Barium peritonitis

A case of generalized peritonitis, secondary to a perforation of the rectosigmoid colon during barium-enema roentgenography, is presented. The patient required immediate surgical intervention with the prime importance of the treatment being removal of as much of the contaminating materials as possible. This was done successfully with irrigation and wiping, using urokinase solution. Peritoneal lavage with urokinase solution was also carried out in the early postoperative period. Fluid replacement with careful monitoring of fluid and electrolyte balance is essential before, during, and after the surgical procedure. Adequate antibiotic therapy and careful respiratory and nutritional support are also important.     

Reoperation following open reduction and plate fixation of displaced mid-shaft clavicle fractures

Background

Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary.

Patients and Methods

We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication.

Results

143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p = 0.52). Indications for reoperation included implant irritation (n = 25), implant failure (n = 2), and non-union (n = 2). There was near statistically significant association with reoperation and female gender (p = 0.05) but no association between reoperation and age (p = 0.14), fracture class (p = 0.53), plate type (p = 0.49), or plate location (p = 0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5–12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6–36.0; 95% CI) versus 6.7 (3.6–9.8; 95% CI).

Conclusions

This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be observed several years after clavicle fracture fixation.     

神经补片在去骨瓣减压术中的作用

目的探讨神经补片在去骨瓣减压术中的作用。方法回顾性研究,治疗组的78例患者在标准去骨瓣减压时使用神经补片修补硬脑膜,对照组的36例患者在标准去骨瓣减压时使用自体筋膜修补硬脑膜。术后对比两组患者的癫痫发生率;在二期的修补治疗中对比两组患者的手术时间、术中出血量及硬脑膜破损率。结果治疗组和对照组的癫痫发生率分别为6.4%和22.2%,差异显著(χ2=6.095,P=0.014),在二期的颅骨缺损修补中,治疗组和对照组的手术时间分别为(121.9±18.6)min vs.(156.1±14.6)min,出血量分别为(108.1±42.3)ml vs.(181.9±46.5)ml,硬脑膜破损率为3.8%vs.25%;差异均有统计学意义(P0.05)。结论在标准去骨瓣减压时使用神经补片修补硬脑膜能降低患者术后的癫痫发生率,同时有利于患者二期进行的颅骨缺损修补手术,能减少修补手术中的出血量及手术时间,减少副损伤。     

Heart Failure in Remission for More than 13 Years after Removal of a Left Ventricular Assist Device

Mechanical cardiac unloading with use of a left ventricular assist device (LVAD) is associated with substantial improvements in left ventricular function and enables subsequent LVAD explantation in some patients. We describe the case of a 35-year-old man with dilated nonischemic cardiomyopathy who was supported with an LVAD for 9 months. After the device was removed, he led a normal life for 13 years and 4 months. However, at 49 years of age, he presented with new signs and symptoms of heart failure, necessitating implantation of a 2nd LVAD. Afterwards, he has remained asymptomatic. This case is unique in that the patient lived a normal life for longer than a decade before renewed left ventricular decompensation necessitated repeat LVAD therapy. Histologic examination revealed few changes between the first device''s removal in 1999 and the 2nd device''s implantation in 2012.     

Effects of different orthodontic adhesives and resin removal techniques on enamel color alteration

Objective: To investigate the color alterations in enamel following the use of different orthodontic bonding resins and adhesive residue–removal burs.Materials and Methods:Metal brackets were bonded to extracted human premolars (n  =  175) by using an etch-and-rinse adhesive system, a self-etch adhesive system (SEP), or a resin-modified glass ionomer cement (RMGIC). After 24 hours of photoaging, the brackets were removed and the adhesive residue on the tooth surfaces was cleaned with either a tungsten carbide bur or a Stainbuster bur. Tooth colors were measured with a spectrophotometer at baseline, after adhesive removal, and after additional photoaging. Color evaluation was made, and color differences induced by photoaging were calculated. Statistical evaluation was made using the Kruskal-Wallis test and the Mann-Whitney U-test, with Bonferroni correction.Results:All specimens showed discoloration at varying levels. The highest color change was observed in the etch-and-rinse adhesive/tungsten carbide bur group. When the etch-and-rinse and self-etch adhesives were used, adhesive-remnant removal with Stainbuster burs resulted in significantly lower discoloration. The type of bur did not affect the extent of enamel discoloration in the RMGIC group.Conclusions:Orthodontic treatment alters the original color of enamel, and both the adhesive system and the resin-removal methods are responsible for this change. When brackets are bonded with the etch-and-rinse system or the SEP, cleaning the adhesive residuals with Stainbuster burs is recommended for minimal change. RMGIC can be safely cleaned with tungsten carbide burs.     

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.     

Effect of systematic nursing intervention on rehabilitation after colorectal polyps of endoscopic removal in children: A protocol for systematic review and meta-analysis

Background:Endoscopic removal is the main method for the treatment of colorectal polyps in children. Due to the small age of children, poor coordination, postoperative sensitive postoperative response, it is not good for postoperative recovery. Systematic nursing has an advantage in promoting the postoperative recovery of children with colorectal polyps of endoscopic removal, but it is lack of evidence-based basis. The purpose of this study is to evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal.Methods:China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database and Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and the Cochrane Library databases will be searched by computer. A randomized controlled study is searched on the application of systematic nursing intervention of children with colorectal polyps of endoscopic removal from the establishment of the database in February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. The RevMan5.3 software is used to conduct meta-analysis of the included literature.Results:This study will evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal by the indexes of total effective rate, complication rate, and hospital stays.Conclusion:This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing intervention for endoscopic removal of colorectal polyps in childhood.OSF Registration number:DOI 10.17605/OSF.IO/S57UX.     

Behaviour of Impurities during Electron Beam Melting of Copper Technogenic Material

The current study presents the electron beam melting (EBM) efficiency of copper technogenic material with high impurity content (Se, Te, Pb, Bi, Sn, As, Sb, Zn, Ni, Ag, etc.) by means of thermodynamic analysis and experimental tests. On the basis of the calculated values of Gibbs free energy and the physical state of the impurity (liquid and gaseous), a thermodynamic assessment of the possible chemical interactions occurring in the Cu-Cu₂O-Me_x system in vacuum in the temperature range 1460–1800 K was made. The impact of the kinetic parameters (temperature and refining time) on the behaviour and the degree of removal of impurities was evaluated. Chemical and metallographic analysis of the obtained ingots is also discussed.     

立体定向与神经导航技术在少量大脑半球出血患者中的应用

目的对于少量自发性脑出血伴明显功能障碍的患者是采取保守治疗还是手术,通常有争议性,探讨通过立体定向技术清除血肿对患者预后的改善作用。方法选取近5 a大脑半球出血患者150例(出血量20~30 mL),其中50例采用立体定向技术给予血肿清除术,50例采用导航技术给予血肿清除术,分别为手术组1、手术组2,另50例为药物保守治疗组,对比3组患者的改良Barthel指数评分及mRS评分。结果入组患者单侧肢体肌力<3级,出血量≤30 mL,出血部位为基底节区或丘脑。通过6个月随访,手术组改良Barthel指数评分、mRS评分显著优于保守治疗组。手术组相对保守组有更好的功能改善,差异有统计学意义(P<0.05)。结论对于少量自发性脑出血伴明显功能障碍的患者,通过立体定向手术、神经导航技术能显著改善患者的日常生活功能,其中立体定向技术并发症及血肿清除率优于神经导航技术。