VSD负压引流结合重组人表皮生长因子在治疗皮肤软组织缺损中的应用

目的探讨VSD负压引流结合重组人表皮生长因子治疗皮肤软组织缺损的效果。方法将80例皮肤软组织缺损的患者随机分为治疗组与对照组各40例,治疗组采用VSD负压引流结合重组人表皮生长因子治疗,对照组采用传统清创缝合治疗。结果所有患者经治疗后均痊愈出院。治疗组各种类型的创面愈合时间明显短于对照组,两者比较差异有统计学意义（P〈0.05）。经过观察与统计,治疗组患者的疼痛评分明显低于对照组,满意度得分则明显高于对照组,两者比较差异有统计学意义（P〈0.05）。结论 VSD负压引流结合重组人表皮生长因子治疗皮肤软组织缺损能有效缩短愈合时间,减轻患者的痛苦,提高患者的满意度,值得推广。     

Decreasing expander breast infection: A new drain care protocol

BACKGROUND:

Risk factors for expander reconstruction infection are well known. However, drain use as a risk factor for the development of infection is unclear.

OBJECTIVE:

To review a simple method for drain use to help reduce rates of infection in expander breast reconstruction.

METHODS:

Two hundred consecutive single-surgeon (JDM) immediate first-stage expander breast reconstructions were retrospectively reviewed. The records were reviewed for history and physical examination, intra-operative technique, perioperative management, adjuvant therapy, and outcome with respect to expander infection necessitating premature explantation within the first eight weeks. Infection was defined on clinical basis, with or without culture positivity. All expanders (Mentor, USA) were the same model (textured, port-integrated and biodimensional). Two consecutive series of reconstructions were then created. The first series included 177 reconstructions while the second series included 23 reconstructions. Unlike the first series, the second series introduced a protocol in which all reconstructions received mupirocin 2% cream to the drain sites and all drains were removed at the end of the first week. Additionally, in the second series, all expanders were secluded from direct in vivo contact with the closed suction drain either by the use of an intervening Alloderm sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling the drain superficial to an adequate fatty subcutaneous layer (eight of 23 breasts).

RESULTS:

Patients who developed infection in the first series and all patients in the second series shared statistically the same level of aggregate risk factors (P=0.531). The infection rate (5.65%, 10 infections in 177 breasts) in the first series was statistically greater than in the second series (0%, 0 in 23 breasts, P=0.001).

CONCLUSIONS:

The present study found that percutaneous closed suction drains do serve as an increased risk for expander infection. However, early results indicate that in vivo protection of the expander with Alloderm or subdermal tunnelling, topical antibiotic ointment use and early drain removal may significantly reduce expander infection.     

早期纤支镜吸痰对改善老年人吸入性肺炎临床症状的意义

目的观察早期纤支镜吸痰改善老年人吸入性肺炎的临床症状。方法在综合治疗的基础上早期实行纤支镜吸痰45例为治疗组（A组）,综合治疗44例为对照组（B组）,治疗后对体温、白细胞、呼吸频率、动脉血氧分压（PaO2）进行比较。结果A组体温、白细胞、呼吸频率恢复正常及动脉血氧分压（PaO2）升高的时间明显缩短,差异有显著意义（P〈0.01）。结论早期实行纤支镜吸痰对改善老年人吸入性肺炎的临床症状有肯定疗效,是一项有效的抢救措施。     

Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements

The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting, were randomly allocated either to a control group (group A; n=15) or an intervention group (group B; n=15) in which mediastinal and residual CPB blood was collected and processed by a continuous autotransfusion system before re-infusion. Intravascular fibrin degradation as indicated by D-dimer generation was measured at five specific intervals and corrected for hemodilution. In addition, chest tube drainage and need for homologous blood were monitored. D-dimer generation increased significantly during CPB in group A, from 312 to 633 vs. 291 to 356 ng/mL in group B (p = .001). The unprocessed residual blood (group A) revealed an unequivocal D-dimer elevation, 4131 +/- 1063 vs. 279 +/- 103 ng/mL for the processed residual in group B (p < .001). Consequently, in the first post-CPB period, the intravascular fibrin degradation was significantly elevated in group A compared with group B (p = .001). Twenty hours postoperatively, no significant difference in D-dimer levels was detected between both groups. However, a significant intra-group D-dimer elevation pre- vs. postoperative was noticed from 312 to 828 ng/mL in group A and from 291 to 588 ng/mL in group B (p < .01 for both). Postoperative chest tube drainage was higher in the patients from group A, which also had the highest postoperative D-dimer levels. Patients in group A perceived a higher need for transfusions of red cells suspensions postoperatively. These data clearly indicate that autotransfusion management during and after CPB suppresses early postoperative fibrin degradation. Keywords: cardiopulmonary bypass, cardiotomy suction, coronary surgery, autotransfusion, fibrin degradation.     

In memoriam: a tribute to dr. Owen H. Wangensteen, the greatest teacher of surgery during the 20th century (1898-1981)

My philosophy regarding teaching has been formulated primarily by my close personal relationship with my beloved mentor, Dr. Owen Wangensteen, Professor and Chairman of the Department of Surgery at the University of Minnesota, who is recognized as the greatest teacher of surgery during this last century. By 1930, he had become Chairman of the Department of Surgery of the University of Minnesota Health Sciences Center, a position he held for 37[1/2] years. He transformed the University of Minnesota into a great center for surgery and attracted a group of brilliant young surgeons to do research on impossible problems. His lifelong recognition of the relevance of basic science and the insight to be derived from research in the training of young surgeons created the milieu and opportunities for great surgical achievements. During the period of almost 40 years in which he served as Chairman of the Department of Surgery, he became the greatest surgical educator of the 20th century. The future academic careers for his residents were indeed impressive: 38 became the department chairs; 31 accepted positions as division heads of their departments; 72 were directors of training programs; 110 became full professors; and 18 had appointments as associate professors. In this favorable environment uncluttered by the cobwebs of tradition, significant developments in surgery were forthcoming: open heart surgery; the heart-lung machine; cardiac pacemaker; conservative management of intestinal obstruction; heart, pancreatic, and intestinal transplantation and metabolic surgery for weight loss as well as elevated blood cholesterol; and revolutionary advances in wound repair.     

Wall suction applied to needle muscle biopsy - a novel technique for increasing sample size

BACKGROUND: The needle biopsy technique described by Bergstr?m is the most commonly used technique to obtain samples to assess muscle metabolism. Sampling of muscle, particularly the vastus lateralis, has become an essential tool in biomedical and clinical research. Optimal sample size is critical for availability of tissue for processing. To evaluate the effectiveness of a novel technique to obtain adequate sample size using wall suction applied to needle muscle biopsy, we collected samples from subjects in on-going clinical studies for gene expression. MATERIALS AND METHODS: Muscle biopsy samples of the vastus lateralis using 6 mm Bergstr?m needles under local anesthesia were obtained from 55 subjects who had volunteered to participate in this research project. The vastus lateralis was biopsied according to the methods described by Bergstr?m with a 6 mm biopsy needle. Wall suction was applied to the inner bore of the biopsy needle after the needle was inserted into the muscle. RESULTS: The mean sample of biopsy taken using the 6 mm was 233 mg (n = 55). The wall suction (200 mm Hg) applied to the needle pulled the surrounding tissue into the central bore of the needle. The quality of the samples was adequate for all biochemical assays. The biopsy technique did not result in any complications due to infection or bleeding. CONCLUSIONS: Using a novel technique of connecting a 6 mm Bergstr?m biopsy needle to wall suction, we have obtained 200 to 300 mg muscle biopsy specimens uniformly, with ease, and minimal discomfort. An increase in sample size allows for a wider variety of biochemical and histopathological analysis.     

