Sequential hemodynamic changes for large volume paracentesis in post-hepatitic cirrhotic patients with massive ascites

Large volume paracentesis (4.8 to 15.5 liters) was performed in 42 patients with post-hepatitic cirrhosis and massive ascites, not only to derive parameters capable of predicting the development of severe clinical hypotension after large volume paracentesis, but also to determine the optimal time to introduce preventive volume expanders. Systemic hemodynamics were sequentially measured for 72 hours in thirty-two patients. Severe clinical hypotension occurred in 13 (31.0%) patients 4-62 hours from the start of paracentesis. Univariate analysis, with the Mantel-Cox test used to compare Kaplan-Meier curves, and the subsequent multivariate analysis by stepwise Cox regression procedure were utilized to identify two variables, withdrawn ascitic fluid greater than 7.5 liters (p = 0.0121) and the absence of peripheral edema (p = 0.0148), reaching statistical significance to predict the occurrence of severe clinical hypotension. Compared to the baseline value, the cardiac output of patients not developing severe clinical hypotension increased (6.26 +/- 0.66 vs. 6.65 +/- 0.69 liter/min, p < 0.01) one hour from the start of paracentesis and right atrial pressure decreased (11.2 +/- 2.4 vs. 8.7 +/- 2.3 mmHg, p < 0.05). The cardiac output returned to the baseline value at the 9th hour. Based on the results presented herein, we can conclude that severe clinical hypotension occurs in a high percentage of patients with post-hepatitic cirrhosis and massive ascites within 72 hours from the start of large volume paracentesis. At potential risk of this occurring are those patients without peripheral edema and withdrawn ascitic fluid greater than 7.5 liters. Volume expanders should be introduced before 4th hour from the start of large volume paracentesis.     

Patient selection is important in studying the impact of large-volume paracentesis on intravascular volume

An intact barrier between the hands of the surgeon and the patient remains the single most important factor in protection against infection for both. Increasing the awareness of possible glove perforation without skin penetration will decrease the risk of contamination. We performed a prospective, randomised trial comparing the incidence of glove perforation using a new type of glove (Regent Biogel Reveal) and standard double-gloves in total hip and knee replacement. One or more perforations was detected in 14.6% of all gloves. The new gloves increased significantly the awareness of perforation. Multiple perforations at the base of the ring finger were found in surgeons who wore wedding rings during the operation and we recommend that rings be removed before undertaking surgery.     

Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy

AIMS: This series analyses the results of conservative surgery for large lower pole breast cancers by lumpectomy associated with a bilateral remodelling mammoplasty, in order to avoid residual deformities. METHODS: This retrospective study concerns 50 patients with a lower pole breast cancer treated between 1986 and 1996 by lumpectomy, mammoplasty and irradiation. The contralateral breast was immediately made symmetrical in all cases. The mean tumour size was 32.5 mm. RESULTS: The mean weight of the lumpectomy specimen was 270 g. Resection margins were tumour-free in 90% of cases. The main complication observed was delayed healing, thus postponing post-operative treatment in 6.5% of cases. The median follow-up was 48 months. The 5-year actuarial ipsilateral local recurrence rate was 7% and 5-year actuarial metastasis-free and overall survival rates were 81 and 97%, respectively. Cosmesis was satisfactory in 85% of patients. We observed better results when radiotherapy was performed after rather than prior to surgery (92 vs. 67%: NS). CONCLUSIONS: Performing a bilateral mammoplasty at the time of initial surgery for large breast cancers situated in the lower quadrants of the breast facilitates larger lumpectomies with good cosmetic results.     

