医源性胆管损伤的治疗现状

Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic cholecystectomy. Many factors may cause IBDi, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and patholo-gical changes of the patient. The Bismuth's classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg's classification made a supplement by including other types of extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows: biliary peritonitis often required an emergency reoperation, while extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.     

Ignorance is bliss: the Listerian revolution and education of American surgeons

PURPOSE: Joseph Lister introduced antiseptic surgery in 1867. American surgeons, entrenched in the old ways of 19th century medicine, failed to adopt Lister's methods. MATERIALS AND METHODS: Examples of the hubris and arrogant thinking displayed by early American surgeons are best shown by Thomas Eakins' masterpiece, The Gross Clinic, and by the death of President James Garfield. RESULTS: Samuel Gross, preeminent American surgeon in 1875 boldly revealed in The Gross Clinic, and the team of distinguished surgeons using outdated methods caring for Garfield in 1881, illustrate American surgeons' woeful disdain and disregard of sterile surgical methods. CONCLUSIONS: Public outcry over the failure of some of America's best surgeons led to widespread adoption of antiseptic surgery by the late 1880s and introduction of basic science into the medical education by the dawn of the new century.     

Hydrophilic polymer microemboli in a patient with a chronic cutaneous ulcer: a case report

Hydrophilic polymer coatings were designed to reduce friction between the catheter and vessel wall and facilitate intravascular manipulations during catheterization and placement of drug‐eluting stents. One newly reported complication of such hydrophilic coatings is the fragmentation and embolization of the polymer, which can lead to ischemia and infarct by blocking the small vasculature. In this report, we present a patient with a non‐healing ulcer on the leg. Biopsy from the ulcer revealed the presence of hydrophilic polymer emboli within the dermal vessels. This is one of the few reports of such a complication involving the skin. Our objective is to emphasize the histopathologic features of this uncommon iatrogenic phenomenon.     

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders in a patient with anti-melanoma differentiation-associated gene 5-positive dermatomyositis: A case report and systematic literature review

A 58-year-old man with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (MDA5-DM) developed Epstein–Barr virus (EBV)-associated malignant lymphoma as other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) during the combined immunosuppressive therapy of high-dose prednisolone, tacrolimus, and intravenous cyclophosphamide for MDA5-DM. Serum EBV DNA was detected, and EBV-encoded small RNA was positive in the tissue sample of LPD, indicating that EBV reactivation contributed to the pathogenesis of LPD in our case. The patient underwent chemotherapy, including rituximab, promptly after discontinuation of tacrolimus and cyclophosphamide, resulting in complete remission of the malignant lymphoma, and MDA5-DM has not recurred with 3.5 mg/d of prednisolone monotherapy. We reviewed 19 cases of OIIA-LPD in patients with idiopathic inflammatory myopathies and herein report the first case of MDA5-DM complicated with OIIA-LPD. Among the 19 patients, 7 showed regression of LPD only following withdrawal of immunosuppressants, 9 took chemotherapy for LPD, and 5 died. It should be noted that patients with MDA5-DM-associated rapidly progressive interstitial lung disease could develop OIIA-LPD because they receive aggressive immunosuppressive therapy.     

Iatrogenic Arteriovenous Fistula With Associated Pseudoaneurysm of Posterior Tibial Artery After Revision Total Ankle Arthroplasty: A Case Report

Iatrogenic vascular injuries in elective orthopedic surgery are rare. However, these are important complications to recognize early and treat appropriately because the potential sequelae can be devastating. Arteriovenous fistula of the lower extremity after total ankle arthroplasty has not been previously described in published studies. The proper diagnosis of arteriovenous fistulas can be difficult without a high index of suspicion, and treatment often involves surgical intervention. We present the case of a 62-year-old male who developed an iatrogenic arteriovenous fistula with associated pseudoaneurysm of the posterior tibial artery after revision total ankle arthroplasty that was treated with surgical ligation and excision, followed by reverse saphenous vein grafting.     

医源性低钠血症对慢性心力衰竭的预后价值

目的探讨慢性心力衰竭患者医源性低钠血症的预后价值。方法对2004年1月至2009年12月我院心内科入院资料完整的慢性心力衰竭患者进行回顾性分析,除外入院即刻血清钠离子浓度135mmol/L的患者,共786例,根据入院24h、48h血清钠离子浓度最低值分为三组:A组Na+≥135mmol/L;B组Na+120～135mmol/L;C组≤120mmol/L。比较各组心功能、血清钾离子浓度、住院病死率等指标。结果住院期间存活714例,死亡72例,存活组与死亡组血清钠离子浓度分别为(134.00±5.83)mmol/L和(121.00±7.15)mmol/L,差异有统计学意义(P0.01),而血清钾离子浓度分别为(4.4±0.6)mmol/L和(4.3±0.8)mmol/L,没有统计学差异(P0.05)。三组住院病死率分别为:A组7.8%(36/461),B组8.0%(23/289),C组36.1%(13/36),C组分别与A组和B组比较,均有统计学差异(P0.01)。结论医源性低钠血症是慢性心力衰竭患者预后不良的重要危险因素之一,应采取积极措施避免其发生。     

Tissue necrosis under a Nance palatal arch: a case report

A Nance palatal arch is a method of reinforcing anchorage to help prevent mesial movement of maxillary first permanent molars. It is recognised that it is difficult to maintain oral hygiene around the appliance and that iatrogenic damage can occur. We present a case of a 22-year-old male patient in whom the palatal mucosa became necrotic, palatal bone became exposed and long-term periodontal damage occurred. We describe the case, his treatment and the resolution of the inflammation as well as exploring the causes for the damage and alternate treatment options.     

医源性胆道损伤的诊治体会

目的:探讨医源性胆道损伤的原因和处理方法.方法:回顾性分析20例医源性胆道损伤患者的临床资料.结果:损伤类型以胆管横断和部分切除等为多,行胆管-空肠Roux-en-y吻合11例,胆管对端吻合2例,胆管修补2例,胆道引流或单纯腹腔引流5例,其中1例行开腹胆囊切除术(OC)后并发胆瘘,予腹腔引流后出现多脏器功能衰竭死亡,其余均治愈.结论:胆囊切除术是医源性胆道损伤的主要原因,损伤后治疗处理效果重在及时发现,早期处理.