游离腓肠内侧动脉穿支皮瓣修复前臂及足部软组织缺损

目的 探讨应用腓肠内侧动脉穿支皮瓣(MSAP)修复前臂及足部软组织缺损的临床效果.方法 自2015年5月至2017年9月,应用MSAP修复前臂及足部软组织缺损创面13例,其中男9例,女4例,年龄19~57岁,平均41岁;其中前臂6例,足部7例,足部创面均位于前中足.皮瓣切取面积为3.0 cm×4.0 cm^7.0 cm×15.0 cm.修复足部创面时均选用同侧小腿,小腿供区创面均进行一期直接缝合.术后通过门诊复查及微信方式,对皮瓣外形、感觉及供区恢复情况进行定期随访.结果 13例皮瓣全部成活,无血管危象发生及坏死,3例术后存在感染,给予换药及抗炎治疗后创面逐渐愈合.术后随访11例(2例外省患者失访),随访时间4~18个月,平均12个月,未发现供区明显功能障碍,受区皮瓣外形良好;7例感觉恢复至S2~S3,TPD 6~9 mm.结论 游离MSAP不损伤主干血管,血管蒂长,穿支恒定,皮下脂肪相对较薄,游离移植修复前臂及足部创面效果良好.     

Heart catheterization via the femoral artery with a 4 French and mobilization at 2 hours]

The use of small catheters for cardiac catheterization, as well as for other diagnostic and interventional procedures, can reduce iatrogenic trauma on cardiac and vascular structures. Early patient mobilization may thus reduce both patient discomfort and the length and cost of stays. The performance of 4 French catheters was evaluated in a pilot cohort of consecutive in patients who underwent coronary arteriography with the use of the femoral Judkins technique and who had no restriction to full ambulation. Patients were helped to resume full ambulation two hours after the procedure, and the femoral access site was inspected 24 hours later upon discharge. Coronary arteriography with 4 French catheters was performed in 45 patients (10 women) aged 62 +/- 10 years. In one patient with anomalous origin of the right coronary artery, selective catheterization of the coronary ostium required a catheter style available only in 5 French. In all cases, selective opacification with 4 French catheters was adequate for diagnosis. Forty-three patients were mobilized 115 +/- 10 minutes after the end of manual compression. Hematoma, bleeding or limb perfusion disturbances were absent in all cases upon inspection 22 +/- 4 hours later. This pilot experience indicates that coronary arteriography with femoral 4 French Judkins catheters is technically feasible and that patient ambulation 2 hours later is safe. This data requires confirmation in a larger patient cohort and can lead to new standards for both patient comfort and the use of hospital resources in coronary arteriography.     

The effects of desferrioxamin and vitamin E as supplements to antibiotics in the treatment of peritonitis in rats

AIM: The aim of the study was to determine the effects of vitamin E and the iron chelating agent desferrioxamin (Dfx), supplemented by clindamycin and gentamycin therapy, on peritonitis caused by caecal ligation of a puncture wound in an experimental model. MATERIALS AND METHODS: One hundred and twenty Spraque Dawley rats were divided into eight groups. Three groups were used as controls; intraperitoneal (i.p.), subcutaneous (s.c.) and i.p. and s.c., respectively. Group 4 was treated with Dfx, Group 5 with vitamin E and Group 6 with antibiotics. Group 7 was treated with vitamin E in combination with antibiotics, and Group 8 with a combination of antibiotics and Dfx. The rats were studied for 14 days following treatment, and survivors then humanely dispatched. Post-mortem examination was undertaken on all the rats studied. RESULTS: In the control groups, mortality at 14 days was 66%. Rats treated with antibiotics alone (Group 5) had a mortality rate of 40%. Those treated with a combination of antibiotics and vitamin E (Group 7), however, had a mortality rate of only 14%, and those treated with antibiotics and Dfx had a mortality rate of only 7%. CONCLUSION: This study suggests that treatment of peritonitis in rats with a combination of Dfx and antibiotics has a significant beneficial effect on survival, in comparison with treatment with antibiotics alone.     

Ambulation three hours after elective cardiac catheterisation through the femoral artery.

