少见急性肠梗阻的临床分析与策略

目的:了解少见急性肠梗阻的临床特征,为制订诊疗对策提供参考依据.方法:利用SPSS12.0统计软件包,回顾性分析我院2002.01/2006-08少见急性肠梗阻(病因构成比<3.0%)发病情况及诊治情况,病例分成3组:儿童组(0岁-,组Ⅰ),青少年与成年组(14岁-,组Ⅱ)和老年组(60岁-,组Ⅲ).结果:在338例急性肠梗阻病例中,少见急性肠梗阻是122例(36.1%).在少见急性肠梗阻中:男94例(77.0%),女28例(23.0%),病因36种(急性肠梗阻总病因数是41种),组Ⅰ31例患者,13种病因:组Ⅱ62例,26种病因:组Ⅲ29例,14种病因.组Ⅰ,Ⅱ,Ⅲ患者就诊时间分别为:2.3±1.5 h,60.0±43.2 h和84.0±67.2 h,有显著性差异(P=0.000);组Ⅰ,Ⅱ,Ⅲ患者急性生理和慢性健康评分(APACHEⅡ)分别为:2.5±1.8分,5.5±3.6分和17.8±5.8分,有显著性差异(P =0.000),3组患者的总手术治疗率为65.6%,病死9例,病死率为8.0%,组Ⅰ,Ⅱ,Ⅲ患者治愈率分别为100.0%,95.0%和79.3%,差异有显著性(P=0.000).结论:少见急性肠梗阻诊断困难,易延误治疗时机而造成高病死率;病情(局部病变与全身状况)的准确判断和有效的治疗(手术治疗与非手术治疗)是少见急性肠梗阻诊治的关键.

URETERAL INJURY DURING GYNECOLOGICAL LAPAROSCOPIC SURGERIES: REPORT OF TWELVE CASES

Objective To investigate ureteral injury during gynecological laparoscopic surgeries.Methods From January 1990 to December 2005, 12868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis. Results The incidence of ureteral injury was 0.093% (12/12868) in all cases, 0.42% (11/2586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases. Conclusions Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.

Pelvic arterial embolization in obstetric hemorrhage

AIM: To analyze safety and efficacy of pelvic arterial embolization(PAE) in preventing and treating obstetrical hemorrhage.METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception. CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.

DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed. Re, salts CSP constituted 1.05 % of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1 ： 1 221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment. The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging （MRI）. The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies. Conclusions CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.

Individualized misoprostol dosing for labor induction or augmentation: A review

Cesarean birth rates are greater than 20% in many developed countries. The main diagnoses contributing to the high rate of cesarean births in nulliparous women are dystocia and prolonged labor. Traditionally, a policy of vaginal dinoprostone for the treatment of unripe cervix or early amniotomy with oxytocin administration for a ripened cervix has been associated with a modest reduction in the rate of cesarean births due to arrest disorders. However, the course of vaginal dinoprostone is tedious and oxytocin should be administered through an infusion pump, which may be inconvenient in certain settings. Because misoprostol has powerful uterotropic and uterotonic effects, and has become a common agent used in the practice of obstetrics and gynecology, the United States Food and Drug Administration removed the absolute contraindication of the drug during pregnancy from its label in April 2002. However, excessive uterine contractility resulting in tachysystole or fetal distress is always a concern with the oral or vaginal use of fixeddosage misoprostol. Therefore, misoprostol should be administered with caution to ensure that fetal hypoxia does not occur. A pilot trial examining the use of very small, frequent, titrated oral misoprostol dosages administered every 2 h was fi rst conducted by Hofmeyr et al in 2001. Given women's different metabolisms and responses tomisoprostol, another method of titrating individualized oral misoprostol with dosing administered every hour relative to uterine response was then developed by Cheng in 2006. Based on previous studies, this titration method is potentially an ideal alternative to traditional dinoprostone, oxytocin or the previously established misoprostol dosing method for labor induction or augmentation.

Intrapartum application of the continuous glucose monitoring system in pregnancies complicated with diabetes: A review and feasibility study

Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system(CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specifi c period of time. The resulting profi le provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus(DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.

