前列腺增生伴逼尿肌无力患者的电切术治疗

目的 :探讨良性前列腺增生 (BPH)伴有逼尿肌无力 (ACD)患者的治疗方法和效果。方法 :对尿动力学检查确认有ACD的 12例BPH并发膀胱出口梗阻 (BOO)的患者 (A组 )进行经尿道前列腺电切术 (TURP)或加膀胱颈内切开术 (TUIBN) ,同时与逼尿肌功能正常或高于正常的行TURP的BPH患者 2 4例 (B组 )进行对照分析。结果 :A组术后 7～ 30d复查 ,国际前列腺症状评分 (IPSS)为 12 .5 8± 0 .70分 (P <0 .0 0 1) ,最大尿流率 (Qmax)为11.0 5± 0 .85ml/s (P <0 .0 5 ) ,均比术前有改善 ,但术后效果不如B组明显 (P <0 .0 0 1)。术后 3、6个月复查IPSS及Qmax,两组略有改变 ,但差异无显著性意义 (P >0 .0 5 ) ,剩余尿测定也均在正常范围。术后 3个月对ACD的 5例复查逼尿肌收缩力 ,无明显改善。结论 :对ACD并伴有BOO的BPH患者可以采取电切术治疗     

A double or bilobar gallbladder as a cause of severe complications after (laparoscopic) cholecystectomy

A double or bilobar gallbladder is a rare congenital anomaly. If not recognized during preoperative evaluation or operation, it can cause severe complications. We describe two cases in which a second operation had to be performed because of the presence of a second or bilobar gallbladder that was not recognized in the preoperative evaluation and during (laparoscopic) cholecystectomy. The types of anomalies, the concomitant pathology, and treatment are discussed.     

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.     

3-D echocardiographic imaging of double aortic arch.

Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.     

出血性脑室铸型的疗效分析

目的 探讨出血性脑室铸型的治疗方法与疗效。方法 分析脑室外引流、尿激酶脑室内注入、气管切开、控制血压以及脑积水的处理等多种治疗手段在治疗脑室铸型过程中的作用及其效果。结果 经过综合治疗完全恢复日常生活者10例(28．6％)，部分恢复日常工作或独立进行家庭生活者13例(37．1％)，生活需要照顾或护理者7例(20％)，死亡5例(14．2％)。结论 对于出血性脑室铸型这类重症病人早期及时的脑室外引流是快速而有效的抢救措施，尿激酶脑室内注入对溶解血凝块，疏通脑室系统行之有效。气管切开对降低死亡率至关重要，控制血压是防止再出血的关键。脑积水的处理是康复过程中需要高度重视的环节。     

重睑成形术后发生上睑下垂的原因分析及其防治

目的 探讨重睑术后发生上睑下垂的原因及早期防治方法，避免术后医疗纠纷的发生。方法 对拟做重睑术的患者，术前详细询问病史并认真查体。对18例术前发现有睁眼乏力或轻度上睑下垂者，采用切开法重睑术并同时行上睑提肌缩短术，对3例切开法重睑成形术后，出现上睑下垂并发症者即刻打开切口行上睑提肌缩短术；对5例埋线法术后出现上睑下垂者在7d内拆除缝线，重新设计重睑线。无论切开法或埋线法，如超过10d即均在3个月后再行切开法重睑成形术。结果 对26例术前存在或术后发现的轻度上睑下垂者重行手术修复，24例随访3个月至2年，医者与受术者双方满意或基本满意。结论只要遵循预防为主、早期发现、早期治疗的原则，重睑成形术后出现上睑下垂这一特殊并发症是可以治愈的。     

Right ventricular-pulmonary arterial interactions

The application of pulsatile models to hemodynamic data has made possible a more complete understanding of the relationship of pulmonary pressure and flow. To review the genesis of these concepts, the unique characteristics of the pulmonary artery and right ventricle are outlined as a basis for understanding why differences in their pulsatile properties from the systemic circuit must exist. The pulmonary impedance spectrum is introduced and the concept of optimal right ventricular-pulmonary artery coupling is explored based on a review of extensive experimental data. Finally, available studies of normal pulmonary impedance in man and abnormal impedance in human disease states are reviewed, with emphasis on disturbances in optimal ventricular-vascular coupling. The important implications of these concepts for understanding and treatment of cardiovascular disease are developed.     

心脏连续横断断层的解剖学研究

用20个成人尸体心脏,从右心耳上缘平面向下作1.0cm厚的连续横断断层切片。对心脏每一断层下断面,进行各项观测,同时还观察了心脏各断层与胸壁的对应关系。     

Diagnosis of thoracic outlet syndrome Relative value of electrophysiological studies

The diagnostic utility of various electrophysiological techniques was evaluated in patients with thoracic outlet compression syndrome (TOCS). Our results suggest that in true neurogenic TOCS, there is no standard electrophysiological picture, but that this evolves with the severity of the syndrome. The first changes observed are electromyographic, followed by changes in F-wave and SEPs, followed finally by changes in nerve conduction parameters. EMG study was certainly more informative, showing neurogenic damage not only in limbs with neurological signs but also in about 1/4 of limbs with only subjective symptoms. The study of F-wave and SEPs does not seem to be particularly helpful, however, in view of the peculiar changes found in these patients, SEPs may be a useful complement to EMG. Nerve conduction studies were of little utility since changes in these parameters are only found in patients with long-standing anomalies and severe atrophy.     

侧脑室肿瘤的显微外科治疗19例报告

目的 分析探讨侧脑室肿瘤临床特点及手术体会。方法 回顾分析我院近6年手术治疗的19例侧脑室肿瘤患者临床资料。结果 侧脑室肿瘤临床无特异症状，据肿瘤的具体部位选择合适的手术入路。肿瘤全切10例，大部分切除6例，切除3例。术后症状明显改善14例。结论 侧脑室肿瘤以脑膜瘤、星形细胞瘤、室管膜瘤多见，但各有其好发部位。手术入路选择应结合肿瘤具体位置、大小和血供情况，既要满足暴露。尽量减少神经功能缺失，又要达到全切肿瘤目的。