早期手术治疗阑尾周围脓肿63例分析

目的 探讨阑尾周围脓肿早期手术的疗效。方法 对63例1990—2005年阑尾周围脓肿行早期阑尾切除，脓肿清除，肠粘连松解，回盲部修补和右半结肠切除术进行回顾性研究，分析其术中情况、手术方法、并发症以及治疗结果。结果 所有患者均在术后3周内痊愈出院，手术发生并发症10例，发生率15．87％。结论 阑尾周围脓肿早期手术切实可行。     

胰岛素泵在糖尿病酮症治疗中的应用

目的评价胰岛素泵连续皮下输注(CSII)和静脉连续胰岛素输注(CVII)在糖尿病酮症治疗中的疗效差异。方法120例糖尿病酮症患者分为两组,CSII组和CVII各60例,观察两组不同方法的治疗效果。结果两组治疗后血糖明显下降,尿酮体均能恢复正常,CSII组优于CVII组,差异有统计学意义(P<0 05);CSII组平均胰岛素用量为(42.5±6.3)U/d明显少于CVII组(57.8±6.6)U/d(P<0 05);CSII组尿酮体恢复正常所需时间为(18.5±5.9)h明显短于CVII组(39.8±8.4)h(P<0 01);CSII组低血糖发生率为(0.41±0.13)次/例,显著低于CVII组的(0.96±0.45)次/例(P<0 05)。两组均无死亡病例。结论CSII模拟胰岛素的生理分泌模式,能更快、更有效地纠正代谢紊乱,控制高血糖,提高生活质量。     

中西医结合治疗细菌性肝脓肿临床观察

目的：观察抗生素、厌氧治疗、局部穿刺引流合用中药“银鱼角消脓汤”治疗细菌性肝脓肿的疗效。方法：对临床诊断细菌性肝脓肿患者66例随机分为两组。治疗组44例用中西医结合治疗，对照组22例用单纯西医治疗。观察两组总有效率及体温复常、疼痛消失、血象复常、脓肿消失、住院时间五项临床指标。结果：治疗组总有效率95．5％，明显高于对照组的77．3％（P〈0．05），临床五项指标治疗组均优于对照组。结论：中西医结合治疗细菌性肝脓肿比单纯西医治疗更有效。     

Tubo-ovarian Abscess in Virginal Adolescent Females: A Case Report and Review of the Literature

BackgroundA tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.CaseA 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.ConclusionReview of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.     

Biocompatibility of subcutaneously implanted marine macromolecules cross-linked bio-composite scaffold for cartilage tissue engineering applications

There is an intense interest in developing innovative biomaterials which support the invasion and proliferation of living cells for potential applications in tissue engineering and regenerative medicine. Present study demonstrated the in vivo biocompatibility and toxicity of a macromolecules cross-linked biocomposite scaffold composed of hydroxyapatite, alginate, chitosan and fucoidan abbreviated as HACF. The in vivo biocompatibility and toxicity of HACF scaffold were tested by comparing them with those of a biocompatible surgical metal implant (SMI) in a subcutaneous rat model. Following the implantation, animals were sacrificed and the scaffolds were resected at 1st, 4th, and 8th weeks; the surrounding tissue along with the implant was removed to evaluate its biocompatibility. The effects of implanted biomaterial scaffolds on vital organ systems such as liver, kidney, etc., have been studied by hematology and serum biochemistry. The activities of pro-inflammatory marker enzymes such as COX, 5-LOX, 15-LOX, and NOS were normal in rats implanted with HACF scaffold. Hematological parameters, antioxidant and lipid peroxidation status were also found to be normal in implanted rats same as that of control and SMI. The modulatory effect of implanted scaffold over inflammatory and stress signaling cascades were confirmed by the normalized mRNA expressions of NF-κB, TNF-α and IL-6. The histopathological analysis of liver, kidney and tissue support our results. Taken together, these results demonstrated that HACF biocomposite scaffold signifies its suitability for further research as a scaffold material for cartilage tissue engineering applications.     

腹腔镜治疗阑尾周围脓肿25例报告

目的：探讨腹腔镜手术治疗阑尾周围脓肿的手术方法及临床疗效。方法：回顾分析2010年4月至2013年4月为25例阑尾周围脓肿患者行腹腔镜手术的临床资料。其中18例行阑尾切除加脓肿病灶清除术，7例行脓肿引流术。结果：25例均顺利完成腹腔镜手术，手术时间平均（60．25±30．12）min，平均住院（7．53±3．44）d。术后2例发生切口脂肪津化，切口延迟愈合：余均无并发症发生。结论：腹腔镜手术治疗阑尾周围脓肿是安全、可行的，应根据患者病情采取合适的术式。     

Spinal epidural abscesses – The role for non-operative management: A systematic review

BackgroundSpinal Epidural Abscesses (SEAs) are traditionally seen as a surgical emergency. However, SEAs can be discovered in entirely asymptomatic patients. This presents a dilemma for the attending clinician as to whether to subject these patients to significant surgery. This systematic review updates the evidence surrounding the efficacy of non-operative SEA management by means of intravenous antibiotics ± radiologically-guided aspiration.Aims1. To assess failure rates of medical therapy for SEA. The absolute definition of ‘failure’ used by the study was recorded, and comparisons made. 2. To review of risk factors for success/failure of medical treatment for SEA.MethodsA database search with the MESH term ‘epidural abscess’ and keywords [‘treatment’ OR ‘management’] were used.Results14 studies were included. The number of SEA patients managed non-operatively ranged from 19 to 142. There was significant heterogeneity across the studies. Pooled Failure of Medical Therapy (FMT) (defined as any poor outcome) was 29.40%. When FMT = mortality the pooled rate was 11.49%. Commonly cited risk factors for FMT included acute neurological compromise, diabetes mellitus, increasing age and Staphylococcus aureus.ConclusionSEA will always be a condition mostly managed surgically. Despite this, there is growing evidence that non-operative management can be possible in the correct patients. The key is in patient selection – patients with any of the above-mentioned risk factors have the potential to deteriorate further on medical treatment and have a worse outcome than if they had undergone emergency surgery straight away. Ongoing research will hopefully further investigate this crucial step.     

Splenic Abscess Complicating Infective Endocarditis: Three Case Reports

We present three case-reports of splenic abscess in patients who were initially diagnosed with bacterial endocarditis. In all cases the diagnosis of splenic abscess was based on the findings of abdominal CT scan or MRI. All patients were treated by laparotomy and splenectomy. Two patients fully recovered and one patient, who suffered from splenic rupture and massive blood loss before surgery, died.

Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can prove fatal.

Abdominal CT scan or MRI should be performed if there is clinical suspicion of splenic abscedation. Immediate splenectomy combined with appropriate antibiotics and valve replacement surgery is the treatment of choice. Splenic tissue is very fragile — especially if the abscess is located subcapsular — and a splenic rupture can result from minimal trauma. If the patient’s general state allows it, it is best to perform splenectomy prior to valve replacement surgery to prevent re-infection of the valve prosthesis. A combined one-stage procedure is also an option.