Peritonitis determined by the site of intra-abdominal surgery

The aim of this study was to determine bacterial flora infecting the peritoneal cavity during intraabdominal surgery by site of operation. Three groups of patients were examined. 29 patients who underwent surgery on the stomach, duodenum, biliary tract or pancreas, 15 patients operated on because of acute appendicitis and 63 patients operated on because of colon or rectum tumours. At the end of the operation but before closure cultures were obtained by swab from the completed anastomosis site. Samples were placed into transport medium and transported promptly to the laboratory. The results of the bacteriological examinations showed that the peritoneal cavity of all patients operated on were infected with bacteria characteristic for the digestive tract, especially by Enterobacteriaceae spp., Enterococcus spp. and Bacteroides spp. From patients operated on because of rectum or colon tumours 3 or 4 bacterial species were isolated most often and they were often infected with P. aeruginosa and C. albicans. This was in contrast to patients from the other groups. In patients infected with polymicrobial flora, B. fragilis and E. coli or enterococci and E. coli and enterococci were most often seen.     

浅部真菌病影响患者生活质量的调查分析

目的了解浅部真菌病对患者生活质量的影响程度。方法对确诊为浅部真菌病的患者进行现场问卷调查。结果调查显示61．3％患者担心真菌病影响身体健康,63．6％的患者因为真菌病影响到情绪,50．8％的患者担心会影响到与人交往,72．3％患者担心会传染给家里人,47．5％的患者担心别人会疏远自己,70．5％的患者认为影响到平时的生活和社会活动。结论不同部位、不同性别、不同年龄、不同职业、不同病程的浅部真菌病都对患者的生活质量产生影响。对浅部真菌病要积极预防和治疗。     

Polypharmacy in the management of patients with schizophrenia on risperidone in a tertiary-care hospital in Malaysia

The present study was conducted primarily to determine the occurrence of polypharmacy in patients with schizophrenia on risperidone. The secondary aim was to ascertain the incidence of inappropriate prescribing with anticholinergics. A retrospective review of the medical records of all patients who were being followed up at the out-patient clinic of a tertiary-care hospital in Malaysia was conducted. Only patients who were being prescribed risperidone between 1 June 2008 and 31 December 2008 were included in the study. Demographic data such as patient’s age, gender and race were obtained from the patient’s medical records. In total, 113 patients met the selection criteria. Polypharmacy was found to occur in 34 patients (30.09%), with the majority (76.47%) being on two antipsychotics. In total, 27 patients (34.18%) on monotherapy with risperidone were prescribed an anticholinergic on scheduled dosing, while 19 patients (24.05%) were prescribed it on an as-needed basis. Of the patients on polypharmacy, 26 (76.47%) were on scheduled dosing of anticholinergics, while three (8.82%) were taking the medication on an as-needed basis. Polypharmacy should be avoided, and the use of anticholinergics should be closely reviewed. By adopting more efficient prescribing practices, costs can be reduced and financial resources can instead be channelled towards more beneficial areas for the patients.     

Effects of dopamine on sensitivity to social bias in Parkinson's disease

Patients with Parkinson's disease (PD) sometimes develop impulsive compulsive behaviours (ICBs) due to their dopaminergic medication. We compared 26 impulsive and 27 non-impulsive patients with PD, both on and off medication, on a task that examined emotion bias in decision making. No group differences were detected, but patients on medication were less biased by emotions than patients off medication and the strongest effects were seen in patients with ICBs. PD patients with ICBs on medication also showed more learning from negative feedback and less from positive feedback, whereas off medication they showed the opposite effect.     

Increased plasma ghrelin levels in chronic renal failure are not associated with hemodynamic parameters.

