Maîtrise des risques liés à la production des fluides de dialyse dans une unité de télédialyse

Objective

The “Centre Hospitalier Francois Dunan” is located on an isolated island and ensures patients care in hemodialysis thanks to telemedicine support. Many research studies have demonstrated the importance of hemodialysis fluids composition to reduce morbidity in patients on chronic hemodialysis. The aim of this study was to identify the risks inherent in the production of dialysis fluids in a particular context, in order to set up an improvement action plan to improve risk control on the production of dialysis fluids.

High-Pressure Water Swelling Sealant Injection Injury to the Hand: a Case Report and Review of the Literature

High-pressure injection injuries (HPII) caused by water swelling sealant are rare at present. The patient generally has small-sized skin lesions, and the misleadingly benign presentation may cause delayed treatment at the early stage of management. In addition, radiographic examination may be underestimated. Subsequently, the inadequate surgical intervention may cause tissue necrosis and poor prognosis. Furthermore, the early recognition of water swelling sealant injected into tissue and emergent surgical intervention are the key to successful management for the patient with HPII caused by injecting water swelling sealant to tissue.     

How current risk assessment and risk management methods for drinking water in The Netherlands cover the WHO water safety plan approach

In the Netherlands, safe and sufficient drinking water is provided to the general population by ten drinking water companies. To guarantee safe drinking water the World Health Organization (WHO) developed a Water Safety Plan (WSP), a Risk Assessment and a Risk Management (RA/RM) framework. The objective of the study was to identify legally required RA approaches, to document application of RA/RM activities at Dutch drinking water companies and to determine to what extent these RA/RM activities as a whole cover all the elements of the WHO WSP approach. This study could be of interest to both managers of large water utilities and decision makers.The assessment was performed by means of a policy review and interviews with two to four staff members involved in RA/RM from all ten Dutch drinking water companies combined with a joint workshop. The drinking water companies are well aware of the potential hazards and risks that can influence the drinking water quality. To guarantee the supply of safe and sufficient drinking water, the Dutch drinking water sector uses six different legally required RA/RM approaches. This study shows that by using the six legally required RA/RM approaches, all WSP steps are covered. WSP entails a generic risk assessment for identifying all hazards and hazardous events from source to tap, whereas the six legally required RA/RM each focus on specific risks at an advanced level. Each risk assessment provides information on specific hazards and hazardous events covering a part of the water supply chain. These legal requirements are complemented with additional RA/RM activities at sector and water company level such as codes of practices and standard operating procedures. The outcomes of all RA/RM approaches combined provide information from source to tap. When using multiple RA/RM approaches, it is crucial to share and combine information derived from the different activities.     

针刺配合肠炎散保留灌肠治疗肛窦炎临床研究

目的观察肛窦炎应用针刺配合肠炎散保留灌肠治疗的效果。方法选取2017年10月-2018年10月就诊的72例肛窦炎患者,采用随机数字表法分为观察组(n=36)与对照组(n=36)。对照组给予肠炎散保留灌肠治疗,观察组为针刺配合肠炎散保留灌肠治疗,比较2组症状、疗效及安全性。结果观察组症状(放射痛、指诊症状及镜检症状)少于对照组,总有效率高于对照组,差异有统计学意义(P<0.05);2组安全性相比,差异无统计学意义(P>0.05)。结论针对肛窦炎患者,予以针刺配合肠炎散保留灌肠治疗效果确切,可减少临床症状,加快疾病转归,且治疗安全性较好。     

大陷胸汤灌肠治疗流出急性肾衰的观察与护理

目的 探讨中药大陷胸汤高位保留灌肠对流行性出血热（EHF）急性肾衰的治疗作用。方法 将60例EHF急性肾衰患者随机分为对照组与治疗组各30例，对照组予以常规治疗，治疗组在常规治疗的基础上加用大陷胸汤高位保留灌肠，观察两组患者治疗前后的疗效。结果 治疗组治愈23例，好转6例，无效1例，总有效率96．7％；对照组治愈17例，好转7例，无效6例，总有效率80．0％；两组疗效比较，有显著差异性p〈0．05（x^2=4．630）。结论 大陷胸汤高位保留灌肠治疗EHF急性肾衰疗效显著，且简便、安全、经济、病人乐于接受等优点。     

