Changgeng yi xue za zhi最新文献

Colon perforation can be caused by a variety of entities, including iatrogenic trauma, tumors, ischemia, inflammatory bowel disease, and steroid use. Parasitic infection rarely leads to colon perforation. Secondary peritonitis results from mixed microorganism infection, including enterococci, enteric bacilli, and anaerobes. A combination of an optimal antibiotic regimen and surgical intervention is of paramount importance. Nevertheless, intra-abdominal infections usually have a high mortality rate. Schistosomiasis occurs worldwide. S. japonicum infection is endemic in Asia. The most common complications of gastrointestinal schistosomiasis are periportal fibrosis, intestinal polyposis, and bowel stricture. Rarely, schistosomiasis results in colon perforation. The diagnosis of schistosome infections is based on ova in stool or tissue specimens, and/or immunologic diagnostic tests. The most effective anti-schistosomiasis agent is praziquantel. Herein, we describe an unusual case of colon perforation associated with Schistosoma japonicum infection, which resulted in severe peritonitis and led to the patient's death.

Background: Retrobulbar anesthesia is considered effective in ocular surgery but it can give rise to serious complications. We used peribulbar anesthesia with sub-Tenon's irrigation to perform encircling scleral buckling for retinal detachment, as it could reduce the complications caused by retrobulbar anesthesia. We also recorded the course of pain for 72 hours after surgery.

Methods: Thirty patients who were diagnosed with rhegmatogenous retinal detachment were treated with an encircling scleral buckle. The surgery was performed with peribulbar anesthesia with occasional sub-Tenon's irrigation. We evaluated the patient's pain with a visual analogue scale after surgery at 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours.

Results: In 24 cases (80%), the anesthesia was complete with the peribulbar block. Only 6 patients (20%) needed sub-Tenon's irrigation and four of them felt no pain after augmentation. Although all the surgical procedures proceeded without problem, two of the patients felt pain and were uncomfortable during the surgery. No serious complications occurred. The course of pain peaked 6 hours after surgery when 26 patients (86.7%) felt pain and 12 patients (40%) were uncomfortable (pain score > or = 5). Forty-eight hours after surgery, 9 patients (30%) still felt pain but no one felt uncomfortable.

Conclusion: Peribulbar anesthesia can be used safely in encircling scleral buckling for retinal detachment. The postoperative pain is maximal 6 hours after surgery and becomes mild (pain score < or = 4) after 48 hours.

A new technique for producing a Computer-Aided Design and Computer-Integrated Machining Ceramic Reconstruction crown is presented. After completion of the tooth preparation, an "optical" impression of the tooth was made with a charged couple device camera, and the electronic image was transferred to a computer screen. The "proposed" crown was electronically designed on the screen by the operator, and a proper prefabricated ceramic block was selected and used as milling material. A miniature milling machine then fabricated the crown from the ceramic block. The marginal adaptation and the contour of the crown were verified, and an external shading technique was utilized to improve the esthetics. The prepared tooth and crown were acid-etched, and the crown was cemented with a dual-curing composite luting agent. Once bonded in place, the occlusion was adjusted and the crown polished and finished. The advantage of this technique is that it eliminates the traditional laboratory casting procedure and corresponding laboratory fee while utilizing materials with superior physical properties for maximum strength and esthetics.

Background: We evaluated the effects of a medical decision support system on the preoperative diagnosis of prostate cancer with pelvic lymph node metastases.

Methods: The preoperative accuracy of staging prostate cancer with pelvic lymph node metastasis by the prostate cancer expert system (PCES) for 43 patients was compared to the accuracy of staging performed by 2 urological attending physicians and 5 residents, to test the validity of the PCES. The effect of PCES consultation on physicians' staging for prostate cancer with pelvic lymph node involvement was evaluated.

