上肢屈曲性旋转撕脱离断伤的形成及功能挽救

目的探讨上肢轴向屈曲性旋转撕脱离断伤的形成以及侧胸和背部组织在功能挽救中的应用方式和疗效。方法2000年7月～2003年9月共收治6例上肢轴向屈曲性旋转撕脱离断伤患者,所有病例行一期再植或寄养再植。术后肩关节外展90°、肘关节屈曲100°位石膏或支具固定,6周后去除固定行功能锻炼。结果6例患者再植均顺利成活,随访3个月～2年,术后肩关节外展50°～90°,前屈50°～70°,后伸20°～30°,内收20°～40°;肘关节屈曲100°～140°,伸-20°～0°;重建术后3个月时屈肘肌力达Ⅳ～Ⅴ级。结论充分利用侧胸和背部组织特点进行分期、分层手术,解决创面覆盖和功能重建互相干扰的矛盾,是挽救严重轴向屈曲性旋转撕脱离断伤上肢,恢复其外形和功能的可靠方法。     

超声对2型糖尿病患者肱动脉内皮功能的测定

目的:研究2型糖尿病患者微量白蛋白尿对肱动脉血管内皮功能的影响及与亚临床期动脉粥样硬化的关系。方法:运用高频超声观察55例不伴有微量白蛋白尿MAU(-)的2型糖尿病,25例伴有微量白蛋白尿MAU(+)的2型糖尿病及30例对照者(对照组)的右肱动脉反应性充血后内皮依赖性舒张功能和含服硝酸甘油后非内皮依赖性舒张功能的内径变化。结果:2型糖尿病两组病人较对照组内皮依赖性舒张功能及非内皮依赖性舒张功能显著降低(P<0.01);MAU(+)较MAU(-)组内皮依赖性舒张功能显著下降(P<0.01)。结论:微量白蛋白尿与2型糖尿病患者血管内皮功能损害密切相关,是导致动脉硬化发生,加速动脉硬化进程的因素。     

大隐静脉曲张微创外科治疗

目的　总结外科微创方法治疗大隐静脉曲张的经验。方法　采用大隐静脉高位结扎微创剥脱术治疗 465例 ( 5 72条患肢 )及静脉腔内激光治疗 6例 ( 7条患肢 )下肢静脉曲张患者。结果　在 471例患者中 ,随访到 42 7例 ,随访率 90 .7% ,平均随访时间 3 .8年。结果显示手术创伤小、并发症少、复发率低 ( 1.41% )。结论　此两种微创手术操作简单、合理、易于掌握 ,且疗效理想 ,值得推广。     

应用外固定器进行双节段骨块滑移治疗下肢感染性骨缺损

在临床上由外伤和骨髓炎造成的下肢感染性骨缺损的患者并不少见,对其治疗修复方法也很多,但其效果不一,成为骨科临床上的一个难题。我院自1998-2005年应用外固定器进行双节段骨块滑移治疗下肢感染性骨缺损11例,取得了较好的效果,现报告如下。1临床资料本组11例,男8例,女3例;年龄15~48岁,平均35.6岁;骨缺损部位:胫骨9例,股骨2例;骨缺损长度8~20cm,平均10cm。前期治疗病程6个月~3年,7例行钢板内固定手术,2例行髓内针内固定手术,2例行石膏外固定治疗,均治疗失败。固定器材:外固定器采用特制双杆外固定滑动延长器。2治疗方法2.1手术方法在硬膜外…     

Human Herpesvirus 6 in Bronchalveolar Lavage Fluid after Lung Transplantation: A Risk Factor for Bronchiolitis Obliterans Syndrome?

Bronchiolitis obliterans syndrome (BOS) is the limiting factor to long-term survival after lung transplantation. Previous studies suggested respiratory viral tract infections are associated with the development of BOS. To identify the impact of virus detection in bronchoalveolar lavage (BAL) fluid, we analyzed BAL samples from 87 consecutive lung transplant recipients for human herpesvirus (HHV)-6, Epstein-Barr virus, Herpes simplex virus 1/2, Cytomegalovirus, respiratory syncytical virus and adenovirus by PCR. Acute rejection, BOS and death were recorded for a mean follow-up time of 3.27 +/- 0.47 years. Results of PCR analysis and other potential risk factors were entered into a Cox regression analysis of BOS predictors and death. Only acute rejection was a distinct risk factor for BOS of all stages, death and death from BOS. HHV-6 was detected in 20 patients. Univariate and multivariate analysis revealed that HHV-6 was associated with an increased risk to develop BOS > orb = stage 1 and death, separate from the risk attributable to acute rejection. Identification of HHV-6 DNA in BAL fluid is a potential risk factor for BOS. Our results warrant further studies to elucidate a possible causal link between HHV-6 and BOS.     

