Successful Foley catheter tamponade of an epigastric vessel trocar injury in a toddler – A case report

Introduction and importanceInjuries to the inferior epigastric vessels during laparoscopic surgery are rare but reported. They can lead to significant morbidity. We report the successful tamponade of a bleeding epigastric vessel during laparoscopic inguinal hernia repair in a child using a Foley catheter. A Foley catheter has not been routinely used in pediatric surgery for this indication so far.Case presentationA 32-month-old boy underwent laparoscopic left inguinal hernia repair. During insertion of a 2 mm trocar, the left inferior epigastric vessels were lacerated, leading to a brisk bleed into the abdominal wall and into the abdomen through the trocar site during the procedure. When the hemorrhage was noted, the trocar was removed. The trocar tract was slightly dilated using a blunt forceps and a 12 F Foley catheter was introduced into the abdomen. The balloon was insufflated with 10 ml of water and the catheter was retracted towards the abdominal wall, tamponading the bleed. The inguinal hernia repair was completed, and after desufflating the catheter at the end of the procedure, the hemorrhage had stopped.Clinical discussionPostoperatively, the hemoglobin had dropped by 1.5 g/dl to 9.3 g/dl. The patient was observed and then discharged on the same day. Besides an additional 2 mm scar in the right lower quadrant, he had no further sequellae or adverse effects.ConclusionHemorrhage resulting from trocar injury of the inferior epigastric vessels during laparoscopy can be controlled by Foley catheter insertion and tamponade in children. Pediatric surgeons should be aware of this useful maneuver to manage this complication.     

Retention of Tourniquet Application Skills Following Participation in a Bleeding Control Course

IntroductionThe American College of Surgeons’ Stop the Bleed program has trained more than 1 million individuals to recognize and treat external hemorrhage. Central to this training is tourniquet application. No published studies review the retention of this skill after initial class participation.MethodsOne hundred fourteen volunteers agreed to participate. A random sample of 57 was selected and 46 participated. Upon return 6 months later, each participant demonstrated tourniquet application. An observer compared the application process with steps on a checklist. Each step completed correctly was tallied, and the total score for all 10 steps was computed as a percentage correct between 0% and 100%.ResultsThe baseline score on the tourniquet skill test was 100% following initial training. At 6 months, mean scores were lower, 69% (SD = 31%) (χ² = 52.09, df = 1, P < 0.001). Fourteen volunteers (30%) attained a score of 100%, and 28 volunteers (61%) achieved a passing score. Bleeding was stopped or reduced to non–life-threatening levels by 34 participants (74%). Participants with passing scores were more likely to stop or reduce the bleeding than those with failing scores (97% vs 35%; χ² = 20.99, df = 1, P < 0.001). Of the 17 volunteers who failed, 18% stopped the bleeding, 18% slowed bleeding to a non–life-threatening level, and 64% were unable to control bleeding.DiscussionAt 6 months, 39% of participants were unable to successfully apply a tourniquet, and 26% were unable to control life-threatening bleeding. This study demonstrates that refresher training is needed within 6 months of initial training.     

蛇毒抗栓酶对家兔颈动脉和股动脉血流量及心血管作用的初步观察

本文用电磁流量计和多导生理记录仪初步观察了蛇毒抗栓酶对正常麻醉兔颈、股动脉血流量、血压及心率的影响。结果表明,蛇毒抗栓酶能减少颈动脉血流量,增加股动脉血流量,降低血压,增大脉压,对心率无明显影响。     

Postoperative tonsillectomy bleed: coblation versus noncoblation

OBJECTIVE: To examine the incidence of postoperative bleeding after coblation and noncoblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with this new surgical technique. STUDY DESIGN: A retrospective review of records from January 1999 to April 2003 to determine type of tonsillectomy performed and the presence of postoperative bleeding. A chi-square analysis was used to determine a statistical difference between the postoperative bleed rate of coblation and noncoblation procedures. The examined time period was divided into 3-month intervals, and the coblation postoperative bleeds were tallied for each interval. The Cochraine-Armitage test of linear trend was used to assess change in the postoperative bleeds. RESULTS: One thousand seven hundred sixty-two tonsillectomies were performed. The postoperative bleed rate for noncoblation tonsillectomy was 6.1% (74/1,216). The bleeding rate for coblation tonsillotomy was 5.9% (18/303) and 5.4% (13/239) for coblation tonsillectomy. There was no statistical difference (P = .93) between bleed rates for coblation versus noncoblation techniques. There was no difference in the need for operative intervention to control postoperative bleeding: 16.2% (12/74) for noncoblation technique and 25.85 (8/31) for coblation procedures (P = .25). The postoperative coblation bleed rates for the 3-month periods did not reveal an increasing or decreasing trend in the postoperative bleed rate (P = .49). CONCLUSION: Coblation is a safe procedure for performing tonsil surgery with no significant difference in postoperative bleeding from previous techniques and no increased need for operative intervention to control postoperative bleeding. A learning curve could not be identified when using postoperative bleeding as an outcome measure for coblation tonsillectomy.     

