BACKGROUND & AIMS: A case of complete uterine rupture during a trial of labour in which epidural analgesia was used is described. The pain of uterine rupture was not masked by the addition of fentanyl 25 micrograms to bupivacaine 0.25% 6 ml but was relieved by bupivacaine 0.375% 6 ml.

背景与目标： 描述了在使用硬膜外镇痛的分娩试验中子宫完全破裂的情况。在布比卡因0.25% 6毫升中添加芬太尼25微克并没有掩盖子宫破裂的疼痛，但布比卡因0.375% 6毫升减轻了子宫破裂的疼痛。

BACKGROUND & AIMS: BACKGROUND:A few prospective controlled trials comparing early functional rehabilitation after Achilles tendon repair and non-operative immobilization have been reported. HYPOTHESES:There is no difference in Achilles tendon elongation between early motion and immobilization after Achilles tendon repair. Tendon elongation does not correlate with the clinical outcome. STUDY DESIGN:Randomized clinical trial; Level of evidence, 2. METHODS:Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weightbearing was allowed after 3 weeks in both groups. Standardized radiographs to measure previously placed radiographic markers were taken on the first day postoperatively and at 1, 3, 6, 12, 24 weeks postoperatively, with the final radiograph a mean of 60 (SD, 6.4) weeks postoperatively. The outcome was assessed at the 3-month and final checkups by the clinical scoring method described by Leppilahti et al and included subjective factors and objective factors. RESULTS:Tendon elongation occurred in both groups but was somewhat less in the early motion group (median 2 mm in the early motion group vs median 5 mm in the cast group a mean of 60 weeks postoperatively, P = .054). The elongation curves first rose and then slowly fell in both groups. The patients who had less elongation achieved a better clinical outcome (rho = -.42, P = .017). Tendon elongation did not correlate significantly with age, body mass index, or isokinetic peak torques. CONCLUSION:Achilles tendon elongation was somewhat less in the early motion group and correlated with the clinical outcome scores. We recommend early functional postoperative treatment after Achilles rupture repair.

背景与目标：

BACKGROUND & AIMS: :We reviewed six cases of primary sarcomas requiring scapulectomy within the past 13 years in the Surgery Branch of the National Cancer Institute, Bethesda, Md. Five of these patients returned for evaluation of disease status, evaluation of functional defects as determined by muscle group testing, and assessment of daily living skills and limitations. We demonstrated excellent shoulder function with partial scapulectomy and significant impairment with the additional loss of the glenoid fossa. In addition, we developed a thorough method of postoperative evaluation. Involvement of rehabilitation therapists before and after operatively is integral to this process in preparation for surgery and subsequent treatment.

背景与目标： : 在过去的13年中，我们在马里兰州贝塞斯达的国家癌症研究所外科分支机构中回顾了6例需要进行肩胛骨切除术的原发性肉瘤病例。这些患者中有五名返回以评估疾病状况，评估通过肌肉群测试确定的功能缺陷以及评估日常生活技能和局限性。我们通过部分肩胛骨切除术证明了出色的肩部功能，并通过关节盂窝的额外损失而明显受损。此外，我们开发了一种彻底的术后评估方法。在手术和后续治疗的准备过程中，康复治疗师在手术前后的参与是必不可少的。