BACKGROUND/AIMS: Hardly anything is known about the effect of renal function on plasma ghrelin levels. Ghrelin is an orexigenic hormone with important hemodynamic effects. We examined differences in plasma ghrelin levels between chronic renal failure (CRF) patients and healthy subjects, and ghrelin's relationship with indices of left ventricular (LV) function. METHODS: Fasting total plasma ghrelin levels were measured in 122 CRF patients (57 on, 65 not on hemodialysis) and 57 control subjects. Indices of LV function were evaluated using echocardiography. RESULTS: Total plasma ghrelin levels were higher in patients with CRF compared to controls, but were not different between patients on and those not on hemodialysis. In a multivariate linear regression model, presence of kidney dysfunction explained 41 % of the variability of ghrelin values. The etiology of renal failure (diabetic nephropathy or not) had no influence on ghrelin levels in the renal patients. Ghrelin levels were not associated with indices of LV systolic function or blood pressure in these patients. CONCLUSION: Fasting plasma ghrelin concentrations are higher in CRF patients regardless of their need for hemodialysis compared to controls. The etiology of renal failure does not have any effect on plasma ghrelin levels. In addition, ghrelin levels are not associated with hemodynamic parameters in patients with CRF.     

Dermatoglyphic findings in periodontal diseases

The finger-tip palm and sole prints of 13 male and 23 female, a total of 36 patients with juvenile periodontitis (JP) 24 male and 21 female, a total of 45 patients with rapidly progressive periodontitis (RPP) and 19 male and 19 female, a total of 38 patients with adult periodontitis (AP) were compared with those of 17 male and 22 female, a total of 39 periodontally healthy (PH) individuals for the aim of finding a pattern type that would identify those patients. Besides, the finger-tip and palmar patterns of the patients were compared with those of 446 male and 447 female, a total of 833 school children (SC), and the sole patterns of the patients were compared with those of 250 male and 250 female, a total of 500 SC. When, the finger-tip patterns of the patients were compared with those of PH individuals, the decreased frequencies of twinned and transversal ulnar loops on all fingers of the patients with JP, a decreased frequency of double loops on all fingers and an increased frequency of radial loops on the right second digits of the patients with RPP, and the increased frequencies of concentric whorls and transversal ulnar loops on all fingers of the patients with AP, an increased frequency of t″ triradii on the palms of the patients with JP, the increased frequencies of IV and H loops and tb triradii on the palms of the patients with RPP and an increased frequency of e triradii on the soles of the patients with JP were found. In summary, in the light of these findings dermatoglyphics could be used together with the other diagnostic methods such as clinical and radiologic investigations and in the identifying of the patients from distinct groups of PD’s.     

Usefulness of endometrial aspiration cytology for the preoperative diagnosis of ovarian carcinoma

OBJECTIVE: To evaluate the usefulness of endometrial aspiration cytology for the preoperative diagnosis of ovarian carcinoma. STUDY DESIGN: A total of 210 patients with ovarian carcinoma were investigated by endometrial aspiration cytology. RESULTS: Fifty-five of 210 patients (26.2%) had positive endometrial aspiration cytology. The positive rates of endometrial cytology were 3.9% in stage I, 23.8% in stage II, 36.5% in stage III and 53.3% in stage IV. When classified by histologic type, the positive rates of endometrial cytology in patients with serous adenocarcinoma, mucinous adenocarcinoma, clear cell adenocarcinoma, undifferentiated carcinoma and yolk sac tumor were 38.9%, 11.8%, 21.1%, 16.7% and 16.7%, respectively. One hundred twenty-eight of 210 patients (61.0%) were positive on peritoneal cytology, and 54 of these 128 cases (42.2%) were also positive on endometrial cytology. The positive rates of endometrial cytology were especially high in patients with serous adenocarcinoma (51.2%) and those with clear cell adenocarcinoma (40.0%) among those who were positive on peritoneal cytology. Of 74 patients who were negative on peritoneal cytology, only one (1.4%) with mucinous adenocarcinoma had positive endometrial cytology. Hysterectomy was performed on 130 patients, and the positive rate of endometrial cytology was 100% in 4 patients with endometrial invasion and 15.9% in 126 cases without invasion. CONCLUSION: Endometrial aspiration cytology can detect ovarian carcinoma cells not only in patients with endometrial involvement but also in patients with positive peritoneal cytology. Endometrial aspiration cytology appears to be useful for the preoperative diagnosis of ovarian carcinoma.     

