手指末节损伤58例修复治疗体会

目的探讨手指末节损伤的修复与治疗。方法回顾性分析我院1997年—2009年门诊、急诊和住院58例手指末节损伤患者手术修复治疗的情况。结果 58例患者全部保留了伤指原有的长度,没有再截残余指骨,局部无明显感染,直接缝合8指Ⅰ期愈合。结论修复手指末节损伤时,对残留的患指应尽量修复,保留其长度,不再截残余指骨,闭合伤口。     

碘缺乏病对儿童智力发育的影响

甲状腺是人体重要的内分泌腺体，位于颈部气管两侧，由两个侧叶和一个峡部组成，形状类似古战场使用的盾甲，故名甲状腺。侧叶大小相当于本人拇指末节，整个腺体重量在我国成人中约为20～30g，正常情况下是看不见摸不着的。甲状腺作为人体最大的内分泌腺体，主要功能有两个：一是合成和分泌甲状腺激素；二是分泌能调节血钙浓度的降钙素。     

拇甲瓣(带少许末节趾骨)移植再造拇指术一例

1．病例介绍 患者，男，28岁，2008年1月16日因工伤致右拇、食、中指疼痛、流血、活动功能障碍1小时入院，入院查体：生命体征平稳，心、肺、腹部未见异常，专科情况：右食、中指重度压榨，近节部分指骨残留，中远节指骨缺如，皮肤挫烂，残留的骨、肌腱外露，右中指掌侧一节半皮肤仍较好残留，右拇指近节远侧半、远节皮肤缺如，以背侧为甚。末节指骨骨折，末节指骨缺损长约1／3，肌腱外露。     

残指移植急症右手再造术

我们于1988年10月为1例右手搅压伤后仅残留部分掌骨的病人进行了手再造术,将其残留尚较完整的拇指末节和中指移位再植于第一、五掌骨残端,第二、三、四掌骨残留部分切除,形成“V”形,类似虎口,获得成功。经一年余随访,外形、功能均较满意,现报告如下。病例报告     

腮腺浅叶功能性切除术的临床观察

腮腺浅叶肿瘤是临床上相当常见的疾病，治疗以手术为主，保留面神经的腮腺浅叶及肿瘤切除术是现有教材及手术工具书所列的传统经典术式，术中常规结扎切除腮腺主导管，使残留的腺体、深叶腮腺组织萎缩。这一术式在临床上应用十分广泛，但术后也出现一定的并发症，部分病例甚至遗留严重的面部凹陷性畸形。我科自1996年以来，试行采用保留腮腺     

前列腺增生术后排尿困难原因分析

目的 分析前列腺增生术后排尿困难的原因,为预防和治疗提供依据.方法 回顾性分析27例前列腺增生术后出现排尿困难病例的临床资料.结果 7例耻骨上(经膀胱)前列腺摘除术病例中,膀胱颈梗阻5例,尿道狭窄、腺体残留各1例;20例经尿道前列腺电切术病例中,尿道外口狭窄12例,腺体残留 6例,血块堵塞2例.结论 膀胱颈口梗阻为耻骨上(经膀胱)前列腺切除术后引起排尿困难的主要原因,而尿道外口狭窄则为经尿道前列腺电切术后排尿困难的重要原因.     

全腔镜下保留乳头乳晕皮下腺体切除术的临床应用

目的：探讨保留乳头乳晕全腔镜乳房皮下腺体切除的手术方法及治疗效果。方法：对5例乳腺癌患者行全腔镜下保留乳头乳晕的皮下腺体切除术。腔镜手术前位于乳房皮下及和乳房后间隙注入脂肪肿胀液,通过自制的分离棒分离皮下及乳后间隙,充分溶脂后通过充气法在间隙内建立操作空间,腔镜下切断乳房皮下和腺体之间相连的纤维索以及腺体周围的筋膜附着点,将乳房腺体完整切除,术中病理证实患侧乳头后方腺体组织无癌残留。常规术式行前哨淋巴结活检术或腋窝淋巴结清扫。观察手术的安全性和美容效果。结果：5例均顺利完成全腔镜皮下腺体切除手术;全腔镜皮下腺体切除手术时间为150～240min,平均190min;术中出血10～60mL;其中局部皮下积液1例。术后美容效果良好,患者满意率100％。结论：全腔镜下保留乳头乳晕皮下腺体切除术具有良好的微创和美容效果,手术并发症少,是值得临床上推广的一种手术方式。     

保留真皮下血管网腋臭腺体剥脱术并发症的分析

目的探讨保留真皮下血管网行腋臭腺体剥脱术后并发症的原因,改进手术方法。方法回顾2002年3月至2008年3月352例采用保留真皮下血管网行腋臭腺体剥脱术恢复情况,并对其所产生的并发症进行分析。结果352例中无异味腋下皮片存活良好、切口愈合良好314例;腋下散在表皮坏死26例;皮片部分坏死3例;术后血肿7例;血清肿6例;异味轻度残留7例;局部感染0例。上肢功能障碍0例。结论通过对保留真皮下血管网行腋臭腺体剥脱术后并发症的处理和分析,能够进一步提高治疗效果     

前列腺增生症术后排尿困难临床分析

目的探讨耻骨上经膀胱（TVP）与经尿道前列腺切除术（TURP）后排尿困难的病因、预防及处理。方法回顾性分析21例前列腺增生症术后出现排尿困难的临床资料。结果8例TVP术后排尿困难的病例中,膀胱结石与前尿道狭窄各2例;前列腺癌、膀胱颈挛缩、腺体残留和出血各l例;13例TURP病例中腺体残留6例,尿道狭窄、出血和膀胱颈水肿各2例,逼尿肌收缩力减弱l例,均经治疗恢复。结论TVP与TURP术后排尿困难原因较多,腺体残留是TURP术后排尿困难的主要原因。充分的术前准备、正确的术中与术后处理是预防前列腺增生症术后发生排尿困难的关键。     

青少年原发性甲亢28例手术治疗分析

目的探讨青少年原发性甲状腺功能亢进症（甲亢）的治疗方法。方法本组28例青少年原发性甲状腺功能亢进症,采用甲状腺次全切除术,切除腺体组织约80%～90%,残留腺体总量约6～8g.结果无窒息、甲亢危象和手术死亡病例,术后随访1年～10年,治愈27例,治愈率为96.4%;复发1例复发率为3.6%.术后出现暂时性甲状旁腺功能低下2例,经补钙治疗,3d～5d症状消失。无喉返、喉上神经损伤和甲状腺功能低下病例。结论在严格掌握手术适应证的情况下,手术治疗青少年原发性甲亢是一种安全、迅速、有效、并发症少、复发率低的治疗方法。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.