Clinical study of pulmonary infection in traumatic patients / 国际检验医学杂志

Objective To investigate the clinical characteristics ,pathogenic bacteria detection rate and drug sensitivity situation of pulmonary infection in surgical trauma inpatients .Methods The characteristics ,pathogenic clinical examination and treatment method of pulmonary infection among traumatic inpatients in Fengdu County Hospital of Traditional Chinese Medicine from June 2013 to December 2014 were retrospectively analyzed .Results The clinical symptoms of pulmonary infection were usually atypical . The laboratory detection showed 31 cases of WBC>10 .0 × 109/L ,32 cases of (4-10)× 109/L ,0 case of 70% ,8 cases of neutrophils proportion 50% -70% and 0 case<50% .51 cases (81% ) were definite in pathogenic diagnosis ,in which 46 cases were obtained by sputum culture and 12 cases were obtained from blood culture .Lung in‐fections were mainly caused by bacterial infections (68 .3% ) ,which was nominated by Gram‐negative bacteria ,including 15 cases of single bacterial infections ,23 cases of complex bacterial infection and 15 cases of complicating fungal infection .Conclusion The treatment success rate of surgical trauma patients is affected by the combined action of lung infection and complicated drug resist ‐ance ,so the clinical examination plays a very important role .

The impact of celastrol on cognitive function and the expression of Cdk5, p25 and p35 in hippocampus in APPswe/PS1dE9 double transgenic mouse after partial hepatectomy / 临床麻醉学杂志

Objective To investigate the impact of celastrol on cognitive function and the ex-pression of Cdk5/p25 in hippocampus in APPswe/PS1dE9 double transgenic mouse after partial hepa-tectomy.Methods Three-month-old APPswe/PS1dE9 double transgenic mice (n=96)were randomly divided into surgery group (partial hepatectomy,group S),celastrol group (celastrol and partial hepa-tectomy,group C)and DMSO group (DMSO and partial hepatectomy,group O).Eight mice were se-lected randomly in each group and were Morris-water maze trained for 5 continuous days.Their learn-ing and memory abilities were evaluated at 1,3,7 and 14 d after the surgery,respectively.For the remaining mice in each group,the hippocampus were collected and the changes of Cdk5,p35 and p25 in hippocampus were measured by western blot at the time 1,3,7,14 d after partial hepatectomy. Six mice were killed at each time for data collection.Results The average escape latency of group C was significantly shorter than those of groups S and O at 3,7 and 14 d after partial hepatectomy (P <0.05).The percentages of time in target quadrant of groups S and O decreased significantly than that in group C (P <0.05).Western blot showed the expression of Cdk5 in group C was significantly low-er than that in groups S and O at 3,7 and 14 d after partial hepatectomy (P <0.05),and the same re-sult was also found in the expression of p25 at 1,3,7 and 14 d after partial hepatectomy (P <0.05). There was no significant difference in the expression of p35 between each group.Conclusion Celas-trol can improve the learning and memory ability in APPswe/PS1dE9 the double transgenic mouse, with the mechanism may be related to the decrease of Cdk5 and p25 in hippocampus.

Methylene blue 1% solution on the prevention of intraperitoneal adhesion formation in a dog model / Solução de azul de metileno a 1% na prevenção da formação de aderências intraperitoneais em um modelo experimental em cães

Intraperitoneal adhesions usually are formed after abdominal surgeries and may cause technical difficulties during surgical intervention, chronic abdominal pain and severe obstructions of the gastrointestinal tract. The current study aimed to evaluate the efficacy of methylene blue (MB) 1% solution on the prevention of intraperitoneal postsurgical adhesion formation in a canine surgical trauma model. Twenty bitches were submitted to falciform ligament resection, omentectomy, ovariohysterectomy and scarification of a colonic segment. Prior to abdominal closure, 10 bitches received 1mg kg-1 MB intraperitoneally (MB group) and 10 bitches received no treatment (control group, CT). On the 15th postoperative day the bitches were submitted to laparoscopy to assess adhesions. The mean adhesion scores were 13.9 (±5.6) for MB group and 20.5 (±6.4) for the CT group (P=0,043). In conclusion, the 1% MB solution was efficient on the prevention of intraperitoneal postoperative adhesion formation in bitches, especially those involving the colonic serosa.

