颈部切割伤患者的护理

人体颈部位于头与胸部之间，呈圆颈筒形，连接头、躯干和上肢。颈部的正前方有呼吸道及消化道的上段，正后方有颈椎及上段胸椎，两侧有大血管及神经，颈根部胸膜顶和肺尖，并有斜行的大血管和神经［1］。颈部肌肉组织较薄，除有丰富的神经、大血管外，还有甲状腺等重要器官。受伤后容易引起大出血，重者喉肌痉挛，气管堵塞以至危及生命。必须迅速采取急救措施，才能脱离危险。我科2005年3月－2014年3月收治了36例颈部切割伤患者，经积极抢救、治疗及精心护理，效果满意。现报告如下。     

Analysis on anatomical references to assess the coronal alignment of tibial and femoral cuts in mega prosthetic knee replacement

BackgroundIn megaprosthetic knee replacement, surgeons use cutting guides that depend on anatomLevel of evidenceical references to determine the ideal cutting plane alignment. In this work, we investigated the accuracy of using femoral cortical surfaces and tibial canal portions as the references. The study aims to improve the design and use of the cutting guides.ResultsAt the central femoral region, on average, both lateral and medial cortical surfaces give accurate alignment of the ideal cutting plane (0.6° and 0.8°, respectively), with no significant difference (p > 0.01). At the distal region, the lateral cortical surface gives significantly better alignment compared to the medial cortical surface (p < 0.01), but not as accurate (1.4°) as in the central region. For tibia, the central tibial canal gives significantly accurate alignment of the ideal cutting plane (−0.3°) on average, compared to the proximal tibial canal (p < 0.01).ConclusionsFor a femoral cut, both lateral and medial cortical surfaces are the best anatomical references, but only at the central region. For a tibial cut, the central anatomical axis is the best reference.

Level of evidence

IV.     

Conventional cutting vs. internal anal sphincter-preserving seton for high trans-sphincteric fistula: a prospective randomized manometric and clinical trial

Abstract. Background: Cutting setons have been used in complicated perirectal sepsis with good effect, although there is a moderately high incidence of fecal leakage after their use. The aim of this study was to compare a modified cutting seton, which repaired the internal anal sphincter muscle and re-routed the seton through the intersphincteric space, with a conventional cutting seton. Methods: A total of 34 patients were randomized between 1998 and 2002. They were prospectively assessed by continence score and anorectal manometry, and for anal function, clinical sepsis and fistula recurrence. Results: There was no difference in postoperative continence score, incidence of recurrent fistula or healing time between groups after a mean follow-up of 12 months. Resting anal manometric pressures and vector volumes were consistently higher with the modified seton (although not statistically significant), as was the area under the inhibitory curve during elicitation of the rectoanal inhibitory reflex across the full sphincter length. (p<0.05). Conclusion: A larger prospective study of internal anal sphincter-preserving seton use in cryptogenic high transshincteric fistula-in-ano appears justified.     

Simplified placement and management of cutting setons in the treatment of transsphincteric anal fistula: technical note

Background We report one safe and standardized technique of seton placement and management.Conclusions A simplified way to manage cutting setons helps to minimize manipulation and may reduce pain. In most patients our technique can be used with no additional anesthesia and in an outpatient setting.An invited commentary on this paper is available at     

普通球囊与切割球囊成形术对冠状动脉支架内再狭窄的近远期疗效

目的　对切割球囊成形术 (CBA)与普通球囊成形术 (POBA)支架内再狭窄病变的近远期血管造影结果比较 ,评价 CBA对支架内再狭窄病变的有效性。方法　 37例 ,共 39处病变 ,2 3处进入 CBA组 ,16处进入 POBA组。分别比较术后即刻及远期定量冠状动脉造影最小血管径 (ML D)、狭窄度 (DS)、再狭窄率、即刻管腔获得 (AL G)、即刻血管弹性回缩 (AR)及弹性回缩率 (ARR)。结果　术后即刻 ML D、DS、AL G两组差异无显著性。 CBA组最大扩张压、AR及 ARR均较 POBA组低 (P<0 .0 5或 P<0 .0 0 1)。随访造影结果 ,CBA组 ML D明显大于 POBA组 (P<0 .0 5 ) ;DS及再狭窄率均小于 POBA组 (P<0 .0 1)。结论　 CBA组的低压扩张治疗支架内再狭窄病变是有效的 ,对血管损伤小于 POBA,且获得较 POBA低的再狭窄率 ,值得进一步探讨     

