44Sacral extracorporeal magnetic stimulation is an effective treatment for pelvic floor dyssynergia; Comparative study with biofeedback therapy

Background: Recent development of extracorporeal magnetic stimulation (ECMS) which uses current‐changing magnetic fields allows the induction of electrical stimulation in the desired deep tissue. Recent study showed the sacral nerve stimulation reduces corticoanal excitability that may play a functional role in anal continence mechanisms. Preliminary study shows that ECMS of sacral nerve can modify pelvic floor function and expel rectal balloon in patients with pelvic floor dyssynergia (PFD). Aims: To evaluate the effect of ECMS compared with biofeedback therapy (BF) in patients with PFD. Methods and Materials: Thirty‐eight patients who fulfilled Rome II criteria for PFD by colon transit time and anorectal function tests, were randomly treated with 8 sessions of ECMS (2/weeks; n = 19) at prone position or BF (2/weeks; n = 19) at sitting position. Stimulation parameters were set at 50–80% of maximum intensity, 10 and 50 Hz frequency, 3 s burst length with 3 and 6 s off using arm‐typed stimulator (BioCom‐1000, Mcube Co., Korea). Symptom scores for constipation with/without anorectal function test were repeatedly measured after each treatment. Response was defined as 50% or more decreased symptom score after treatment (partial response: 30–50%, poor: <30%). Results: Fifteen patients (age 49.1 ± 13.4 years, mean ± SD; 4 men) completed 8 session of BF and 14 patients (54.5 ± 17.6 years, 3 men) completed 8 session of ECMS. Four patients of BF group discontinued treatment due to unsatisfactory therapeutic effect (n = 1) and withdrew consent (n = 3) and 5 patients of ECMS group discontinued treatment because of same reasons (n = 1, 4). Total symptom scores were significantly decreased after treatment of 8 session in both treatment groups (13.4 ± 6.6 vs. 4.3 ± 4.0 for BF, p = 0.009; 14.9 ± 5.6 vs. 3.4 ± 4.0 for ECMS, p < 0.001). Bowel movements per week were also significantly increased after treatment in both groups (median 2 vs. 7 for BF, p = 0.035; median 2 vs. 7 for ECMS, p = 0.008). Thirteen out of 15 patients showed response in BF group and 12 out of 14 showed good response in ECMS group. No adverse effects in both groups. Conclusions: ECMS is as effective as BF for the treatment of PFD. Long‐term effect of ECMS for the patients with pelvic floor dyssynergia need to be evaluated in the near future.     

Patient satisfaction during the administration of local anesthesia using a computer controlled local anesthetic delivery system

Patients undergoing a surgical procedure first must be properly anesthetized prior to the procedure to minimize discomfort. The effectiveness of a Computer Controlled Local Anesthetic Delivery System (CCLADS) known as the "wand," was evaluated. Patient anxiety and pain associated with the injection of anesthesia both decreased using this method.     

Choosing general surgery: insights into career choices of current medical students

HYPOTHESIS: The number of unfilled general surgery programs in the United States increased from 4 in 1999 to 41 in 2001. This study seeks to determine if changes in student attitudes occurring during their medical school careers and during the third-year general surgery clerkship contribute to a decline in interest in a surgical career. DESIGN: Prospective survey of medical students at a public medical school in California. PARTICIPANTS AND METHODS: Each medical student received a survey via the Internet. Responses were anonymous. Once quantified, chi(2) analysis was used for comparison and analysis of survey results. Comparisons were made between individual class years and on the basis of whether the respondent completed the third-year general surgery clerkship. RESULTS: Of 368 surveys sent, 232 (63%) were successfully completed and included in the study. Comparison of students' attitudes before and after completion of their general surgery clerkship showed that following surgical course exposure more students believed surgery lacked breadth of expertise, limitations over stress, control over one's time, regularity of schedule, adequacy of leisure time, and income commensurate to workload (P<.05). These results are also consistent in comparisons between individual class years. CONCLUSIONS: Data suggest that medical students seem to be more concerned with issues of "controllable lifestyle" such as adequacy of family and/or leisure time, high level of stress, and amount of work and commitment. The erosion of income differential between demanding and less taxing specialties was also an important cause cited for the flagging interest in surgical disciplines.     

Threats to the surgical residency in the academic medical center

Threats to the current form of surgical training in the academic medical center include financial pressures from the government and managed care organizations. A diminishing medical student interest in surgical careers has been noted. The constraints of managed care hold the potential to introduce weaknesses in surgical training in the academic medical center.     

