Use of the donor iliac vein to replace the retrohepatic vena cava in pediatric reduced-size liver retransplantation

The authors describe a new technique that used the donor common iliac vein and its bifurcation into the external iliac and internal iliac veins to replace the retrohepatic vena cava; this was used in a recipient who underwent her second reduced-size transplantation (segments II and III). Anastomosis of the donor hepatic vein to the internal iliac vein, with use of this segment of the venous graft to replace the retrohepatic vena cava, is for patients who have had more than one surgical procedure before liver transplantation.     

Use of wide-diameter and standard-diameter implants to replace single molars: two case presentations

Rats were treated with daily oral doses of 1, 4, and 6 mg/kg risperidone (RSP) and its metabolite, 9-hydroxy-risperidone (9-OH-RSP), for 15 consecutive days. Concentrations of RSP and 9-OH-RSP were measured in plasma, brain, liver, kidney, lungs and fat tissue by high-performance liquid chromatography with electrochemical detection. Non-specific distribution of RSP and 9-OH-RSP in various brain regions was also studied after administration of 6 mg/kg per day oral dose for 15 days. After RSP treatment, concentrations of 9-OH-RSP were higher than those of RSP in plasma and tissues except in brain, where both compounds were present in nearly equal concentrations. Similarly, after 9-OH-RSP treatment, levels of 9-OH-RSP were higher than levels of either RSP or 9-OH-RSP or the sum of RSP and 9-OH-RSP levels measured after treatment with RSP. There was a moderate relationship between RSP dose and tissue levels of RSP and 9-OH-RSP (all rs > or = 0.62, P < 0.01), except in fat. There was also a strong relationship between the dose and tissue levels of 9-OH-RSP (all rs > or = 0.68, P < 0.005). A significant relationship was found between plasma levels of RSP and brain levels of RSP and 9-OH-RSP (all rs > or = 0.57, P < 0.03) after treatment with RSP. After 9-OH-RSP treatment, a much stronger relationship was observed between plasma and brain 9-OH-RSP levels (rs > or = 0.90, P < 0.005). The plasma concentrations of RSP and 9-OH-RSP appear to reflect their concentrations in brain. The tissue-to-plasma ratios of RSP and 9-OH-RSP were relatively low compared to other antipsychotics. In liver, kidney and lung the tissue to plasma ratio for RSP and 9-OH-RSP after treating with RSP ranged from 0.85 to 3.4. The brain to plasma ratio for RSP and 9-OH-RSP was several-fold lower than that in peripheral tissues. After RSP administration, the mean brain to plasma level ratio for RSP was 0.22, and for 9-OH-RSP to it was 0.04. The brain to plasma ratio of 9-OH-RSP after giving 9-OH-RSP was similarly low (0.04). The low brain/plasma ratio of high potency RSP and 9-OH-RSP may in part be due to their low lipophilicity, log P = 3.04 and 2.32, respectively, resulting in limited non-specific accumulation in brain tissue.     

采用髋关节置换术治疗老年股骨粗隆间骨折30例

目的:探讨采用髋关节置换术治疗老年股骨粗隆间骨折的疗效.方法:收集我院30例老年股骨粗隆间骨折,19例采用全髋关节置换术治疗,11例合并有其他器官疾病不能耐受长时间手术患者,采用半髋关节(人工股骨头)置换术治疗.结果:本组病例随访3年,30例中优17例、良11例、中2例;优良率达到93.33%.结论: 髋关节置换术治疗老年股骨粗隆间骨折,具有缩短患者卧床时间、减少并发症、手术创伤相对较小等优点.值得临床推广应用.     

摩擦提升机首绳更换方法

摩擦提升机在岩金地下开采矿山应用较普遍.介绍了3种更换摩擦提升机首绳的方法,即用八联绳卡同步更换全部首绳,用专用绳盘同步更换全部首绳,利用2台绞车逐根更换首绳;并对3种首绳更换方法进行了对比分析,指出其优点、缺点和适用场所.值得参考.     

