Tolerance of the cirrhotic liver to normothermic ischemia. A clinical study of 15 patients

Temporary occlusion of hepatic inflow, namely, the Pringle maneuver, was adopted for 15 patients with liver cirrhosis who underwent partial hepatectomy. The warm ischemia time ranged from 2 to 32 minutes with an average of 19 minutes. The procedure did not cause any harmful effects on systemic hemodynamic and postoperative liver function. The results in our patients were compared with those of 15 comparable control patients who had been operated on over the same period of time without inflow obstruction. The Pringle maneuver significantly diminished the estimated blood loss during surgery, intraoperative and postoperative complications, and suppressed the operative mortality rate from 20 percent to 0.     

缪刺考

At present, most physicians hold that Miu Ci is "left and right cross collateral prick-ing",but it does not conform to the original meaning of "Suwen·Miucilunpian"(Plain Questions ·Trea-tise on Miu Ci). Miucilanpian holds that Miu Ci is the extension and perfection of Ju Ci (contralateral me-ridian needling), which mainly pricks the collateral but is not limited to the collateral, as it also pricks the acupuncture point. As for the "left and right cross" point selection, it is one step in the procedure of the treatment in the process of contralateral collateral needling instead of being a principle.     

Familial focal loss of cross striations

Summary Two patients, a brother and sister, both suffering from congenital generalized muscle weakness with a progressive course are reported. Muscle biopsy revealed areas with loss of cross striations in the muscle fibers, electronmicroscopically presenting complete disorganization of the myofibrils with streaming of the Z discs and absence of mitochondria. Vesicular nuclei with prominent nucleoli were present in these areas. There was a type I fiber prodominance in both cases. The mean diameter of the type I muscle fibers in one of the cases was too small. Motor endplate alterations in this patient gave no evidence of denervation but were suggestive of a delayed development of motor nerves.This study was supported by grants from the Prinses Beatrix Fonds, from the FRSM of Belgium and from the Free University of Brussels     

Alpha fetoprotein in the antenatal diagnosis of the congenital nephrotic syndrome.

In the congenital nephrotic syndrome (Finnish type), concentrations of alpha fetoprotein in the amniotic fluid and maternal serum are markedly elevated in the second trimester of pregancncy. Demonstration of this alteration allows early prenatal diagnosis of this fatal condition and elective termination of the pregnancy before 20 week's gestation.     

Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

Objective

this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery.

Methods

Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília.

Results

351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2).

Conclusion

Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.     

国内部分医院β-内酰胺类抗生素皮肤试验现状调查分析

摘 要 目的：采用问卷调查了解并分析我国医院β-内酰胺类抗生素皮肤试验的实际操作情况。方法：通过电子邮件或传真方式对国内100家医院的临床药师进行问卷调查。问卷内容涵盖医院的名称、级别;β-内酰胺类药物皮肤试验方法,包括皮试液的来源和浓度、操作方法、观察时间、阳性结果的判定标准;涉及过敏史时,β-内酰胺类药物的皮肤试验以及针对口服青霉素制剂是否需要皮肤试验等14个方面的相关问题。结果：共收到信息完整的反馈问卷80份（反馈比80%）。调查显示各医院β-内酰胺类药物皮肤试验流程各有不同。不同医院在抗生素皮试品种、皮试方法、涉及过敏史时药物的选择以及口服青霉素制剂是否进行皮试等方面均存在明显差异。结论：本研究反映了现阶段我国医疗机构在β-内酰胺类抗生素皮肤试验方面缺乏统一标准,亟需尽快出台相关临床指南或共识,以保证临床使用该类药物的安全性与规范性。