胃癌大肠转移的X线钡灌肠表现

目的:分析胃癌大肠转移的X线钡灌肠表现。方法:104例胃癌入院术前检查发现结肠转移或胃癌术后转移入院治疗的病例。分析钡灌肠初次发现大肠转移征象的年龄、发现胃癌原发病变距初次发现大肠转移的间隔时间、转移病变的发生部位和病变造成的X线钡灌肠图像上的肠管变形和粘膜面的改变。结果:104例胃癌结肠转移,男67例,女37例。胃癌术前检查中发现结肠转移者32例,术后发现的大肠转移中,多数转移发生在手术后3年内(占91.3%)。胃癌原发灶的肉眼形态BorrmannⅢ型(28例)和BorrmannⅣ型(65例)者占89.4%,组织学中以低分化腺癌和印戒细胞癌为主要成分者占91.3%。X线钡灌肠检查显示大肠转移的好发部位为横结肠(80),其次为直肠(50)。转移灶可累及多节段肠管,其中横结肠中1/3段(47),横结肠左1/3(44),横结肠右1/3(39)和直肠腹膜返折之上(39)。X线显示肠管单侧变形者227处,双侧变形者96处。黏膜面表现为梳齿状黏膜纹聚集改变253处,颗粒结节状改变23处,外压性改变20处,弥漫性改变62处。结论:胃癌大肠转移的好发部位为横结肠和直肠,结肠黏膜面的梳齿状黏膜纹聚集为胃癌大肠转移的主要X线钡剂灌肠表现。     

侧方扩展型大肠肿瘤的X线特征

目的:探讨扩展型大肠肿瘤的X线与病理学特征。方法:分析了经组织病理学证实的46例54处病变的X线钡灌肠造影表现和内镜图像,将病变分为非结节扁平隆起、结节集簇性隆起和混合性结节集簇隆起3种类型,与病理组织学进行对照研究。结果:扩展型大肠肿瘤好发于直肠、盲肠和升结肠近段,组织病理学多为腺瘤或黏膜内癌,混合结节集簇隆起型病变癌变率高、浸润较深,且有进展期癌。结论:扩展型大肠肿瘤表面的形态改变,可以作为推测有无癌变与癌变浸润深度的指标。     

钡灌肠和CT及MRI对结直肠癌诊断的比较影像学研究

目的比较钡灌肠(BE)、计算机X线断层扫描(CT)和磁共振成像(MRI)对结直肠癌检查的临床价值。方法对64例经临床拟诊结直肠癌患者的影像学资料进行对比分析。结果64例患者中39例行BE检查,31例行螺旋CT检查,42例行MRI检查。其中经手术病理证实的结直肠癌54例。BE、CT和MRI对结直肠癌检查的敏感度分别为96.9%、96.2%和97.1%;准确度分别为92.3%、83.9%和90.5%。CT和MRI对结直肠癌T分期诊断的准确度分别为73.1%和82.9%。结论BE是结直肠癌的基本影像学检查方法,CT和MRI是BE必要的补充检查手段,BE加MRI是诊断结直肠癌的优选组合检查方法。     

中药高臀位灌肠治疗慢性肾功能衰竭疗效观察

目的 观察中药高臀位灌肠治疗慢性肾功能衰竭(chronic renal failure,CRF)的临床疗效.方法 将100例CRF患者随机分为两组,治疗组70例采用中药高臀化灌肠治疗,对照组30例口服活性炭治疗.结果 治疗组总有效率为88.6%,对照组总有效率为50.0%.结论 中药高臀位灌肠治疗CRF有效.     

Low doses of the 5-HT1A agonist 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH DPAT) increase ethanol intake

Previous work has reported that the 5-hydroxytryptamine (5-HT)_1A agonist, 8-hydroxy 2-(di-n-propylamino)tetralin (8-OH DPAT), reduces ethanol intake by rats. However, as 8-OH DPAT reduces 5-HT neurotransmission, these findings are inconsistent with the proposed inhibitory role of central 5-HT neurons on ethanol intake. We examined the effect of 8-OH DPAT on ethanol, water and food intake in rats maintained on a limited access schedule using a lower dose range (6–250 µg/kg) and by assessing concomitant changes in behaviour. Low doses of 8-OH DPAT enhanced ethanol intake even when food and water were offered as alternatives. Suppression in ethanol intake was observed at higher doses where elements of the 5-HT syndrome were apparent. Similar observations were made in both fluid and non-fluid deprived water drinking rats, suggesting the latter effect is non-selective. Therefore 8-OH DPAT may both increase or decrease ethanol consumption in the rat depending on the dose used.