A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.     

新生儿胃穿孔14例治疗体会

目的　探讨新生儿胃穿孔的发病特点和治疗方法。方法　对我院近 10年治疗的 14例新生儿胃穿孔进行回顾性分析。结果　 14例新生儿胃穿孔皆行手术治疗 ,术后死亡 7例。结论　新生儿胃穿孔多因先天性胃壁肌层发育不良及胃内张力增高缺血缺氧所致。早期诊断 ,及时手术 ,减少并发症及术后加强支持疗法是提高本病治愈率的关键     

Pycnogenol® as an Adjunct in the Management of Childhood Asthma

A randomized, placebo-controlled, double-blind study involving 60 subjects, aged 6-18 years old, was conducted over a period of 3 months to determine the effect of Pycnogenol® (a proprietary mixture of water-soluble bioflavonoids extracted from French maritime pine) on mild-to-moderate asthma. After baseline evaluation, subjects were randomized into two groups to receive either Pycnogenol® or placebo. Subjects were instructed to record their peak expiratory flow with an Assess® Peak Flow Meter each evening. At the same time, symptoms, daily use of rescue inhalers (albuterol), and any changes in oral medications were also recorded. Urine samples were obtained from the subjects at the end of the run-in period, and at 1-, 2-, and 3-month visits. Urinary leukotriene C₄/D₄/E₄ was measured by an enzyme immunoassay. Compared with subjects taking placebo, the group who took Pycnogenol® had significantly more improvement in pulmonary functions and asthma symptoms. The Pycnogenol® group was able to reduce or discontinue their use of rescue inhalers more often than the placebo group. There was also a significant reduction of urinary leukotrienes in the Pycnogenol® group. The results of this study demonstrate the efficacy of Pycnogenol® as an adjunct in the management of mild-to-moderate childhood asthma.     

外伤性肝破裂的救治

目的 分析创伤性肝破裂外科多种干预治疗的效果。方法 总结分析1982-2002年我院收治创伤性肝破裂76例的救治方法和病死率。其中Ⅲ级以上的严重肝破裂46例(60．53％)。手术治疗56例，手术方式包括单纯修补、清创性肝切除、规则性肝切除、肝周填塞止血；非手术治疗20例。结果 手术组：治愈44例，术后并发症17例均经保守治疗治愈，死亡12例，其中术中死亡2例；非手术组：治愈12例，好转6例，2例失访。全组治愈64例，死亡12例，病死率15．8％。结论 Ⅰ-Ⅱ级单纯性外伤性肝破裂可保守治疗；手术是治疗创伤性肝破裂的主要措施，正确的手术方式，积极处理合并伤，重视综合治疗可提高救治成功率。     

Breast augmentation with silicone implants: the role of surgical drainage—report on 502 consecutive patients

Breast augmentation is one of the most frequently performed cosmetic surgery procedures worldwide. We report on a series of 502 consecutive cosmetic breast augmentations by a single surgeon, using both the submuscular and submammary approaches. A vacuum drain was placed in the surgical pocket at the end of the procedure. The drain fluid collection was recorded immediately after the surgery and the following day before removal. A tenfold increase in the amount of fluid collection was noted in the drain’s reservoir. Thirteen patients presented with minor wound healing problems at the second postoperative follow-up, which were treated conservatively; two of them had the implant removed and replaced after 2 months. There were only two capsular contractions at 1-year follow-up. We focus our discussion on the drainage in the early postoperative period and conclude that the routine use of a surgical drainage reduces the risk for complications. Based on our findings, we advocate that short-term routine use of a surgical drain is advisable.     

Glycine transporter I inhibitor, N-methylglycine (sarcosine), added to antipsychotics for the treatment of schizophrenia.