Open surgery of choledochus in Denmark

For each of the years 1991-1994 400, 209, 170 and 133 open common bile duct stone extraction were performed in Denmark, corresponding to 35%, 17%, 12% and 5% respectively of patients diagnosed with common bile duct stone. There was only little variation between the 16 hospital counties. The expected decrease in open common bile duct surgery corresponds to the introduction of several non-invasive methods for the treatment of common bile duct stones. To achieve further reduction in open surgery, centralization of the treatment of common bile duct stones is necessary.     

Atresia of the appendix

A 4-day-old black male underwent laparotomy for intestinal obstruction. At surgery, multiple jejunal atresias (type IV) of the jejunum were detected. As an incidental finding, atresia of the appendix was also present. The jejunal atresia was repaired, and resection of the tip of the cecal pole and atretic appendix was performed. Gross and histological examination confirmed the presence of a type IV atresia of the jejunum and a cordlike (type II) atresia of the appendix with inflammatory changes in the tip of the appendix. The boy made an uneventful recovery. Examination of all organ systems did not show any associated findings, and the family history was unremarkable. To our best knowledge, this case represents the first case of atresia of the appendix described in the literature.     

Adenocarcinoma of the cecal appendix

The authors report one rare case of primary adenocarcinoma of the vermiform appendix. The patient, an 83 year old female, presented with a non-pathognomonic symptomatology; diagnosis was made postoperatively. Surgery consisted of appendicectomy. The patient, due to her poor general condition, died three days after surgery for cardiocirculatory complications. In the light of the very rare case published in the literature, some diagnostic, anatomic-clinical, therapeutic and prognostic aspects of this rare tumor are discussed.     

Carcinoid tumors of the appendix

OBJECTIVE: A retrospective study of 41 patients with histologically confirmed diagnosis of appendix carcinoid tumors was undertaken by reviewing the surgical records at Massachusetts General Hospital. METHODS: There were 8 male and 33 female patients (mean age 32 years). Twenty-two patients (54%) presented with signs and symptoms suggestive of acute appendicitis. In 19 patients (46%) the lesions were discovered incidentally. The tumors were located in 32 patients at the tip, in 6 patients in the middle third, and in 3 patients at the base of the appendix. The tumor was less than 1 cm in diameter in 32 patients, between 1 and 2 cm in 7 patients, and was bigger than 2 cm in 2 patients. In 29 patients, the depth of tumor penetration was confined to the submucosa or to the muscle layers of the appendix, and in 8 patients the serosa was involved. In 4 patients, evidence of tumor extension into the meso-appendicular fat was present, including one patient with a tumor bigger than 2 cm and local lymph-node metastases. Forty patients underwent appendectomy alone. One patient with a tumor size bigger than 2 cm in diameter with positive lymph nodes in the mesoappendix underwent secondary right hemicolectomy. Complete follow-up was achieved in 35 patients, and all patients remained free of tumor recurrence. CONCLUSIONS: The authors conclude that appendiceal carcinoids are rare and most often are asymptomatic. Tumors of less than 1 cm are adequately managed by appendectomy alone. The appropriate treatment for tumors of 1 to 2 cm continues to be controversial. Right hemicolectomy is recommended for all tumors larger than 2 cm, whereas preference for an aggressive approach should be given in young patients.     

Primary adenocarcinoma of the appendix

Two cases of carcinoma of the appendix presenting as appendicular masses are discussed. Carcinoma of the appendix is rare and hence a pre-operative diagnosis is seldom made. Awareness of the condition would naturally arouse suspicion of its presence, especially in elderly patients who present with cute appendicitis or an appendix mass. It is known to have occurred in an appendix stump several years after the initial appendicectomy, and also in a 17-year-old patient. The need for histological examination of all appendicetomy specimens is stressed. The operation of choice is right hemicolectomy, either as a primary or as a secondary procedure. This is associated with better survival rates than when the condition is treated by appendicectomy alone.     