Early Mobilization after Myocardial Infarction: a Controlled Study

During the years 1968-71 203 patients with proved myocardial infarction were admitted to the trial. Patients were mobilized either on day 10 (102 patients) or on day 20 (100 patients). All patients were kept in hospital for 30 days in order to ensure a detailed comparison of clinical course and laboratory data. In neither group was there a fatal complication and the differences in clinical outcome or laboratory data were statistically not significant. Half of the patients from each group were re-examined after an average of one-and-a-half years, and again no differences were observed. It is concluded that patients with an uncomplicated myocardial infarction may safely be mobilized after 9 days and discharged after three weeks.     

“沟通”在特需病房护理工作中的作用

摘要目的：探讨并分析“沟通”文化在特需病房护理中的作用。方法：选取自2010年11月至2012年11月在我院接受过特需病房护理的相关病症患者100例作为本研究的观察组;另选取同时期在普通病房接受护理的患者100例作为对照组。对照组则采用常规的护理方法进行护理;观察组中,护理人员采用“一切以病人为中心”的护理观念和人性化护理方式与患者进行相应的沟通,最大程度的满足患者的需求。采用回顾分析的方法对两组患者的临床资料及其对护理方式的满意度评价等进行分析回顾。结果：与对照组相比,患者及患者家属对医护人员采用与患者进行沟通的方法进行护理的评价及满意度普遍较高,其中99位（99．00％）患者表示非常愿意接受该种护理方法;有98住（98．00％）患者的家属也十分赞同该护理方法。结论：在对特需病房患者进行相应的护理时,与患者以及患者的家属进行相应的沟通,根据患者的所需进行人性化的护理十分重要。采用沟通的方法对特需病房患者进行人性化护理能够提高相应的护理质量,充分的提高护理人员的主观能动性。而且,适时的与患者进行相应的沟通,令其感受到温暖、尊重以及关爱,对患者的康复具有重要的意义。     

Use of medications on the restricted list by the elderly.

On 1 April 1985 the range of drugs that may be prescribed on the National Health Service was limited by the government. We studied the possible effects of this new policy on 1066 elderly patients in two general practices in south Wales. Many patients who were prescribed drugs from the restricted list were also disabled, had psychological problems, or were on supplementary pension. We intend later this year to study the consequences of the changes in prescribing on elderly patients.     

Effect of degree of knee osteoarthritis on balancing capacity after sudden perturbation

This study aimed to assess equilibrium ability after sudden perturbation in patients with moderate and severe unilateral knee osteoarthritis (OA), with regard to age, gender, and lateral dominance. Our clinical trial included 45 female and 45 male healthy elderly subjects, 24 female and 24 male patients with moderate OA (mOA), and 24 female and 24 male patients with severe OA (sOA). Subjects were divided in two age groups: 65-69 and 70-74years. Using an oscillatory platform, we conducted provocation tests and determined the Lehr's damping ratio (D), which represents balancing capacity after sudden perturbation. D values determined for standing on both legs were similar to those of healthy individuals on the dominant limb or for OA patients on the non-affected limb; they were significantly lower for healthy individuals on the non-dominant limb and OA patients on the affected limb. For healthy subjects and mOA patients, D was significantly decreased with age and influenced by gender. sOA patients presented lower D values than other groups under all conditions, which were not influenced by age or gender. Our results demonstrate that OA patients were less capable of responding to perturbations, possibly indicating that they have an increased risk of falling.     

复方氨基酸胶囊与整蛋白型肠内营养合用对慢性支气管炎患者的应用观察

为了了解应用复方氨基酸胶囊联合整蛋白型肠内营养制剂对慢性支气管炎患者疗效的影响,将70例需进行治疗的慢性支气管炎患者随机分为治疗组和对照组.治疗组35例,在常规饮食的基础上,服用复方氨基酸胶囊联合应用整蛋白型肠内营养制剂;对照组35例,进行常规饮食,不进行肠内营养治疗.分别观察两组患者治疗前1d、治疗第20 d症状改善...     

