Use of totally implantable central venous access ports for high-dose chemotherapy and peripheral blood stem cell transplantation: results of a monocentre series of 376 patients.

BACKGROUND: The complication rate of central venous totally implantable access ports (TIAP), used for high-dose chemotherapy with autologous stem cell transplantation support, has not been fully investigated to date, due to the almost exclusive use of externalised, tunnelled devices in this clinical setting. PATIENTS AND METHODS: During a 66-month period (from 1 January 1997 to 30 June 2002), 376 patients suffering from breast cancer, ovarian cancer, lymphoma or multiple myeloma were treated with high-dose chemotherapy and autologous stem cell transplantation at the European Institute of Oncology (Milan, Italy). A single type of port was used, constructed from titanium and silicone rubber, connected to a 7.8 F polyurethane catheter (Port-A-Cath; SIMS Deltec, Inc., St Paul, MN, USA) inserted into the subclavian vein. They were followed prospectively for device-related complications until the device was removed, the patient died or the study was closed (30 June 2002). RESULTS: No TIAP-related deaths were observed in this series. Seven pneumothoraxes (1.8%) occurred as a complication of TIAP placement, one patient only (0.2%) requiring a tube thoracostomy. Port pocket infection occurred twice in this series (0.53%, 0.01 episodes/1000 days of use), whereas three patients suffered from port-related bacteraemia (0.8%, 0.016/1000 days of use). Infections were successfully treated with antibiotics; all three cases had the ports removed at programme completion. Four cases of deep vein thrombosis were detected (1.06%, 0.022/1000 days of use); low molecular weight heparin was given, followed by oral anticoagulants. Finally, one case of extravasation occurred (0.26%, 0.005/1000 days of use), requiring port removal and local medical therapy. CONCLUSIONS: The use of TIAPs has resulted in a safe and effective option for high-dose chemotherapy deliverance and stem cell transplantation, in spite of inducing severe neutropenia and increasing the risk of sepsis in this category of oncology patient.     

基于单片机的功能磁共振同步器的设计

目的：设计一种处理功能磁共振成像( fMRI)同步输出信号的同步器,对其解决同步问题的性能进行鉴定。方法fMRI在采集图像数据时,有两种同步信号输出方式：其一,采集一幅完整脑图时,每采集一层图像输出一个同步方波信号;其二,采集完一幅脑图输出一个同步信号。首先设定一幅完整脑图的采集层数,也称同步参数( SP);然后采集第一种同步方波信号,用单片机外部中断方法对第一种同步方波信号的上升沿计数,并保持初始输出为高电平;直到最后一层脑图时,将输出信号置为低电平并延时一段时间。结果同步器成功将第一种同步方波信号处理成第二种同步信号;matlab编程串口程序自动化设定SP,通过串口传输至单片机;结果表明该同步器可自动化设置SP。结论设计的同步器能使某类功能磁共振输出同步信号的同步问题得以解决,设备兼容性得到提升,其自动化设置SP,可减少医护人员的工作量。     

针孔腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的临床疗效

目的探讨针孔腹腔镜经腹腹膜前疝修补手术（NP-TAPP）治疗腹股沟疝的安全性与可行性。 方法回顾性分析2019年1月至2019年12月,大庆油田总医院行腹腔镜手术治疗的85例单侧腹股沟疝患者的临床资料。其中腹腔镜经腹腹膜前疝修补手术（TAPP）组患者53例,NP-TAPP组患者32例,观察记录2组的手术时间、术中出血量、术后住院时间、疼痛评分、腹壁瘢痕满意度及手术并发症等指标并进行对比分析。 结果85例患者均顺利完成手术,2组手术时间、术中出血量、术后住院时间比较,差异均无统计学意义（P>0.05）;NP-TAPP组术后疼痛程度、腹壁瘢痕满意度均优于TAPP组,差异有统计学意义（P<0.05）。2组术后并发症发生率及复发率比较,差异均无统计学意义（P>0.05）。 结论NP-TAPP治疗腹股沟疝安全有效,能最大程度减少手术创伤,提高术后腹壁切口美容效果。     

