A Rapid Pulse After Coronary Bypass Surgery

Abstract

A secondary aortoenteric fistula is a complication of earlier aortic grafting due to an aortic abdominal aneurysm. A primary aortoduodenal fistula (ADF) is a rare clinical entity that usually causes gastrointestinal bleeding that can be occult, intermittent, or massive. This article presents the case of a 68-year-old man with acute onset of a massive hematemesis and hematochezia. Eight years earlier he had undergone the implantation of an aortobifemoral prosthesis to treat an aortic aneurysm. The patient's condition was unstable, and it was during emergency surgery that the diagnosis of an ADF was made. An infected graft was removed in its entirety, and a new prosthesis was implanted. An omentoplasty with a pedunculated flap was performed. After 8 months, the patient had a recurrent ADF. He underwent another operation, but hemorrhaging from the aortic anastomosis occurred, so he required emergency surgery. Eventration occurred on the 14th postoperative day. The resection of the transversal colon was performed with a cecostomy for the decompression of the end-to-end anastomosis. Three months later the patient suffered a recurrent ADF. An aortobifemoral stent graft was implanted. Periaortal flow-drainage was established for the irrigation of the retroperitoneal space. A microjejunostomy tube was also inserted. The patient recovered without any complications. This case represents an example of a rare serious complication of aortic abdominal aneurysm. This case report covers pathophysiology, diagnostic evaluation, and management of an aortoenteric fistula.     

宫颈环型电切术治疗宫颈疾病的临床疗效观察

目的:研究探讨宫颈环形电切术(LEEP)治疗宫颈疾病的临床疗效。方法:收集该院2009年1月～2010年1月因宫颈疾病行LEEP术的患者66例(观察组),与同期68例因宫颈疾病行传统的宫颈锥切术患者(对照组)进行比较,比较两组患者手术时间、术中平均出血量、术后阴道出血情况、宫颈的恢复情况及宫颈狭窄情况等。结果:两组比较观察组患者手术时间、术中平均出血量、术后阴道出血均少于对照组(t=16.2,18.4,35.5,P<0.05)有明显统计学差异。观察组术后随访宫颈恢复情况示,1月内治愈率65%,2月内治愈率100%,对照组1月内治愈率60%,2月内治愈率95%,两组患者术后阴道分泌物约两周恢复干净,临床疗效两组无明显统计学差异。结论:宫颈环型电切术治疗宫颈疾病的临床疗效显著,且简便安全,临床上值得推广。     

Milligan-Morgan术式联合痔核套扎术治疗痔病的经验

目的介绍Milligan-Morgan术(M-M术)联合痔疮套扎术(M-M-R术)治疗痔病的经验和优势。方法选择2014年7月~2015年12月Ⅲ期~Ⅳ期痔病接受(M-M-R组)术治疗的患者91作为观察对象,另选择具有可比性的同期接受吻合器痔上黏膜环切术(PPH)78例作为对照(PPH组),观察各组患者的术中情况、术后表现,并发症发生、住院费用、术后住院时间以及满意度等方面情况。结果 M-M-R和PPH术式的手术用时为(42.7±28.6)min和(28.5±5.3)min,两组相比较有统计学意义。两组手术出血量均小于10 m L。M-M-R组与PPH组在术后疼痛(VAS)、肛门坠涨感、肛缘水肿方面差异具有统计学意义,但上述表现均短期内恢复。M-M-R组最明显优势是费用明显少于PPH组(P0.05)。两组手术的满意度差异没有统计学意义。术后便血、排尿、术后住院时间以及满意度,直肠-肛管反射功能两组比较差异无统计学意义。随访3月,两组均为发生肛门狭窄、大便再出血、复发等情况。结论 M-M-R术式效果至少在短期内与PPH相当,术后肛门疼痛患者可以接受;由于治疗费用相对低廉,M-M-R术尤其适合于基层医院实施。     

从护理收费过低现象看我国综合医疗服务项目价格调整的必要性

我国护理服务价格一直处于较低水平,难以真正体现护理人员的劳务价值.同样,其他综合医疗服务项目的价格也不尽合理,不利于医疗机构的经济运行和发展.文章基于对上述现象的分析提出调整综合服务项目收费价格的一些建议.     

The oncological and obstetric outcomes of cervical squamous cell carcinoma at stage IA1 managed with the loop electrosurgical excision procedure

ObjectiveTo evaluate the efficacy and superiority of loop electrosurgical excision procedure (LEEP) in managing stage IA1 cervical microinvasive squamous cell carcinoma (MISCC) without lymph-vascular space invasion (LVSI).Materials and methodsThe oncological and reproductive outcomes of a series of patients affected by stage IA1 MISCC without LVSI, initially treated by LEEP between February 2006 and December 2017, were retrospectively reviewed.ResultsUltimately, 109 patients were included. The mean age at diagnosis was 35.4 years old, and 36 patients were nulliparous. Multifocal lesions were identified in 15 patients (13.8%). The mean cone depth was 17.4 mm. Resection margins were positive/unevaluable and negative in 26 (23.9%) and 83 (76.1%) cases, respectively. Among cases undergoing salvage treatments, the residual disease rate for patients with positive/unevaluable margins was significantly higher than those with negative margins (P = 0.003). During the follow-up period of 43.0 ± 28.9 months, no relapse was identified. Fifteen of 20 patients (75.0%) conceived successfully, with a full-term live birth rate of 93.3%.ConclusionsFor stage IA1 MISCC without LVSI unexpectedly found in a loop excision, initial LEEP with clear margin is efficient and adequate. For cases with multifocal MISCC, or for those young patients who wish to become pregnant in the future, LEEP is the optimal choice.     

Aneurysm formation of pericardial patch in Manouguian procedure

Pericardial patch has been used to repair cardiac defects; however, its strength as an aortoplasty patch to tolerate systemic pressure is a matter of debate. We report an aneurysmal dilatation of pericardial patch in aortoplasty. Our patient was a 56-year-old female known case of rheumatic heart disease that underwent redoes mitral and aortic valve replacements along with Manouguian aortoplasty at the age of 44?years old. After 2?months, she was readmitted with a diagnosis of endocarditis. Echocardiography revealed a small cavity in the posterior wall of the aorta. She responded to medical therapy and discharged in a good condition. Twelve years later, she was scheduled to undergo reoperation due to a severe paraprosthetic aortic valve leakage and a pericardial patch aneurysm. The leaking prosthetic aortic valve was explanted and the aneurysmal tissue was replaced with a polyethylene terephthalate patch.     

A new retractor for cochlear implantation

Abstract

In cochlear implantation and other major ear surgeries a post auricular incision is often used. Following this, fascia, muscle and fat is divided, and then a periosteal flap is raised. This creates different tissue planes which need to be held back and protected from the surgeon and the drill. We present a new device which provides excellent retraction for this procedure, does not put undue pressure on the pinna, while at the same time it allowing the surgeon an unobstructed view. Copyright © 2008 John Wiley & Sons, Ltd.