BACKGROUND & AIMS: BACKGROUND:The Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) score is a useful scheme for risk stratification of thromboembolism patients, but there is little information about its usefulness for the evaluation of antiarrhythmic drug (AAD) therapy. METHODS AND RESULTS:This study included 459 paroxysmal atrial fibrillation (AF) patients (309 men, mean age 66 ± 12 years, mean follow-up 50 ± 35 months) and prophylactic efficacy was analyzed on the basis of CHADS(2) score. (1) Survival rates free from AF recurrence at 1, 6, 12 and 24 months were, respectively, 89%, 74%, 63% and 47% in score-0 group (n=152); 92%, 68%, 59% and 48% in score-1 group (n=158); 86%, 64%, 56% and 46% in score-2 group (n=84); 81%, 65%, 51% and 35% in score-3 group (n=43); and 68%, 50%, 36% and 18% in ≥ score-4 group (n=22) (P<0.05; score-0, score-1 or score-2 vs. ≥ score-4 group). (2) Survival rates free from progression to chronic AF at 12, 36, 60 and 90 months were, respectively, 95%, 93%, 91% and 89% in score-0 group; 97%, 91%, 89% and 88% in score-1 group; 96%, 93%, 88% and 83% in score-2 group; 91%, 74%, 67% and 60% in score-3 group; and 91%, 82%, 68% and 55% in ≥ score-4 group (P<0.01; score-0, score-1 or score-2 vs. ≥ score-4 group). (3) In multivariate logistic regression analysis adjusted for potentially confounding variables, CHADS(2) score was associated with AF recurrence (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.16-1.81, P<0.001), and progression to chronic AF during AAD therapy (OR 1.64, 95% CI 1.04-2.69, P<0.001). CONCLUSIONS:When using a rhythm control strategy, the CHADS(2) score is a useful scheme for predicting the outcome of AAD treatment of patients with paroxysmal AF.  

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Laparoscopic total gastrectomy (LTG) is seldom used for gastric cancer because the complex vascularization and lymphatic drainage makes lymphadenectomy and esophagojejunal anastomosis difficult and requires special skills. Our aim was to demonstrate the feasibility and accuracy of LTG in gastric cancer with D2 lymphadenectomy. MATERIAL AND METHODS:Eighty-eight LTG and four laparoscopic remnant gastrectomies (LRGs) were performed over >12 years. The median patient age was 64 years, and the male/female ratio was 1.49/1. Eighty-seven patients had a D2 and only five patients had a D1 lymphadenectomy. We propose the retrospective analysis of intra- and perioperative mortality and morbidity. RESULTS:In only four of 96 cases approached by laparoscopy, a conversion to laparotomy was needed. There were two (2.17%) perioperative deaths in 92 procedures and few complications. Histological data show 79 advanced gastric cancers (AGC), 11 early gastric cancers (EGC), and two gastric diffused lymphomas. The five-year Kaplan-Meier overall survival in patients with EGC and AGC was 100% and 58%, respectively. CONCLUSIONS:The results demonstrate the feasibility of an oncologically correct minimally invasive total gastrectomy. We would like to promote comparisons among different institutions to achieve better standardization of indications and techniques for a laparoscopic approach to gastric cancer.

背景与目标：

BACKGROUND & AIMS: :Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

背景与目标： : 伤口感染是全膝关节置换术的罕见但严重的并发症。在1984年1月和1987年11月之间，两家附属医院的243名患者中有20名 (8.2% 名) 在清洁空气手术室中进行了259次全膝关节置换术后发生了手术伤口感染。18 (90%) 名患者患有深部感染; 9名需要移除假体。单个外科医生 (外科医生X) 与18例随后感染的手术相关 (风险比 (RR) = 9.4，95% 置信区间 (CI) 2.2-39)，并进行了一项调查，以解释外科医生X与其他外科医生之间感染率的差异。在一项队列研究中，分层分析确定术前美国麻醉医师协会 (ASA) 的身体状况等级大于或等于3，外科医生X，以及术后早期使用连续被动运动装置是与全膝关节置换术后手术伤口感染相关的危险因素。Logistic回归分析确定是由ASA等级大于或等于3的外科医生X手术的患者，是全膝关节置换相关手术伤口感染的唯一重要独立危险因素 (RR = 9.3，95% CI 2.8-31)。不能通过接受或及时施用抗菌药物，插入的假体类型，手术持续时间，术后使用连续被动运动或关节疾病的潜在病因来解释外科医生X的作用。作者得出结论，手术技术和患者的疾病严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性，以及在解释外科医生特定的感染率时考虑患者疾病严重程度的重要性。