OBJECTIVE: To test whether very early resumption of ambulation after femoral cardiac catheterisation is feasible and safe in patients with stable symptoms. DESIGN: Prospective study in a selected group of men and women undergoing elective cardiac catheterisation, with next day physical inspection. SETTING: Inpatient study. SUBJECTS: Two hundred consecutive ambulant patients submitted to diagnostic cardiac catheterisation through the femoral arterial route using 5F catheters: a femoral right heart study was done at the same time in 40 patients (20%). RESULTS: No patient had major complications during the study. Early ambulation was not allowed in two patients (1%) because of haematoma formation immediately after sheath removal, and in seven (3%) because of poor haemostasis or haematoma on inspection at 3 h. Early ambulation was interrupted in two patients (1%) because of transient arterial hypotension on standing in one, and the patient's preference in the other. Of 189 patients who resumed full ambulation at 3 h, one (0.5%) had a groin haematoma on discharge the next morning. Overall, haematoma 12 h after cardiac catheterisation was present in seven of the 200 patients initially included in the study (3.5%). None of the 191 patients with attempted early mobilisation had signs or symptoms of vascular complications one month or later after discharge. CONCLUSION: Supervised resumption of ambulation 3 h after uncomplicated cardiac studies with 5F femoral arterial catheters is safe and feasible in most ambulant patients undergoing elective cardiac catheterisation.     

Disability in multiple sclerosis is associated with age and inflammatory,metabolic and oxidative/nitrosative stress biomarkers: results of multivariate and machine learning procedures

The aim of this study was to evaluate the immune-inflammatory, metabolic, and nitro-oxidative stress (IM&NO) biomarkers as predictors of disability in multiple sclerosis (MS) patients. A total of 122 patients with MS were included; their disability was evaluated using the Expanded Disability Status Scale (EDSS) and IM&NO biomarkers were evaluated in peripheral blood samples. Patients with EDSS ≥3 were older and showed higher homocysteine, uric acid, advanced oxidized protein products (AOPP) and low-density lipoprotein (LDL)-cholesterol and higher rate of metabolic syndrome (MetS), while high-density lipoprotein (HDL)-cholesterol was lower than in patients with EDSS <3; 84.6% of all patients were correctly classified in these EDSS subgroups. We found that 36.3% of the variance in EDSS score was explained by age, Th17/T regulatory (Treg) and LDL/HDL ratios and homocysteine (all positively related) and body mass index (BMI) (inversely related). After adjusting for MS treatment modalities, the effects of the LDL/HDL and zTh17/Treg ratios, homocysteine and age on disability remained, whilst BMI was no longer significant. Moreover, carbonyl proteins were associated with increased disability. In conclusion, the results showed that an inflammatory Th17 profile coupled with age and increased carbonyl proteins were the most important variables associated with high disability followed at a distance by homocysteine, MetS and LDL/HDL ratio. These data underscore that IM&NO pathways play a key role in increased disability in MS patient and may be possible new targets for the treatment of these patients. Moreover, a panel of these laboratory biomarkers may be used to predict the disability in MS.

     

Mother-father differences in screening for developmental delay in infants and toddlers

PurposeIn most cases, caregiver questionnaires are completed by mothers and seldom by fathers. Although parents tend to have moderate to high congruence, some studies suggest that differences between the mothers’ and the fathers’ answers can complicate diagnostic decision-making. The aim of this study was to determine mother–father response differences on a widely used screening checklist and to describe possible clinical implications of the observed differences.MethodThe Communication and Symbolic Behavior Scales Developmental Profile Infant–Toddler Checklist, a screening and evaluation tool, is commonly used in many countries to identify developmental delays in infants and toddlers. A Croatian version of the CSBS-DP checklist was completed by 422 parents (211 mothers and 211 fathers). The mean age of children was 15.4 months (6–24 months). Inter-rater reliability and mother–father differences were calculated. An item-by-item analysis was performed, and the relationship between the parental concern and the score a child achieved was also examined.ResultsMothers and fathers did not differ in Total Scores (p = .165). Item-by-item analysis showed that the level of congruence between mothers’ and fathers’ scores was, on average, 78%. However, in 10–15% of cases, the parent scores placed a child in different clinical categories (above vs. below the cut-off score). In cases of discordance, fathers placed a child below criterion level more often than mothers, and this trend was more pronounced for girls than boys. The level of parental concern was found to be relatively low and not well balanced with the scores children achieved.ConclusionOur findings suggest that the level of parental concern is not a very reliable indicator of delayed or deviant childhood development. Furthermore, in 10–15% of cases, parents differ in the extent to which their responses place a child in different clinical groups.Learning outcomes: The reader will: (1) recognize the importance of early communication skills assessment in infants and toddlers; (2) identify the possible limitations of relying on a single parent report in screening infants and toddlers; (3) describe the factors that might affect screening results when caregiver questionnaires are used; (4) be able to better assess parental concern.     