Comparison of PPIs and H_2-receptor antagonists plus prokinetics for dysmotility-like dyspepsia

AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.

Retained placenta: Do we have any option?

Retained placenta is a known cause of post-partum haemorrhage and maternal mortality. A recent systemic review has confirmed that the incidence of retained placenta had increased all over the world, which is more common in developed countries. Failure of retroplacental myometrium contraction is the main cause of retained placenta. Maternal age greater than 35 years, grandmultipara, preterm labor, history of previous retained placenta, and caesarean section were the risk factors for retained placenta. Manual removal of the placenta has been the treatment of choice. Attempts had been made by clinician and researchers to find a safe, effective and reliable method to avoid the need for surgical intervention. The efficacy and safety of prostaglandin, nitroglycerin or acupuncture in the management of retained placenta are yet to be further evaluated. Nonetheless, till date only intraumbilical vein oxytocin has been studied extensively but with varied success. More randomized clinical trials are needed to address this issue. However, if immediate manual placenta removal service is unavailable, a trial of intra-umbilical vein oxytocin 100 IU at a totalvolume of at least 40 m L while preparing for transfer to a tertiary center or theatre may result in spontaneous expulsion of the placenta.

Perinatal events and the risk of developing primary sclerosing cholangitis

AIM: To investigate whether perinatal events, intrauterine or postpartum, are associated with the development of primary sclerosing cholangitis (PSC) later in life. METHODS: Birth records from 97 patients with adult PSC in Sweden were reviewed. Information on perinatal events including medications and complications during pregnancy, gestation length, birth weight and length were collected. Two control children of the same sex were selected for each subject. Conditional multiple logistic regression was used to assess associations of the perinatal measures with development of PSC. RESULTS: No significant associations were found between gestational age, birth length, breastfeeding, and the majority of medical complications including infections or medication during pregnancy for the mothers or postpartum for the children. Vaginal bleeding and peripheral oedema showed associations with PSC, with matched odds ratios of 5.70 (95% CI, 1.13-28.83) and 2.28 (95% CI, 1.04-5.03), respectively. CONCLUSION: The associations of vaginal bleeding and oedema with subsequent PSC cannot readily beexplained, so our fi ndings do not strongly support the hypothesis of a signifi cant role of perinatal events as a risk for the development of PSC later in life.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Abstract： Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

DEVELOPMENT OF ACUPUNCTURE TREATMENT AND CLINICAL RESEARCH OF THREATENED ABORT ION

In the present paper, the authors review rece nt development of acupunct ure treatment of threatened abortion from 1) clinical application of "Linggui Ba fa"(灵龟八法Eight Methods of Intelligent Turtle), 2) body acupoints , and 3) acup uncture combined with Chinese materia medica, and clinical study from 1) effect of acupuncture on the blood flow of uterus, and 2) effect of acupuncture on plas ma progesterone level. In addition, acupuncture therapy is also used to help wom en in gestation and can effectively raise the pregnant rate. "Lingg ui Bafa" is r ather effective in preventing threatened abortion and should be studied further.

Effect of vaginal speculum lubrication on cervical cytology and discomfort during smear examination

AIM: To evaluate the role of lubricant gel in the cytology of a Pap smear and whether it results in an improvement in the discomfort experienced by women while undergoing Pap smear screening.METHODS: A total of 151 women were analyzed in the study. After screening for inclusion criteria, a Pap smear was taken with no lubricant in all the women and the discomfort experienced was rated on a visual analogue scale. The women underwent a second Pap smear on the next visit using a lubricant gel and were again rated on a visual analogue scale for the discomfort felt. The pathologist was blinded to the fact of whether the lubricating gel was used.RESULTS: The number of unsatisfactory smears in the no gel group was 3 vs 5 in the gel group, P < 0.05. However, a significant difference(P = 0.00) was observed in the visual analogue pain score in both groups, suggesting that application of lubricant gel over the speculum improves the pain experienced by women. CONCLUSION: Using a small amount of lubricant overthe speculum does not impair cervical cytology but significantly improves the discomfort experienced by women while undergoing a Pap smear.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Effect of Soil and Water Conservation Measures on Selected Soil Physical and Chemical Properties and Barley （Hordeum spp.） Yield