国境口岸快速处置一起邮轮诺如病毒性急性胃肠炎爆发疫情

〔目的〕通过对某大型豪华邮轮一起诺如病毒性肠胃炎疫情处置,关注国际间疫情变化,为国境口岸突发公共卫生事件快速反应提供对策依据。〔方法〕对来沪某大型豪华邮轮发生旅客不明原因腹泻的情况开展临床诊断、流行病学调查、实验室检测和实施卫生检疫措施。探讨口岸突发疫情的快速反应对策。〔结果〕经过对邮轮患者标本和食品样品的细菌学和病毒学检验,结合流行病学调查和临床表现确定为诺如病毒引起的群发性腹泻,采取了以传染源控制和管理为重点,切断传播途径和保护易感人群等卫生检疫措施后控制了疫情的蔓延。〔结论〕国境卫生检疫应在排除检疫传染病的情况下,扩大疾病的监测范围,以控制常见的、多发的、易引起突发公共卫生事件的传染病作为重点。根据新的《国际卫生条例》,调整国境口岸卫生检疫策略,加强口岸卫生检疫核心能力建设,为防止疾病的国际传播提供技术保障,建立应对突发疫情快速反应体系。     

Implantable catheter system for long-term intravenous chemotherapy

Fifty-three implantable catheter systems (Port-A-Cath) were placed subcutaneously in 48 patients with malignant tumours. This device consists of a stainless steel chamber covered by a silicone membrane connected to a silicone catheter placed in a central vein. All systems were used for administration of chemotherapy. The mean function time was 187 days (range 0-867). Complications necessitating reoperation occurred in six patients. In three cases, the catheter occluded from thromboses. In two patients, wound dehiscence occurred, and in one a wound infection developed. In one case, the catheter was disconnected from the port. Four patients who had had the port removed later received new ports. One patient had the second port removed and was given a third catheter system. It is concluded that subcutaneously implantable injection ports constitute a safe and convenient access for long-term intravenous chemotherapy. The complication rate is low, and it should be possible to avoid most recorded complications in the future.     

A prospective randomized trial demonstrating valved implantable ports have fewer complications and lower overall cost than nonvalved implantable ports

BACKGROUND: The purpose of the current study was to evaluate whether a totally implanted valved subcutaneous port system would have fewer complications as compared to a standard nonvalved port. METHODS: Study subjects requiring port placement were randomized to receive a valved port (PASV; Boston Scientific, Natick, MA) or a nonvalved port (BardPort; Bard Accesss Systems, Salt Lake City, UT). Each port was placed with standard operative technique. Difficulty with blood return, excess time spent accessing the port, and required interventions were reported over the initial 180 days of port usage. RESULTS: Seventy-three patients were randomized to receive either a valved port (n = 37) or a nonvalved port (n = 36). No major complications were identified from port placement, and there were no differences in rates of infection between the 2 ports. A reported inability to withdraw blood was noted in the valved port group on 21 of 364 (5.8%) port accessions and in the nonvalved port group on 37 of 341 (11%) accessions (P = 0.02). Significantly more total time was spent ensuring adequate blood draw from nonvalved ports as opposed to valved ports (750 minutes vs. 1545 minutes, respectively) (P <0.03). CONCLUSIONS: This study revealed that the PASV valved port is associated with significantly fewer instances of poor blood return and less nursing access time, indicating that a port with a PASV valve may be superior to a nonvalved device.     

