Reinforcement of the suture line with an ePTFE graft attached with histoacryl glue in duodenal trauma.

BACKGROUND: Most duodenal injuries are managed with primary repair, but the degree of duodenal-wall injury may threaten the integrity of the primary repair. Therefore, we evaluated whether the primary repair site could be reinforced with histoacryl glue (HAG) or HAG with an expanded polytetrafluoroethylene (ePTFE) mesh. METHODS: Grade 3 duodenal injury in the second portion of the rat duodenum was chosen as a standard trauma model. Thirty-three male rats were divided into sham (n = 3), 2-layer primary repair (n = 10), 1-layer primary repair plus HAG application (n = 10) and ePTFE attached with HAG over the 1-layer primary repair site (n = 10) groups. Ten-day survival, adhesion grades and histological assessment were taken as outcome measures. RESULTS: A significant survival advantage was identified in the group that had an ePTFE graft attached with HAG over a 1-layer repair when compared with the group that had a 2-layer primary repair. Adhesion grades were found to be particularly increased in the group that had an ePTFE graft attached with HAG over the primary repair site, moderately increased in the primary repair plus HAG application group and lower in the 2-layer primary repair group. ePTFE graft application was found to be beneficial to coverage of the HAG-dependent empty spaces in the serosal layer. CONCLUSIONS: A primary repair site after duodenal trauma or a difficult duodenal stump can be reinforced with the application of HAG or ePTFE graft implantation with HAG.     

周围性面神经损伤患者对侧神经支配的研究

目的　通过测定面神经损伤患者组及大学生志愿者组面神经各分支对侧神经支配率 ,探讨周围性面肌瘫痪恢复过程中面神经对侧代偿支配的问题。方法　分别测定大学生志愿者 2 2例( 2 2侧 )及 10 8例面神经损伤患者的面神经电图对其对侧神经支配率进行分析其中损伤组又按发病原因不同 ,分为医源性损伤组、Bell氏面瘫组和创伤性损伤组 ,测试损伤支数为Ⅰ支 76支 ,Ⅱ支 81支 ,Ⅲ支 88支 ,Ⅳ支 6 6支。结果　①损伤组 3组间对侧支配率差异无显著性 (P >0 0 5 ) ;②损伤组Ⅰ、Ⅱ支对侧支配率明显高于志愿者组 (P <0 0 0 1) ;③损伤组Ⅰ支对侧支配率明显高于Ⅱ支(P <0 0 0 1)。结论　面神经损伤后 ,存在对侧神经支配功能增强的表现     

Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage.

Hydrocephalus is not a rare complication following aneurysmal subarachnoid hemorrhage. Hydrocephalus following subarachnoid hemorrhage can progress acutely (0-3 days), subacutely (4-13 days) or chronically (after 13 days). The predisposing factors leading to hydrocephalus after subarachnoid hemorrhage are not known exactly. This study assessed the predictive factors for the development of this condition. All patients presenting with subarachnoid hemorrhage between 1992-2001 were evaluated. All of them had initial computed tomography (CT) and hydrocephalus was diagnosed on CT scans. Age, gender, preexisting diabetes mellitus and hypertension, neurological state according to the Hunt and Hess scale at admission, Fischer grade on CT, the presence of intraventricular hemorrhage and localization of aneurysm were analyzed to see if there was any meaningful relationship between hydrocephalus and these factors. One hundred and fourteen patients with aneurysmal subarachnoid hemorrhage were evaluated. The incidence of hydrocephalus was 28.1 %. The incidence for acute hydrocephalus was 18.4 %, for subacute 5.2 % and for chronic 4.3 %. Sixty-nine percent of patients with hydrocephalus were graded as 3, 4 or 5 according to the Hunt and Hess scale on admission. Fifty-five percent of patients with hydrocephalus were graded as 3 and 4 according to Fisher grade on initial CT scan. Preexisting diabetes, higher Fisher grade and intraventricular hemorrhage were statistically significant predictors for the development of hydrocephalus. But only preexisting diabetes and higher Fisher grade were independent predictors according to multivariate analyses.     

