Iatrogenic colorectal perforation induced by anorectal manometry:Report of two cases after restorative proctectomy for distal rectal cancer

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.

Principles of the roof cut short-arm beam mining method (110 method) and its mining-induced stress distribution

Since the 1960 s, mining science and technology in China has experienced two technical innovations, i.e.the ‘‘Masonry Beam Theory(MBT)" and ‘‘Transfer Rock Beam Theory(TRBT)". Based on those theories, the conventional mining method(being called the 121 mining method) was established, consisting of excavating two tunnels with a pillar left for mining a working panel. However, with increasing mining depth,engineering geological disasters in the underground caverns have been frequently encountered. In addition, the use of the coal-pillar mining results in a large amount of coal resources unexploited. In order to address the problems above, the ‘‘Roof Cut Short-Arm Beam Theory(RCSBT), being called the 110 mining method)" was proposed by He Manchao in 2008. The 110 mining method features the mining of one coal seam panel, excavating necessarily only one roadway tunnel and leaving no pillars. Realization of the 110 mining method includes the following steps:(1) directional pre-splitting roof cutting,(2) supporting the roof by using high Constant Resistance Large Deformation bolt/cable(CRLD), and(3) blocking gangue by hydraulic props. This paper presents an overview of the principles, techniques and application of the 110 mining method. Special emphasis is placed on the numerical simulation of the geostress distribution found in the mining panel using the 110 method compared to that of the 121 method. In addition, the stress distribution on the ‘‘short beam" left by the roof cutting when performing the 110 method was also investigated using both numerical simulation and theoretical formulation.

CLINICAL OBSERVATION ON TREATMENT OF HICCUP BY ACUPOINT DIGITAL-PRESSING AND MASSAGE

In the present paper, 32 cases of hiccup are treated with acupoint digital pressing and massage. According to syndrome differentiation, hiccup is divided into 5 types including stomach-cold, reversed rising of the stomach-fire, adverse flow of qi and phlegm obstruction, deficiency of both spleen-yang and kidney-yang and insufficiency of the stomach-yin. Acupoints used are Zusanli (ST 36), Neiguan (PC 6), Zhongfu (LU 1), etc. and pressed with fingers repeatedly. Then, massage manipulations are performed by tapping the patient's back repeatedly for 5 - 6 times; tapping Jiuwei (CV 15) area, and pressing the tender-point beside the left side of T3_4 spinous processes and Geshu (BL 17). After treatment, of the 32 cases of hiccup, 23 cases are cured, 6 have remarkable improvement and 3 are failed in treatment, with the effective rate being 90.6% .

Biophysical Substantiation of a Surgical Method of Treatment of a Primary Arterial Hypertension

It is shown that flow of a blood in a passive elastic tube essentially unstable process accompanying with a flutter of a stream. Biophysical principles of neuroreflex regulation of an arterial bloodstream in cardiovascular system are considered. It is shown that this regulation has dual-purpose character： reduction of the hydraulic resistance and maintenance stable no flutter stream of blood. The reasons of a primary arterial hypertension occurrence, and also some accompanying it physical and physiological phenomena are considered. The surgical method of treatment of the primary arterial hypertension, connected with denervation of renal arteries is substantiated.

Prediction of pulmonary arterial wedge pressure from arterial pressure or pulse oximetry plethysmographic waveform

Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP) Methods Fourteen American Society of Anesthesiologists grade Ⅰ-Ⅱ patients aged 33-69 years and weighing 62 0±9 5 kg scheduled for elective abdominal tumor surgery were studied Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35% Pre operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet , dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation Central venous pressure was maintained at 10-12 mm Hg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR) Results APR, SPV, dDown, SPV plet and dDown plet all correlated well with PAWP ( r =0 717, -0 695, -0 680, -0 522 and -0 624 respectively, P <0 01) There was a closer linear correlation between APR and PAWP than between the other parameters The regression equation was PAWP (mm Hg)=0 207×APR (%)-0 382 Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPV plet and dDown plet can be used to estimate PAWP effectively

Outcome of surgical treatment of type Ⅳ capitellum frac- tures in adults

Objective： Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type Ⅳ capitellum fracture is still controversial in regard to its ra- diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type Ⅳ capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods： We treated 10 patients of type Ⅳ capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results： Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera- tively 6 capitellotrochlear fragments were devoid of soft tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures. Conclusions： Type Ⅳ capitellum fractures are rare and belong to complex articular injuries. A good functional out- come can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preopera- tive radiographic assessment and computed tomography help surgeons in choosing the right surgical approach and implants. Good surgical technique and stable internal fixa- tion are the keys to early mobilization and good functional outcome.

Effects of auricular point sticking on dry eye in myopia patients after SMILE surgery:a prospective randomized controlled clinical trial

Objective:To observe the intervention effect of auricular point sticking on dry eye in myopia patients after small-incision lenticule extraction(SMILE)surgery.Methods:This was a prospective randomized controlled study conducted among the myopia patients who received SMILE surgery at Eye and ENT Hospital of Fudan University.The post-SMILE operation patients who screened by the inclusion and exclusion criteria were randomized into a control group and a treatment group.Patients in the control group were given 0.1%fluorometholone and 0.5%carboxymethylcellulose sodium eye drops,while the treatment group was given additional unilateral auricular point sticking for 1 month.The patients were estimated using ocular surface disease index(OSDI),Schirmer tear test-1(STT-1),tear film break-up time(TF-BUT),corneal fluorescein staining(CFS)score,corneal sensitivity(CS)and visual quality(VQ)at 1 d,1 week and 1 month after surgery;the changes in anxiety and depression were also observed in the patients.Results:Compared with the first day after operation,CS in the nasal region was improved in the treatment group,and the VQ score increased in the control group patients at 1 week after operation(both P<0.05);at 1 month after operation,the TF-BUT increased,CFS score decreased,CS in the central and nasal regions increased(all P<0.05),and VQ score increased(P<0.01)in the treatment group,and the CS in the central,upper,lower and nasal regions were improved(all P<0.05),and VQ score increased(P<0.01)in the control group.The between-group comparison showed that the differences in the change of TF-BUT were statistically significant at 1 week and 1 month after surgery,respectively(both P<0.05).Conclusion:Auricular point sticking therapy can increase the TF-BUT and accelerate the repair of ocular surface function in post-SMILE patients.