Results: In the diagnosis of prostate cancer with pelvic lymph node metastasis, PCES was significantly more accurate than the two attending physicians alone (p = 0.042; p = 0.008). All the urological residents' diagnoses were significantly less accurate than those of the PCES. After PCES consultation, all the urological residents increased diagnostic specificity significantly. Most residents usually used PCES for consultation only after the attending physician or department asked for the results.

Conclusion: Owing to an increased ability for preoperative diagnosis of prostate cancer with pelvic lymph node metastasis, as supported by the PCES, some unnecessary pelvic lymphadenectomies may be avoided.

Background: Currently, intramedullary nailing is a well-accepted method for treating tibial shaft fractures, but some patients complain of anterior knee pain after surgery. Multiple factors may influence this troublesome complication.

Methods: This was a retrospective analysis of the medical records of 200 patients who were treated with intramedullary nailing after tibial shaft fractures. Sixty-four patients complained of knee pain after surgery. We evaluated the knee pain in relation to the surgical approach, radiographic readings, and the type of nail used.

Results: Among the 64 patients, 45 (70%) received central approaches and 19 (30%) received paramedial approaches (p = 0.0002); 46 patients (72%) showed nail protrusions on radiographs and only 18 patients (28%) were without nail impingement (p = 0.0001). Forty-three patients (67%) received Kuntscher nail fixation and just 21 patients (33%) had interlocking nail fixation (p = 0.0015).

Conclusion: The use of the central patellar tendon splitted approach, nail protrusion observed on radiographs, and the insertion of a non-locking intramedullary nail were all significant risk factors for anterior knee pain after surgery. All these risk factors should be avoided in tibial nailing to decrease the problem of postoperative knee pain.

Background: Insertion of a nasopharyngeal airway by nurses is considered to be invasive. We compared the incidence and severity of nasal injury associated with nasopharyngeal airway insertion by trained nurses to those by anesthesiologists to determine the safety of inserting a nasopharyngeal airway by nurses in cardiopulmonary resuscitation (CPR).

Methods: One hundred and sixteen male and 96 female patients scheduled for general anesthesia were included in the study. The male and female patients were randomly assigned to two groups respectively. Anesthesia was induced with sodium thiopental and fentanyl intravenously. The patients were then ventilated with a bag-valve-mask by trained nurses or anesthesiologists. In the unsuccessfully ventilated patients, nasopharyngeal airways were inserted to facilitate subsequent ventilation. The nasopharyngeal airway, oropharynx, and nostrils were then examined. The incidence and severity of nasal trauma induced by trained nurses or by anesthesiologists were compared.

Results: The study revealed that nasopharyngeal airways applied by trained nurses did not induce more severe nasal trauma than those by anesthesiologists.

Conclusion: We suggest that nasopharyngeal airways may be applied safely by trained nurses in CPR.

Tracheal tumors are often overlooked as a cause of pulmonary symptoms until they reach an advanced state. They are often presented with a prolonged cough and shortness of breath. Most tracheal tumors in adults are cancerous (80% to 90%). Benign tracheal tumors are rare in adult patients. A case history is presented of a 19-year-old patient with a rare tracheal neurilemmoma. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with traditional therapy. The possibility of the presence of an upper airway obstruction was not raised until the typical "inspiratory tubular sound" was heard. Flow-volume loop testing, bronchoscopy, and three-dimensional computed tomography (3-D CT) confirmed the diagnosis of upper airway obstruction caused by a tracheal tumor. Therefore, surgical intervention rather than bronchoscopic removal was performed without difficulty. The patient was leading a stable life 8 months after a surgical resection. The presence of an upper airway obstruction can be proven by flow-volume loop testing and 3-D CT. Further pathologic confirmation can be accomplished by bronchoscopy. High suspicion of an upper airway obstruction such as a tracheal lesion should be raised when bronchial asthma patients fail to respond to conventional treatment.

Background: Endoscopic carpal tunnel release was developed by Okutsu and Chow in 1989. Many reports have indicated that endoscopic carpal tunnel release diminishes postoperative pain and accelerates the recovery time.