中度高原老年人消化性溃疡临床内镜分析

探讨高原地区老年人消化性溃疡临床特点 ;方法 :2年中对西宁地区(海拔 2 2 6 0m) 3 6 79例病人进行上消化道内镜检查 ,检出老年人消化性溃疡 75例 (2 % )。男性 6 4例 ,女性 11例 (5 .8 1,P <0 .0 0 1)。球溃疡多于胃溃疡 (1.4 1,P <0 .0 1)。复合性溃疡 (8% )、多发性溃疡 (16 % )明显升高 ;结论 :临床症状多不典型 ,上消化道出血是其主要并发症 ,探讨不同民族老年人在不同海拔地区的消化性溃疡的发病规律 ,对高原老年人的健康有重要意义。     

严重烫伤家兔球结膜微血流动态和微血管周围状态的观察

目的观察严重烫伤后家兔球结膜微循环（BCMC）的血流动态以及血管周围状态的变化。方法30只成年健康家兔，采用自身对照，依次观察并记录假烫后与烫伤后九个时相的BCMC血流动力学变化和BCMC的出血和渗出。结果烫伤后与假烫后的家兔BCMC的血流动力学各指标存在显著性差别（P〈0．05）；从烫后即刻到烫后12h，出血和渗出进行性加重，到烫伤12h左右出血达高峰。结论严重烫伤可致家兔BCMC的血流动态发生显著改变；家兔球结膜微血管出血和渗出明显；出血时间的早晚与烫伤的面积和深度有关。     

静脉全麻对鼻内镜手术中出血量的影响

目的 观察综合措施基础上静脉全身麻醉对鼻内镜手术中出血量的影响。方法 将60例患者随机分为2组, 每组30例。A组为静脉全麻组, B组为吸入全麻组。两组患者诱导气管插管后, A组以丙泊酚及瑞芬太尼持续泵注维持麻醉至手术结束前5 min停药;B组以吸入七氟烷维持麻醉, 手术结束前5 min停药。两组均行桡动脉置管测压和采血, 综合措施包括:手术开始前15 min行急性高容量血液稀释、控制性降压及静脉注射蛇毒类血凝酶1.0单位。观察手术开始前30 min(T₀)、手术开始后30 min(T₁)、90 min(T₂)及手术结束后30 min(T₃)4个时间点的动脉血气、静脉血乳酸浓度、凝血功能变化。记录2组患者手术结束时术中出血量及手术时间。结果 与T₀比较, T₁、T₂、T₃ 3个时间点动脉血气、静脉血乳酸浓度及凝血功能差异无统计学意义(P>0.05)。A组手术出血量明显少于B组(P<0.05)。结论 综合措施基础上采用静脉全身麻醉有助于减少鼻内镜手术中出血量。     

预见性护理在异位妊娠破裂出血患者护理中的作用分析

目的：探讨预见性护理在异位妊娠破裂出血中的作用,提高异位妊娠破裂出血患者的护理效率。方法：回顾性分析2008年1月～2011年1月本院收治的32例异位妊娠破裂出血患者的临床资料,并以以往本院采用常规护理的32例异位妊娠破裂出血患者为对照组,比较两组患者的临床治愈率、并发症发生率、患者满意度。结果：经过精心治疗和护理,两组患者均痊愈出院,组间比较差异无统计学意义（P〉0.05）,但是观察组患者术后恢复更快,患者满意度明显高于对照组,组间比较差异具有统计学意义（P〈0.05）。结论：预见性护理措施可有效促进异位妊娠破裂患者康复,提高临床护理工作效率,值得临床推广。     

云南白药胶囊减少经尿道前列腺电切术中出血的随机双盲对照试验

目的评价云南白药胶囊在减少经尿道前列腺电切术(TURP)术中出血的疗效与安全性。方法采用随机、双盲、对照的试验方法,将40例接受TURP手术的患者随机分为试验组和安慰剂组。试验组(n=20)术前3天起口服云南白药胶囊,每次0·25g/粒,2粒,一日4次。对照组(n=20)术前3天起口服空白淀粉胶囊。术中监测冲洗液的出血总量、腺体出血指数、出血强度,比较两组住院时间、尿管保留时间及术后膀胱冲洗的时间。结果试验组在TURP出血总量、腺体出血指数及出血强度明显低于对照组,其差异有统计学意义(P<0·05);但平均住院时间、术后保留尿管时间和术后膀胱冲洗时间与对照组比较,其差异均无统计学意义(P>0·05)。用药期间,两组均无明显毒副反应发生。结论云南白药胶囊能减少TURP术中出血量,且无明显副作用,是一种安全有效的术后止血方法。