逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区

目的探讨股前外侧皮瓣供区覆盖的新方法，以减少供区并发症。方法2003年12月～2005年12月，在应用股前外侧皮瓣移植修复肢体创伤的同时，采用逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区8例，股前外侧皮瓣修复部位：手背侧损伤伴肌腱缺损骨外露2例，足部开放性骨折伴皮肤缺损2例，小腿Gustilo Ⅲ型开放性骨折伴皮肤缺损3例，前臂掌侧皮肤缺损伴肌腱外露1例。腹壁供区伤口直接缝合。结果移植股前外侧皮瓣全部成活。逆转腹壁浅动脉皮瓣完全成活7例，1例部分坏死，经换药后愈合。股前外侧皮瓣供区伤口平均15d愈合，随访6～18个月（平均12个月），股前外侧皮瓣供区愈合平整，色泽均衡，髋关节和膝关节活动完全正常。腹壁伤口仅留线状瘢痕。结论应用逆转腹壁浅动脉皮瓣修复股前外侧皮瓣供区是一种实用而又有创意的方法。     

中医中药治疗胃脘痛120例临床观察

运用中医中药辨证治疗胃脘痛120例,分为肝郁气滞、脾胃气虚和阴虚郁热三个证型,分别采用疏肝理气,健脾和胃及滋阴清热等方法治疗,总有效率达94.7%.经统计学处理,对肝郁气滞型疗效最好,与脾胃气虚型相比有一定差异,与阴虚郁热型相比有显著差异(P<0.05);阴虚郁热型疗效最羞,与脾胃气虚型相比有显著差异(P<0.05).     

张声生教授运用风药治疗脾胃病经验

风药者,取象春季生发之气也,兼轻巧活泼、芳香辛散、轻扬升浮、通达宣散之性,此药可调肝宣肺运脾、斡旋气机升降,辅有承转机体脏腑气机以交通各脏之功,配伍风药医脾胃之疾,每获良效。张声生教授巧用风药于脾胃之疾,配伍敛阴、补气、活血、降气之药以取风药之长兼制风药之弊,其虽属佐使之品,然组方配伍之术于诊疗临床脾胃之疾常为点睛之笔,甚有裨益。     

CLINICO-PATHOLOGIC CONFERENCE: 12-YEAR-OLD GIRL WITH FATIGUE, ANEMIA, WEIGHT LOSS, ABDOMINAL DISTENTION, AND OCCASIONAL NAUSEA AND VOMITING

A clinicopathologic case is presented. The patient was a 12-year-old white girl with a history of fatigue and dizziness, occasional nausea and vomiting, and anemia, who showed abdominal distention, especially in the epigastrium. An epigastric mass was palpable. Gastroscopy was done, and surgery followed. Pertinent laboratory findings are presented, and clinical discussion follows. The pathology is then presented and discussed.     

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 The balloon was insufflated with 10 ml of water and the catheter was retracted towards the abdominal wall, tamponading the bleed.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.     

An unusual presentation of perforated appendicitis in epigastric region

INTRODUCTION

Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.

PRESENTATION OF CASE

A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.

DISCUSSION

While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.

CONCLUSION

Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.     

A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias

In accordance with the tension-free principles for other hernias, umbilical and epigastric hernia repair should probably be mesh-based. The number of randomized studies is increasing, most of them showing significantly less recurrences with the use of a mesh. Different devices are available and are applicable by several approaches. The objective of this review was to evaluate recent literature for the different types of mesh for umbilical and epigastric hernia repair and recurrences after mesh repair. A multi-database search was conducted to reveal relevant studies since 2001 reporting mesh-based repair of primary umbilical/epigastric hernia and their outcomes in adult patients. A total of 20 studies were included, 15 of them solely involved umbilical hernias, whereas the remaining studies included epigastric hernias as well. A median of 124 patients (range, 17–384) was investigated per study. Three quarters of the included studies had a follow-up of at least 2 years. Six studies described the results of laparoscopic approach, of which one reported a recurrence rate of 2.7 %; in the remaining studies, no recurrences occurred. Two comparative studies reported a lower incidence of complications and postoperative pain after laparoscopic repair compared to open repair. Seventeen studies reported results of open techniques, of which seven studies showed no recurrence. Other studies reported recurrence rates up to 3.1 %. A wide range of complication rates were reported (0–33 %). This collective review showed acceptable recurrence rates for mesh-based umbilical and epigastric hernia repair. A wide range of devices was investigated. A tendency toward more complications after laparoscopic repair was found compared to open repair.     

Colorimetric capnography to ensure correct nasogastric tube position

Purpose

We evaluate a procedure, combining colorimetric capnography with epigastric auscultation, to ensure nasogastric (NG) feeding tube correct position without any radiograph.

Methods

We first evaluated the accuracy of colorimetric capnography in detecting tracheal positioning in a control group of 100 mechanically ventilated patients. The procedure was thereafter evaluated in a study group including patients requiring an NG tube. The NG tube was first inserted 30 cm and connected to a colorimetric capnograph (first step). If the capnograph did not detect carbon dioxide, insertion was completed to a total distance of 50 cm. An epigastric auscultation after air insufflation and a second capnography (second step) were performed. A radiograph evaluated correct tube position.

Results

In the control group, colorimetric capnograph sensitivity to detect tracheal placement was 100%. In the study group, negative predictive value of first-step capnography to rule out tracheobronchial insertion was 100%. The association of a first-step negative capnography with a positive epigastric auscultation correctly identified all but one gastric insertions, yielding a sensitivity of 98.5% (95% confidence interval, 95.7-100). The positive predictive value of this association to detect gastric placement was 100%.

Conclusion

Colorimetric capnography combined with epigastric auscultation is safe and accurate in ensuring correct gastric tube insertion.     

奥美拉唑联合坦度螺酮治疗上腹痛综合征的临床疗效观察

目的:探讨奥美拉唑联合坦度螺酮治疗上腹痛综合征(EPS)的临床疗效。方法:选择符合罗马Ⅲ诊断标准的EPS患者96例,随机分为对照组48例和治疗组48例,对照组给予奥美拉唑20mg qd,治疗组在对照组的基础上联用坦度螺酮10mgtid,疗程均为4周。观测两组患者用药前后症状改善程度。结果:①治疗组和对照组用药4周后临床症状总有效率分别为93.75%和75%,治疗组显著高于对照组(P<0.05),其中治疗组上腹痛症状积分下降幅度显著大于对照组(4.30±1.95;1.00±0.53,P<0.05),治疗组上腹烧灼感症状积分下降幅度亦显著大于对照组(3.90±1.45;0.76±0.46,P<0.05);②治疗组SAS及SDS评分用药后均比用药前显著下降(P<0.01),对照组SAS和SDS评分治疗后较用药前都有所减轻,但无统计学意义。结论:奥美拉唑联合坦度螺酮治疗能有效改善EPS患者的上腹痛、上腹烧灼感及焦虑、抑郁症状。     

An unusual and life-threatening cause of epigastric pain presenting to the general surgical team: a case report

As general surgeons, we are regularly referred patients with epigastric pain. There are a huge number of common pathologies which cause this complaint, most of which are gastrointestinal in origin. Although the old adage goes ’common things are common’, we must always keep our minds open to the possibility of the uncommon and not miss warning signs which are present in the history or examination. We present the case of a 59-year-old woman with a ruptured sinus of Valsalva aneurysm presenting to the accident and emergency department as epigastric pain.