The comparative pharmacokinetics of ceftriaxone in the blood and bronchial secretion in patients with different durations in the course of chronic bronchitis

The study on ceftriaxone penetration into bronchial secretion showed that in patients with a short-term history of chronic bronchitis (no more than 3 years) ceftriaxone used in a dose of 1 g once a day intramuscularly was detectable in the bronchial secretion within 10 hours after the administration, its concentrations being 0.67-2.41 micrograms/ml in 3 hours, 15.87 micrograms/ml in 4.5 hours, 4.58 micrograms/ml in 6.5 hours and 2.29 micrograms/ml in 10 hours. In patients with a long-term history of chronic bronchitis (mean 10 to 20 years) the presence of ceftriaxone in the bronchial secretion was detectable in a concentration of 0.51-3.75 micrograms/ml only in 2 hours after its administration. Beginning from the 5th hour after the administration its detection failed. This is indicative of lower ceftriaxone penetration into the bronchial secretion of such patients. The duration of chronic bronchitis did not influence ceftriaxone pharmacokinetics in blood. The contents of the antibiotic in serum and bronchial secretion were determined by HPLC (the resolving power of 0.5 micrograms/ml).     

高脂血症对直肠癌不同手术方式合并症的影响

目的:探讨高脂血症对直肠癌不同手术方式合并症的影响。方法:回顾分析行开腹或腹腔镜直肠癌根治术治疗的255例患者的临床资料,比较伴或不伴高脂血症患者的围手术期指标,采用卡方检验或t检验进行统计学分析。结果:与非高脂血症组患者相比,高脂血症组术中出血量大(P<0.01),术后恢复进食时间长(P<0.01),术后住院时间增加(P<0.05),拔除引流管时间延长(P<0.01),切口脂肪液化并发症增多(P<0.05)。与开腹组相比,腹腔镜组术中出血量少(P<0.01),手术时间、术后恢复进食时间、术后住院时间、拔除引流管时间均明显缩短(均为P<0.01),切口脂肪液化发生率低(P<0.05)。在腹腔镜手术组,与正常血脂组相比,高脂血症患者术中出血量较大(P<0.01),余指标无明显差异。结论:高脂血症可引起直肠癌手术出血量增加、术后恢复慢、伤口脂肪液化发生率高,腹腔镜手术可加快患者术后恢复。     

Intensity of thrombin activity and surgical trauma

Increased level of in vivo thrombin activity represents the essential mark of prethrombotic state. In order to assess the influence of surgical trauma on the constitution of prethrombotic state immediately after the surgical intervention, dynamic estimations of fibrinopeptide A (FPA) have been done in a group of 18 patients who had undergone abdominal surgery and in the group of 25 patients who underwent the replacement of artificial hip, and who were on preventive treatment with subcutaneous heparin. At the same time the presence of soluble fibrinmonomer complex and, in the group of patients on heparin treatment, the concentration of plasma heparin were examined. The investigations were done before the surgical intervention and on the first, third and seventh postoperative day. Our dynamic study showed the existence of certain relation between the surgical trauma and values of FPA which were the expression of intensity of in vivo thrombin activity. The mean values of FPA increased markedly on the first postoperative day in comparison with the preoperative levels. On the third postoperative day significant reduction of FPA was observed and on the seventh day marked increase was found only in patients who were not on heparin prevention. Although preventive application of subcutaneous heparin did not affect the whole blood coagulability it showed a suppressive impact on the thrombin activity level in examined surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cefoperazone in a multi-profile surgical clinic]

The results of the clinical trials of cefoperazone (cefobid, Pfizer, USA), a 3rd generation cephalosporin, carried out at the Research Centre of Surgery are presented. The antibiotic was used to treat and prevent postoperative infections in 44 patients. Good and satisfactory results were observed in 43 out of the 44 patients (99.9 per cent). Antimicrobial activity of cefoperazone against 182 bacterial strains isolated from the patients was assayed and compared with that of other cephalosporins i.e. cefotaxime, ceftriaxone and ceftazidime. The cefoperazone pharmacokinetics was studied in the patients with normal renal functions after surgical operations on the organs of the chest and abdominal cavity. The antibiotic was shown useful in the monotherapy of mixed infections involving anaerobic pathogens.     

Behavioral and physiologic effects of inapparent wound infection in rats.