BACKGROUND & AIMS: BACKGROUND & AIMS:Some patients with chronic hepatitis B virus (HBV) infection progress to hepatocellular carcinoma (HCC). However, the long-term effect of nucleos(t)ide analogue (NA) therapy on progression to HCC is unclear. METHODS:Therefore, we compared chronic hepatitis B patients who received NA therapy to those who did not, using a propensity analysis. RESULTS:Of 785 consecutive HBV carriers between 1998 and 2008, 117 patients who received NA therapy and 117 patients who did not, were selected by eligibility criteria and propensity score matching. Factors associated with the development of HCC were analyzed. In the follow-up period, HCC developed in 57 of 234 patients (24.4%). Factors significantly associated with the incidence of HCC, as determined by Cox proportional hazards models, include higher age (hazard ratio, 4.36 [95% confidence interval, 1.33-14.29], p=0.015), NA treatment (0.28 [0.13-0.62], p=0.002), basal core promoter (BCP) mutations (12.74 [1.74-93.11], p=0.012), high HBV core-related antigen (HBcrAg) (2.77 [1.07-7.17], p=0.036), and high gamma glutamyl transpeptidase levels (2.76 [1.49-5.12], p=0.001). CONCLUSIONS:NA therapy reduced the risk of HCC compared with untreated controls. Higher serum levels of HBcrAg and BCP mutations are associated with progression to HCC, independent of NA therapy.

背景与目标：

BACKGROUND & AIMS: :In this study, we evaluate the nature of the relationship between particulate matter and total mercury concentrations. For this purpose, we estimate both of the two values in water column over 12-h tidal cycles of the Jade Bay, southern North Sea. Total particulate mercury in 250 mL water samples was determined by oxygen combustion-gold amalgamation. Mercury contents varied from 63 to 259 ng/g suspended particulate matter (SPM) or 3.5-52.8 ng/L in surface waters. Total particulate mercury content (THg(p)) was positively correlated with (SPM), indicating that mercury in tidal waters is mostly associated with (SPM), and that tidal variations of total particulate mercury are mainly due to changes in (SPM) content throughout the tidal cycle. Maximum values for THg(p) were observed during mid-flood and mid-ebb, while the lowest values were determined at low tide and high tide. These data suggest that there are no mercury point sources in the Jade Bay. Moreover, the THg(p) content at low tide and high tide were significantly lower than the values recorded in the bottom sediment of the sampling site (>200 ng/g DW), while THg(p) content during the mid-flood and mid-ebb were comparable to the THg content in the surface bottom sediments. Therefore, changes in THg(p) content in the water column due to tidal forcing may have resulted from re-suspension of underlying surface sediments with relatively high mercury content.

背景与目标： : 在这项研究中，我们评估了颗粒物与总汞浓度之间关系的性质。为此，我们估计了北海南部玉湾12小时潮汐周期内水柱中的两个值。通过氧燃烧-金汞齐化测定250毫升水样中的总颗粒汞。地表水中的汞含量从63到259 ng/g悬浮颗粒物 (SPM) 或3.5-52.8 ng/L不等。总颗粒汞含量 (THg(p)) 与 (SPM) 呈正相关，说明潮水中的汞主要与 (SPM) 相关，而总颗粒汞的潮汐变化主要是由于整个潮汐周期中 (SPM) 含量的变化。在洪水中期和退潮中期观察到THg(p) 的最大值，而在低潮和涨潮时确定最低值。这些数据表明翡翠湾没有汞点源。此外，低潮和高潮时的THg(p) 含量明显低于采样点底部沉积物中记录的值 (>200 ng/g DW)，而中洪和中潮期间的THg(p) 含量与表层底部沉积物中的THg含量相当。因此，由于潮汐强迫，水柱中THg(p) 含量的变化可能是由于汞含量相对较高的下层表层沉积物的重新悬浮所致。