BACKGROUND: Hypofunction of N-methyl-D-aspartate glutamate receptor had been implicated in the pathophysiology of schizophrenia. Treatment with D-serine or glycine, endogenous full agonists of the glycine site of N-methyl-D-aspartate receptor, or D-cycloserine, a partial agonist, improve the symptoms of schizophrenia. N-methylglycine (sarcosine) is an endogenous antagonist of glycine transporter-1, which potentiates glycine's action on N-methyl-D-aspartate glycine site and can have beneficial effects on schizophrenia. METHODS: Thirty-eight schizophrenic patients were enrolled in a 6-week double-blind, placebo-controlled trial of sarcosine (2 g/d), which was added to their stable antipsychotic regimens. Twenty of them received risperidone. Measures of clinical efficacy and side effects were determined every other week. RESULTS: Patient who received sarcosine treatment revealed significant improvements in their positive, negative, cognitive, and general psychiatric symptoms. Similar therapeutic effects were observed when only risperidone-treated patients were analyzed. Sarcosine was well-tolerated, and no significant side effect was noted. CONCLUSIONS: Sarcosine treatment can benefit schizophrenic patients treated by antipsychotics including risperidone. The significant improvement with the sarcosine further supports the hypothesis of N-methyl-D-aspartate receptor hypofunction in schizophrenia. Glycine transporter-1 is a novel target for the pharmacotherapy to enhance N-methyl-D-aspartate function.     

纳米技术在肿瘤诊断与治疗中的现状与展望

目的介绍21世纪前沿科技--纳米技术在肿瘤诊断与治疗中的现状与展望.方法通过检索国内外文献,从肿瘤的诊断与治疗两方面分别论述.结果纳米技术在肿瘤诊断与治疗中有其巨大优势.结论尚处初级阶段,广泛应用于临床还需多方努力.     

外科手术切口脂肪液化的诊疗体会

目的 探讨外科手术切口病因及预防措施.方法 回顾分析我科自2001年5月～2005年7月施行大、中手术后发生切口脂肪液化的60例病例.结果 肥胖,术中皮下脂肪层使用电刀,术中切口器械挤压时间长,大块组织钳夹,老年人、糖尿病等可引发切口脂肪液化.结论 手术切口脂肪液病因较多,肥胖、术中使用电刀、器械挤压时间长、老年人糖尿病均为重要影响因素.     

Growth, bone maturation and pubertal development in children with the EMG-syndrome

In 7 patients (5 girls, 2 boys) with the EMG or Wiedemann-Beckwith syndrome, statural growth, bone age (BA), weight and pubertal development were studied longitudinally. Height was above the 90th percentile (%) for chronological age (CA) after age 2 years, reaching an average of 2.5 SD above the mean at or after puberty. Adult or attained height also exceeded significantly (P<0.015) parental (genetic) target height by 13.2 cm on the average. In one girl, adult height prognosis (190 cm) could be reduced to an adult height of 183 cm by high-dose estrogen treatment. In most children, growth velocity remained above the 90th % up to 4–6 years of age and normalized thereafter. In all patients studied, bone age was markedly advanced and particularly so during the first 4 years after birth. Weight was above the 90th–97th % during infancy and early childhood and remained there, appropriate or slightly subnormal for height, until adulthood, except for 3 girls who reached and maintained the 50th % during or after puberty. Spontaneous pubertal development occurred within normal limits for CA and around the 50th % for BA. Except for the marked bone age acceleration, the reason for the increased statural growth and adult height in patients with the EMG syndrome is still unknown.     

游离背阔肌皮瓣修复四肢肿瘤切除后创面

我院骨科组于1985年5～10月份为4例患下肢高分化低度恶性肿瘤的病人,在化疗的配合下施行肿瘤局部大块切除,吻合血管的背阔肌肌皮瓣移植修复创面等综合治疗,早期获得了满意的效果.4例病人中有2例患小腿软骨肉瘤,1例小腿脂肪肉瘤和1例髋部纤维肉瘤.背阔肌肌皮瓣较适用于修复软组织缺损大的创面,其大而扁平的肌肉部分几乎能完全覆盖缺损,外形亦常较满意.