There is a common notion that rats are resistant to postoperative wound infection because many recover from surgery performed under nonsterile conditions. As a result, nonaseptic surgical techniques are used commonly in rat surgery. Our aim was to determine if these techniques cause wound infection and, if so, whether or not the infection, inapparent to casual observation, creates measurable changes in rat physiology and behavior. Rats subjected to craniotomies or laparotomies and inoculated with 10(8) Staphylococcus aureus or Pseudomonas aeruginosa or sterile saline were tested for open-field activity, freezing behavior, home-cage behavior score, and wheel-running activity. Physiologic indices included lactate dehydrogenase, blood glucose, plasma fibrinogen, complete blood counts, wound bacterial counts and histology scores, body temperature, and body weight. Although no clinical signs were detected by postoperative observation, rats inoculated with bacteria were significantly less active in the open field and the duration of freezing behavior was shorter. Plasma fibrinogen, serum glucose, total white blood cell counts, and wound histology scores were significantly altered in the bacteria-inoculated rats. These findings underscore the need for sterile techniques in rat surgery to avoid confounding experimental data.     

PPH与Milligan-Morgan术式治疗环状混合痔的临床效果观察

目的:比较PPH与Milligan-Morgan术式治疗Ⅲ～Ⅳ期环状痔的临床效果,探讨治疗Ⅲ～Ⅳ期环状痔的最佳术式。方法:选择Ⅲ～Ⅳ期环状痔患者130例,随机均分为PPH组和Milligan-Morgan组,两组患者分别采用PPH术式和Milligan-Morgan术式治疗,比较两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用和术后并发症情况。结果:PPH组优于Milligan-Morgan组,两组患者手术时间、术中出血量、术后疼痛评分、住院时间、住院费用及术后发生急性尿潴留、肛门水肿和吻合口感染病例比较,差异具有统计学意义(P<0.05)。结论:应首选PPH术式治疗Ⅲ～Ⅳ期环状痔患者,可显著减轻术后疼痛,加快患者术后恢复,减少术后并发症。     

胸外科手术术后神经病理性疼痛的发生情况及相关因素分析

目的:探讨胸外科手术术后神经病理性疼痛的发生情况及相关危险因素。方法:回顾性分析2015年至2016年就诊于我院行胸外科手术的患者的临床资料,包括患者的年龄、性别、吸烟史、BMI、术前是否使用催眠药物、术前诊断、手术侧别、手术方式、是否为微创、硬膜外自控镇痛泵使用情况、术中失血量、手术持续时间、引流管引流时间及是否发生神经病理性疼痛,对比分析是否发生神经病理性疼痛患者的临床资料,对有差异的临床资料进行多因素Logistic回归分析探讨发生神经病理性疼痛的危险因素。结果:共有123例患者纳入研究,33例(26.8%)患者的患者术后出现神经病理性疼痛,6例(4.9%)患者在术后一年仍有持续性神经性病理疼痛,术后出现神经病理性疼痛的平均时间为术后第7天,平均持续时间为75天,发生神经病理性疼痛的患者吸烟比例(81.8%)、术前使用催眠药比例(57.6%)、开胸手术比例(81.8%)、术中失血量(185 mL)、手术时间(196分钟)、术后引流时间(2.5天)均高于没有发生神经病理性疼痛的患者。多因素分析显示术前使用催眠药(OR=2.322,P<0.001)、手术时间延长(OR=3.703,P<0.001)和术后引流时间延长(OR=2.675,P=0.002)均是神经病理性疼痛发生的危险因素,电视辅助胸腔镜手术方式是保护性因素(OR=0.453,P=0.002)。结论:术前使用催眠药物、延长的手术时间及术后引流时间增加了神经病理性疼痛发生的风险,电视辅助胸腔镜技术可减少其发生率。     

Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors

Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe), longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI), the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with postoperative bleeding and poor outcomes and merits careful attention. Practitioners should monitor plasma fibrinogen levels in patients with risk factors for postoperative fibrinogen deficiency. In addition, postoperative fibrinogen deficiency should be remediated as soon as possible to reduce postoperative bleeding, especially when postoperative bleeding is confirmed.     

Chromobacterium violaceum lymphadenitis successfully treated in a Northern Italian hospital

Lymphadenitis can be caused by different gram positive and gram negative bacteria and non-tuberculous mycobacteria. Cervical lymphadenitis in children is thought to result from ingestion of or contact with environmental microrganisms. Chromobacterium violaceum is a common inhabitant of soil and water in tropical and sub tropical countries. In these parts of the world Chromobacterium violaceum is able to cause skin infection with diffuse pustular lesions and also multiple liver abscess with often fatal evolution in sepsis. We describe a case of cervical lymphadenitis caused by Chromobacterium violaceum in a 14-year-old boy, born in Guinea and resident in Italy for 7 years in a fair condition with general measurable swelling in the right lateral cervical region and with blood tests that showed increased inflammatory indices. The patient was subjected to surgical incision. Antibiotic therapy with ceftriaxone was continued for 10 days, then replaced successfully with oral ciprofloxacin on the basis of purulent material culture positive for Chromobacterium violaceum sensitive to fluoroquinolones.     