Domiciliary nebulisers in asthma: a district survey.

Fifty three patients who were found to be using a home nebuliser for asthma completed a questionnaire. The results showed some confusion about the criteria for recommending whether a patient should buy a nebuliser and for its correct use. Twelve patients had not received any instruction on the use of their nebuliser, and only 11 of those old enough used a peak flow meter in conjunction with it. Eight patients aged 7-15 were using inhaled sympathomimetic aerosols only at the time of buying a nebuliser as compared with most of the older patients, who were using regular oral steroids. Forty nine patients assessed their asthma as moderate to severe, but eight of these were not attending a hospital clinic. Several patients were using 20 mg salbutamol or more every day, and on occasion doses of up to 50 mg a day were reported. It is recommended that patients should be assessed before they buy a nebuliser and advice given on correct use by a district nebuliser service, organised either by respiratory function technicians or in physiotherapy departments for adults together with a paediatric health visitor for children.     

分层管理对大面积烧伤患者早期康复治疗的临床意义

目的：重度烧伤早期易合并多种并发症且病情复杂、死亡率高,严重影响患者的生存周期和生活质量。本研究分析并探讨不同干预措施对重度烧伤患者早期并发症的效果,为临床研究提供可借鉴的方法。方法：选取2011年1月．2012年11月我院收治的重度烧伤患者66例,随机分为常规护理组和分级管理组,每组各33例。常规组采取基本护理模式对患者进行康复期护理,分级管理组根据病情对患者进行分级,分配不同专业技能等级的护理人员进行护理。观察并比较两组患者的临床效果及对护理服务的满意度。结果：分层管理组患者并发症发生率为42.3％,明显低于常规护理组69．7％（P〈0．05）;分层管理组的护理质量、患者依从性及对护理服务的满意度均显著高于常规护理组,差异具有统计学意义（P〈0．05）。结论：对大面积烧伤患者实施分层管理的护理模式具有积极的作用,不仅有效降低并发症发生率,而且能够合理分配护理人员,优化服务质量,提高患者满意度,值得在临床护理实践中推广应用。     

应用神经导航系统手术切除颅内肿瘤病人的整体护理临床效应

目的:探讨神经导航系统辅助下颅内微侵袭手术的整体护理临床效应。方法:神经导航系统因其能在术前制定最佳手术路径,术中准确快速地找到病灶,确定肿瘤切除范围,减少周围组织的损伤,术后并发症少,在临床已日渐推广。在临床护理中,为了确保达到预期疗效,对20例采用神经导航系统辅助下颅内肿瘤手术切除的病人从生理、心理、社会等各方面需求做出全面、有效的护理计划,制定出护理措施,进行健康指导。结果:全组无残疾或死亡,无1例术后因护理不当而出现并发症,15例患者4d左右下床活动,1例术前昏迷,术后15d清醒,2例术后出现尿崩症,经处理后恢复正常,1例术后脑水肿,给予脱水剂后症状消失,1例术后癫痫,药物控制后缓解。全组患者于术后平均20d左右痊愈出院。结论:在神经导航系统辅助下加强护理配合,严格操作规程,对提高手术成功率,减少并发症有重要意义。     

银环蛇咬伤致急性呼吸衰竭的治疗及临床观察

目的观察抗银环蛇毒血清和机械通气对银环蛇咬伤致急性呼吸衰竭的疗效。方法应用抗蛇毒血清和机械通气救治23例银环蛇咬伤致急性呼吸衰竭患者。结果银环蛇咬伤患者及早应用抗银环蛇毒血清,毒蛇咬伤后发生急性呼吸衰竭时间为2.5～16h。当患者出现睁眼困难、吞咽困难、呼吸节律改变或呼吸困难时,即予气管插管行机械通气,可获得较好的疗效。结论机械通气辅助抗蛇毒血清是救治银环蛇咬伤致呼吸衰竭有效的方法。     