BACKGROUND & AIMS: AIMS:We sought to evaluate bleeding complications and periprocedural outcomes of the radial approach (RA) as compared to the femoral approach (FA) during percutaneous coronary intervention (PCI) in "real-world" patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS:The study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centres in Poland (the ORPKI Polish National Registry). Patients treated using the RA and FA were compared using a propensity score analysis to avoid possible selection bias. The analysis was carried out in an "as-treated" manner. The FA was used in 9,334 (40.9%) and the RA in 13,478 (59.1%) patients. After propensity score matching, a higher total amount of contrast (191.8±8.0 vs. 174.8±68.8 ml; p=0.001) and lower radiation doses (1,279.5±1,346.3 vs. 1,182.6±887 mGy; p=0.02) were reported in FA. More access-site-related bleeding complications after both angiography (0.17% vs. 0.02%; p=0.004) and PCI (0.23% vs. 0.09%; p=0.049) were reported in the FA group. Periprocedural death (1.94% vs. 0.93%; p=0.001) was more common after PCI performed with the FA. CONCLUSIONS:The radial approach was associated with a lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at the access site.

背景与目标：

BACKGROUND & AIMS: AIMS:It is not known if successful catheter ablation for atrial fibrillation (AF) improves the patient's long-term cardiovascular outcomes. This study investigated the long-term outcomes and mortality of AF patients at high risk who received antiarrhythmic medication and catheter ablation. METHODS AND RESULTS:The propensity scores for AF were calculated for each patient and were used to assemble a cohort of 174 AF patients with ablation who were compared with an equal number of AF patients without ablation. Composite cardiovascular end points (major adverse cardiovascular event, MACE), including mortality and vascular events in the medically treated patients representing the control group (group 1), were compared with those in the ablation-treated patients (group 2). The rates of the total mortality (2.95% vs. 0.74% per year; P < 0.01), cardiovascular death (1.77% vs. 0% per year; P = 0.001), and ischaemic stroke/transient ischaemic attack (2.21% vs. 0.59% per year; P = 0.02) were higher in group 1 than group 2, respectively. A multivariate Cox regression analysis of the MACE scores showed that a higher CHA2DS2-VASc score [hazard ratio (HR) = 1.309 per increment of score, 95% confidence interval (CI) = 1.06-1.617; P = 0.01] and the performance of the ablation procedure (HR = 0.225, CI = 0.076-0.671; P = 0.007) were independent predictors of a MACE. In patients who received catheter ablation, recurrence of any atrial arrhythmia was a predictor of vascular events and total mortality (P < 0.05). CONCLUSION:In AF patients with CHA2DS2-VASc score ≥1, catheter ablation of AF reduced the risk of the total/cardiovascular mortality and total vascular events. Atrial fibrillation recurrence predicts long-term cardiovascular outcomes, as well as the CHA2DS2-VASc score.

背景与目标：

BACKGROUND & AIMS: :The aim of this study was to investigate alterations in the leukocyte and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period. The study population consisted of 40,325 pregnant women. A full blood count and automated differential leukocyte count were performed and all the haemogram results in the different trimesters of pregnancy were recorded. Percentiles were calculated using statistical software. A total of 82,786 complete blood count evaluations were performed in 40,325 subjects from the 6th to 41st week of pregnancy and in the initial postpartum period. The leukocyte counts increased from the 1st to the 3rd trimester and peaked in the initial postpartum period. Our reference values for the total and differential leukocyte counts may assist clinicians in distinguishing between leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Impact statement Pregnancy requires profound adaptation by multiple systems to accommodate the demands of the developing foetus. Similar to all other systems, many haematological changes occur during pregnancy. Studies of normal variation in leukocyte counts were insufficient to distinguish normal from abnormal leukocyte counts during pregnancy and in the initial postpartum period, due to small numbers of patients and a lack of differential leukocyte counts. Without reference leukocyte levels, infections may be more difficult to assess during pregnancy and in the postpartum period. In this study, we report the 3rd, 5th, 10th, 50th, 95th and 99th percentile values for the total and differential leukocyte counts according to trimester in normal pregnancy and the initial postpartum period. Our reference values for the total and differential leukocyte counts in each trimester and the initial postpartum period may assist clinicians in distinguishing between normal leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Our results may prevent misdiagnosis of physiological elevated leukocytes as bacterial infection that leads to unnecessary medication use that may compromise the foetus.

