Surgical Complications and Long-Term Outcome of Different Biliary Reconstructions in Liver Transplantation for Primary Sclerosing Cholangitis—Choledochoduodenostomy versus Choledochojejunostomy

Choledochojejunostomy (CJS) is commonly used for biliary reconstruction in liver transplantation for primary sclerosing cholangitis (PSC). We alternatively performed choledochoduodenostomy (CDS) and side-to-side choledochodocholedochstomy in a large cohort of patients. Fifty-one patients with PSC, transplanted between 1988 and 2000, were analyzed retrospectively. Biliary reconstruction was CDS in 25 (49%), CJS in 20 (39%) and CC in 6 transplantations (12%). Biliary leaks occurred in the early follow-up (< or =41 days) only in CDS patients (20%). However, in the late follow-up (>4 months), stricturing of anastomosis was found once in CDS (4%) and CJS (5%). Later (>9 months), intrahepatic bile duct strictures were diagnosed in four CDS (16%), one CJS (5%) and one CC (17%) patient(s). In 48% of CDS (12/25), 60% of CJS (12/20) and 17% of CC (1/6) at least one incidence of cholangitis was observed. Overall, biliary complication rates were significantly higher in CDS (40%) than CJS (10%) and CC (17%); of those none in CC and 12% in CDS were anastomosis-related. Graft/patient survival showed no significant differences among groups. Based on our results we consider CJS the standard method for biliary reconstruction in PSC; however, in selected cases where CJS is difficult to accomplish because of previous surgery or for retransplantation, CDS may present an alternative technique.     

硬膜外高渗氯化钠溶液术后镇痛的临床双盲研究

为观察高渗盐水硬膜外注射术后镇痛效果,用双盲法对60例病人进行了研究。生理盐水对照级术后镇痛优良率为3.33％,镇痛有效率为10％,均需用镇痛药;高渗盐水组术后镇痛优良率为86.67％,有效率为96.67％,很少使用镇痛药。两组差别显著(P<0.05,P<0.01)。对其他感觉和运动功能无明显影响。高渗盐水组与吗啡组比较镇痛效果相同(P>0.05),副作用少(P<0.01)。说明硬膜外高渗氯化钠溶液是一种安全有效的镇痛方法,有较高推广应用价值。     

Collagenous colitis: Clinical and histological spectrum in ten patients

Collagenous colitis is characterized by the presence of a thick subepithelial collagen band in the colonic mucosa. The condition was diagnosed on rectal biopsy in 10 patients (one male, nine females) who presented with watery diarrhoea. Although rectal mucosal erythema was present in three and ulceration in two, the mucosa was of normal endoscopic appearance in five of the patients. There was marked variability in the thickness of the submucosal collagen band, both between and within individuals. Empirical drug therapy included sulphasalazine, glucocorticoids and antidiarrhoeals. All patients reported symptomatic improvement.     

肛周按揉及温水足浴对腹部手术后患者肛门排气时间的影响

目的探讨肛周按揉及温水足浴对腹部手术后患者肛门排气时间的影响。方法选择普外科180例腹部手术后患者，随机分为A组（肛周按揉＋温水足浴组＋常规护理）90例和B组（常规护理组）90例。比较2组肛门排气时间及腹胀情况。结果首次肛门排气时间A组早于B组，2组比较差异有统计学意义（P＜0．01）；腹胀症状A组较B组轻。结论肛周按揉结合温水足浴可显著缩短腹部手术术后患者肛门排气时间，减轻术后腹胀症状。     

Diclofenac and post-tonsillectomy haemorrhage

The authors noticed a marked increase in the incidence of reactionary post-operative haemorrhage after tonsillectomy during the course of 1992. This increase appeared to be related to the introduction of diclofenac as a post-operative analgesic. A retrospective review of casenotes of patients having tonsillectomy under the care of the senior author (P. M. R.) in 1992 revealed that four of the 73 patients (5.5%) receiving diclofenac at induction of anaesthesia suffered reactionary haemorrhage requiring operative control, as compared with two of 293 (0.7%) receiving other analgesics.     

The effect of fibrin sealant haemostasis on post-operative pain in tonsillectomy

Pain following tonsillectomy is an important problem. It is caused by the surgical trauma of excision and haemostasis. Numerous surgical and pharmacological solutions have been tried, with disappointing results. Fibrin sealant is a widely used atraumatic haemostatic agent. This study aims to determine whether tonsillectomy with fibrin sealant haemostasis results in less post-operative pain than that with the conventional technique of diathermy. Fifty consecutive adult patients undergoing tonsillectomy were prospectively studied. They were randomized to receive either fibrin sealant or diathermy haemostasis. Other pain variables were controlled. Pain was measured by a visual linear analogue scale and inter-incisor distance on both the day of operation and the first post-operative day. The patients and pain measurer were blind to the randomization. The results showed that tonsillectomy with fibrin sealant haemostasis was significantly (P < 0.05) less painful than that with diathermy on both days studied and by both methods of pain measurement     

The effects of acute exercise on colonie motility

Abstract Changes in colonic motor activity during aerobic exercise were investigated in ten regularly exercising volunteers (five males and five females) aged 27–70 years. Motility was recorded with a catheter containing three solid-state pressure transducers spaced 5 cm apart. The motility catheter was advanced 40–50 cm from the anal verge by flexible sigmoidoscope without anesthesia at least 60 min prior to testing. Manometric recordings were made from the colon during a 1-h pre-exercise rest period, 1 h of jogging at 70–80% maximum heart rate, and 1-h post-exercise rest period. The dominant frequency of contractile activity in the colon shifted from 1–4 cpm during rest, to 4–9 cpm with the onset of exercise. Activity also shifted from sporadic, isolated contractions to regular, propagated contractions in six of ten subjects, five of whom reported a history of runner's diarrhoea. The dominant frequency returned to 1–4 cpm during the post-exercise period. These changes in distal colonie motility may account for the diarrhoea which some subjects experience during intense, acute exercise.     

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T₃ carcinoma, 15 patients T₄ and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.     

闽东农村婴幼儿腹泻病原学调查

对闽东农村５８２例婴幼儿腹泻患者进行细菌性病原调查，在２０８例腹泻患儿粪便中检出致泻菌２４６株，检出率为４２．２６％，其中ＥＴＥＣ７７株（１３．２３％），ＥＩＥＣ１９株（３．２６％），空肠弯曲菌１７株（２．９２％），沙门氏茵６株（１．０３％），亲水性气单胞菌２株（０．３４％）。表明致泻大肠杆菌（ＥＴＥＣ，ＥＰＥＣ，ＥＩＥＣ）是我区婴幼儿致泻主导菌群，占检出菌的６６．３％。混合感染率在农村腹泻患儿中高达１７．３％，值得临床工作者重视。