Point-of-care prothrombin time measurement for professional and patient self-testing use. A multicenter clinical experience. Oral Anticoagulation Monitoring Study Group

We enrolled 386 subjects in a multicenter study of a point-of-care (POC) prothrombin time (PT) testing device. POC tests were performed by health care professionals using venous and finger-stick specimens and by patients using finger-stick specimens. Venous blood also was analyzed in the local hospital laboratory and a national reference laboratory. Accurate POC results were obtained by professionals using both types of specimens. Patients' results were equivalent to those of professionals. The identification of the patient's therapeutic status based on the International Normalized Ratio (INR) was equivalent for POC and local hospital laboratory PT results; 75% of local laboratory results and 77% of POC results were within 0.4 INR of reference laboratory results, while 93% of either system (POC or local laboratory) were within 0.7 INR. Patients overwhelmingly reported satisfaction with the self-test, including the finger stick and device operation. The INR from the POC device is clinically equivalent to the laboratory INR for assessment of anticoagulation status and management decisions in professional and self-testing environments. Patients can learn to perform accurate PT testing, and POC PT testing is feasible in patients' homes.     

狗颌面高速投射伤区小血管病理改变

用光镜、电镜观察狗颌面高速投射伤区小血管的病理变化。实验发现:伤区小血管可见内皮细胞缺失、管壁断裂及细胞内的变性、坏死等病理变化,外径1.0～2,5mm的小血管损伤可远达距伤缘3.0cm处,该处血管7d后基本恢复。提示:临床运用血管化游离组织移植修复颌面部火器伤后的组织缺损时,其血管蒂应与距伤缘3.0cm以外的受区血管吻合,手术最好在伤后7d进行。     

颌面部狗咬伤的临床处理

目的 结合病例讨论颌面部狗咬伤后特点及临床处理。方法 本组19例,男18例,女1例;13岁以下17例。8天后就诊者给予抗感染及换药治疗,其余均行清创缝合,组织缺损者行拉拢缝合、全厚皮移植、皮瓣转移、唇颊及鼻沟组织瓣转移修复。常规注射破伤风抗毒素及狂犬疫苗。结果 8天后就诊者瘢痕愈合,2例轻度感染,其他均Ⅰ期愈合,无破伤风及狂犬病感染。结论 患者多为儿童,均为撕裂伤,就诊时要注意全身情况,彻底清创的同时,要尽可能保留组织;组织复位要准确,及时修复缺损,防止感染,减轻面部畸形。     

Salbutamol or mist in acute bronchiolitis

Abstract Background : The role of bronchodilators in the treatment of bronchiolitis remains controversial.
Methods : A double-blind, placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol. One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were randomized to three groups as follows: (i) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline; (ii) saline was nebulized to 52 patients in group II and (iii) in group III 52 patients received mist in a tent. All three groups were administered oxygen during the procedures. Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more. Respiratory rate, heart rate, oxygen saturation and presence of cyanosis, wheezing, retractions were recorded before and after each treatment.
Results : The decrease in the respiratory score was 5.2 ± 1.8, 0.82 ± 2.4 and 1.7 ± 1.3 in group I, II and III, respectively. The decrease in group I was significantly higher than in the other groups. Heart rate was similar between groups. Oxygen saturation decreased in group I without reaching statistical significance.
Conclusions: Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis.     

HSV-tK与IL-2基因对涎腺多形性腺瘤细胞的杀伤作用

目的:观察腺病毒介导的单纯疱疹病毒胸苷激酶基因(HSV-tK)和白细胞介素-2基因(IL-2)联合杀伤人涎腺多形性腺瘤细胞的效果.方法:采用腺病毒介导的HSV-tK基因和IL-2基因联合转染人涎腺多形性腺瘤细胞;采用逆转录聚合酶链式反应(RT-PCR)检测转染后细胞的基因表达;采用四唑盐比色(MTT))法测定tK与IL-2基因对肿瘤细胞的杀伤作用及旁观者效应:采用光镜观察基因治疗后肿瘤细胞的形态学变化.结果:单独转染HSV-tK/GCV及IL-2基因5天后,涎腺多形性腺瘤细胞的存活率分别为37.7%和66.0%:联合转染5天后,细胞的存活率降至21.5%,与前二者相比差异有显著性(P＜0.05).结论:HSV-tK和IL-2基因联合使用对涎腺多形性腺瘤的杀伤作用高于上述基因单独使用的杀伤作用.