钠、氯变化无统计学意义 (P >0 .0 5 )。结论 :经尿道前列腺等离子体双极电切术 ,灌洗液选用 0 .9%生理盐水是安全可行的 ,较 5 %葡萄糖注射液更有利于机体内环境的稳定和组织代谢。     

Intra- and Retroperitoneal Irrigation Liquid After Arthroscopy of the Hip Joint

The case of intra- and retroperitoneal irrigation solution after hip arthroscopy of a 15-year-old girl is presented. She underwent hip arthroscopy for intra-articular adhesiolysis after previous surgical dislocation of the hip for the treatment of femoroacetabular impingement. Arthroscopy was performed in the lateral decubitus position without traction to debride the peripheral joint compartment. The irrigation pressure was set at 40 mm Hg. There were no intraoperative complications. By the end of surgery, the anesthesiologist reported a drop in the patient's body temperature from 36.3° to 34.5°C. Postoperatively, she complained about abdominal swelling and discomfort. Abdominal sonography revealed approximately 2 to 3 L of intra- and retroperitoneal liquid, which was considered to be irrigation fluid. The irrigation fluid was absorbed within 16 hours without further treatment. The only possible way the irrigation fluid could have flown was a retroperitoneal course along the iliopsoas muscle and the iliac vessels with intraperitoneal perforation along their course. We observed at arthroscopies that irrigation pressure incidentally can rise to 140 mm Hg when leaking of fluid through the portals occurs. Intra-abdominal fluid is a potentially devastating complication. A sudden drop of body temperature has to raise suspicion for intra-abdominal leaking of irrigation fluid.     

HPC-MMC膀胱灌注尿液的药代动力学研究

目的:比较研究粘膜粘附性抗癌药羟丙基纤维素-丝裂霉素C(HPC-MMC)与丝裂霉素C水溶液(S-MMC)膀胱灌注的药代动力学。方法:将16只日本大耳白兔随机平分为两组,分别膀胱灌注4mg/4ml1%HPC-MMC和4mg/4mlS-MMC,于灌注后不同时间点排空膀胱并收集尿样,用高压液相色谱法测量尿液MMC浓度。尿药数据用药代动力学尿药法推算清除速度常数(k)、半衰期〔t(1/2)〕等药代动力学参数。结果:HPC-MMC组尿液中MMC平均t(1/2)为2.61h,而S-MMC组平均t(1/2)为0.556h,前者是后者的4.69倍(t检验,P<0.01)。结论:HPC-MMC比S-MMC在膀胱内的停留时间延长,有望提高MMC化疗疗效,具有较好的临床应用前景。