腹腔镜与开腹手术治疗穿孔性阑尾炎患儿的临床疗效及对血清CRP和PCT水平的影响比较

目的:分析和比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗穿孔性阑尾炎患儿的临床效果及对患儿血清C反应蛋白(CRP)、降钙素原(PCT)水平的影响。方法:选取我院2013年1月～2016年12月收治的98例穿孔性阑尾炎患儿,依据随机数字表法均分为两组。对照组行OA治疗,观察组行LA治疗。记录比较两组患儿切口长度、术中出血量、手术时间、术后排气时间及住院时间等手术情况;术后镇痛药物使用及并发症情况;围术期各时点血清CRP、PCT水平。结果:两组患儿均成功完成手术,观察组患儿中无中转开腹者。观察组患儿的切口长度、术中出血量、手术时间、术后排气时间及住院时间均显著优于对照组(P0.01)。观察组患儿术后镇痛药物使用率及并发症率均为4.1%,均明显低于对照组的16.3%、18.4%(P0.05)。两组术前12 h时血清CRP、PCT水平比较差异均无统计学意义(P0.05);与术前12 h时相比,两组术后24、48 h时血清CRP、PCT水平均显著升高(P0.01);两组术后48 h时血清CRP、PCT水平较术后24 h时均显著降低(P0.01);与对照组同期对比,观察组术后24、48 h时血清CRP、PCT水平均显著降低(P0.01)。结论:与开腹手术相比,腹腔镜手术治疗穿孔性阑尾炎患儿具有创伤小、手术时间短、术后并发症少等优势,能更有效降低血清CRP、PCT水平,促进患儿术后恢复。     

Effect of hyperbaric oxygenation on central hemodynamics and oxygenating function of the lungs in open-heart surgery]

The dynamics of some oxygenating pulmonary function (OPF) indices has been studied in 33 patients with coronary cardiac disease and rheumatic lesions of cardiac valves 4-6 hours after surgery in response to a single hyperbaric oxygenation (HBO) session (1.5 ata, 45 min) in the immediate postoperative period. It is found that in the presence of slight or, on the contrary, pronounced arterial hypoxemia, no significant negative OPF changes were observed. At the same time, a temporary increase in the alveolo-arterial gradient has been found in some patients. The comparison of data on the systemic blood flow with the OPF indices permits suggesting the prevalent role of the membrane component in a PaO2 decrease in patients after using assisted circulation.     

Origin of Kupffer macrophages in the regenerating liver

Male Wistar rats were injected intraperitoneally with H3-thymidine (5 muC/g). Two thirds of the liver was removed one hour later. Sham operated animals served as control. A moderate elevation of the labeled nuclei indices of hepatocytes (LNI) was seen by the third hour, increased significantly by the ninth, and especially by the 24th hour after the operation. The indices decreased by the 48th hour after partial hepatectomy. In 3 hours the LNI was 10 times higher than in the control; in 9 hours it reached the maximum, decreasing by the 24th and 48th postoperative hours. The origin of Kupffer's macrophages in the regenerating liver is discussed.     

Significance of the statistical characteristics of the sinus rhythm of the heart

Statistical analysis of prolonged continuous recordings of the ECG RR intervals was carried out in 64 patients with purulent surgical infection. The following indices were considered: the mean value of the RR intervals, the mean quadratic deviation (delta), the variation amplitude, the 1st and the 3rd correlation coefficients, the excess, asymmetry, the RR/delta ratio. Besides, the size and the shape of the autoregression could was analyzed. Statistically significant differences of the RR/delta ratio, of the mean quadratic deviation, and of the variation amplitude were revealed in 3 groups of patients differing by the severity of condition. These differences were reflected in the size and shape of the autoregression cloud. The results obtained suggest that statistical characteristics of prolonged recordings of the cardiac rhythm could be used for objective assessment of the severity of the patient's condition and of the therapeutic effect in the patients with a purulent surgical infection.     