背景与目标： : 这项研究的目的是调查妊娠不同三个月和产后初期白细胞和白细胞计数差异的变化。研究人群由40,325名孕妇组成。进行了全血细胞计数和自动差异白细胞计数，并记录了妊娠不同三个月的所有血象结果。使用统计软件计算百分位数。从怀孕的第6周至第41周和产后初期，对40,325名受试者进行了总共82,786次全血细胞计数评估。白细胞计数从第1个月到第3个月增加，并在产后初期达到峰值。我们的总白细胞计数和差异白细胞计数参考值可以帮助临床医生区分白细胞增多和妊娠和产后初期白细胞计数的病理升高。影响声明怀孕需要多个系统进行深刻的适应，以适应发育中的胎儿的需求。与所有其他系统相似，许多血液学变化发生在怀孕期间。由于患者人数少且缺乏差异的白细胞计数，对白细胞计数正常变化的研究不足以区分妊娠期间和产后初期的正常白细胞计数与异常白细胞计数。如果没有参考白细胞水平，则在怀孕期间和产后期间可能更难评估感染。在这项研究中，我们根据正常妊娠和产后初期的三个月报告了总白细胞计数和差异白细胞计数的第3、5、10、50、95和99个百分位数值。我们在每个孕期和产后初期的总白细胞计数和差异白细胞计数的参考值可以帮助临床医生区分正常的白细胞增多和妊娠和产后初期的白细胞计数的病理升高。我们的结果可以防止将生理性白细胞升高误诊为细菌感染，从而导致不必要的药物使用，从而可能损害胎儿。

BACKGROUND & AIMS: INTRODUCTION:Prosthetic and operative modifications in total knee arthroplasty (TKA) have been proposed to maximise post-operative knee flexion as it is essential in routine functional activities. METHODS:We performed a double blind randomised controlled trial to compare clinical outcomes of primary cruciate-retaining TKA for osteoarthritis with the femoral component implanted in either 4° flexion in the sagittal plane (F) or in a neutral position (C). The primary outcome of knee flexion and secondary outcomes knee extension, quadriceps strength, WOMAC, SF-12v2, timed stand test, stair climb test and satisfaction were assessed at 1 year. Knee flexion and extension were also assessed intra-operatively. Implant flexion was measured from true lateral radiographs. RESULTS:Thirty-nine participants (40 knees) were recruited, 20 knees per group. Three subjects from the control group and two from the flexed group were lost to 1 year follow-up but numbers were sufficient to satisfy the sample size calculation. Significant differences were found between the groups in knee flexion (F: 113.6±8.8° pre-operative, 122.4±6.0° intra-operative, 110.2±7.5° 1 year, C: 117.4±11.7°, 117.4±7.6°, 103.5±10.7°. p=0.031) and mental component score of the SF12-v2 (F 53.3±13.2, C 61.1±7.3, p=0.009) but there were no significant differences in other outcomes and patients were equally satisfied. CONCLUSION:Flexing the femoral implant in this cruciate retaining TKA system provided a significant difference in knee flexion compared to a neutral position. The improvement appears to occur predominantly at surgery and was not associated with a clinical or functional benefit at 1 year. (ACTRN12606000325505). LEVEL OF EVIDENCE:Level 1; randomised controlled trial.

背景与目标：

BACKGROUND & AIMS: :A simple and rapid procedure for measuring total mercury in human hair was evaluated and compared with a conventional technique. An Advanced Mercury Analyzer (AMA-254) based on sample catalytic combustion, preconcentration by gold amalgamation, thermal desorption, and atomic absorption spectrometry (AAS) (Comb-AAS) was assessed for the direct determination of milligram quantities of human hair. Precision (% relative standard deviation) was < 7% and accuracy was determined by using two human hair reference materials (i.e., NIES No. 13 and IAEA-086) that were within the certified range. In comparison to conventional graphite-furnace atomic absorption spectrophotometry (GF-AAS), we found that our method obtained statistically equivalent results. Because total analysis time per sample was less than 10 min, the Comb-AAS method was in fact much faster than the GF-AAS method. In addition, Comb-AAS does not generate waste products and could be mainly useful for the analysis of a large amount of samples. Then, the authors suggest that this quick method could be useful for measuring mercury in human hair. Therefore, the mercury content in hair for a non-exposed group of children (n=40) living in Spain was evaluated. The mean and median hair mercury levels for the subjects under study were found to be lower than the value of 1 microg/g, corresponding to the reference dose of 0.1 microg of methylmercury per kilogram body weight set by the U.S. Environmental Protection Agency.

