下腹部Joel—Cohen切口术后切口愈合临床观察

目的探讨肥胖患者下腹部手术采用Joel—Cohen切口对预防非感染性切口裂开的临床效果。方法选择切口部位皮下脂肪层厚达4—5cm的妇产科手术患者90例，随机分为观察组44例，采用Joel—Cohen切口；对照组46例，采用下腹正中直切口。观察切口愈合和脂肪液化情况。结果观察组切口甲级愈合率显著高于对照组（P〈0．01）；脂肪液化切口裂开率显著低于对照组（P〈0．05）。结论脂肪组织厚达4—5cm以上下腹部手术切口，采用Joel—Cohen切口可以减少脂肪液化，切口愈合显著优于下腹直切口，值得临床推广应用。     

Cohen syndrome: fertility in a female patient

In this report we describe fertility in an adult female with Cohen syndrome. She gave birth to a son, now 1.5 years old, with discrete facial stigmata and slight psychomotor retardation.     

The cohen syndrome: Report of a case

Summary We report on a sporadic case satisfied with a proposed diagnostic criteria for Cohen syndrome. This 10 year-old Japanese boy had truncal obesity, short stature, mild mental retardation, hypotonia, maxillary hypoplasia, micrognathia, narrow hands and feet, high-arched palate, prominent upper central incisors, high nasal bridge, but no pigmentary retinopathy. Autosomal recessive manner of inheritance was suggested by the pedigree.     

Effect of maternal perceived stress during pregnancy on gestational diabetes mellitus risk: A prospective case-control study

Background and aimsA variety of risk factors have been reported for the development of gestational diabetes mellitus (GDM). But limited review on the role of antenatal perceived stress necessitated the design of the present study to evaluate the association between GDM and perceived stress during pregnancy.MethodsA prospective case-control study was carried out among 100 GDM cases and 273 matched controls, attending regular antenatal clinic at two private hospitals of Karnataka. Data was collected by personal interviews using a standard questionnaire. Perceived stress was assessed using the Cohen 10-item Perceived Stress Scale. Score of ≥20 was identified as high stress. Statistical Package for the Social Sciences version 15 was used for analysis.ResultsExposure rates for high maternal perceived stress among cases during pregnancy were noted. The odds of GDM were 13 folds higher among those with high antenatal stress (≥20) compared to those with low (<20) (p < 0.001) perceived stress. No correlation between maternal antenatal stress and blood glucose following OGTT was noted.ConclusionsThe study identified high perceived stress during pregnancy as a potential risk factor for GDM.     

Effects of Nisoldipine on Hypertension and Glomerulosclerosis in Cohen Diabetic Rat with Goldblatt Hypertension

Nisoldipine treatment for five months prevented a rise in blood pressure in Cohen diabetic rats with Goldblatt hypertension, compared to a significant elevation in untreated controls. Blood creatinine and urea also decreased significantly in the treated animals, and renal lesions were less severe. The prevalence of glomerulosclerosis, however, remained unaltered in both the treated and control groups. These findings indicate that increased blood pressure aggravates renal changes, while reducing it eliminates the aggravation.     

Comparison of late (62 to 140 months) degenerative changes in simultaneously implanted and explanted mitral valve positions in six patients

A Hancock porcine bioprosthesis (PB) was simultaneously implanted in each of 6 patients aged 30 to 64 years (mean 45) in the tricuspid and mitral valve positions and both PBs were explanted 62 to 140 months (mean 102) later. Cuspal degenerative changes occurred in all 12 PBs. In 5 patients, the changes were more extensive on the PBs in the mitral position than in those in the tricuspid position. Cuspal calcific deposits, as determined by radiographs of the explanted bioprostheses, occurred in 5 PBs in the mitral position and in 3 in the tricuspid position: 1 patient with calcific deposits in the PB in the mitral position had no calcific deposits in the corresponding PB in the tricuspid position; 1 patient had heavy calcific deposits in the PB in the mitral position and only mild deposits in the PB in the tricuspid position; and 3 patients had similar but mild calcific deposits in both PBs. Cuspal tears occurred in 5 of the 6 PBs in the mitral position and in no PB in the tricuspid position. Thrombus was observed on the ventricular aspects of the bioprosthetic cusps in 1 PB in the mitral position and in 4 PBs in the tricuspid position. Thus, in our 6 patients, the degenerative changes were more extensive in the PBs in the mitral position than in those in the tricuspid position. These observations indicate that wear characteristics of simultaneously implanted PBs vary according to the site of implantation.     