Serial abdominal closure technique (the "SAC" procedure): a novel method for delayed closure of the abdominal wall

Abdominal compartment syndrome may occur after any elective or emergent abdominal operations that are complicated by postoperative hemorrhage or in the trauma patient who has massive fluid replacement for intra-abdominal bleeding. Once the abdomen is decompressed the type of closure varies as much as the surgeon performing the procedure. We have devised a simple, reproducible, inexpensive, and safe method to close the abdomen at the bedside. Serial abdominal closure (SAC) was performed on three patients 45, 54, and 14 years of age who had developed abdominal compartment syndrome secondary to an upper gastrointestinal bleed requiring massive transfusion, a tear of the superior mesenteric vein, and a grade 4 liver laceration respectively, all necessitating abdominal decompression. All three patients had their abdominal wounds closed at the bedside over the course of several days with our SAC technique. Subsequent postoperative course was uneventful and the abdominal wall was free of defects at one-year follow-up. SAC is an efficient, inexpensive, and easily reproducible method of managing the open abdomen. The use of SAC prevented abdominal closure-related complications such as enteric fistula and hernia formation in our three patients.     

Carcinoid Tumors of the Common Bile Duct: Report of Two Cases

We report two cases of carcinoid tumors of the common bile duct. The first patient was a 65-year-old woman in whom a carcinoid tumor of the distal bile duct was incidentally found during an open cholecystectomy for cholecystitis. The second patient was a 27-year-old man in whom a distal common bile duct carcinoid was incidentally found during orthotopic liver transplantation for sclerosing cholangitis and multiple biliary strictures. There are few reports of carcinoid tumors of the extrahepatic ducts, and a brief review of the relevant literature is discussed following these case reports. Received: April 22, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: D. K. Imagawa     

小鼠脑缺血后的能量代谢改变和药物的作用

应用部分结扎小鼠颈总动脉(包括迷走神经)及小鼠断头法引起脑缺血后,脑组织的ATP和磷酸肌酸明显降低,乳酸明显升高。部分结扎颈动脉出现四肢无力、转圈及昏睡等症状,其严重程度与脑能量代谢改变相平行。皮下注射尼莫地平、硝苯吡啶、尼卡地平和三七皂甙对脑缺血有一定保护作用。苯巴比妥钠能改善正常和脑缺血小鼠的脑能量代谢,人参皂甙Rb₁可降低正常小鼠脑乳酸含量。     

聚羟基丁酸己酸酯/聚碳酸亚丙酯共混材料作为血管组织工程支架的性能特征

目的：为改善生物材料聚羟基丁酸己酸酯（PHBHHx）的力学性能和聚碳酸亚丙酯（PPC）的可加工性,将两者共混,制备不同比例的共混材料,并对共混膜上血管平滑肌细胞的黏附和共混材料制成的管形支架的力学性能进行评价,以选出合适比例的共混材料作为血管组织工程支架。 方法：实验于2006-08/2007-04在清华大学生物科学与技术系生物膜与膜生物工程国家重点实验室完成。①制备5种不同比例（PHBHHx∶PPC分别为0∶10,3∶7,5∶5,7∶3,10∶0）的共混材料,利用CCK-8试剂测定兔主动脉平滑肌细胞在共混膜上培养24h后的黏附数量。②采用热致相分离和冷冻干燥法制备管形支架,通过反复浸渍和晾干,在多孔支架外层形成一层晾干的膜层。利用扫描电镜观察支架形貌、压汞仪测量孔隙率和孔径分布,利用自制装置以6.65kPa/s的加压速度测定管形支架的破裂强度,万能材料试验机测定支架的缝合强度,以羊颈动脉为对照。 结果：①兔主动脉平滑肌细胞在各种膜上培养24h后,在5∶5比例PHBHHXx/PPC共混膜和PPC膜上相对黏附量高于PHBHHXx膜（P〈0.05）。②PHBHHx和共混材料均可制备成管形支架,而单纯PPC支架在制备晾干层时溶化,无法维持原形。管形支架的孔径随PPC含量的增加而增大,孔隙率提高。③支架的破裂强度与羊颈动脉相似（P〉0.05）;缝合强度均强于羊颈动脉,以5∶5和3∶7PHBHHx/PPC共混材料制备的管形支架的缝合强度高于PHBHHx支架。 结论：①与PHBHHx相比,5∶5PHBHHx/PPC共混膜和PPC膜上兔主动脉平滑肌细胞的黏附更好。②共混材料均可以制备成管形支架,并且力学强度符合移植的要求,缝合强度以5∶5和3∶7的PHBHHx/PPC共混材料最佳。