Loop excision of the transformation zone (LETZ) as an outpatient method of management for women with cervical intraepithelial neoplasia: our experience

Between March 1996 and July 1998, 90 patients were treated with diathermy loop excision (LETZ) for cytologically, colposcopically and histologically verified cervical intraepithelial neoplasias (CIN), at the outpatient clinic. In average, the patients were 30.22 years of age, and 61.1% of them were nulliparas. In 80 surgical samples (88.9%), the exocervical and endocervical margins were histologically free of disease. From the total of 65 patients with CIN III diagnosis, 58 (89.2%) had free margins samples. In the post-operative period the patients had a changed vaginal discharge for 16 days. A slight feeling of pain in the abdomen lasted for 2.5 days on the average, and most patients did not take analgetics. Moderate postoperative hemorrhage from the excision site occurred in 5 (5.5%) patients, and was outpatiently treated with electrocoagulation, with no need for blood replacement. In 65 patients (90.3%), the cytological control results were normal. During the follow-up period, 9 patients became pregnant, which resulted in 6 terminal deliveries so far; 2 pregnant women are about to deliver, and one is in the first trimester of pregnancy. Cerclage cervicis has not been performed on any of the patients. LETZ is a safe and simple procedure which can be done at outpatient clinics, it is relatively easily mastered, it is short, quite bearable for patients if done only under local analgesia, the equipment costs are acceptable, and the treatment can be used both diagnostically and therapeutically, since an adequate surgical sample is obtained for histological assessment. Cytological and colposcopical check ups are imperative in the postoperative period.     

建立三位一体管理体系,提高企业管理水平

唐钢耐材公司是功能性耐火材料企业 ,主要为国内外钢铁企业提供炼钢连铸用滑动水口系列产品和不定型耐火材料。其产品特点是必须保证功能性 ,满足不同钢种、不同炼钢条件的要求 ,达到安全、适用、方便 ,因此为满足顾客的要求 ,本公司不断探索管理的新路子 ,从 1996年开始贯彻ISO90 0 0系列标准并通过认证 ,2 0 0 1年又按ISO90 0 1:2 0 0 0标准重新改进了质量体系。在 2 0 0 3年为了建立一套全新的管理体系和不断改进的机制 ,借鉴国际上的先进管理经验 ,提高本企业的管理水平 ,协调环境保护、职业健康安全与经济发展的关系 ,开始贯彻ISO1…     

Ultrasonic diagnosis of fetal ascites (author's transl)

Fetal ascites is relatively rare, but confronts the obstetrician with difficult decisions. By X-ray methods such as plain X-ray or fetography fetal ascites may only be suspected. Performing ultrasonic examinations however it is not only possible to detect the fluid collection in the peritoneal cavity but as well to recognize the inducing causes. This is documented by sonograms of three cases observed within the last year. The different decisions for the obstetrician in respect to fetal ascites with or without malformations are discussed.     

Hemoglobin M equon beta 41 (C7) phenylalanine leads to tyrosine

A severe hemolytic crisis was observed in a 34-yr-old female of English-Irish extraction following a viral illness treated with acetaminophen. Heinz bodies and heat instability were present only during a transient hemolytic event. A challenge dose of acetaminophen caused no detectable hematologic abnormality. Structural studies of the hemoglobin during hemolysis and again after complete recovery localized the abnormality to tryptic peptide beta Tp-5, and automated sequencing of I 125-labeled beta chains indicated a replacement of phenylalanine (C7) beta 41 by tyrosine. Substitution of the next residue, phenylalanine (CD1) beta 42 by serine (Hb Hammersmith), has resulted in chronic severe Heinz body hemolytic anemia. The lack of chronic anemia in the present disorder may reflect the different relationships of beta41 and beta 42 and/or the similarities in volume and hydrophobicity of tyrosine and phenylalanine. It is suggested that substitution of tyrosine for phenylalanine in Hb Mequon may disturb the critical environment around the heme group and render it susceptible to oxidative denaturation in the presence of infections and/or drugs.     