Practical model description of peripheral neural excitation in cochlear implant recipients: 3. ECAP during bursts and loudness as function of burst duration

In this, the third paper of the series, the loudness of low-rate bursts of electrical pulses was measured as a function of the burst duration, in subjects implanted with the Nucleus^® 24 cochlear implant system (three with straight and two with Contour™ electrode arrays). In order to help distinguish between the contributions of peripheral and more central effects, the ECAP was recorded to the individual pulses comprising the bursts, using the Neural Response Telemetry™ (NRT™) system. At a pulse rate of 250 pulses/s, the ECAP amplitude did not decrease greatly during the bursts: the mean reduction factor was 0.89. The time-constant for summation of the loudness contributions from the pulses comprising a burst was found to be larger than that associated with normal hearing. In addition, the first pulse of a pulse train was found to contribute much more to the overall loudness than did the subsequent pulses, although a corresponding difference was not observed in the ECAP recordings. These results establish a necessary connection between the essentially single-pulse model, developed in the fourth and fifth papers of the series, and the psychophysical data for pulse bursts, but they also have broader implications.     

Metabolic, endocrine, and drug-induced interference with pituitary function tests: a review.

Data are summarized concerning some common disease-induced and drug-induced alterations of pituitary function tests. These factors must be kept in mind in order to avoid errors in the diagnosis and treatment of pituitary disease.     

Field potential and single unit analyses of the avian dorsal motor nucleus of the vagus and criteria for identifying vagal cardiac cells of origin

The compound action potential components and their associated fiber contingents were investigated in the pigeon vagus nerve with a view toward identifying the vagal cardioinhibitory fibers. In the cervical vagus, the compound action potential evoked by electrical stimulation included four major components that conducted at 17.0-30.0 (A-wave), 8.0-14.5 (B2-wave) and 0.8-2.0 (C-wave) m/sec. Cardiac slowing was not elicited until activation of the Bl-wave, and the bradycardic response was maximal when this component was maximized. Electron microscopic analysis of the cervical vagus revealed myelinated fibers 1.1-6.8 micron in diameter and unmyelinated fibers 0.3-1.4 micron in diameter. A contingent of myelinated fibers approximately 2-4 micron in diameter apparently generated the Bl-wave, while the prominent unmyelinated fiber contingent (37%) accounted for the C-wave. Analysis of various vagal branches indicated that approximatley 20% of the cervical vagal fibers exit the main trunk between cervical and mid-thoracic levels, but few of these are the larger myelinated fibers greater than 2 micron in diameter. The upper abdominal vagus consists largely of unmyelinated and small myelinated fibers, and consequently the vast majority of larger myelinated fibers found in the cervical vagus exit between mid-thoracic and upper abdominal levels, presumably in the cardiac branches. Direct examination of the cardiac branches confirmed this. Thus, it is concluded that the Bl-wave of the compound action potential is uniquely associated with cardiac slowing, that this component is generated by myelinated fibers ranging from 2 to 4 micron in diameter, and that almost all such fibers are destined for the cardiac branches of the vagus.     

The suicidal patient on the surgical ward: a multidisciplinary case conference

A multidisciplinary conference was held concerning a young woman hospitalized with multiple injuries resulting from a suicide attempt. This case demonstrates the usefulness of a unified biopsychosocial approach to the care of a suicidal patient requiring treatment by numerous services in the general hospital.