Aderências intraperitoneais se formam frequentemente após cirurgias abdominais, podendo causar dificuldades técnicas durante intervenções cirúrgicas, dor abdominal crônica e obstrução grave do trato gastrintestinal. O objetivo do presente estudo foi avaliar a eficácia da solução de azul de metileno (MB) a 1% na prevenção da formação de aderências intraperitoneais em um modelo experimental de trauma cirúrgico abdominal em caninos. Vinte cadelas foram submetidas à ressecção do ligamento falciforme, omentectomia, ovário-histerectomia e escarificação da serosa de um segmento de cólon. Antes da síntese abdominal, 10 cadelas receberam 1mg kg-1 de MB a 1% via intraperitoneal (grupo MB) e 10 cadelas não receberam tratamento (grupo controle, CT). No 15o dia pós-operatório, as cadelas foram submetidas à laparoscopia para avaliação da formação de aderências. Os escores de formação de aderências foram 13,8 (±5,6) para o grupo MB e 20,5 (±6,4) para o grupo CT (P=0,043). A solução de azul de metileno a 1% foi eficaz na prevenção da formação de aderências intraperitoneais pós-cirúrgicas em cadelas, sobretudo nas relacionadas à serosa do cólon.

Clinical Analysis of Surgical Trauma between Complete Video-assisted Thoracoscopy and Traditional Open Surgery for Lung Cancer / 昆明医科大学学报

Objective To compare the traumatic indicators of complete video-assisted thoracoscopic surgery (c-VATS) with traditional open surgery (TOS) for lung cancer patients, and further explore the minimal invasiveness of c-VATS. Methods From January 2010 to February 2013, 45 cases with complete video-assisted thoracoscopic surgery (c-VATS gurop) and 42 cases with traditional open surgery (TOS group) were compared in operation time, intraoperative blood loss, duration of chest drainage, the perioperative cytokine and immune cells (CRP,WBC,N,L),pain score and shoulder function score. Results There was no significant difference between groups in sex, age, pathological type, stage,operating time and the perioperative cytokine and immune cells (CRP, WBC, N, L) ( >0.05);Compared with TOS group, c-VATS group intraoperative blood loss was significantly reduced [(167.4±68.5) mL vs (288.6±84.0) mL, =0.000];Drainage time of TOS group was significantly longer than that of c-VATS group [(4.64±2.10) days vs (3.20±1.20) days, =0.000];The postoperative pain measurements in c-VATS group were less than that in TOS group, but the difference between groups was not significant on postoperative 1 day ( =0.542) and significant on postoperative 3 day,7 day,30 day ( = 0.034, 0.000, 0.000) . Patients activities of daily living scores at postoperative 7 day and 30 day in c-VATS group were significantly better than those in TOS group, with statistically significant differences ( =0.000,0.000) . Conclusion Whether the short-term effect or the long-term results,the VATS lung resection is better than the traditional open surgery. c-VATS resection of lung cancer is more invasive.

Study of nursing measures for foot-drop complicated after surgical trauma / 中国实用护理杂志

Objective The purpose of this study was to observe the recovery effects of nursing intervention on foot-drop complicated after surgical trauma of bone fracture, and to discuss effective nursing strategies and measures. Methods 60 cases of patients with foot-drop complicated after internal fixation of tibial fractures were randomly divided into the observation group and the control group with 30 cases in each group, the observation group used lower limb joints rehabilitation trainers for ankle passive motion, the control group used artificial methods for ankle passive motion. Ankle movement and muscle strength recovery was observed and recorded after 12 weeks in two groups. Results Ankle joint mobility and muscle strength was significantly better in the observation group than in the control group. Conclusions Using lower limb joints rehabilitation trainers for ankle passive motion showed better effect than artificial methods for ankle passive motion.

Caracterização dos traumas abdominais em pacientes atendidos noHospital Universitário Regional de Maringá, 2006 / Abdominal trauma at the University Hospital of Maringá, 2006

De todas as mortes por causas externas por trauma, metade poderia ser evitada,e um terço delas é dito potencialmente evitável. Objetiva-se determinar as características comuns referentes ao paciente com traumatismo abdominal. Realizou-se um estudo de 57 casos de pacientes com traumatismo abdominal atendidos no Hospital UniversitárioRegional de Maringá, no período de janeiro a dezembro de 2006. Constatou-se que a maioria das vítimas é do sexo masculino; a faixa etária mais acometida é a terceira década devida; o trauma abdominal aberto mostrou-se discretamente mais frequente, sendo o ferimento por arma branca mais comum; a maioria das contusões abdominais se deveu aacidentes de trânsito; a realização de intervenção cirúrgica supera o tratamento conservador nos traumas abdominais abertos; nos traumas contusos, o baço e os rins foram os órgãos mais acometidos, enquanto nos ferimentos abertos a víscera mais acometida foi o intestino delgado; a evolução para óbito predominou nos traumas abdominais abertos. Em virtude da prevalência, gravidade e importância do tema, sugere-se que mais estudos sejam realizados para que, assim, seja possível estabelecer condutas cada vez mais apropriadas à realidade doSistema Único de Saúde.