PSATZ (prostate specific antigen adjusted for the transition zone volume)

This brief review discusses the diagnostic ability of prostate specific antigen adjusted for the transition zone volume (PSATZ) for the detection of prostate cancer in patients with intermediate prostate specific antigen (PSA) levels. PSATZ was defined as the quotient of the PSA value and the calculated transition zone volume. In comparison with standard parameters including PSA and prostate specific antigen density, PSATZ could be a useful indicator for the detection of prostate cancer in patients with PSA values between 4.1 and 10.0 ng/ml, especially in those with normal digital rectal examinations. Similar observations consistent with our results have been also reported by other investigators. PSATZ has some disadvantages including volumetry and expensive cost. Further study is necessary to discuss whether PSATZ is superior to other new modalities such as free-to-total PSA ratio with regard to diagnostic cost and efficacy.     

Effect of Poultry Litter Treatment (PLT) on death due to ascites in broilers

Fifty-one cases of bacteremia due to the "Streptococcus milleri" group were analyzed. Among these were 40 patients with underlying diseases, and associated local infections were present in 27 patients. The most frequent sites of infection were the thoracic cavity and the digestive and hepatobiliary tracts. A probable portal of entry related to mucosal-barrier trauma was identified for an additional 16 patients. The origin of bacteremia was unknown for the remaining eight patients. Abscess formation was evident for only six patients, and there were no cases of endocarditis. Multiple positive blood cultures and polymicrobial bacteremia were associated significantly with the presence of local sites of infection. The most common causative species were Streptococcus anginosus and Streptococcus constellatus. Two patients died of bacteremia.     

Possibilities and limits of outpatient surgery (author's transl)

The aims of modern outpatient surgery include: the comprehensive development of ambulatory therapy especially the repertoire of operations, preclinical standardized diagnostic procedures, postoperative outpatient care and rehabilitation. The main reasons for this development are analyzed. In order to make further progress in the direction indicated the number of surgeons working in outpatient departments will have to be increased. Own experiences in outpatient saphenectomy, excisions of Dupuytren's contracture, haemorrhoidectomy, mastectomy, herniorrhaphy, enucleation of cold nodes in the thyreoid gland (171 operations between 1972 and 1974) encourage further efforts in this direction.     

Managing capital and administrative (indirect) costs to achieve strategic objectives: the dialysis clinic versus the outpatient clinic

During the race for costing accuracy in health care, managers should acknowledge the equal importance of interdepartmental relations. Although newer costing systems can produce more accurate numbers, greater costing accuracy may not always strengthen the organization. This article demonstrates that subsidizing some capital and administrative (indirect) costs for select hospital departments may help to achieve strategic management objectives.     

创建长效机制 加快高级技能人才培养步伐

在人力资源开发过程中,将人力资源优势转化为人才优势,最终转化为科技优势,产业优势,提高操作人员技术素质、创新能力是关键.本文通过对高级技能人才现状、作用、地位的分析,进一步明确加快培养高级技能人才的重要性和紧迫性.从而达到创新培训形式,提高高级技能人才素质的目的.     

Crystal structure of the simian immunodeficiency virus (SIV) gp41 core: conserved helical interactions underlie the broad inhibitory activity of gp41 peptides

The gp41 subunit of the envelope protein complex from human and simian immunodeficiency viruses (HIV and SIV) mediates membrane fusion during viral entry. The crystal structure of the HIV-1 gp41 ectodomain core in its proposed fusion-active state is a six-helix bundle. Here we have reconstituted the core of the SIV gp41 ectodomain with two synthetic peptides called SIV N36 and SIV C34, which form a highly helical trimer of heterodimers. The 2.2 A resolution crystal structure of this SIV N36/C34 complex is very similar to the analogous structure in HIV-1 gp41. In both structures, three N36 helices form a central trimeric coiled coil. Three C34 helices pack in an antiparallel orientation into highly conserved, hydrophobic grooves along the surface of this coiled coil. The conserved nature of the N36-C34 interface suggests that the HIV-1 and SIV peptides are functionally interchangeable. Indeed, a heterotypic complex between HIV-1 N36 and SIV C34 peptides is highly helical and stable. Moreover, as with HIV-1 C34, the SIV C34 peptide is a potent inhibitor of HIV-1 infection. These results identify conserved packing interactions between the N and C helices of gp41 and have implications for the development of C peptide analogs with broad inhibitory activity.