Hypothalamic LHRH and plasma LH levels after electrical stimulation of the deafferented medial basal hypothalamus

The medial basal hypothalamus (MBH) of female rats was surgically isolated on the morning of proestrus and luteinizing hormone (LH) levels in the blood were determined before and after electrochemical stimulation (ECS) of the disconnected arcuate-median eminence (ARC-ME) region either on the same afternoon (Group 1) or on the 5th postoperative day (Group 2). Animals of Groups 3 and 4 were stimulated and sampled for LH on the 5th or 10th postoperative day, respectively, these rats having been primed with 5 micrograms estradiol injected daily throughout the experimental period. ECS resulted in a significant rise of plasma LH level in Group 1 and caused full ovulation as evaluated by the presence of ova found the next morning in the Fallopian tubes. Rats of Groups 2-4 failed to show any changes in plasma LH, and no ovulation was observed following ECS. Immunohistochemical examination of the brains revealed that axons staining for the luteinizing hormone-releasing hormone (LHRH) in the ARC-ME region remained at control levels 3 days after deafferentation (e.g. Group 1), whereas a marked decrease or complete absence of these structures was observed 8 or 13 days following surgical isolation of the MBH (e.g. Groups 2-4). These studies strongly support the view that no LHRH synthesizing perikarya are located within the MBH of the rat.     

Is mitral valve repair safe procedure in elderly patients?

The aim of this randomized, prospective, study was to evaluate postoperative hospital mortality and morbidity after mitral valve repair by comparing two surgical techniques for resolving mitral valve insufficiency in elderly patients. In comparison were: mitral valve repair vs. mitral valve replacement in patients older than 70 years. In period from January 1st 2006 until August 30th 2009. Eighty patients with mitral valve disease, isolated or associated with other comorbidities, were scheduled for mitral valve repair or mitral valve replacement in our institution. Patients were randomized in two groups, one scheduled for mitral valve repair and another one for mitral valve replacement using the envelope method with random numbers. Results show no difference in hospital mortality and morbidity postoperatively in both groups. In group undergoing valve replacement we had one significant complication of ventricle rupture in emphatically calcified posterior part of mitral valve annulus. In conclusion we found no distinction in postoperative hospital mortality and morbidity after using one of two surgical techniques.     

高血压脑出血患者术后重症监护治疗与早期再出血的相关因素分析

目的:探究高血压脑出血患者术后重症监护治疗与早期(24 h内)再出血的相关因素。方法:回顾性分析2014年1月至2018年10月于中山大学附属第一医院及中山市人民医院行手术治疗并进行重症监护的高血压脑出血患者的相关资料,记录术后早期发生再出血情况,比较其相关因素,包括年龄、性别、术前格拉斯哥昏迷量表(GCS)评分、出血量、术前收缩压、术后收缩压、镇静时间、插管时间、有无使用止血药、血压波动、血压差、有无镇痛情况,分析术后早期再出血的影响因素。结果:本研究共纳入465例患者,其中术后早期再出血患者44例,未再出血患者421例,再出血发生率为9.46%(44/465)。高血压脑出血术后早期再出血患者的术后收缩压、有无镇痛、血压差、血压波动与未再出血患者比较差异具有统计学意义(P0.05)。术后早期再出血患者的年龄、性别及术前GCS评分、出血量、术前收缩压、镇静时间、插管时间、有无使用止血药与未再出血患者比较差异无统计学意义(P0.05)。多因素Logistic回归分析显示,患者血压波动大是术后早期再出血的危险因素,手术前后血压差大、术后使用镇痛治疗是其保护因素。结论:高血压脑出血患者术后血压波动、手术前后血压差及术后镇痛治疗均是早期再出血的影响因素,合理降压及镇痛治疗可减少脑出血术后早期再出血的发生。     

腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的临床观察

目的：探讨腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的应用价值。方法：回顾性分析2005年1月．2011年12月我院收治的210例65岁以上因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组（LC组）和剖腹胆囊切除术组（OC组）,分析和比较两组患者的手术时间、术后肠功能恢复时间及住院时间,术中出血、腹腔引流量和术后并发症的发生情况。结果：与OC组比较,LC组的手术时间、术后肠功能恢复时间及住院时间均显著缩短,差异有统计学意义（P〈0．01）;但两组之间术中出血、腹腔引流量和术后并发症的发生率差异均无统计学意义（P〉0．05）。LC组中转开腹10例,占7_35％;其中粘连严重导致胆囊三角解剖不清6例,无法控制的出血2例,结石嵌顿胆囊管2例。结论：老年急性胆囊炎患者在条件合适的情况下行腹腔镜胆囊切除术治疗有助于患者更快地恢复．具有较强的临床应用价值。     

