我院门诊2013～2015年外科用中成药临床应用分析

目的：了解我院外科用中成药的应用情况。方法采用回顾性方法，对我院2013～2015年外科用中成药的销售金额、用药频度、日均药费等进行统计、分析。结果3年来我院外科用中成药销售金额排前3位的药品无变化，大部分外科用中成药价格平稳，DDC持续平稳，一定程度上减轻了患者的经济负担。结论我院外科用中成药使用基本合理。

外科1号药茶的制备与疗效观察

外科1号药茶是我院外科用于治疗急性蜂窝织炎、脓肿、丹毒、痒疹等系列制剂之一,具有凉血解毒的功效,临床应用取得了良好的效果.现将其制备工艺介绍如下.

外科丹药——汞制剂丹药的制备与应用

本文通过回顾丹药的起源与发展过程,介绍外科丹药的分类、化学成分及汞制剂丹药的炼制方法和储存条件,归纳概括外科丹药——红升丹、白降丹的临床应用,说明外科丹药在中医外治中的重要地位和作用。

自制泌尿外科尿道给药器在男性尿路感染治疗中的应用效果研究

目的:探讨自制的泌尿外科尿道给药器在男性尿路感染治疗中的应用效果。方法:选择2019年1月至2021年3月重庆市万州区第一人民医院收治的90例男性尿路感染患者作为试验对象。随机将其分为口服药物组、尿道给药器组和常规冲洗器组。口服药物组患者通过口服左氧氟沙星进行治疗,常规冲洗器组患者使用常规的尿道冲洗器进行尿道冲洗治疗,尿道给药器组患者采用自制的泌尿外科尿道给药器进行经尿道给药治疗,然后比较三组患者的疗效及各项临床指标。结果:治疗后,尿道给药器组患者的尿白细胞计数少于常规冲洗器组患者与口服药物组患者,其治疗的时间短于常规冲洗器组患者与口服药物组患者,P<0.05。尿道给药器组患者的治愈率和治疗的总有效率均高于口服药物组患者与常规冲洗器组患者,P<0.05。结论:采用自制的泌尿外科尿道给药器对男性尿路感染患者进行经尿道给药治疗的效果显著,能有效降低其尿白细胞计数,缓解其临床症状,缩短其治疗的时间。

巴黄片在外科领域中的应用

以巴豆霜、生大黄分别提取后,制成片剂,具有通里攻下作用,效果好,副作用少,除用于治疗各类急腹症外,还可用于腹部手术后、术前肠道准备等方面。

Prevention of metastasis to liver by using 5-FU intraperitoneal chemotherapy in nude mice inoculated with human colonic cancer cells

AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.

Timing of surgery in Crohn’s disease: A key issue in the management

The timing of the decision for operation in Crohn’s disease is based on an evaluation of the several factors such as the failure of medical treatment, complications due to the Crohn’s disease or to the farmacological therapy, development of dysplasia or cancer and growth retardation. A complete evaluation of these factors should result in operation timed to the patient’s best advantage, achieving maximal relief of symptoms with improvement of quality of life. Given the complexity and heterogeneity of the disease and the different options for treatment, is difficult to systematize when the optimal moment for the surgery is arrived. A very important factor in the management of Crohn’s disease is the multidisciplinary approach and the patient preference should be a significant factor in determining the choice of therapy. The surgery should be considered such another option in the sequential treatment of Crohn’s disease. We have analyzed the factors that are involved in the decision taking of the surgical treatment regarding to the experience and the published literature. When did the medical therapy fail? when is the appropriate moment to operate on the patient? Or which complications of Crohn’s disease need a surgery? These are some of the questions we will try to answer.

Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries:A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.

Postoperative changes of manometry after restorative proctocolectomy in Korean ulcerative colitis patients

To investigate the changes of postoperative anal sphincter function and bowel frequency in Korean patients with ulcerative colitis (UC). METHODSA total of 127 patients with UC who underwent restorative proctocolectomy (RPC) during 20 years were retrospectively analyzed. The parameters of anal manometry and bowel frequency were compared according to the 6-mo intervals until 24 mo postoperatively. Manometry was used to measure the maximal squeezing pressure (MSP) and maximal resting pressure (MRP). RESULTSMSP decreased after surgery until 6 mo (157 to 142 mmHg); thereafter, it improved and was recovered to and maintained at the preoperative value at 12 mo postoperatively (142-170 mmHg, P < 0.001). Although the decreased MRP (65 to 56 mmHg) improved after 18 mo (62 mmHg), it did not completely recover to the preoperative value. The decreased rectal capacity after surgery (90 to 82 mL) gradually increased up to 150 mL at 24 mo. Although bowel frequency showed significant gradual decreases at each interval, it was stabilized after 12 mo postoperatively (6.5 times/d). CONCLUSIONPostoperative changes of manometry and bowel frequency after restorative proctocolectomy in Korean patients with UC were not different from those in Western patients with UC.

