Wooden stick penetration from the perineal region up to the thorax

BACKGROUND: Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important.METHODS: The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing.RESULTS: The post operative period was uneventful and the patient recovered fully.CONCLUSION: Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.     

Theophylline and status epilepticus in children

We studied the role of theophylline on outcome of status epilepticus (SE) in children. During a two-year-period, 16 of 114 episodes of SE occurred in children receiving theophylline. At the onset of SE, theophylline blood levels were elevated in 8 episodes, and were therapeutic or subtherapeutic in 8 episodes. In the 8 episodes of SE with elevated theophylline levels, one child died and three suffered permanent new neurologic deficits. In the 8 episodes of SE with normal or low theophylline levels, only one child had a transient deficit. The occurrence of death or disability in 4 of 8 episodes of SE with elevated theophylline was considerably higher than the 23% incidence of death or persistent CNS deficit in the overall series of 114 episodes of SE. We conclude that theophylline, at toxic levels, is a significant factor in increased morbidity. We suspect that the hypoxia from the respiratory disorder for which theophylline was used, and the reduced cerebral blood flow known to occur with theophylline led to a failure to compensate for the increased cerebral metabolic rate of SE, thus increasing the risk of a poor outcome.     

A study of 10 cases of velopharyngeal incompetence treated by flap pharyngoplasty

Velopharyngeal incompetence (VPI) is a condition of incomplete closure of V.P. port area, normally formed by velum and posterior pharyngeal watt. The condition primarily results in various types of speech defects, which form- the main complaint of the patient. We have studied 10 cases of VPI due to various causes and the speech improvement obtained by flap pharyngoplasty procedures. The results have been evaluated with a follow-up of six months. Highly encouraging results only indicate a more frequent need to undertake such surgery without any hesitation if the ENT surgeon is familiar with and has an adequate exposure to this simple and effective procedure.     

锁骨中段骨折--手术与非手术治疗比较

有些证据表明,锁骨中段骨折采用手术或非手术治疗都可以获得成功,但非手术治疗的并发症更少。数据多数来自病例组研究,因此还需要对比研究来证明这些原始数据的真实性。     

An oral selective M3 cholinergic receptor antagonist in COPD.

Cholinergic antagonists have been used since the early 1900s as bronchodilators for chronic obstructive pulmonary disease (COPD). The present study investigated whether an oral muscarinic M3-selective anticholinergic agent (OrM3) would provide an improved therapeutic advantage compared with an inhaled anticholinergic agent in patients with COPD. A 6-week, multicentre, randomised, placebo- and active-controlled, parallel-group study was performed at 56 sites in the USA. In total, 412 male and female patients (aged 35-86 yrs) with a clinical history consistent with COPD were randomised to receive OrM3 0.5, 2, 3 or 4 mg orally once daily, ipratropium bromide 36 mug by inhalation four times daily or placebo. OrM3 demonstrated a significant dose-related improvement in serial forced expiratory volume in one second and a trend for dose-related improvement in patient-reported symptoms compared with placebo. However, at a dose that provided efficacy less than that of ipratropium, the incidence of dose-related, mechanism-based side-effects for OrM3 exceeded those observed for ipratropium. In patients with chronic obstructive pulmonary disease, the oral M3-selective agent did not offer a therapeutic advantage over inhaled ipratropium. These results do not support the hypothesis that high selectivity for muscarinic M3 receptors over airway neuronal M2 receptors will represent a more effective therapy than current inhaled anticholinergics in obstructive airway disease.