Three-port vs standard four-port laparoscopic cholecystectomy

Background: Since the first laparoscopic cholecystectomy (LC) was reported in 1990, it has met with widespread acceptance as a standard procedure using four trocars. The fourth (lateral) trocar is used to grasp the fundus of the gallbladder so as to expose Calots triangle. It has been argued that the fourth trocar is not necessary in most cases. Therefore, the aim of this study was to compare the three-port vs the four-port technique. Methods: Between 1998 and 2000, 200 consecutive patients undergoing elective LC for gallstone disease were randomized to be treated via either the three- or four-port technique. Results: There was no difference between the two groups in age, sex, or weight. In terms of outcome, there was no difference between the two groups in success rate, operating time, number of oral analgesic tablets (paracetamol), visual analogue score, or postoperative hospital stay; however, the three-port group required fewer analgesic injections (nalbuphine) (0.4 vs 0.77, p = 0.024). Conclusion: The three-port technique is as safe as the standard four-port one for LC. The main advantages of the three-port technique are that it causes less pain, is less expensive, and leaves fewer scars.     

二溴海因消毒剂的杀菌原理与应用

二溴海因是一种新型的消毒杀菌剂。其具有抗菌谱广,杀菌力强,稳定性高,使用量小,无毒低味,安全环保,不受pH值影响及水体条件限制等特点,可广泛应用于国境口岸消毒,以提高口岸卫生处理工作的整体水平和拓宽口岸消毒用药范围。为此,对二溴海因的理化性质,作用机理,对微生物的杀灭作用以及在口岸的应用范围作一综述,以便在国境口岸卫生处理工作加以推广。     

Is Fourth Port Really Required in Laparoscopic Cholecystectomy?

Since the advent of four-port laparoscopic cholecystectomy, many modifications regarding port number and size have been tried. The feasibility of three-port technique has been found comparable to the conventional four-port laparoscopic cholecystectomy. To assess the feasibility and safety of three-port laparoscopic cholecystectomy in a prospective study. Between March 2007 and March 2009, fifty patients with cholelithiasis aged between 15 and 56 years underwent three-port cholecystectomy in a prospective study in Government medical college, Srinagar. A single surgeon did all the cases and there was no criterion for the patient selection. These were consecutive fifty surgeries done by the surgeon. The outcome was assessed in terms of intra-operative and post-operative parameters. The mean (range) age was 45 (15–56) years and there were thirty-nine females and eleven males in the study. All the procedures were completed successfully without any conversions to open or any major complications; though three patients needed the addition of a fourth port as in conventional laparoscopic cholecystectomy. The mean (range) operative time was 55 (30–90) min and the average blood loss was 30 ml. The mean (range) hospital stay was 1 (1–3) days. All patients returned to routine work within 1 week of surgery. The mean follow-up was 5 (2–7) months. We conclude, from the results above, that three-port laparoscopic cholecystectomy is safe and feasible. There are only two visible surgical scars, better cosmetic appearance with no increased risk of bile duct injury. It reduces the manpower in the form of a second assistant. Thus, it can be recommended as a safe alternative procedure to conventional four-port laparoscopic cholecystectomy.     

上海口岸首例邮轮大规模诺如病毒感染爆发的应急处置

〔目的〕通过对某大型邮轮一起诺如病毒引起的急性胃肠炎疫情处置,关注国际间疫情变化,为国境口岸突发公共卫生事件快速反应提供对策依据。〔方法〕通过对来沪某大型邮轮的一起诺如病毒引起的急性胃肠炎的临床诊断、流行病学调查、实验室检测和卫生检疫措施的实施,探讨口岸突发公共卫生事件的快速反应对策。〔结果〕经过对邮轮上患者样本和食品样本的细菌学和病毒学检测,结合流行病学调查和临床表现确定为诺如病毒引起的急性胃肠炎,采取了以传染源控制和管理为重点、切断传播途径和保护易感人群等卫生检疫措施后控制了疫情的蔓延。〔结论〕国境卫生检疫应在排除检疫传染病的情况下,扩大疾病监测范围,以控制常见的、多发的、易引起突发公共卫生事件的传染病为重点。根据新的《国际卫生条例》的规定,调整国境口岸卫生检疫策略,加强口岸卫生检疫核心能力建设,建立应对突发公共卫生事件快速反应体系的新机制,为防止疾病的国际传播提供技术保障。