Postoperative sore throat: cause, prevention and treatment

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.     

输卵管性不孕的X线诊断与腹腔镜对照(附34例分析)

目的：通过子宫输卵管造影和腹腔镜检查的对照,提高对输卵管性不孕的Ｘ线诊断。方法：输卵管不孕症患进行了输卵管造影和腹腔镜检查,将其结果进行比较。结果：子宫输卵管造影;输卵管各部阻塞１５支,通而不畅２１支,输卵管未通１５支,输卵管积水９支,输卵管通畅７支。     

Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus

To elucidate the necessity of pyloroplasty for the gastric tube through the posterior mediastinum in esophageal surgery, gastric emptying and duodenogastric reflux (DGR) were evaluated in 16 cases undergoing an anterior pylorectomy (group P) and in 16 cases treated by the finger bougie method (group F). First, the obstruction and reflux symptoms were examined based on a patient questionnaire using a brief scoring system. The median value of the symptom score showed the patients in P to have more symptoms than those in F; however, the difference was not significant (8.0 vs 6.0). Secondly, the swallowed Tc O₄ ⁻ (85 MBq) was counted using a gamma camera at three sites on the sternal bone in the upright position based on a gastric transit scintigram. Both the descending time of the RI peak and the clearance rates were similar between the two groups. Thirdly, intragastric 24-h pH monitoring was carried out. Antimony pH sensors were anchored 5 and 15 cm below the esophagogastrostomy. We could not find any difference between the two groups in both the % time pH>4 and %time pH>7. These findings thus revealed no big difference between groups P and F. The finger bougie method to drain the vagotomized posterior mediastinal stomach was found to achieve results similar to conventional pyloroplasty, while it was also simpler and safer.     

More than just a health issue: a review of current issues in the care of enterally-fed children living in the community

There are increasing numbers of children with a disability living in the community who require enteral tube feeds to optimize their nutritional status. Whilst there appears to be evidence of health gains, for some children there may also be serious and unintended social deprivations resulting from the need to be tube fed. This paper reviews the literature on support for children who are tube fed and makes a case for more coordinated and effective support services for families who are tube feeding a child at home. It is argued that national guidance should be developed which clarifies the position of all non-parent carers and staff who are willing to administer enteral tube feeds. Such guidance should also ensure that enterally-fed children have the same rights to educational and social services as other children and that families are given the opportunity to make informed decisions about the implications of enteral feeding prior to it being established.     

十二指肠腔内置管引流减压在毕-Ⅱ式胃大部切除术中应用疗效的观察

目的探讨防止毕-Ⅱ式胃大部切除术后十二指肠残端破裂发生的方法;方法对毕-Ⅱ式胃大部切除术中出现十二指肠残端水肿或血运差的病例,采取预防性十二指肠腔内置管引流减压的方法,收集临床资料、观察治疗效果;结果采取十二指肠腔内置管引流减压后,十二指肠残端破裂发生率明显下降;结论十二指肠腔内置管引流减压,可以预防十二指肠残端破裂的发生,并可拓宽溃疡穿孔病例采用胃大部切除术的适应证。     

Use of a Calibration Balloon Tube to Size the Pouch and Channel in Gastroplasty Procedures

Gastroplasty is currently one of the most common surgical procedures performed on the morbidly obese for weight loss. An adequate result can be assured only if the pouch that is created is less than 30 ml and the channel that connects that pouch to the distal stomach is approximately 1 cm in diameter. The current method to size the pouch is to occlude the esophagus and the outlet of the pouch and to measure with a manometer through a naso-gastric tube. We contend this method is both time consuming and adds to the potential of complications. Through the use of a calibration balloon tube the size of the pouch can be quickly and safely estimated. It can also be used to size the channel between the pouch and the distal stomach and check for leaks. The technique of how this tube has been used over the past 6 years is described. By the use of a calibration balloon tube, three problem areas in gastric stapling surgery for morbid obesity are avoided, namely: inappropriate pouch size, inappropriate channel size and postoperative leaks.     

