松解及眼轮匝肌下脂肪垫转移充填矫正重睑术后睑粘连畸形

目的矫正重睑成形术后的上睑粘连、重睑较宽、眼睑上抬受限等畸形。方法另设计重睑线,彻底松解眼睑内的组织粘连,释放眶隔内脂肪及转移眼轮匝肌下脂肪垫充填。结果两年来为32例重睑成形术后畸形者用此法治疗得到满意效果。结论此方法简单易行,效果好。     

Upper thoracic myelopathy caused by vertebral collapse and subluxation in rheumatoid arthritis: report of two cases

We report two cases of rheumatoid arthritis (RA) with upper thoracic myelopathy and a review of the literature. Clinical data of a 47-year-old woman (case 1) and a 54-year-old woman (case 2) are described. Case 1 showed a transverse-type myelopathy at the T2 segment level of the spinal cord and case 2 had the same type of myelopathy at the T4 segment level. Case 1 had anterior vertebral subluxation of C7 due to marked vertebral collapse and Case 2 had subluxation of T2 with vertebral destruction. These two patients had the mutilating type of RA with multilevel spontaneous fusion in the cervical spine. The lesions in the thoracic spine might be caused by the severe destructive inflammation that is characteristic in mutilating disease. The vertebral collapse might lead to subluxation of the upper thoracic vertebra, resulting in spinal cord compression. Upper thoracic subluxation might be caused by vertebral collapse due to RA and the increased motion as a compensation for decreased mobility caused by spontaneous fusion in the cervical spine.     

两种术式治疗甲状腺相关眼病上睑退缩的比较

目的对比两种术式矫正甲状腺相关眼病上睑退缩的临床疗效。方法将22例(32只眼)甲状腺相关眼病上睑退缩患者,随机分为A、B两组。A组11例18只眼采用上睑提肌中央腱膜切断术矫正;B组11例14只眼采用上睑提肌和Muller肌延长术矫正。术后随访6个月,评价其临床疗效。结果所有患者术后自觉症状均明显减轻或消失,A组及B组各自术前与术后疗效相比,均有统计学意义(P<0.01),组间比较无统计学意义(P>0.05)。术后6个月A组有4例6眼,B组有1例1眼上睑回退,经卡方检验,回退率组间比较有统计学意义(P<0.05)。两组均无一只眼过矫。结论两种术式均可有效矫正静止期甲状腺相关眼病的上睑退缩,但上睑提肌和Muller肌延长术回退率低。     

持续靶控输注异丙酚复合硬膜外麻醉用于上腹部手术探讨

目的:评价持续靶控输注异丙酚复合硬膜外阻滞有用于上腹部手术的可行性。方法:30例胃癌手术患者,ASAⅠ～Ⅱ级。随机分成靶控输注异丙酚全麻(T)组15例,靶控异丙酚复合硬膜外阻滞(T+E)组15例。结果:(T+E)组术后躁动、芬太尼、丙泊酚的用量低于(T)组(P<0.05)。异丙酚单位标准化剂量亦较低。两组苏醒时间相似。诱导后两组血压均显著下降(P<0.05),T+E组在诱导后DBP的下降幅度较T组更为显著(P<0.05),T组在探查、术毕、拨管后的SBP、DBP、MAP比(T+E)组显著增高(P<0.05)。两组诱导后至术毕BIS、SEF显著下降,两组间的比较无统计学意义(P>0.05)。结论:靶控输注异丙酚复合硬膜外阻滞用于上腹部手术是可行的,具有异丙酚、芬太尼的用量少、苏醒快、术后躁动少,麻醉深度易于调控,血液动力学较稳定,是一种良好的麻醉方式。     

上前牙倒置阻生拔除后再植的临床体会

为探讨上前牙倒置阻生拔除后再植的可行性，选择上前牙倒置阻生病例15例，经正畸治疗扩展间隙，再经口腔外科手术拔除后再植。结果，86．7％的病例获得良好的治疗效果，无明显松动。认为用拔除后再植术治疗上前牙倒置阻生，能明显改善面形和咀嚼功能，避免了拔牙后再修复。     

上睑下垂78例手术分析

用额肌悬吊术或提上睑肌缩短术治疗７８例上睑下垂病例，治愈７眼，基本治愈１２眼，矫正不足３眼，矫正过度２眼，笔者认为，术前分析病因；注意提上睑肌肌力的测定；采用适当的手术方法，是手术成功的关键。     