Risk factors for bleeding after endoscopic mucosal resection

AIM: To clarify the risk factors for bleeding after endoscopic mucosal resection (EMR). METHODS: A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios (OR) with 95% confidence intervals (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. RESULTS: Of the 297 patients, 57 (19.2%) patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 (95%CI, 1.59-5.92) compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile (16-50 mm) of tumor diameter was 5.63 (95%CI, 1.84-17.23) compared with that for the lowest (4-7 mm). The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 (95%CI, 1.75-10.10) compared with elevated type. CONCLUSION: It is important to take tumor characteristics (tumor size and endoscopic pattern) and cutting method of EMR into consideration in predicting bleeding after EMR.     

管花肉苁蓉切制法优劣比较

目的:探索管花肉苁蓉最优切制工艺。方法:采用润透法切片、烘软法切片、蒸法切片,分别计算饮片回收率、乙醇浸出物含量、饮片含水量。结果:润透法切片、烘软法切片、蒸法切片三者饮片回收率分别为84%、85%、90%,乙醇浸出物含量分别为30.5%、35.5%、32.7%。结论:管花肉苁蓉采用蒸法切制回收率最高,乙醇浸出物含量达药典要求,可作为最优切制工艺。     

趁鲜切制法对牡丹皮饮片中丹皮酚含量的影响研究

目的:考察趁鲜切制法对牡丹皮饮片质量的影响。方法:采用高效液相色谱法,测定不同加工方法样品中丹皮酚的含量。结果:采收4年生凤丹皮药材净制、趁鲜切片、晒干的方法加工牡丹皮饮片。结论:该研究为牡丹皮饮片的产地趁鲜切制提供了科学依据。     

Results of a Peripheral Cutting Balloon Prospective Multicenter European Registry in Hemodialysis Vascular Access

Purpose To report initial experience with the Peripheral Cutting Balloon (PCB) in treatment of failing hemodialysis shunts. Methods A total of 190 patients (95 men, 95 women; average age 64.4 ± 11.9 years, range 32–87 years) who were treated with the PCB for pressure-resistant stenosis, restenosis or failed percutaneous transluminal angioplasty (PTA) in the venous limb of an arteriovenous shunt were followed in seven European centers using a simple registry. The group consisted of 109 de novo lesions (57%) and 79 restenotic lesions (43%). Results Technical success was achieved in 88.9% of cases. Primary patency was as follows (the results for whole group and simultaneous results for de novo lesions and restenoses are presented): 1 month (140 patients followed): 94%, 98%, and 93%; 3 months (116 patients followed): 93%, 98%, and 92%; 6 months (40 patients followed): 85%, 92%, and 79%; 12 months (27 patients followed): 74%, 87%, and 48%. No complication occurred. Patients experienced an equal or lower level of pain during the procedure compared with conventional PTA. Conclusion The PCB proved to be successful in dilating pressure-resistant stenoses. We cannot conclude whether PCB angioplasty can lower the restenosis rate in hemodialysis access lesions, but the long-term patency for de novo lesions is high. A further randomized study is advisable.     

Partial fistulotomy and multiple setons in high anal fistulae

Setons are employed in high perianal fistulae. Our study aimed to use multiple setons in addition to a partial fistulotomy in high perianal fistulae involving the sphincter complex to combine the effects of cutting and drainage of the fistulous tract. This prospective study included 16 patients over a period of 4 years who presented with high perianal fistulae. The internal opening was identified and tract laid open till the dentate line. Four prolene threads were passed along the remainder of the tract and taken out through the external opening. One was tied tightly while the others were tightened every 7 days. No patients developed major faecal incontinence. Fistula recurred in one patient within a year and one patient had occasional incontinence to flatus. Multiple setons after partial fistulotomy is an effective treatment for high anal fistulae with low incidence of incontinence and recurrence and adequate patient satisfaction.