Anemia and iron deficiency in gastrointestinal and liver conditions

Iron deficiency anemia(IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

Air in the main pancreatic duct:A case of innocent air

Air in the main pancreatic duct has been reported only rarely and might be associated with either a spontane- ous or a surgically induced alteration of the anatomy of the biliary tract. We report a case of ＂innocent＂ air found incidentally in the main pancreatic duct. To our knowledge, this is only the third such case reported. A 54-year-old woman presented with hemoptysis that had lasted for 3 d. She underwent a chest computed tomography scan, which revealed not only focal bron- chiectasis in the left lower lobe, but also air in the main pancreatic duct and dilatation of the common bile duct. She was managed conservatively for the hemop- blsis and no further problems developed. She had no specific gastrointestinal symptoms and had no history of surgery or medication. Her laboratory parameters were normal. Magnetic resonance cholangiopancrea- tography also demonstrated air in the main pancreatic duct and a dilated common bile duct （CBD）. Duode- noscopy revealed separate biliary and pancreatic ori-rices with patulous openings and some air bubbles ap- pearing in the pancreatic orifice. Endoscopic retrograde cholangiopancreatography （ERCP） showed the dilated CBD and pancreatic duct with some air bubbles, but no other abnormal lesions. She was discharged with no further problems. Most patients with air in the main pancreatic duct have had a pancreatobiliary disease, or a history of pancreatobiliary disease, pancreatobiliary surgery or sphincterotomy. If the air is innocent, as in our case, ERCP should be performed to evaluate any altered sphincteric function or anatomy such as patu- Ious openings.

In Vitro and In Silico Studies of Lunacridine from Lunasia Amara Blanco as Anticancer

Lunasia amara Blanco is a famous plant in South Sulawesi. It was used largely by local people as antibacteria and aphrodisiac. Quinoline alkaloid lunacridine was known as the active principle from Lunasia amara Blanco. Its activity was reported as a DNA Intercalating Topoisomerase II inhibitor. In this study, we have isolated and assayed the cytotoxic activity of lunacridine on P388 murine leukemia cells by MTT colorimetric assay （in vitro）. Lunacridine showed the less cytotoxic activity with the IC50 of 39.52 μg/mL. With the aim to explore the structural determinants responsible for this activity, molecular docking study have been carried out with DNA model using AutoDock 4.0 software with various total of energy evaluations （in silico）. The best docking reached at the total energy evaluations of 2.5 × 107 with the binding free energy of-6.63 kcal/mol. Analysis of the docking results was in accordance with the ability of lunacridine to intercalate between base pairs of DNA. Cytotoxic activity of lunacridine is less probably due to low affinity and molecular interaction. Therefore this study suggests to design and to develop lunacridine as a lead compound for anticancer drug.

The effect of Shen-Fu on gastrointestinal tract injury and its potential mechanism during cardio-pulmonary bypass in patients undergoing cardiac surgery

Objective: To investigate the effect of Shen-Fu (SF) injection on gastrointestinal tract injury and its potential mechanism.Methods: Thirty-eight patients undergoing elective open heart surgery were assigned to Group C (control group, n = 18) and Group SF (n = 20) randomly. In Group SF, the patients received intravenous injection of SF (0.5 ml/kg) at the beginning of the surgery followed by a continuous infusion of 100 ml SF (1.0 ml/kg) solution diluted by saline at a rate of 0.004 ml · Kg-1 · min-1 with a Grasby pump. The control group was injected with normal saline in the same volume. Gastric intramucosal pH (pHi), activity of blood diamine oxidase ( DAO ), and concentrations of blood LPS and IL-6 were measured before CPB ( S0) and 1 h ( S1 ) and 2 h ( S2) after aortic declamping, respectively.Results: In Group C, pHi value was significantly lower at S1 and S2 than at S0 ( mean P <0.01) and blood DAO and concentrations of LPS and IL-6 were significantly higher at S1 and S2 than at S0 ( meanP < 0.01). In Group SF, pHi was obviously lower at S1 and S2 than at S0(P< 0.05) but LPS and IL-6 levels and DAO were higher at S, (mean P<0.05). Blood DAO and LPS level demonstrated significant negative correlations with pHi ( mean P < 0.01) while LPS concentration showed a positive correlation with blood DAO (P < 0.01) and IL-6 concentration (P < 0.05). At S1 and S2 after aortic declamping, the levels of pHi were higher in Group SF than in Group C (mean P <0.01 ) but DAO and LPS and IL-6 levels were significantly lower in Group SF than in Group C ( P <0.01).Conclusions: SF has a protective effect on gastrointestinal tract and can reduce inflammatory actions.