背景与目标： : 评估了一种简单，快速的测量人发中总汞的方法，并将其与常规技术进行了比较。评估了基于样品催化燃烧，金汞齐化，热解吸和原子吸收光谱法 (AAS) (梳状AAS) 的先进汞分析仪 (AMA-254)，用于直接测定毫克量的人发。精密度 (% 相对标准偏差) <7%，并且通过使用在认证范围内的两种人类毛发参考物质 (即，NIES no.13和IAEA-086) 来确定精密度。与传统的石墨炉原子吸收分光光度法 (gf-aas) 相比，我们发现我们的方法获得了统计上等效的结果。由于每个样品的总分析时间少于10分钟，因此Comb-AAS方法实际上比gf-aas方法快得多。此外，梳状AAS不会产生废物，并且可能主要用于分析大量样品。然后，作者建议这种快速方法可用于测量人发中的汞。因此，评估了居住在西班牙的未暴露儿童 (n = 40) 的头发中的汞含量。研究对象的平均和中位头发汞水平低于1微克/克的值，对应于美国环境保护署设定的每公斤体重0.1微克甲基汞的参考剂量。

BACKGROUND & AIMS: Among the complications of hydatid liver disease, spontaneous cyst rupture into the biliary tract is unusual, occurring in 3.2-17% of cases. Its endoscopic management has been reported rarely, and corresponding complete photodocumentation is unique. Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with upper abdominal pain, obstructive jaundice, and fever. Impaction of hydatid material into the common bile duct and the papilla of Vater was relieved endoscopically, and the patient was consecutively treated with two courses of mebendazole. This management resulted in complete clinical resolution of hepatic hydatosis after 8 months of follow-up. Complications of overt cyst perforation may be allergic, obstructive, secondary infectious, or metastatic. Ultrasound and computed tomography are complementary tools for diagnosis of hepatic echinococcosis, with endoscopic retrograde cholangiography being the "gold standard" in confirming rupture into the biliary system. Laboratory results are usually non-specific. While surgical excision is the treatment of choice, selected patients may primarily be managed endoscopically, followed by anthelminthic therapy.

背景与目标： 在包虫肝病的并发症中，自发性囊肿破裂进入胆道是罕见的，发生在3.2-17% 的病例中。它的内窥镜管理很少有报道，相应的完整照片记录是独一无二的。在一名48岁的免疫功能低下的男子中描述并全面说明了这种情况，该男子表现为上腹痛，阻塞性黄疸发热。内镜下减轻了包虫物质进入胆总管和Vater乳头的影响，并连续接受了两个疗程的甲苯咪唑治疗。经过8个月的随访，这种治疗可使肝囊肿的临床完全消退。显性囊肿穿孔的并发症可能是过敏性，阻塞性，继发性感染或转移性。超声和计算机断层扫描是诊断肝包虫病的补充工具，内窥镜逆行胆管造影是确认胆道系统破裂的 “金标准”。实验室结果通常是非特异性的。虽然手术切除是首选的治疗方法，但选定的患者可能主要是内镜治疗，然后是驱虫疗法。

BACKGROUND & AIMS: :A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation.

背景与目标： : 已经描述了一种完全腋窝清扫全乳房切除术的技术。该程序利用胸大肌在锁骨和胸骨部分之间的划分，保留其神经支配，并在解剖完成后进行重建。胸小肌被切除。这种修饰有助于彻底的腋窝解剖，尤其是在顶点处，同时保留了Patey手术的美容和功能益处。