HV-CBP对急性重症胰腺炎患者机体免疫功能的影响

目的:探讨连续性高容量血液净化(HV-CBP)对急性重症胰腺炎患者免疫功能的影响及其临床效果。方法:选取我院消化科收治的急性重症胰腺炎患者220例,根据治疗方案不同分为对照组及试验组。对照组给予常规治疗,实验组在常规治疗基础上应用HV-CBP治疗。观察并比较两组患者治疗前后血清淀粉酶、脂肪酶、CRP、TNF-α及T淋巴细胞亚群的变化情况。结果:试验组体温、腹痛、黄疸症状恢复时间及住院天数均较对照组明显缩短(P0.05);治疗后试验组血清淀粉、脂肪酶、CRP、TNF-α水平明显低于对照组,而CD4+/CD8+比率明显高于对照组,差异均具有统计学意义(P0.05)。结论:HV-CBP对急性重症胰腺炎患者的临床症状、炎性刺激、病情进展及免疫功能具有良好的改善作用。     

Hypercoagulability and hypofibrinolysis in sickle-cell disease.

Fifty-two patients with sickle-cell (SC) disease (48 with SC-beta-thalassaemia and 4 with homozygous SC-anaemia) were studied as regards blood coagulation and fibrinolysis. It was found that the thrombin and the reptilase times of the patients' plasma were significantly shorter than normal. The mean values of platelet count, fibrinogen level and factor VIII activity of patients with SC disease were higher than normal; however, in the group of patients transfused, with less than 50% haemoglobin S (HbS), the fibrinogen level and the factor VIII activity were significantly lower compared to the other patients. Antithrombin-III (At-III) activity was normal in all. The fibrinolytic activity was normal in patients with asymptomatic SC disease, but reduced in patients on painful crises. Plasminogen and fibrinogen/fibrin degradation product (FDP) levels were normal in all patients. Two patients on painful crises with complications had additional abnormal findings, namely prolonged prothrombin time, reduced At-III level and elevated FDP.     

Chemoimmunotherapy of advanced breast cancer: prolongation of remission and survival with BCG.

Forty-five patients with disseminated breast cancer were given a trial of combination chemotherapy consisting of fluorouracil, adriamycin, and cyclophosphamide (FAC) and immunotherapy with BCG given by scarification. The results were compared with those in a comparable group of 44 patients treated with FAC alone immediately before the chemoimmunotherapy study. The remission rates (73% and 76% for FAC and FAC-BCG respectively) were similar in both studies. The durations of remission for patients on FAC-BCG (medium 12 months) were longer than remissions achieved for patients given FAC alone (median 8 months) (P = 0.068). The most notable effect of BCG was on survival. Thus 21 out of 34 patients achieving remission on FAC-BCG were alive at the time of the last follow-up examination (median over 22 months) compared with 11 out of 32 patients achieving remission on FAC (median 15 months) (P = 0.01). Twenty-six of the 45 patients given FAC-BCG were alive at the time of the last follow-up examination (median over 22 months) compared with 12 of the 44 patients given FAC (median 15 months) (P = 0.005). Although the apparent benefit of BCG could be explained by a maldistribution of some prognostic factors, the data suggest that further trial of chemoimmunotherapy of breast cancer should be carried out.     

内分泌疾病血浆氨基酸的模式

内分泌疾病血浆氨基酸的模式蒋滢,黄美英,何达纯ＰｌａｓｍａＦｒｅｅＡｍｉｎｏＡｃｉｄｉｎＥｎｄｏｃｒｉｎｅＤｉｓｅａｓｅｓ￥ＪｉａｎｇＹｉｎｇ;ＨｉｉａｎｇＭｅｉｙｉｎｇａｎｄＨｅＤａｃｈｕｎ（ＤｅｐａｒｔｍｅｎｔｏｆＢｉｏｃｈｅｍｉｓｔｒｙ,Ｓｕｚ...