A study was conducted in 2007/2008 at Absela locality, Banja Shikudad District of the Amhara National Regional State, Ethiopia to evaluate the effects of soil bunds stabilized with vetiver grass （IT. zizanioides） and tree lucerne （C. palmensis） on soil physical and chemical properties, bund height, inter-terrace slope and barley （Hordeum vulgare L.） yield. Data were analyzed using one-way analysis of variance （ANOVA） and mean values for the treatments were separated using Duncan＇s Multiple Range Test. Results indicated that the non-conserved fields had significantly （p 〈 0.05） lower organic carbon and was found to contain 66% less OM from the average of the conserved treatment. 9-year old sole soil bund, the 9-year old soil bund stabilized with tree lucerne, the 9-year old soil bund stabilized with vetiver, and the 6-year old soil bund stabilized with tree lucerne had 71.20, 68.56, 52.30, and 36.12%, respectively higher percent OM than the control treatment. The trend was similar for total nitrogen. The non-conserved treatment had a higher bulk density when compared to the conserved fields. Fields with soil bunds stabilized with vetiver grass had the highest bund height and the lowest inter-terrace slope than fields treated with the rest of remaining conservation measures. Barley grain yields were significantly （P 〈 0.05） greater in both the soil accumulation and loss zones of the conserved fields than the non-conserved （control） treatment. Practicing soil conservation measures and curtailing causes of land degradation could improve the soil physical and chemical properties thereby increase land productivity of the conserved land.

Use of REGWQ Multiple Comparisons of Qualitative Data

The REGWQ （Ryan-Einot-Gabriel-Welsch and Quiot） test produces allow us to compare a large numbers of data while controlling the probability of making at least one Type I error or Family wise error. The purpose of this study was to use the REGWQ multiple comparisons test of qualitative data. Okra characterization data was applied and submitted to ANOVA （P_0.05） with REGWQ for multiple comparisons of the means. The results of this study establish a summary strategy of following a significant ANOVA F with REGWQ test on multiple comparisons of means in summation a large entries/treatments to the small groups when variances are heterogeneous. Cluster analysis should be especially useful for grouping qualitative treatment and could also be used in conjunction of with REFWQ multiple produces. The development of study will be in REGWQ multiple producers in SAS option for distributed the large number of treatment to small group with summering the best choice of treatments.

Chinese and Western medicine treatment of blocking antibody in recurrent spontaneous abortion

The causes of recurrent spontaneous abortion are complex traditional Chinese medicine holds that its etiology is losses of spleen and kidney qi, qi and xue deficiency, in addition to secretion, genetic, anatomical, infection, systemic diseases, environmental factors and other related immune factors, the deficiency of blocking antibody is also one of the reasons for the lack of immune factors. In treating it, Chinese medicine treatment combines the patients personal constitution and treatment based on syndrome differentiation; Western medicine treatment mainly applies Aspirin, active immune lymphocyte treatment, low molecular heparin, gamma globulin protein passive immune treatment and psychological intervention therapy. In this paper, a review of the treatment methods for closed antibodies in the past 5 years is made.

Antioxidant therapy in the management of acute,chronic and post-ERCP pancreatitis:A systematic review

We systematically reviewed the clinical trials which recruited antioxidants in the therapy of pancreatitis and evaluated whether antioxidants improve the outcome of patients with pancreatitis. Electronic bibliographic databases were searched for any studies which investigated the use of antioxidants in the management of acute pancreatitis （AP） or chronic pancreatitis （CP） and in the prevention of post-endoscopic retrograde cholangio-pancreatography （post-ERCP） pancreatitis （PEP） up to February 2009. Twenty-two randomized, placebo-controlled, clinical trials met our criteria and were included in the review. Except for a cocktail of antioxidants which showed improvement in outcomes in three different clinical trials, the results of the administration of other antioxidants in both AP and CP clinical trials were incongruent and heterogeneous.Furthermore, antioxidant therapy including allopurinol and N-acetylcysteine failed to prevent the onset of PEP in almost all trials. In conclusion, the present data do not support a benefit of antioxidant therapy alone or in combination with conventional therapy in the management of AP, CP or PER Further double blind, randomized, placebo-controlled clinical trials with large sample size need to be conducted.