Gastrostomy and oesophagoplasty with a flap from the greater curvature of the stomach as stages of surgical and combined treatment of cancer of the thoracic oesophagus

Four-hundred fifty-eight patients with cancer of the oesophagus were subjected to revisional laparotomy. Metastases into subphrenic lymph nodes were registered in 24% of the cases with a tumor in the bronchial segment; 42% with tumor in the subbronchial segment; 48% with tumor in the retropericardial segment; 71% with tumors in the sub-, intra-, and supraphrenic segments of the oesophagus. In 345 cases, laparotomy was followed by tube gastrostomy (Beck—Carrel method) with two operative deaths. Fifty-six patients in good condition with a small tumor in the middle part of the oesophagus (≤5 cm) without any abdominal metastases were subjected to primary oesophagoplasty: a 30–32-cm tube was formed out of the greater curvature of the stomach and placed retrosternally; gastrostomy was performed on the level of the thyroid cartilage (without any operative deaths). In two weeks, extirpation of the thoracic part of the oesophagus (with preoperative irradiation) was performed on patients with no abdominal metastases. Then the patients with primary oesophagoplasty were subjected to oesophago-gastrostomy of the neck. From six to 12 months following the combined treatment, the gastrostomy tube of 45 patients was lengthened to 30–32 cm and used for retrosternal oesophagoplasty (six operative deaths). Oesophagoplasty was performed on 14 patients during the extirpation of the oesophagus (six operative deaths).     

分泌性中耳炎咽鼓管及鼓室黏膜的光镜及电镜观察

目的：探讨分泌性中耳炎的发病原因，为临床治疗提供理论依据。方法：通过微波烧灼双侧咽鼓管口，建立分泌性中耳炎动物模型。光镜观察比较咽鼓管管腔及黏一软骨膜和鼓室黏膜变化。电镜观察咽鼓管鼓室段暗颗粒分泌细胞及其表面活性物质样板层体的变化。结果：各组咽鼓管管腔通畅，咽鼓管黏一软骨膜不易受炎症浸润及负压影响。鼓室黏膜水肿、增生、炎性细胞浸润明显，暗颗粒细胞分泌功能受损，表面活性物质板层体结构明显减少或消失。结论：咽鼓管黏一软骨膜在分泌性中耳炎发病过程中起重要作用。表面活性物质减少与分泌性中耳炎的发生密切相关。     

神经管发育不良患儿及其核心家庭MTHFR基因A1298C多态性分布的研究

目的　通过对神经管发育不良 (NDTs)患儿及核心家庭MTHFR基因A1 2 98位点多态性分布的研究 ,探讨该基因多态性与NDTs之间的关系。方法　 2 0 0 0年 9月～ 2 0 0 2年 3月 ,40例 3～ 1 5岁NDTs患儿 (男 2 8例 ,女 1 2例 )及其中 2 6个核心家庭进行研究。应用聚合酶链反应 限制性片段长度多态性分析 (PCR RFLP)技术 ,分析MTHFR基因第 1 2 98位核苷酸基因型 (野生型、杂合型、突变纯合型 )的分布情况 ;并对 2 6个核心家庭进行以父母为对照的病例对照研究 ,计算传递失衡指数 (TDT)及基于单体型的单体型相对危险度 (HHRR)。结果　NDTs患儿、核心家庭与正常对照中均未发现纯合突变。基因型构成比采用 χ2 检验 ,NDTs患儿及患儿母亲野生型分别占 1 7.50 % ,1 1 .54 % ,杂合型分别占 82 .50 % ,88.46 % ,与正常对照之间差异无显著性意义 (分别为P >0 .2 5 ;P>0 .90 )。患儿父亲野生型占 30 .77% ,杂合突变型占 69.2 3 % ,低于正常对照 (P <0 .0 5)。等位基因频率比较采用u检验 ,患儿为 41 .2 5 % ,与对照间差异无显著性意义 (P >0 .0 5) ;患儿父母分别为69 .2 3 % ,88.46 % ,均高于正常对照 (P <0 .0 1 )。核心家庭分析结果 :TDT(χ2 ) =0 .36 ,P >0 .0 5 ;HHRR(χ2 ) =0 .369,P >0 .0 5。结论　MTHFR基因第 1 2     

慢性盆腔炎输卵管病理与IL-2 IL-6的关系

目的 :探讨慢性盆腔炎输卵管病理与其组织中IL - 2、IL - 6等细胞因子的关系。方法 :用混合菌接种法制作大鼠慢性盆腔炎动物模型 ,观察输卵管的病理变化 ,并以ELISA法检测其中IL - 2、IL - 6的含量。结果 :模型大鼠输卵管组织呈慢性炎症改变 ,IL - 2、IL - 6皆呈显著上升趋势。结论 :慢性盆腔炎及其继发不孕输卵管的病理改变与细胞因子IL - 2、IL - 6的升高有密切关系