Epidemiology of abdominal symptoms in a random population: Prevalence,incidence, and natural history

The study presents results from a five-year follow-up on abdominal symptoms in an age and sex stratified random sample of 4,581 Danes. Abdominal pain occurred significantly more often among women (prevalence: 49%, incidence: 21%) compared to men (prevalence: 38%, incidence: 15%). Five years later the pain had disappeared in 43% of the men and 31% of the women (p=0.003). Distension, borborygmi, and altering consistency of stools occurred with a prevalence of approximately 50% and an incidence of approximately 30%, significantly more often among women compared to men. Five years later these symptoms had disappeared in about 20%. Prevalence of both heartburn and acid regurgitation were significantly higher among men (38%) than women (30%), whereas no sex difference was observed regarding incidence of these symptoms (16%). Approximately 30% of subjects who had experienced heartburn or acid regurgitation did not do so five years later. In conclusion, abdominal symptoms occur frequently and recurrently in the general population. This information is of importance to doctors when they evaluate patients with abdominal complaints, but no obvious organic etiology.     

Intraoperative radiotherapy of upper abdominal tumours

Thirty patients with malignant tumours in the upper abdomen underwent surgery and intraoperalive radiation (IORT), using electron beam, to: the surgical bed, residual or unresected tumour. The technical aspects and results of this treatment are described. Renal, adrenal, bile duct and gastrointestinal tumours were treated. along with several other lesions. The surgical procedure consisted in 10 cases simply of exposure of the tumour for IORT and in 20 the tumour was resected. The TORT dose ranged from 10 to: 20 Gv. In 13 patients, external beam radiation was also given to: residual tumour or to: areas of high risk for recurrence. Chemotherapy was given to: 10 patients. Tolerance to: the combined treatment was acceptable; with few complications related to: IORT.The median follow-up and survival time 23 months (range 4-more than 70 months). Local tumour control rate (or tumour stabilisation) is 90%. Distant metastases developed in 19 patients (63%). The actuarial survival rate for the group projected at 70 months (maximum follow-up) is 37%. IORT in useful in the management of tumours arising in the upper abdominal organs, for palliation surgery or when resectability of the tumour is in doubt. Indications for IORT include patients with uncommon tumours of the upper abdomen who are not be candidates for standardised cancer treatment.Presented at the European Congress of Radiology, Vienna, September 15–20,1991     

胃镜取上消化道异物112例体会

我院从2000年至2005年,共用电子胃镜取上消化道异物112例,经急诊胃镜取出104例,失败2例,效果良好。胃镜取异物具有方便快捷、价廉、创伤小等优点,值得推广,现将取得的经验操作体会报告如下。1资料与方法1.1一般资料本组中男74例,女38例,年龄2岁~65岁,平均年龄42岁,10岁以下儿童为17例,112例中咽部异物17例,均为鱼刺,食道异物35例,胃内异物56例,十二指肠球部异物2例,降部异物2例,除外咽部17例鱼刺,所剩95例中难取异物44例,其中带钩义齿11例,刀片8例,玻璃片6例,铁片3例,铁钉2例,铁勺2例,戒指2例,枣核1例,牙刷4例,方便筷2例,围棋3例。1.2器械OLYMPUS电子胃镜、活检钳、鼠齿钳、网篮、胃镜套管、自制的内镜前端保护套(制作方法:将避孕套前端剪开尾端固定在镜头前方1cm并反折,用一皮圈固定外接一拉线,使用石蜡油润滑)。1.3操作方法1.3.1术前准备详细询问病史,了解异物的大小、形状、材质,并行拍片进一步了解有无气腹症及异物所处位置及性状。对锐利者准备好保护装置,胃内食物较多者嘱其平卧,禁食水,保持平静,必要时用X线透视动态了解异物是否移动。1.3.2麻醉采用利多卡因...     

Control accuracy and response time in multiple-state myoelectric control of upper-limb prostheses. Initial results in nondisabled volunteers

In myoelectrically operated prosthetic systems control performance decreases with an increasing number of possible movements. A test has been designed that allows quantification of two related qualities of performance. A predefined amount of training was given to 40 nondisabled volunteers without previous prosthetic experience. After training they attempted the test. The two parameters measured were the response time and the control accuracy corresponding to the different movements. It is concluded that even with a very limited amount of training fairly complex control systems can be operated with acceptable performance.