Study on Feeding Effect of Different Levels of Protein and Energy on Production Performance of Pregnant Mother and Neo-Natal Calves

The present study was undertaken to assess feeding effect on productive and reproductive performances of pre-natal and post-natal Red Chittagong Cattle （RCC） cows under on-station condition. A total of 16 pregnant RCC cows having pregnancy 6-7 months and between 1-3 parities was selected for the study and was allocated randomly into four dietary treatment groups. There are four type diets, i.e., To （standard diet according to National Research Council （NRC）, 1995）, T1 （5% below standard diet）, T2 （5% above standard diet）, T3 （10% above standard diet） and a control treatment T4 （maintained as farm practice）. The energy and protein requirements of experimental cows were determined as per standard developed by NRC. The results revealed that crude protein （CP） and metabolizable energy （ME, MJ/day） requirements among cows of different dietary groups were not significantly different, although CP requirements between T1 and T3 differed significantly. Total dry mater （DM） and ME intake differed significantly （P 〈 0.001） among cows of different dietary groups, but DM intake was significantly lower for cows in farm practice group Z4 compared to the cows of other dietary groups. The total CP intake had no significant variation （P 〉 0.05） among cows of all dietary groups, but CP intake from roughage varied significantly （P 〈 0.001）. Final live weight and total live weight gain had no significant variation for cows of all groups, but there were significant （P 〈 0.05） variation for daily weight gain. Daily weight gain of cows for first four dietary groups were significantly （P 〈 0.05） higher than cows of farm practice groups T4. Weight of calf from birth to 90 days and daily weight gain calves under different dietary groups showed that there were no significant （P 〉 0.05） variation of calf birth weights for all dietary groups, although lower birth weight was found in farm practice groups T4. Gestation length and postpartum heat period of cows of different dietary treatment groups revealed that there was no significant （P 〉 0.05） variation for those traits among cows of different dietary treatment groups, although there seems to be shorter postpartum heat for cows in dietary group T2 and longer period in farm practice group T4. Total and daily milk yield up to 30 days and 90 days of cows had no significant （P 〉 0.05） effect for different dietary treatment groups, although there seems to be slightly better milk production performance for dietary T2 and To, respectively for 30 days and 90 days total and daily milk yield. There were no significant （P 〉 0.05） changes of total and daily weight gain of cows for all dietary groups, however cows of standard dietary group To performed slightly better than those of cows of other dietary groups. Milk composition of cows of different dietary treatment groups showed that there was no significant （P 〉 0.05） variation on milk composition for cows of different dietary groups. Post-natal body condition score （BCS） for the 1st, 3rd and 4th months differed significantly （P 〈 0.05） among different dietary groups, while not found significant difference on the 2nd month. Therefore, it may be concluded that pre-natal feeding has significant effect on body weight gain, birth weight of calves and milk production of dairy cows. Hence, it is suggested that better nutrition may be provided during pre-natal period to harvest good quality of calves and higher milk yield from post-natal period.

Study on Bioremediation of Kelp in AquacultureSea Area and Eutrophy Treatment

At present, the marine environment is faced with extremely serious eutrophication. The kelp＇s ability of taking in nitrogen and phosphorus can be fully performed so that the eutrophication problem can be effectively treated and solved. Based on the analysis of kelp＇s absorption of nutritive salt from aquaculture sewage, this paper further explores the bioremediation of kelp in aquaculture sea area with eutrophication in the hope of providing valuable reference for the aquaculture industry of BohaiSea.

Study on the Treatment of Cellulosic Ethanol

Wastewater from the production of cellulosic ethanol was treated by the processes of internal micro-electrolysis method ＋ABR＋UASB ＋MBR. The results of running indicated that, when COD is 12000 mg/L and HRT of UASB is 48 h, the COD removal rate reaches 72% and HRT of MBR is 20 h, COD removal rate is between 80.8% and 87.5%. The effluent COD concentration stabilized at 301- 537 mg/L, it indicates that the MBR system has a strong ability to resist impact load.