Techniques for difficult cases of laparoscopic cholecystectomy

Our basic techniques for the management of difficult cases of laparoscopic cholecystectomy (LC) are presented in this article. If access to Calot's triangle cannot be gained safely, dissection should be started at the fundus or body of the gallbladder (GB), rather than the neck (fundus-first method). In cases with a short and wide cystic duct, a transfixing suture should be applied for ligation instead of clipping. EndoGIA is useful for ligating and transecting this case to avoid a subsequent stricture caused by normal method of ligation. Intraoperative cholangiography should be performed near the neck of the GB in cases in which orientation is lost during dissection. More dissection should be performed in the direction of the junction of the bile ducts after orientation is regained. In cases with GB filled with stones accompanied by severe fibrosis, part of the GB is incised to remove the stones and expose the lumen of the GB. Confluence stones can be removed by placing an incision on the GB side of the junction of the duct. The incised part is closed with suture. A cystic tube (C-tube) is placed in the common bile duct through the cystic duct for decompression. In more difficult cases in which dissection cannot be started safely at any location, the body and the fundus of the GB are excised, and a drain is placed at the neck of the GB. Dissection can be carried out from the main surgeon's or the assistant's side depending on the situation, and cooperation between the two surgeons is mandatory to achieve safe LC in difficult cases. When performing the LC, one must have a low threshold for converting to open surgery if injuries cannot be managed safely.     

高效液相色谱法测定化妆品中8-甲氧基补骨脂素

[目的]建立测定化妆品中8-甲氧基补骨脂素含量的方法。[方法]采用高效液相色谱法,选用ZORBAX C18柱,流动相为35%甲醇∶乙腈=12∶88,二极管阵列检测器,波长296 nm。[结果]在0.035-0.620μg范围内,线性关系良好（r=0.999 6）,平均回收率为81.5%,RSD为4.79%。[结论]本法操作简便,结果准确,适用于测定化妆品中8-甲氧基补骨脂素的含量。     

Evaluation of the KTP 532 laser in aesthetic facial surgery

This study investigated the ability of the KTP 532 laser to reduce postoperative swelling and bruising in aesthetic facial surgery. Thirty consecutive patients receiving a laser-assist procedure (following skin incision with a scalpel, dissection and hemostasis were accomplished primarily with the laser) were compared to 16 patients who had similar technical operations but relied on scissor/scalpel dissection and electrocautery for hemostasis. Evaluations were performed by comparison of serial photographs after surgery and by patient self-assessment. The clinical observations demonstrated a noticeable reduction in postoperative swelling, bruising, and discomfort in the patients whose procedure was performed with the aid of the laser.Presented in part at the national meeting, American Society for Aesthetic Plastic Surgery, Boston, Massachusetts, April 1993.     

Application of the expanded Creme RIFM consumer exposure model to fragrance ingredients in cosmetic,personal care and air care products

As part of a joint project between the Research Institute for Fragrance Materials (RIFM) and Creme Global, a Monte Carlo model (here named the Creme RIFM model) has been developed to estimate consumer exposure to ingredients in personal care products. Details of the model produced in Phase 1 of the project have already been published. Further data on habits and practises have been collected which enable the model to estimate consumer exposure from dermal, oral and inhalation routes for 25 product types. . In addition, more accurate concentration data have been obtained which allow levels of fragrance ingredients in these product types to be modelled. Described is the use of this expanded model to estimate aggregate systemic exposure for eight fragrance ingredients. Results are shown for simulated systemic exposure (expressed as μg/kg bw/day) for each fragrance ingredient in each product type, along with simulated aggregate exposure. Highest fragrance exposure generally occurred from use of body lotions, body sprays and hydroalcoholic products. For the fragrances investigated, aggregate exposure calculated using this model was 11.5–25 fold lower than that calculated using deterministic methodology. The Creme RIFM model offers a very comprehensive and powerful tool for estimating aggregate exposure to fragrance ingredients.     

125I粒籽植入治疗辐射防护及关键控制技术探讨

目的 探讨碘-125（¹²⁵I）放射性粒籽植入治疗过程中可能存在的放射性职业病危害因素及辐射水平,探讨关键控制技术。方法 以5家开展¹²⁵I粒籽植入治疗项目的医疗机构为研究对象,采用放射卫生学现场调查、工作场所辐射防护水平检测、人员个人剂量监测等方法,调查粒籽植入涉源工作场所及相关人员的辐射水平;结合源项分析及放射卫生管理经验,根据危害分析与关键控制点（HACCP）的原理,探讨¹²⁵I粒籽植入治疗过程的关键控制点。结果 不同涉源场所中粒籽植入源运输包装、粒籽植入治疗室和专用病房工作场所各关注点的周围剂量当量率为本底~1.80 μSv/h（病房门处）,均小于2.5 μSv/h;35名放射工作人员全年个人剂量监测结果为0.20~1.80 mSv,平均为0.42 mSv。结论 不同涉源场所的辐射水平及人员的受照剂量均符合国家标准限值的要求;应根据关键控制措施,对¹²⁵I放射性粒籽植入治疗过程的关键环节予以控制。     

内分泌科患者临床药学监护问诊技巧

目的:通过规范的药学问诊和用药教育过程,得到细致详尽的患者用药信息,提高患者用药依从性,从而提高临床药师药学监护的效率和质量。方法:总结临床药师在内分泌科查房问诊和药学监护的经验和技巧,通过设计问诊和用药教育表格的方式使患者相关信息简洁明了、药学问诊和用药教育过程有条不紊。结果与结论:规范的药学问诊和用药教育,可使患者用药信息更全面,使临床药师参与药学监护更具体、规范。     

尼莫地平肠溶微囊的制备及体外释放度考察

目的：优化尼莫地平肠溶微囊的制备工艺并对其体外释放度进行考察。方法：以纤维醋法酯（CAP）为载体材料,利用单凝聚法,通过正交试验设计,考察囊材与囊芯比、溶解cAP所需磷酸氢二钠pH值及量、span-80量及凝聚剂用量、成囊温度等因素对微囊包封率及载药量的影响,初步筛选出最佳处方工艺条件。此外,还建立了紫外分光光度法测定微囊的栽药量与包封率,考查其体外释放度。结果：所得微囊外观圆整,测得平均包封率为80．4％,平均载药量为41．7％。结论：该制备方法简单易行,所制得的微囊肠溶效果理想。