Methods: In a series of 1278 carpal tunnel release procedures (in 948 patients), 1214 were performed with a modified Menon endoscopic method and the remaining 64 with an open procedure. The patients with idiopathic carpal tunnel syndrome were followed for at least 3 months.

Results: Of the endoscopic release patients, 80.9% recovered grip strength equal to or greater than preoperative levels within 4 weeks, whereas in the open procedure group, the rate was only 59.3%. The difference was statistically significant (p = 0.00011). An immediate complication was one median motor nerve severance. There were 24 conversions to a conventional open procedure during endoscopic release. In the endoscopic group, 81% developed scar tenderness over the thenar crease, 31% developed new sensory disturbance, and 4% developed pillar pain.

Conclusion: Endoscopic release facilitated the recovery of grip strength and diminished the frequency of scar tenderness. However, neurovascular injury should be carefully prevented.

Background: Controversies still exist around the diagnosis and management of Hürthle cell tumors. The aim of this study is to reexamine our experience to improve our methods in the future.

Methods: We treated 34 patients with verified Hürthle cell carcinoma and adenoma at Chang Gung Memorial Hospital, Linkou from 1990 through 1996. Clinical characteristics, thyroid ultrasonogram, 131I, 201Tl, 99mTc-methoxy-isobutyl-isonitrile (MIBI) and 99mTc-thyroid scan, fine needle aspiration cytology (FNAC) and histology results were analyzed.

Results: Female predominance (82.4%) was noticed among our Hürthle cell tumors. Nine (26.5%) patients had carcinoma. The median size of carcinoma was 4.0 cm, which was significantly larger than the median 3.0 cm for adenoma. No significant differences were found between gender, age, multiplicity or echogenicity between two groups. All 12 adenoma and 3 carcinoma patients who received pre-operative 99mTc and/or 131I thyroid scan showed cold nodules. The sensitivity and specificity of detection Hürthle cell carcinoma as indeterminate and malignant using FNAC was 78% and 18% respectively. These improved to 100% and 86% using frozen sections. One carcinoma patient developed neck lymph node metastasis, with normal serum thyroglobulin, negative 131I but positive 201Tl and 99mTc-MIBI whole body scans. Another one showed mediastinum metastasis with elevated serum thyroglobulin, detected using 131I scan, revealed successful regression after 131I therapeutic scan.

Conclusion: Tumor size of carcinoma is significantly larger than adenoma. All patients with FNAC suggestive of Hürthle cell tumors should receive surgery for histological diagnosis to differentiate carcinoma from adenoma. Therapeutic radioiodine ablation is indicated whenever there is 131I uptake by tumor cells.

The livers of some larger fish such as shark, tuna and seabass have been reported to be responsible for a peculiar poisoning causing headaches and desquamation. This type of poisoning can also be induced by ingestion of the livers of the sea whale, the polar bear and the seal. Since these animals contain an extremely large quantity of vitamin A in their livers and the symptoms of poisoning in the patients resembled those of patients with acute hypervitaminosis A, the poisoning was believed to have been caused by excessive vitamin A intake. We observed an episode of acute fish liver intoxication in which 3 man experienced dizziness, headache, blurred vision, nausea, vomiting, fever, and desquamation after ingesting the liver of the grouper fish Cephalopholis boenak (C. boenak). One of the patients had full-blown symptoms and presented with a high fever, headache, dizziness, generalized aching pain, and superficial vesicles and bullae of the skin. The treatment was mainly supportive. In the follow-up period, he subsequently developed hair loss and diffuse peeling of the skin on his palms and soles. Acute fish liver intoxication is rare, especially in subtropical regions. Symptomatologically, the clinical pictures of these patients were comparable to acute hypervitaminosis A or retinoid intoxication. The average vitamin A content in the grouper (C. boenak) is high enough to cause acute vitamin A intoxication. Moreover, ethanol may play a potentiating role in this type of event.