Aortic valve injury 10 years after tetralogy of Fallot repair

Summary Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurence was found.     

Amputation in elderly and high-risk vascular patients

Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Contralateral amputation was required in one-third of the patients after a mean period of eight months. Only younger and healthier patients returned to a meaningful social life after appropriate prosthetic fitting. In view of the high mortality and morbidity rates, above-knee amputation seems a better choice than below-knee amputation in these elderly and high-risk patients.     

Diabetes Education: Whose Priorities Are Met?

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8-month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes-related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p less than 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of 'sick day management' and 'complications', especially favoured by patients, as against 'oral hypoglycaemic agents' and other therapy-related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p less than 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p less than 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p less than 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.     

骨盆骨折合并阴道损伤（附5例报告）

报告5例女性骨盆骨折合并阴道损伤，占骨盆骨折41例中的12.2%,均为交通事故伤，都合并有失血性休克，开放伤3例，闭合伤2例，治疗作阴道修补术2例，用碘仿纱条填塞阴道2例。未作处理1例，均治愈，阴道损伤表现为四型；横行撕裂伤，纵行撕裂伤，斜行撕裂伤和刺伤，强调早期诊断，及时治疗以防止合并症。     

Prediction of severe postoperative complications in patients admitted to neuroanaesthesia

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.     

Allergy to barium sulfate suspension with angioedema of the stomach and small bowel

Hypersensitivity reactions occurring during barium studies of the gastrointestinal tract are rare. A case is presented with radiographically demonstrated angioedema in the stomach and small bowel accompanied by allergic rhinitis, which was apparently an allergic response to the barium sulfate suspension. The reaction was documented twice during separate challenges to the barium suspension performed several months apart.     

蛛网膜下腔出血后正常颅压脑积水(附20例分析)

本文分析了20例有明确蛛网膜下腔出血病史的正常颅压脑积水患者的临床表现,其中有智能、步态障碍、尿失禁三联征典型表现者占11例(55％),有其中二个症状者4例。CT是诊断脑积水的首选检查。本文还结合文献对正常颅压脑积水的发生发展,与之有关的因素及临床表现进行讨论。     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

An improved technique for treating tracheostomal stenosis following laryngectomy

Stenosis of the tracheostome is an occasional complication following laryngectomy. Having tried a number of procedures recommended for correction of such stenoses with limited results, we developed a new technique. This technique which is based on multiple Y-V plasties has been applied to 20 patients. Measurements of the stomal area following surgery in 18 patients showed an average increase in stomal size by a factor of 3.8. One patient apparently had no increase of the stoma. In 2, no post-operative measurements were available. Post-operative infection resulted in recurrence of the stenosis in one patient. He was successfully reoperated using the same technique. Follow-up revealed that none of the patients had complaints related to their stoma.     

Morphologic changes of the liver following chemotherapy for metastatic breast carcinoma: CT findings

Thirty patients with metastatic breast carcinoma to the liver underwent systemic chemotherapy. Twentyfour of these patients also received hepatic arterial infusion chemotherapy, three in conjunction with hepatic artery embolization. The morphologic changes of the liver believed to be due to chemotoxic effect of treatment occurred in 27 patients, and were evaluated by serial computed tomography (CT) examinations. These included fatty changes in seven patients, severe cirrhotic changes in four, localized atrophy with regional contour changes in three, and areas of low density in the regions of previously treated metastases in 13. The CT features of cirrhosis included density changes along with nodular irregularity of the hepatic borders with marked decrease in liver size and development of ascites.