IMPROVED BALLOON‐TIPPED TRANS‐ANAL ILEUS TUBE

Background: For management of bowel obstruction due to colorectal cancer, endoscopic trans‐anal decompression technique has been first reported by Lelcuk et al. in 1986 using balloon dilatation technique. Since then, various types of trans‐anal decompression tubes have been clinically used for patients suffering from left side obstructing colorectal cancer as an emergent decompressing device. At present, two types of trans‐anal ileus tube (trans‐anal decompression tube) have been available for clinical use, but they have two main problems that are late colon perforations caused by the tip of the tube and tube obstruction by stool. Methods: Analysis on three late colon perforations experienced with the use of conventional devices drew possible improvements to make a trans‐anal ileus tube less harmful. To overcome the pitfalls inherent to conventional tubes, the author has developed an improved trans‐anal ileus tube with a balloon installed at the very end of the tube (‘balloon‐tipped type’) made of silicone, measuring 1200 or 1700 mm in total length and 22 Fr in outer diameter. It has been used for 12 cases with obstructing colorectal cancer etc. and its outcomes were compared with those obtained by the use of conventional trans‐anal ileus tube. Results: No late perforations have been encountered, but tube obstruction did occur in one of 12 cases. Conclusion: The new trans‐anal ileus tube with a balloon installed at the tip of ileus tube is considered to be safer and especially effective in preventing late colon perforation and tube obstruction.     

9例结石性肠梗阻的诊断与治疗

目的 探讨结石性肠梗阻的诊断及治疗。方法 比较腹部平片和B超的术前诊断率。随访患者以了解不同手术方法的得失。结果 腹部平片术前诊断率为22％,辅以B超则上升为66％。4例Ⅰ期手术和3例Ⅱ期手术患者无死亡。无胆管炎发作。结论 仅靠腹部平片易漏诊,辅以B超则能提高术前诊断率。争取回期手术切除胆囊、闭合胆肠瘘,如有困难,则动员患者6-8周后Ⅱ期手术。     

刃厚皮片联合微型带真皮下血管网全厚皮片修复截瘫褥疮

目的：应用刃厚皮片联合微型真皮下血管网全厚皮片修复截瘫褥疮。方法：对6例截瘫褥疮，增强全身支持治疗，彻底清除褥疮的炎性肉芽组织及坏死组织后，采用刃厚皮片联合微型真皮下血管网全厚皮片修复．结果：5例Ⅰ期愈合，1例Ⅱ期愈合。结论：本法操作简单，愈合较快，具有一定的耐磨性，为进一步皮瓣修复奠定了基础，是修复难治性截瘫褥疮较理想的方法．     

北京市1989～2002年疫苗相关麻痹型脊髓灰质炎病例的监测

北京市急性弛缓性麻痹 (AFP)病例监测系统 1989～ 2 0 0 2年共诊断疫苗相关麻痹型脊髓灰质炎 (脊灰 )(VAPP) 2 0例 ,其中首次服苗VAPP 18例 ,接触服苗VAPP 2例。所有病例均 <2岁 ,<6月龄病例占 85 %。男女发病之比为 9∶1。每年VAPP发生率无明显季节性高峰和地区差异。VAPP总发生率为 1 2 0 / 10 0万剂口服脊灰减毒活疫苗 (OPV)投放量或 1 5 9/ 10 0万剂OPV接种量 ,首次服苗VAPP发生率为 13 18/ 10 0万剂首次服苗量 ,接触服苗VAPP发生率为 0 16 / 10 0万剂OPV接种量。监测结果表明 ,北京市VAPP发生的危险性高于中国其它省份和其它许多国家与地区 ;免疫缺陷和 /或肛门周围脓肿可能是VAPP重要的危险因素。在中国当前尚未改变脊灰疫苗免疫策略的情况下 ,为减少和避免VAPP的发生 ,必须加强接种前儿童病史询问和体检 ,严格掌握接种禁忌证 ;同时要加强对VAPP的监测工作。     