老年骨科手术患者麻醉后认知功能障碍的多因素分析及模型预测初步研究

摘要 目的：探讨分析影响老年骨科手术患者麻醉后的认知功能障碍的因素并建立预测模型。方法：将2016年1月至2019年1月于我院骨科行手术的227例老年患者根据术后认知功能障碍评分分为认知障碍组及无障碍组,比较两组一般资料及手术方式、麻醉方式等手术相关因素,使用多因素Logistic回归模型分析影响术后认知功能障碍发生的因素,使用R软件建立出现认知功能障碍的列线图预测模型,并验证其效能。结果：术后共有65例患者出现认知功能障碍,认知障碍组患者的年龄、行全麻的患者比例、术中失血量、手术时间及出现术后并发症患者比例均明显高于无障碍组,而术中血压及应用超前镇痛患者比例均明显低于无障碍组（均P＜0.05）;而两组患者性别、BMI及手术部位等指标则无明显差异（均P＞0.05）;多因素Logistic回归分析示高龄、全麻、术中失血量过多、过长手术时间及术后出现并发症均是老年骨科手术患者术后出现认知障碍的独立危险因素（OR=1.077,3.796,3.826,1.712,6.937;均P＜0.05）;而术中高收缩压、舒张压及术前给予超前镇痛是术后出现认知功能障碍的保护因素（OR=0.953,0.913,0.333;均P＜0.05）;列线图预测认知功能障碍发生的一致性指数（C-index）为0.904（95%Cl 0.862~0.961）。结论：高龄、全麻、无超前镇痛、手术时间过长、术中失血量过多、术中低血压及术后出现并发症是出现术后认知功能障碍的危险因素,基于此构建的列线图可有效对术后认知功能障碍进行预测,具有较好的临床应用价值。     

Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas

Glucose metabolism is adversely affected in patients following major surgery. Patients may develop hyperglycemia due to a combination of surgical stress and postoperative insulin resistance. A randomized trial was conducted to elucidate the effect of preoperative supplementation with carbohydrates and branched-chain amino acids on postoperative insulin resistance in patients undergoing hepatic resection. A total of 26 patients undergoing a hepatectomy for the treatment of a hepatic neoplasm were randomly assigned to receive a preoperative supplement of carbohydrate and branched-chain amino acid-enriched nutrient mixture or not. The postoperative blood glucose level and the total insulin requirement for normoglycemic control during the 16 h following hepatic resection were determined using the artificial pancreas STG-22. Postoperative insulin requirements for normoglycemic control in the group with preoperative nutritional support was significantly lower than that in the control group (P = 0.039). There was no incidence of hypoglycemia (<40 mg/dL) observed in patients, including those with diabetes mellitus, when the STG-22 was used to control blood glucose levels. STG-22 is a safe and reliable tool to control postoperative glucose metabolism and evaluate insulin resistance. The preoperative oral administration of carbohydrate and branched-chain amino acid-enriched nutrient is of clinical benefit and reduces postoperative insulin resistance in patients undergoing hepatic resection.     

Stanford A型主动脉夹层患者术后血流感染病原菌分布及其影响因素的Logistic回归分析

摘要 目的：分析Stanford A型主动脉夹层患者术后血流感染病原菌分布及其影响因素。方法：选取2020年6月-2023年1月新疆医科大学第一附属医院收治的102例Stanford A型主动脉夹层患者为研究对象。患者均接受手术治疗,统计术后血流感染的发生率、病原菌分布情况。根据患者术后血流感染的发生情况将患者分为感染组（n=17）和未感染组（n=85）。收集患者的临床资料,以单因素和多因素Logistic回归分析Stanford A型主动脉夹层患者术后血流感染的危险因素。结果：102例Stanford A型主动脉夹层患者术后出现血流感染17例,感染发生率为16.67%。17例血流感染患者分离病原菌45株,其中革兰氏阴性菌29株（64.44%）、革兰氏阳性菌13株（28.89%）、真菌3株（6.67%）。感染组患者的年龄、糖尿病史、抗生素疗程、手术时长、植入人工瓣膜比例、二次气管插管比例、机械通气比例、深静脉置管时长均高于未感染组（P<0.05）。多因素Logistic回归分析发现,高龄、二次气管插管、机械通气、深静脉置管时间长、手术时长、植入人工瓣膜比例高是患者术后血流感染的独立危险因素（P<0.05）。结论：Stanford A型主动脉夹层患者术后有较高的血流感染发生率,且主要感染致病菌以革兰氏阴性菌为主,其中高龄、二次气管插管、机械通气、深静脉置管时间长、手术时长、植入人工瓣膜比例高是患者术后血流感染的危险因素。