间歇声门下吸引联合幽门后喂养预防呼吸机相关性肺炎的临床研究

目的观察机械通气患者应用间歇声门下吸引联合幽门后喂养预防呼吸机相关性肺炎的效果。方法按随机数字表将56例预计机械通气超过48h的患者分为观察组26例和对照组30例,对照组用常规吸痰联合胃内喂养,观察组用间歇声门下吸引联合幽门后喂养。观察两组3周内呼吸机相关性肺炎及胃潴留、反流、误吸的发生率。结果观察组呼吸机相关性肺炎发生率(3.85%)低于对照组(36.67%);对照组胃潴留、反流和误吸发生例数高于观察组。结论间歇声门下吸引联合幽门后喂养可降低呼吸机相关性肺炎的发生率。     

石蜡油应用在高龄患者经鼻吸痰中的效果评价

目的：探讨减轻患者因吸痰而引起的鼻腔疼痛及出血的方法。方法：选择本科住院需经鼻腔吸痰的老年患者84例,分别采用石蜡油润滑前端法和生理盐水润滑吸痰管前端法。对两组患者疼痛和出血情况进行比较。结果：石蜡油润滑前端法和生理盐水润滑吸痰管比较,出血情况减少,疼痛程度减轻。结论：石蜡油润滑前端法吸痰,可以有效地减少粘膜损伤,减少出血及疼痛,提高吸痰质量和患者的舒适程度。     

From the Cover: Universal robotic gripper based on the jamming of granular material

Gripping and holding of objects are key tasks for robotic manipulators. The development of universal grippers able to pick up unfamiliar objects of widely varying shape and surface properties remains, however, challenging. Most current designs are based on the multifingered hand, but this approach introduces hardware and software complexities. These include large numbers of controllable joints, the need for force sensing if objects are to be handled securely without crushing them, and the computational overhead to decide how much stress each finger should apply and where. Here we demonstrate a completely different approach to a universal gripper. Individual fingers are replaced by a single mass of granular material that, when pressed onto a target object, flows around it and conforms to its shape. Upon application of a vacuum the granular material contracts and hardens quickly to pinch and hold the object without requiring sensory feedback. We find that volume changes of less than 0.5% suffice to grip objects reliably and hold them with forces exceeding many times their weight. We show that the operating principle is the ability of granular materials to transition between an unjammed, deformable state and a jammed state with solid-like rigidity. We delineate three separate mechanisms, friction, suction, and interlocking, that contribute to the gripping force. Using a simple model we relate each of them to the mechanical strength of the jammed state. This advance opens up new possibilities for the design of simple, yet highly adaptive systems that excel at fast gripping of complex objects.     

Dry suction water seal system for management of pericardial fluid during epicardial ablation

Introduction

Epicardial ablation is an important approach in the management of patients with complex ventricular arrhythmias. Irrigated ablation catheters present a challenge in this potential space due to fluid accumulation that can cause hemodynamic compromise, requiring frequent manual fluid aspiration. In this series, we report our initial experience with the use of a dry suction water seal system for pericardial fluid management during epicardial ablation.

Methods

Consecutive patients undergoing epicardial ventricular tachycardia (VT) ablation at a single center were included. All patients underwent epicardial access via a subxiphoid approach with a single operator. A deflectable sheath was advanced into the pericardial space, and the side port was attached to a dry suction water seal system attached to wall suction at −20 mmHg. Procedural information including patient characteristics, outcomes, and adverse events. After a period of initial experience, pericardial fluid infusion and aspiration volumes were recorded.

Results

Eleven patients were included in this series. All patients underwent epicardial ablation with complete success achieved in 8 of the 11 patients and partial success in the remaining patients. Pericardial fluid intake ranging from 485 to 3050 mL with aspiration of 350–3050 mL using the dry suction water seal system. No adverse events occurred.

Conclusion

Dry suction water seal drainage systems can provide a safe strategy for efficient pericardial fluid management during epicardial VT ablation, potentially shortening procedure duration.