Of all the deaths due to external cause trauma, half could be avoided, and a third are potentially preventable. The objective of this study was to determine the common characteristics related to patients with abdominal trauma. A study was conducted of 57 cases of abdominaltrauma at the University Hospital of Maringá, during the period from January to December 2006. The majority of victims are male; the most affected age group is in its third decade of life; open abdominal trauma proved to be slightly more prevalent, and wounds from coldsteel weapons were the most common; most abdominal injuries were due to traffic accidents; the conduct of surgical intervention overcomes conservative treatment in open abdominal trauma; in contusion trauma, spleen and kidneys were the most affected organs, while in open wounds the most affected viscera was the small intestine; evolution to death predominated in open abdominal trauma. Because of the prevalence, severity and importance of the issue, it is suggested that further studies be conducted in order to establish conducts more appropriate to our reality.

Persistent Diplopia after Local Anesthesia

PURPOSE: To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.

Impact of mederate surgical trauma on substrate utilization / 肠外与肠内营养

The study was designed to observe the impact of moderate surgical trauma on substrate utilization in 39patients(men,n=1 9;women,n=2 0 ) undergoing elective cholecystectomy. The utilization rate of carbohydrate,fat and protein was estimated on the day before operation and on the1 st,4th and7th post operative day by indirect calorimetry.The result showed that the postoperative utilization rate of carbohydrate was declined,and that of fat elevated significantly when compared with the preoperative values(P0 .0 5 ) .It suggested that the main energy source after moderate surgical trauma be from the oxidation of fat,which might be related to the change of metabolic hormone and the insulin resistance.

Overall Surgical Results and Causes of Unfavorable Outcome in Good Grade Patients with Intracranial Aneurysm

We analyzed the overall surgical results in 100 patients with intracranial aneurysms operated in Presbyterian Medical Center during the period from June 1990 to December 1993. Preoperatively, all patients were in Hunt and Hess grades I-III. Overall outcomes revealed 83 patients(83%) of good outcome, 10 patients(0%) of fair outcome. 3 patients(3%) of poor outcome, and 4 patients(4%) of dead outcome. The outcome was worse if surgery was performed in the 4 to 10 day post- bleed interval(P<0.05) and there was no statistical difference of the rate of good outcome between the parients operated at 0 to 3 days, and 11 day more after subarachnoid hemorrhage. In good grade patients, surgical trauma rather than delayed ischemic deficit was considered as the major cause of unfavorable outcome of aneurysm surgery. Intermedia to period operation increased the chance of postoperative delayed ischemic deficit. Systemic complications and vasospasm were the major causes of dead outcome in the oldaged patients.

RELATIONSHIP BETWEEN PYRUVATE KINASE ACTIVITY OF ERYTHROCYTES AND SURGICAL HYPERGLYCEMIA FOLLOWING UPPER ABDOMINAL SURGERY / 解放军医学杂志

To explore the relationship between the perioperative change in erythrocytic pyruvate kinase (PK) activity and surgical hyperglycemia in the patients undergoing upper abdominal surgery under intravenous procaine balanced anesthesia. Seventeen patients with ASA grade Ⅰ～Ⅱ, being scheduled for selective cholecystectomy or subtotal gastrectomy, were randomly enrolled in our study. PK activity of erythrocytes and its pertinent modulators, such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), inorganic phosphate (Pi), magnesium, plasma glucose and serum insulin were dynamically assayed in the surgical patients receiving intravenous procaine balanced anesthesia. The results showed that PK activity was decreased significantly at 10 min and 24 hours after operation as compared with that of preoperative period. Changes in PK activity were positively correlated with ATP/ADP ratio( r =0 680, P 0 05). It is our supposition that the decreased PK activity and the disturbance of glycolytic pathway might be directly or indirectly induced by anesthesia and surgical trauma, leading to hindrance of utilization of glucose and Pi, as well as synthesis of ATP. Therefore, an inhibition of glycolytic reaction is one of the important mechanisms of "surgical hyperglycemia".