在轧钢设备翻转装置中采用链传动代替齿轮—齿弧传动

本文介绍了在轧钢设备翻转装置中采用链传动代替齿轮－齿弧传动，不仅简化了设备结构，且容易加工，大大降低了机械加工费用，在实际应用中取得了很好的效果。此传动方式也可推广用于其他翻转装置。     

Xeroradiography and ionography: new technologies to replace the x-ray film

Novel methods of radiogram imaging are described and compared with conventional means. They include: xeoradiography, low- and high-pressure ionography and liquid phase ionography. The possibility of real time operation is considered also. Of these systems, xeroradiography is already in use for a limited range of applications. High pressure gas ionography shows great promise and practical systems may be expected to appear in the near future.     

Actinomycosis of the appendix in childhood

Hydrocarbon injection, while commonly seen in domestic accidents or attempted suicide, is not extensively addressed in the literature. This article comprises a review of the various complications of intravascular and soft tissue injection of petroleum distillates, and provides recommendations for patient management. An illustrative case involving the subcutaneous injection of dripless oil, a mixture of mineral oil, nonionic detergents, and petroleum naphtha, is presented.     

Goblet cell carcinoid of the vermiform appendix

To ensure freedom of movement in the European Union, a limited number of professions is regulated by a so-called Sectorial Directive; all other disciplines, including clinical chemistry, fall under a General Directive. However, clinical chemists in the EU wish their specialty to be more specifically regulated; this means that common standards of education, training, experience and compliance with continuing professional developments must be guaranteed. Therefore, the European Communities Confederation of Clinical Chemistry (EC4) is about to implement the European Register for clinical chemists, and has composed a guide to this Register. The document describes the conditions for entry to specialty training, the minimum standards for registration (university education and postgraduate vocational training with a minimum total of eight years), the competencies of those qualifying for registration, and the operation of the register. Registration guarantees professional and managerial competencies; the title conferred is "European Clinical Chemist". EC4 recognises the existing national registers as far as they are based on the minimal requirements as indicated. An EC4 Register Commission (EC4RC) will maintain and control the European Register, supported by National Clinical Chemistry Registration Committees (NCCRC). An NCCRC controls the quality of the education in each country and assesses candidates. An individual (EU citizen or non-EU citizen trained in an EU country) applies privately for the European Register to EC4RC and, where applicable, the application is accompanied by a document from the NCCRC of the country of registration, stating that the applicant has the necessary qualifications. For EU citizens trained outside the EU the final decision is with EC4RC; non-EU citizens not trained in an EU country are not eligible for registration. Registration is renewed once every five years.     

应用临床路径对髋关节置换术患者实行健康教育的效果观察

目的:观察应用临床路径对髋关节置换术患者进行健康教育的效果.方法:将42例髋关节置换术患者随机分为对照组(19例)和实验组(23例).对照组接受常规健康教育,实验组按照临床路径进行健康教育.结果:实验组的掌握相关知识和技能的比率、健康教育达标率及对护士的满意度均明显高于对照组,实验组的平均住院时间为(19.2±3.3)d,则明显短于对照组的(14.3±1.2)d,差异均有统计学意义(P<0.01或<0.05).结论:应用临床路径对髋关节置换患者进行健康教育可提高健康教育质效.     

Designing a mental health center to replace a county hospital

An architectural team worked closely with a county building committee and the administrative staff of a Wisconsin county hospital to design a new active-treatment facility. The goals included changing the hospital's negative image in the community, fostering a close relationship between all programs and all groups of users, and encouraging inpatients to make the best possible use of various treatment areas. Planning was interrupted by a community-wide controversy over the location, and the facility was eventually built on a compromise site. The new facility, a community mental health center serving two counties, has an open, split-level design accommodating six inpatient programs and a day hospital. An informal evaluation of the environment was made a year after the center was occupied.