CO2 laser in cancer surgery of the breast: a comparative clinical study

Review of the literature reveals little to no data regarding the use of the CO2 laser as a surgical modality in the local treatment of breast cancer. This study was undertaken to determine if the CO2 laser is a surgical improvement over the scalpel, influencing patient care during the surgical and postsurgical period. In the author's series, a total of 209 procedures were performed. Within this group, 105 cases were performed with CO2 laser and 104 cases performed with the scalpel. Biopsies were always performed as a separate procedure prior to definitive surgery. This study was not designed to compare cure rates, the medical follow-up period being 1 year. The results of this study demonstrate a significant improvement in patients' postoperative care, surgical technique, and hospital cost-effectiveness.     

塞来昔布对骨科围手术期镇痛的疗效评估

[目的]观察塞来昔布(西乐葆)对骨科围手术期患者术后镇痛的疗效及安全性。[方法]选择2004~2005年住院手术患者,共64例,随机分组,分别给予西乐葆或镇痛泵进行术后镇痛。西乐葆给药时间:一般于手术前8~12 h,即患者手术禁食前首次给药,手术后6 h患者可进食后再次给药,手术后3~5 d按手术大小及患者疼痛程度决定停药时间。给药剂量:西乐葆首次服用400 mg,大手术可加大剂量。观察患者疼痛VAS评分、药物不良反应及患者满意度。[结果]西乐葆的术后镇痛效果与镇痛泵相似,但发生不良反应比及患者总体满意度优于镇痛泵。[结论]西乐葆对手术后镇痛具有满意的疗效及安全性,适合于骨科围手术期术后镇痛。     

刺激视上核对大鼠痛阈及电针镇痛的影响

以钾离子透引起的大鼠甩尾反应为痛指标，观察了电和化学刺激视上核（ＳＯＮ）对大鼠痛阈（ＰＴ）和电针（ＥＡ）镇痛的影响。电刺激ＳＯＮ后，ＰＴ明显高于假刺激组（Ｐ＜０．０５～０．００１），电刺激ＳＯＮ后电针足三里，镇痛效应明显提高，并有明显的量效关系。电刺激ＳＯＮ的近旁部位（０．５—１ｍｍ）对ＰＴ及电针镇痛无明显影响。ＳＯＮ内注射Ｌ－谷氨酸（Ｌ－Ｇｌｕ）后痛阈和电针镇痛效应都明显对照组，也有明显的量效关     

Retardation of pain development: a case of recovery from congenital insensitivity to pain

Congenital analgesia is a rare genetic disorder. We report here that a 12-year-old boy was able to recover from congenital insensitivity to pain. Neurological examinations revealed that there was a 'stocking' distribution of pain decrement on the lower extremities under the patient's knee joints. Magnetic Resonance Imaging (MRI) of his brain showed gyrus thinning with sulcus widening at both sides of the parietal lobe. Southern blot hybridization probed with cDNAs of various opioid receptors did not detect any significant abnormality. Our results suggest that this rare case may not be genetically determined.     

褪黑素和哌替啶对小鼠的镇痛作用比较

利用热板法或甩尾法测定小鼠痛阈，发现褪黑素１０～４０ｍｇ·ｋｇ－１ｉｐ后６０ｍｉｎ时镇痛作用最强，１５０ｍｉｎ时仍有镇痛作用。哌替啶１０～４０ｍｇ·ｋｇ－１ｉｐ后３０ｍｉｎ时镇痛作用最强，１２０ｍｉｎ时已无镇痛作用。在６０ｍｉｎ时两者镇痛作用相近。是示两者的作用特点不同。     

Ambulatory laparoscopic fundoplication

Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis. Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit. Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two were hospitalized for observation after experiencing intraoperative technical problems. Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction with early discharge on follow-up interview. Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize nausea and provide adequate pain control. Received: 1 April 1996/Accepted: 29 May 1997     

青黛颗粒抗炎、镇痛作用的实验研究

目的 :通过对青黛颗粒抗炎、镇痛作用的实验研究 ,探讨该药治疗溃疡性结肠炎的作用机理。方法 :采用小鼠醋酸扭体法、大鼠棉球肉芽肿法和角叉菜胶所致大鼠足肿胀方法。结果 :青黛颗粒给药高、中、低剂量组和阳性对照药组均明显降低小鼠扭体次数 (P<0 .0 5～P<0 .0 1)。对大鼠棉球肉芽肿和大鼠足肿胀有显著的抑制作用 (P <0 .0 1～P <0 .0 0 1)。结论 :青黛颗粒分别对大鼠具有抗炎、对小鼠具有镇痛作用。且镇痛作用呈量效关系     

Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients

OBJECTIVES: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. METHODS: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. RESULTS: A total of 540 charts of hospitalized first-tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. CONCLUSIONS: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation.     

蛛网膜下腔注入小剂量吗啡术后镇痛与PCEA比较研究

目的 :探讨蛛网膜下腔小剂量吗啡术后镇痛的临床效果并与 PCEA相比较。方法 :将 ASA I～II级 6 0例妇科择期手术患者 ,随机分为两组 ,每组 30例。实验组采用腰麻 ,局麻药为 0 .75 %布比卡因 10～ 15 m g加入吗啡 0 .5 mg。对照组采用腰麻复合 PCEA,局麻药 0 .75 %布比卡因 10～ 15 mg,术后 PCEA。术后镇痛效果以视觉模拟评分 (VAS)、Ram say镇静评分、BCS舒适评分、成功率、不良反应并结合医疗费用比进行评价。结果 :VAS评分两组在 4、8、36 h时段无显著性差异 (P>0 .0 5 ) ;实验组在 12、2 4 h镇痛效果优于对照组 ,4 8、5 4 h对照组优于实验组。 BCS舒适评分、Ram say镇静评分两组间无显著性差异。结论 :蛛网膜下腔注入小剂量的吗啡用于术后镇痛的效果并不亚于 PCEA,如采用医疗费用与治疗效果比 ,更优于后者