医源病——一个不容忽视的卫生问题

医源病是由预防、诊断或治疗环节或步骤产生的有害后果 ,造成人体损伤、伤残、残废或死亡。列举了免疫接种、麻醉剂、药物等引发的医源病 ,并对其危害从实验室试验、新疗法临床试验、临床记录和流行病学研究等方面进行评估。强调在进行预防、诊断和治疗过程中 ,应对其效益加以权衡 ,应对医生。

Internal biliary fistula due to cholelithiasis:A single-centre experience

AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.

Comparison of ultrasound-guided thrombin injection and compression repair in treatment of iatrogenic femoral arterial pseudoaneurysms

Objective ：To retrospectively compare the efficacy and safety of ultrasound-guided thrombin injection （UGTI） with ultrasound-guided compression repair （UGCR） in patients with postcatheterizational femoral arterial pseudoaneurysms （PSA）. Methods： Thirty patients of this iatrogenic PSA [8 males, 22 females, average age （66.5±5.2） years] in our institution from 1997 to 2004 were retrospectively analyzed. Among them, 11 patients were treated with UGCR, 2 under continuous uhrasonographic （US） guidance and 9 under the guidance of femoral arterial bruit auscultation and dorsalis pedis artery palpation. Because UGCR was failed in 5 patients, consecutively 24 patients were treated with UGTI. Swine thrombin solution at a concentration of 200 U/ml was injected percutaneously using 22-25 gauge needles under color Doppler US. Demographics, clinical variables, pseudoaneurysm characteristics, and results of the 2 groups were compared by using Fisher＇s exact test and Student＇s t test. Results： The initial success rate of UGCR was 36.4% （4/11） and the overall success rate was 45.5% （5/11）. Tenor 11 patients suffered from local pain during the compression, but there was no any complication in UGTI group. The av- erage dose of injected thrombin was （180±82） U for PSA of a single loculus and （315±150） U for multi- loculated PSA. The initial success rate of UGTI was 89.5% （17/19） and the overall success rate was 100% （24/24）. Conclusion：UGTI offers a safe, quick and effective means of definitively treating femoral pseudoaneurysms and seems superior to UGCR. The amount of thrombin applied on our people seems smaller compared with others＇ work.

Iatrogenic Tumor Implantation

Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment of a malignancy.It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant metastasis from the tumor under treatment.The main clinical feature of the condition is nodules at the operation's porous channel or incision,which is easily diagnosed in accordance with the case history.Final diagnosis can be made based on pathological examination.Tumor implantation may occur in various puncturing porous channels,including a laparoscopic port,abdominal wall incision,and perineal incision,etc.Besides a malignant tumor, implantation potential exists with diseases,such as a borderline tumor and endometriosis etc.Once a tumor implantation is diagnosed,or suspected,surgical resection is usually conducted. During the diagnosis and treatment of diseases,avoiding and reducing iatrogenic implantation and dissemination has been regarded as an important principle for surgical treatment of tumors.In a clinical practice setting,if possible,excisional biopsy should be employed,if a biopsy is needed.Repeated puncturing should be avoided during a paracentesis.In a laparoscopic procedure,the tissue is first put into a sample bag and then is taken out from the point of incision.After a laparoscopic procedure,the peritoneum,abdominal muscular fasciae,and skin should be carefully closed,and/or the punctured porous channel be excised.In addition,the sample/tissue should be rinsed with distilled water before surgical closure of the abdominal cavity, allowing the exfoliated tumor cells to swell and rupture in the hypo-osmolar solution.Then surgical closure can be conducted following a change of gloves and equipment.The extent of hysteromyomectomy should as far as possible be away from the uterine cavity.The purpose of this study is to make clinicians aware of the possibility of tumor implantation and to give special attention to avoid,or reduce iatrogenic implantation during a surgical procedure.

Evaluation of Risk Management of Foodborne Infection in Hospital

As being at the head of the establishment, the hospital manager＇s major concern is food safety in his hospital. Unfortunately, because of their health weaknesses, patients are more susceptible to foodborne illness than any other population group As match as food prepared according to less stringent hygiene＇s rules can infect or intoxicate more than it would be in a healthy population, as hygiene＇s rules must be observed in a particularly strict way, at the kitchen where meals are prepared for health care facilities. In fact, hospitals＇ food hygiene＇s rules are those who defined catering. They are made to avoid food contamination and microbial growth throughout the food chain from raw materials＇ delivery to the consumer. The main objective of taking the meal as a patients＇ tracer is to detect and study the infection＇s risk associated with feeding at hospital, and to provide practical tools to better manage this risk. Methodology was based on an analysis of the last six years＇ work concerning hygiene＇s audits and bacteriological analyses. The results showed that the food infectious risk has an important frequency, on one side; on another, they were used as a standard model of such risk＇s management.

SARS-CoV-2 Infected Cases with Untraceable Epidemic Origin:Its Values,Identification and TCM Treatment in Preventing Recurrence

During the outbreak of coronavirus disease 2019(COVID-19),the identification of a SARS-CoV-2 infected case with untraceable epidemic origin has three values:(1)the region has community transmission of the virus;(2)a certain portion of population in the community is getting immunized and more individuals have already been immunized;(3)an unpredictable future risk exists for regions where there are no infected cases with untraceable epidemic origin.Minimizing or avoiding the aggregation infection through individuals with no clinical symptoms is crucial and possible as its occurrence is mainly attributed to the local environment as opposed to the super spreader with or without clinical symptoms.As infected cases are not necessarily positive with gene test by definition,proper application of gene test is crucial in the identification of asymptomatic cases.In the early stage of an outbreak of infectious disease,gene test can be used to identify asymptomatic cases but it should not be used to exclude cases with typical clinical symptoms and signs.In the middle or late stages of an outbreak gene test should be applied in evaluation of infection rate of the population of a region,in addition to be used in spreader identification and isolation.Although asymptomatic cases are attributed to the overwhelming effect of personalized defense against pathogens,they are still a source of infection.Asymptomatic cases are considered to be Qi deficiency and with lingering toxicity in traditional Chinese medicine(TCM).Treatment in such cases,typically,involves therapy focused on replenishing the Qi,tonifying the lung,clearing the fever,and detoxification in order to return to a normal health condition.The recommended Chinese medicines include Qing Fei Pai Du Decoction,Yi Qi Qu Du Decoction,Xuan Fei Bai Du Granule,Lian Hua Qing Wen Capsule(Granule),and Jin Hua Qing Gan Granule,etc.

Repair of a mal-repaired biliary injury:A case report

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair （right to left hepatic duct anastomosis over the T-tube）,with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepaticojejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical real-repair. We propose an algorithm for the treatment of early and late biliary injuries.