DAY-ONLY ADMISSION FOR VARICOSE VEIN SURGERY

Day-only admissions for surgery are strongly encouraged, in an effort to keep costs down. Varicose vein surgery has been considered too major for day-only management despite the fact that there have been studies from overseas showing that it can be done with a morbidity comparable to inpatient surgery. The morbidity of day-only surgery for varicose veins (both long and short saphenous procedures) was assessed and compared with the results of inpatient surgery. Patients were also asked whether they were satisfied with the surgery being done this way. There were 165 consecutive patients available for study, 64 day-only and 101 inpatient. All patients attending Shellharbour Hospital, Shellharbour, had surgery done as day-only (as it was a morning list and allowed adequate time for recovery). Patients attending Bulli Hospital, Bulli, had surgery done as an inpatient (afternoon list). All surgery was performed by one surgeon. There was no difference (Chi-squared) in the age distribution (mean 48 years for day-only, 51 years for inpatient) or sex proportion in either group (Chi-squared test of proportions with continuity correction). Assessment of the results was done by review of the surgeon's notes, as well as telephone interviews for day-only subjects. The complication rate in both groups was similar. Wound problems represented the main complication with an incidence of 10.5% in each group. There was one deep venous thrombosis (DVT) in each group (diagnosed by duplex scan). Response to the telephone interview suggested that most patients were happy to have the surgery done as a day-only procedure. Sixty-nine per cent responded that they would have it done this way again and 76% were satisfied with the result of the surgery. This study confirms the results of overseas studies, in that varicose vein surgery can be performed as day-only procedures with a complication rate similar to inpatient procedures and with a high degree of patient satisfaction. It is suggested that this should be used as the method of choice for the majority of patients requiring varicose vein surgery.     

伤肢小隐静脉修复腘动脉损伤解剖基础与临床应用

目的:为利用伤肢小隐静脉修复腘动脉损伤提供解剖学依据。方法:对25具标本50侧肢体的腘动脉和小隐静脉进行解剖研究并分别测量其管径。结果:腘动脉与小隐静脉解剖关系恒定,腘动脉管径起始段为(6.6±0.9)mm,中段为(5.9±1.0)mm,分叉前为(4.9±0.9)mm,小隐静脉管径汇入处为(3.1±0.1)mm,外踝平面和中段管径均为(2.9±0.1)mm,在小腿的上段小隐静脉与大隐静脉和深静脉间交通支出现率低。结论:腘动脉与小隐静脉解剖关系恒定,管径较相近,在伤肢小腿的上段切取一段小隐静脉对静脉回流无明显影响,临床应用21例22侧肢体,效果可靠满意。     

Is Preservation of the Adrenal Vein Mandatory in Laparoscopic Adrenal-Sparing Surgery?

BACKGROUND AND OBJECTIVE: Adrenal tissue-sparing or partial adrenalectomy evolved initially for patients with bilateral synchronous adrenal surgical pathology to preserve vital adrenal volume. In the laparoscopic era, the exact criteria for performing such procedures laparoscopically have yet to be defined. Controversy exists regarding the importance of preserving the adrenal vein, main or accessory. The aim of this retrospective study was to present our short series of laparoscopic tissue-sparing adrenalectomies with vein preservation. Our main goal is not to support partial adrenalectomy as an alternative to total (this is already advocated by many surgeons) but to emphasize the vein-preserving technique. METHODS: Seven patients with peripherally located either aldosterone-producing adenomas (4 cases) or myelolipomas (4 cases) underwent laparoscopic lateral partial adrenalectomy. One patient harbored an aldosterone-producing adenoma and a myelolipoma as well. The main adrenal vein was identified and preserved in 6 patients and the accessory vein in one. RESULTS: No conversion to open adrenalectomy was necessary, and no perioperative morbidity or mortality occurred. Three adenoma patients are normotensive 44, 23, and 20 months postoperatively, while the fourth one's pressure is refractory. CONCLUSIONS: Surprisingly, total adrenalectomies preceded the partial ones, which is controversial compared with other procedures. Laparoscopic lateral partial adrenalectomy is a technically challenging tissue-sparing operation. Meticulous dissection allows preservation of the middle artery and main or accessory vein resulting in a functioning adrenal stump.     

Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients.

BACKGROUND: The clinical significance of conduction recurrences in isolated pulmonary veins of patients with atrial fibrillation is not established. METHODS: Twenty-two patients with paoxysmal atrial fibrillation underwent successful pulmonary vein isolation. Six months after the procedure, 14 patients were free of atrial fibrillation. Two of these patients were subjected to repeat mapping of the left superior pulmonary vein. RESULTS: There was recurrence of pulmonary vein to left atrium conduction despite complete lack of symptoms or evidence of recurrent atrial fibrillation. CONCLUSION: Successful pulmonary vein isolation with abolition of paroxysmal atrial fibrillation does not confer permanent disconnection of the pulmonary vein musculature from the left atrium.     

流行性乙型脑炎病毒结构蛋白编码基因的重组构建

目的:建立流行性乙型脑炎病毒(JEV)C、prME,E等结构蛋白编码基因克隆.方法:病毒感染C6/36细胞,RT-PCR法依次获取该病毒结构蛋白基因并进行DNA测序分析,PCR克隆法将PCR产物分别构建于真核表达载体pcDNA 3.1的BamHI与EcoRI酶切位点并依次命名为pJC、pJME与pJE,通过DNA测序、电泳以及限制性内切酶分析加以鉴定.结果:JEV C、prME与E基因片段分别为380、2001以及1 500bp,各基因测序结果与发表的JEV JaGAr-01株相对应序列相一致,从重组质粒释出的插入子分别与各基因大小相符合.结论:pJC、pJME与pJE重组质粒分别含有C、prME与E蛋白编码基因.     

多层螺旋CT三维重建在左肾静脉压迫综合征中的临床应用

目的探讨多层螺旋CT(MSCT)三维重建在左肾静脉压迫综合征中的诊断价值。方法应用16层螺旋CT对11例左肾静脉压迫综合征病例进行泌尿系增强多期扫描,并获得各种后处理图像。结果11例左肾静脉压迫综合征病例均可见肠系膜上动脉(SMA)压迫左肾静脉(LRV)的征象。CT多平面重建(MPR)直观地显示了腹主动脉(AO)与SMA之间的夹角(α),最大为21.88,°最小为12.86°,平均为17.95°。CT横断位图像显示扩张的左肾静脉直径为12~15.3 mm,平均为13.26 mm;LRV受SMA压迫狭窄处直径为3.0~4.0 mm,平均为3.26 mm。左侧卵巢静脉或睾丸静脉直径为2.1~2.6 mm,平均为2.2 mm。5例增强扫描肾实质期(后期)显示双肾实质密度相差20 HU以上。结论MSCT在胡桃夹综合征诊断中具有明显的优势。     

多层螺旋CT双通路注射法行肝门静脉系统成像的研究

目的:确定多层螺旋CT肝门静脉系统检查的合理延迟时间及双通路注射对比剂法的可行性。方法:分为2个步骤研究:①随机选择无腹部及心血管疾患的患者53例,以3 ml/s速率注射造影剂20 ml,行同层动态扫描,计算腹主动脉、肝门静脉、下腔静脉、肝实质的对比剂时间密度曲线,及它们的相关性。②47例需门静脉检查的患者,行MDCT肝区移床式、动态扫描,在右肘部静脉及下肢静脉同时注入对比剂,对比剂总量1.5~2 ml/kg。扫描时使用对比剂自动示踪软件,设动脉血管阈值为120 HU启动扫描,动脉期扫描完成后延时20.1±5.54 s行门静脉扫描,分别评价肝门静脉、肝静脉、下腔静脉的显示率及程度。结果:①20 ml对比剂注射同层动态扫描肝门层面腹主动脉达峰时间为18.5±4.81 s,肝门静脉达峰时间是38.61±6.59 s,下腔静脉达峰时间是55.44±12.16 s,肝实质的达峰时间是56±5.7 s。②肝门静脉显示率达100%,肝门静脉主干等显示程度平均评分2.50~2.93;相关小分支静脉显示率为87%~98%,显示平均评分2.25~2.63。结论:MDCT右肘部静脉及下肢静脉同时注入对比剂,在动脉期扫描完成后,延时20.1±5.54 s行肝门静脉检查,肝门静脉系统成像效果良好。     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.