Effective bleeding control during resection of giant carotid body tumor

Carotid body tumor is a rare neoplasm located at the carotid bifurcation. Ligation and excision of the external carotid artery together with the tumor is preferred in patients with transmural tumor invasion. In those without transmural tumor invasion, temporary occlusion of the external carotid artery at the bifurcation allows trouble-free tumor excision and keeps the external carotid artery intact.     

How informed is patient consent to interventional cardiology procedures. A quality assurance survey by the nurses]

BACKGROUND: A new patient consent form has recently been adopted in our Institution, with a uniformly written text to be used for all medical procedures and interventions. It is accompanied by a separate information sheet, explaining both the details and the risk/benefit profile for each specific procedure/intervention. It should be given to the patient as early as possible after the procedure/intervention is planned. Testing the effectiveness of this new information policy has been included into the quality assurance goals by our nursing staff. METHODS: From mid April to mid June 2004 a questionnaire was administered to all patients who had undergone an elective cardiac interventional procedure. The timing, manner and perceived completeness of the information received by patients was investigated by 14 yes/no or multiple choice questions. A goal of <5% deviation from a 100% standard was set for all indicators. RESULTS: Two hundred and thirty-eight valid questionnaires were obtained out of 308 consecutive procedures. Seven patients (3%) refused the questionnaire. The response rate was >90% for each question. Seventy-eight patients (33%) had a history of cardiac interventional procedures. The information sheet had been received before the procedure in 93% of cases, and this had happened in the ward in 58% of cases; the procedure had been performed at least 1 hour after receipt of the information sheet in 83% of cases. Twenty-seven patients (13%) stated they had not read the information sheet, in most cases (92%) because they felt they already knew enough. Among patients who had read the information sheet, 99% deemed it could be easily understood. Difficulties in asking questions were reported by 6% of patients. When questions had been asked, the nursing staff was addressed in 42% of cases, and the answers were rated as clear in 98% of cases. The consent form was not read at all by 13% of patients, due to alleged lack of time, and was not read completely by another 15%; 98% of those who had read it, however, found it was fairly understandable. CONCLUSIONS: The effectiveness of our new patient information policy seems to approach our quality goals, and is liable to further improvement. The nursing staff of the cardiac catheterization unit is involved in the patient information process, and has full competence to study this issue.     

38. Die Bedeutung gastrointestinaler und extragastraler Hormone für die Ulcuspathogenese und die chirurgische Indikation

Zusammenfassung Bei dem zahlenmäßig (über 80%) im Vordergrund stehenden Ulcus duodeni ist die Bedeutung der vagal ausgelösten Hypersekretion für die Ulcusentstehung allgemein anerkannt. Sie stellt die pathophysiologische Grund lage für die Indikationen zur Vagotomie dar. Darüber hinaus gibt es aber Ulcusformen, deren Behandlung unter Berücksichtigung ihrer Pathogenese häufig noch resezierende Eingriffe am Magen und sogar Eingriffe an anderen Organen erfordert. Es ist in Zukunft zu erwarten, daß neue Beziehungen zwischen Gastroduodenalulcera und den gastrointestinalen Hormonen aufgedeckt werden. Für solche speziellen Ulcusformen lassen sich heute noch keine endgültigen therapeutisch-operativen Richtlinien aufstellen.

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Summary The significance of hypersecretion (triggered off by the vagus) in the genesis of the more common (80%) duodenal ulcer is generally recognized. It represents the pathophysiological basis of the indications for vagotomy. There are, however, types of ulcer that require resection of the stomach or operations of other organs in view of their pathogenesis. It may be expected that new relationships will be discovered in future between gastroduodenal ulceration and gastrointestinal hormones. It is not possible yet to state definitive directives for the surgical tractment of these special types of ulcer.