Minimal Acute Rejection after Lung Transplantation: A Risk for Bronchiolitis Obliterans Syndrome

Bronchiolitis obliterans syndrome (BOS) is a major cause of lung allograft dysfunction. Although previous studies have identified mild to severe rejection (grade>or=A2) as a risk factor for BOS, the role of minimal rejection (grade A1) remains unclear. To determine if A1 rejection by itself is a risk factor for BOS, we performed a retrospective cohort study on 228 adult lung transplant recipients over a 7-year period. Cohorts were defined by their most severe rejection episode (none, A1 only, and >or=A2) and analyzed for the subsequent development and progression of BOS using univariate and multivariate time-dependent Cox regression analysis. In the univariate model, the occurrence of isolated minimal rejection was a risk factor for all stages of BOS. Similarly, multivariate models that included HLA mismatch, cytomegalovirus pneumonitis, community acquired viral infection, underlying disease and type of transplant demonstrated that A1 rejection was a distinct risk factor for BOS. Furthermore, the associated risk with A1 rejection was slightly greater than the risk from >or=A2 and treatment of A1 rejection decreased the risk for subsequent BOS stage 1. We conclude that minimal rejection is associated with an increased risk for BOS development and progression that is comparable to A2 rejection.     

Parainfluenza Virus Infection in Adult Lung Transplant Recipients: An Emergent Clinical Syndrome with Implications on Allograft Function

Parainfluenza virus is a common cause of seasonal upper respiratory tract infections in children and adults. Studies indicate that parainfluenza virus may play an important role in the etiology of respiratory tract infections in lung transplant recipients with an estimated incidence of 5.3 per 100 patients. Parainfluenza virus type 3 is the most frequent serotype in lung transplant patients. The rate of lower respiratory tract infections with parainfluenza virus among lung transplant recipients is between 10 and 66% of cases. In addition, trans-bronchial biopsy at the time of parainfluenza infection shows signs of acute allograft rejection. Subsequently, 32% of patients have been found to have active bronchiolitis obliterans at a median time of 6 months (range 1-14) postviral infection. These findings indicate that parainfluenza virus infections may have long-term implications for lung transplant recipients. Further studies are required to identify the mechanisms of immunomodulation of parainfluenza virus among these patients. In addition, controlled studies are needed to evaluate the efficacy of aerosolized ribavarin in the treatment of parainfluenza virus infection and to determine whether vaccines may be effective in these high-risk patients.     

Is focal task‐specific dystonia limited to the hand and face?

Focal task-specific dystonia (FTSD) of the hand and face have been well described; however, FTSD of the leg is exceedingly rare. We describe and demonstrate by videotape 2 patients with FTSD affecting the leg, in both cases triggered specifically by walking down steps. Walking on a level surface, up steps, and down steps backward, and sideways were normal. An interoceptive sensory trick (imagining walking in a different modality) led to temporary improvement. Our patients appear to demonstrated that task-specificity in focal dystonia may not be limited to skilled, rehearsed actions and that FTSD may occur in an activity that is relatively autonomic.     

眼袋整形术并发症的防治

眼袋整形术的并发症主要包括下睑外翻、下睑睫毛外翻、睑球分离、泪小点外翻、眼鼻沟畸形及眶下睑沟凹陷畸形等。皮肤眼轮匝肌及眶隔脂肪切除过多是造成上述并发症的主要原因，另外，手术中失误或操作粗糙也可造成诸如复视、泪小管撕裂甚至球后血肿等严重并发症。防止下睑外翻的发生，主要在于如何测定松弛皮肤的方法，这要把眼球活动、面部肌肉活动以及重力对面部的影响等诸因素进行综合考虑，正确估算出皮肤的切除量，才能有效防止睑外翻的发生。对于轻度外翻可采用热敷、按摩等保守治疗，对于重度睑外翻据不同情况分别采用，眼轮匝肌提紧术，睑板部分切除、结膜囊缩小术及下睑皮肤移植术加以矫正。对于眶下区凹陷及眼鼻沟畸形，术中就应注意避免，特别是要控制好眶脂的切除量，一旦发生可采用脂肪或筋膜脂肪充填，也可行眼轮匝肌提紧加以矫正。总之，在眼袋整形术中避免去除过多的组织，无论是皮肤，还是眶隔脂肪，都可有效防止并发症的发生。     

ECAT angina pectoris study: baseline associations of haemostatic factors with extent of coronary arteriosclerosis and other coronary risk factors in 3000 patients with angina pectoris undergoing coronary angiography

The ECAT Angina Pecioris Study is a European multicentre studyinvestigating the pathogenetic and possibly predictive roleof the haemostatic system in the progress of coronary heartdisease. In this paper we report the cross-sectional analysisof haemostatic factors in 3043 patients, who underwent coronaryangiography due to angina pectoris. Fibrinogen levels were higherin patients with one or more coronary stenoses of at least 50%than in patients without, by an average of 0.16 g. l^–1(P <0.0001). Depressed fibrinolytic activity due to higherlevels of PAI was also associated with the presence of coronarystenoses. There was no association with the extent of coronaryarteriosclerosis, as assessed by the number of involved arteries,except that patients who had more vessels with total occlusionshad higher fibrinogen levels. Depressed fibrinolytic activitywas also clearly associated with diabetes, obesity, higher triglyceridelevels, smoking and impaired cardiac pump function as assessedby ejection fraction. Cholesterol levels were particularly correlatedwith protein C and plasminogen.