Der operierte mechanische Ileus

Zusammenfassung Von 1972 bis 1983 wurden 351 Patienten wegen eines mechanischen Dünndarm- (n = 256) bzw. Dickdarmileus (n = 95) operiert. Die chirurgische Komplikationsrate betrug beim Dünndarmverschluß 28,1 bzw. beim Dickdarmileus 24,3%, wobei am häufigsten Anastomosendehiscen-zen nach Resektionen (17,7% bzw. 53,8%), Enterotomien (5,8%/27,2%), Platzbäuche (3,5%/4,2%) und ein Re-Ileus (5,5%/3,2%) vorlagen. Die internistischen Komplikationen (postop. Pneumonien, Lungenembolien, kardiale Dekompensationen etc.) betrugen 17,9% bzw. 22,1 %. Die perioperative Letalität lag beim Dünndarmileus bei 20,6% und beim Dickdarmileus bei 33,4%. Als Schlußfolgerungen dieser retrospektiven Analyse ergaben sich die frühzeitige, perioperative, intensiv-medizinische Behandlung, die generelle Thrombose-, Pneumonie- und StreBulcusprophylaxe, die exakte, präoperative Röntgendiagnostik, die strenge Indikationsstellung für Enterotomien und Resektionen, das dreizeitige Vorgehen beim linksseitigen Dickdarmileus, die Inkontinuitätsresektion nach Hartmann bei entzündlichen Prozessen im Sigmabereich und die innere Dünndarmschienung bei Peritonitis bzw. ausgedehnten Adhäsionen. Dadurch konnte seit Anfang 1984 die Komplikationsbzw. Letalitätsrate beim Dünndarmileus (n = 64) auf 9,4% bzw. 4,7% und beim Dickdarmileus (n = 20) auf 10% bzw. 5% gesenkt werden.

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Experiences with operations of mechanical ileus

Summary Between 1972 and 1983 a total of 351 patients was operated suffering from mechanical occlusion of the small intestine (n = 256) and of the colon (n = 95). The surgical complication rate amounted to 28.1% in cases of small intestine ileus and to 24.3% in cases of colon ileus; the most frequent complications were anastomotic dehiscences following resections (small intestine 17.7%/colon 33.8%), enterotomies (5.8%/27.2%), abdominal wall ruptures (3.5%/4.2%) and re-ileus (5.5%/3.2%). The medical complication rate (postop. pneumonia, pulmonary embolism, cardial decompensation etc.) amounted to 17.7% resp. 22.1%. All these complications carried a mortality of 20.6% in small intestine ileus and of 30.4% in colon ileus. The consequences of this retrospective analysis resulted in: early intensive care treatment, general perioperative thrombosis-, pneumonia- and stress ulcer prophylaxis, exact preoperative radiological diagnosis, strict indications for enterotomies and resections, sole transversostomy in stage of ileus for the left-sided colon obstruction caused by carcinoma, discontinuity resection by Hartmann in cases of inflammatory or perforated large bowel stenoses and tube decompression of the small bowel in cases of peritonitis or wide-spread adhesions. Since 1984 we could prospectively decrease the complication resp. mortality rate of the small intestine ileus (n = 64) to 9.4% resp. 4.7% and of the colon ileus (n = 20) to 10% resp. 5%.

     

炎性肠梗阻15例诊治体会

目的探讨炎性肠梗阻的诊断和治疗。方法分析15例炎性肠梗阻的临床特点和治疗。结果15例经保守治疗,其中1例因肠扭转缺血损伤严重,出现全身性炎症反应综合征致多脏器衰竭死亡外,其他病例均痊愈,平均治愈时间为12.6d。结论炎症性肠梗阻由无菌性炎症致广泛肠粘连引起,应用小剂量激素减缓炎症反应,抗生素防止肠道菌群易位,经内镜逆行置入肠减压管及营养支持治疗,多数病例可保守治愈。     

