论泉镜花的婚姻观——以《外科室》《高野圣》《妇系图》为中心

泉镜花的文学作品体裁繁多,小说,随笔等皆有涉及,泉镜花在生活中对于弱势群体深表同情,这种同理心在其作品中几乎随处可见。本文选取《外科室》《高野圣》《妇系图》三部作品,分析各作品中人物的恋爱和婚姻状态,进而探究作品中所体现的泉镜花本人的婚姻观。通过了解三本书的主要内容,介绍影响泉镜花婚姻观的因素来分析泉镜花对于某些婚姻观的态度,最后对泉镜花的婚姻观进行一个总结。

Acute ulcerative jejunal diverticulitis:Case report of an uncommon entity

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations.Its reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical treatment.We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome.Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was performed.The first jejunal loop showed clear signs of jejunal diverticulitis.Primary segmental jejunum resection with end-to-end anastomosis was performed.Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis.The patient made an excellent rapid postoperative recovery.Jejunal diverticulum is rare but may cause serious complications.It should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual symptomatology.Abdominal CT is the diagnostic tool of choice.The best treatment is emergency surgical management.

Surgical Management of Obstructive Urolithiasis in Small Ruminants by Tube Cystostomy in Chittagong, Bangladesh

The present study was conducted to evaluate minimally invasive tube cystostomy technique in goats and calves suffering from obstructive urolithiasis having intact and ruptured urinary bladder. This clinical study was carried out on 84 clinical cases （61 goats and 23 calves） based on the history, clinical signs and physical examination along with common laboratory techniques at the Chittagong Veterinary and Animal Sciences University during January 2015-December 2016. Physical parameters like heart rate, respiratory rate, rectal temperature and dehydration status of animals were noted and corrected abnormality before surgery. Some cases had slightly higher haemoglobin （Hb）, packed cell volume （PCV） and uric acid and epithelial casts in urine. The study revealed that abnormal calcium-phosphorus ratio was predisposing the animals to urolithiasis. It was found that young ruminants （3-5 months） were most commonly affected in both species. All affected animals were male in this study, in which calves were not castrated but in goats 95.08% animals were castrated. Rupture of bladder was more common in calves as compared to goats. Postoperatively all cases were administered with broad-spectrum antibiotic, anti-inflammatory agent and caliculolytic agents like ammonium chloride. Tube cystostomy with Foley’s catheter was the most satisfactory technique for the management of obstructive urolithiasis in small ruminants. Postoperative complications were recorded only in four animals and remaining 80 animals had a normal recovery from tube cystostomy. Tube cystostomy is a simple, inexpensive and very effective procedure for the treatment of urolithiasis in ruminants.

Long-term results of endosurgical and open surgical approach for Zenker diverticulum

AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum. METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years. RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm). CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.

Surgery of pineal region meningioma combining obstructive hydrocephelus

Objective:The aim of our study was to find out the best operative therapeutic regimen by reviewing the comprehension of operation,the improvement of operative method and the selection of operative approach concerning pineal region meningioma combining obstructive hydrocephalus.Methods:We retrospected the clinic data,comprehension of operation and prognosis of 6 cases of pineal region meningioma.Results:Six tumors were all removed,after that the back wall of the third ventricle was cut open.The 6 tumors were defined as meningioma by pathological examination.After 4-48 months follow-up,the manifestation of hydrocephalus disappeared,other symptoms were relieved more or less without any complication with one patient dismissing.The regular MRI examination indicated that the lesions had not reoccur and the cerebral ventricles had been normal.Conclusion:We identify the nourish arteries of the tumor and anatomy relationship between the tumor and its peripheral blood vessels through modern imaging devices,to select reasonable operative method are the premier therapy of pineal region meningioma.The back wall of the third ventricle becomes thin and the suprapineal recess develops shallow and wide,so the third ventricle-quadrigeminal cistern fistulation can effectively eliminate the obstructive hydrocephalus due to the long-term compression on the aqueduct after removing the tumor.

Surgical techniques for improving hemostasis during Bentall procedure

Objective:To evaluate the effect of modified surgical techniques on hemostasis used in aortic root replacement with a composite graft(Bentall procedure).Methods:Data on 15 patients who underwent Bentall procedure during 2005 to 2007 were analyzed.The first 5 patients(Group 1) received the standard procedure.Then next 10 patients(Group 2) received the modified procedure.Techniques including "tandem suture line","endo-button buttress","sandwich anastomosis" and "left ventricle filling" were added to the standard procedure.Perioperative bleeding and the volume of blood transfusion required were compared to estimate hemostasis in different groups.Results:Between groups 1 and 2,a significant difference was found in postoperative bleeding [(2193±383) ml vs(1012±258) ml,respectively;P<0.05] and in volume of blood transfusion required [(7242±1416) ml vs(2520±708) ml,respectively;P<0.05].Conclusion:The modified surgical techniques used in our study are effective in the improvement of the hemostasis in Bentall procedure.

Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.

Liu Zhongjun:3D Printing Reshapes Orthopedic Surgery

THERE is a 3D printing lab in the First Ward Zone of the Department of Orthopedics at Peking University Third Hospital（PUTH）.Although not big,it’s where Professor Liu Zhongjun,director of the department,spends most of his time,when not dealing with patients and students.

Spatial Processing and Coordination Design of Indoor and Outdoor Space

From the review of development history of indoor design in China, we can see that it develops rapidly from sprout to expansion, and has large professional scale. It goes through ignorance, misconception and comprehensive understanding. And it has developed into a perfect and independent composite subject. From the perspective of interior design continuing architectural design in time-space dimension, the paper focuses on observing the application analysis of coordinated interior design, which not only provides reference for interior design in China, but also improves the interior design in China.