ADJUSTABLE SUTURES IN STRABISMUS SURGERY: A PERSONAL SERIES OF CASES

A personal series of 77 separate primary adjustable suture procedures performed on 69 patients is analysed. Adjustable suture surgery was performed on patients over ten years of age undergoing rectus muscle surgery, and a few selected younger patients. The ages ranged from 7 to 74 years. A 24-month-old infant who had a two-stage-anaesthesia is included in the series.
Thirty-eight of the 69 patients were reoperations. Of the 77 primary procedures, 48 (62.3%) required postoperative adjustment; 29 (37.7%) were tied down without adjustment.
Sixty-two of the 69 patients (89.8%) achieved a "cure". A further four patients (5.8%) were initially in desired alignment, but deteriorated within the follow-up period. Three of these were successfully reoperated. Of the three primary failures (4.4 %) two were reoperated with one achieving orthophoria.
Apart from alignment failure in the primary procedure, complications were minimal. Current follow-up periods range from one to 24 months.     

The direct early diagnosis of cystic fibrosis by the detection of the deltaF508 CFTR gene mutation in a prematurely delivered boy

The suspicion of prenatal meconium ileus syndrome was raised in a pregnancy in a family with no history of cystic fibrosis because of significantly higher maternal serum alpha-fetoprotein in the 16th and 19th week of gestation, dispersed areas with increased echogenity in the fetal abdomen, slight fetal ascites in the 24th-25th weeks of gestation, decreased amniotic fluid gamma-glutamyltranspeptidase (GGT) activity and alpha-fetoprotein level in the 25th-26th weeks, and normal 46,XY karotype of the fetus. The detection of a homozygous deltaF508 cystic fibrosis transmembrane regulator (CFTR) gene mutation, by means of PCR from a small amount of white blood cells and urine sediment cells, substantiated the diagnosis of cystic fibrosis in a prematurely delivered boy in the 28th week of gestation. The repeated sweat test was unsuccessful. The autopsy examination confirmed the diagnosis of cystic fibrosis. Fetal meconium ileus syndrome was complicated by peritonitis and by formation of a meconium pseudocyst. Direct PCR typing improves postnatal diagnostic possibilities in the early neonatal period in prematurely delivered babies when the sweat test is difficult to perform.     

An enzyme‐linked immunosorbent assay to detect the presence of paralytic shellfish poison using an induced crab protein marker

A purified, high molecular weight protein (referred to as saxitoxin‐induced protein, SIP), was obtained from crabs, Hemigrapsus oregonesis, by affinity chromatography prior to use in a homologous crab SIP enzyme‐linked immunosorbent assay (ELISA) procedure. The SIP measured in H. oregonesis control crabs given acute saxitoxin (SAX) challenge injections (SAX range 0–50 ng), was less than the amount of SIP present in H. oregonesis crabs exposed to a natural toxic dinoflagellate outbreak. The latter were collected from a paralytic shellfish poison (PSP) contaminated coastal area which also contained PSP toxic butterclams (2000 μg PSP per 100 g shellfish), tested by the conventional mouse lethality bioassay procedure. These ELISA results were confirmed by an immunoblotting procedure using anti‐SIP antibody. An immunoblotting procedure of purified SIP and crude SIP antiserum revealed no cross‐reactivity with control, SAX uninjected crabs, thereby indicating specificity of the assay. The method is fast and useful for the screening of antigens expressed in crabs as a consequence of PSP, and represents a procedure that will complement the standard mouse bioassay.     

一起赤潮后海产品麻痹性贝类毒素衰减结果分析

目的 以2017年漳州沿海一起赤潮引起的麻痹性贝类毒素(paralytic shellfish poisoning,PSP)中毒事件为研究起点,研究贝类海产品中的PSP在自然条件下的衰减情况。方法 在漳浦佛昙和龙海港尾海域采集牡蛎和贻贝进行PSP检测。结果 2017年6月8日相关海域海产品最大毒素总毒力为21 056.7 μg/kg,2017年6月26日海产品PSP总毒力值衰减86%以上,2017年7月20日海产品PSP总毒力值衰减97%以上,2018年12月所有海产品中PSP均未检出。结论 本次赤潮发生后,漳浦佛昙和龙海港尾两个海域贝类海产品约需45天净化周期方可食用,相关海域约需18个月净化至贝类毒素完全消失。