永存左上腔静脉在心脏直视手术中的处理

自1981年8月至1996年10月施行心脏直视手术1800例，发现永存左上腔静脉（PLSVC）11例，其中引入左心房1例。全部并发于其它心内畸形，且无特异体征。认为本中仔细探查是对PLSVC诊断的重要环节。本文对注意事项以及对不同类型的PLSVC引流入左房的外科处理方法进行了阐述。     

骨外露及皮肤软组织缺损的修复

目的　评价和探讨修复骨外露及皮肤软组织缺损的各种方法 ,使其更好地用于临床。方法　 3 5例不同部位的骨外露分别采用皮片移植、皮瓣及肌皮瓣转移、皮瓣及肌皮瓣游离移植等方法 ,覆盖外露的骨面。结果　 3 1例全部存活 ,1例皮瓣部分坏死 ,2例创口延迟愈合 ,1例游离皮瓣失败。结论　对骨外露及皮肤软组织缺损应尽量在早期修复 ,最常用的方法是皮瓣及肌皮瓣的转移或移植。     

前列腺素E1和一氧化氮联合治疗室间隔缺损并肺动脉高压的疗效观察

目的 :观察静脉应用前列腺素E1(PGE1)、吸入一氧化氮 (NO)及二者小剂量联合应用对室间隔缺损 (VSD)并肺动脉高压的治疗作用。方法 :将 2 4例VSD并肺动脉高压的病人随机分为 3组 ,观察静脉注射PGE16 0ng/ (kg·min)、吸入NO 2 0ppm及静脉注射PGE130ng/ (kg·min)联合吸入NO 10 ppm对病人的血流动力学及血氧饱合度的影响。结果 :静脉注射PGE16 0ng/ (kg·min)使肺动脉平均压 (MPAP)明显下降 ,体动脉平均压 (MSAP)亦有所下降 ,心指数 (CI)明显增加。吸入NO 2 0 ppm组MPAP明显下降而MSAP无明显变化 ,CI有所升高 ,但差别不显著。静脉注射PGE130ng/ (kg·min)同时吸入NO 10 ppm组MPAP明显下降 ,但不显著 ,CI明显升高。 3组血氧饱合度均明显升高。结论 :联合应用小剂量PGE1和NO不仅能有效降低MPAP ,又能适当轻度降低MSAP ,改善心功能 ,减轻了NO的毒副作用 ,是一种较理想的治疗方案     

异体甘油保存皮与自体微粒皮复合移植的临床应用

目的：寻找深度大面积\烧伤的早期治疗方法。方法:大面积深度烧伤于4－5天即行切痂，以异体甘油皮为支架，将有限的自体皮制作成微粒皮后均匀地复合植于创面。结果：对5例共12个肢体2个躯干进行早期切痂后异体甘油皮＋自体微粒皮的复合移植，成活后的创面平堤，外观平整，颜色淡红或近拟正常皮肤，触饮，收缩少，结论：异体甘油保存皮＋自体微粒皮复合移植是大面积深度烧伤较理想的治疗方法。     

捻转补泻手法针刺合谷穴对其局部皮肤温度的影响

目的阐明针刺捻转补法与泻法的操作是否存在效应上的差异,并探讨其效应差异是否为补泻效应的差异.方法应用红外线热像技术,采用不同的捻转补泻手法针刺健康人合谷穴后,观察其在即刻,10、20、30min,对局部皮肤温度的影响.结果不同捻转补法与泻法的操作存在着不同程度的效应差异,其中补法可以使皮温升高,泻法可以使皮温降低,以石氏捻转补泻针法较为明显.结论1)补泻手法,补法和泻法的操作可产生不同的效应.2)不同捻转补泻手法对皮肤温度产生的升降效应为补泻效应,其中以石氏捻转补泻手法最为明显.3)证明补泻手法实施的必要性.     

The surgical management of resistant club foot by rotation skin flap and extensive soft tissue release

Summary Resistant club foot remains an unsolved problem because of the complex aetiological and pathological factors, and is still seen quite frequently, especially in developing countries. The posteromedial skin contracture is a potent deforming force which is responsible for many failures or relapses. I report the results of an operation in which a rotation skin flap was combined with an extensive soft-tissue release. The age of the children was from 9 months to 10 years. The follow-up period was from one to 9 years with an average of 43 months, and in 50 cases for more than 5 years. I consider that the outcome has been excellent or good in 94 out of 100 feet.

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Résumé Le pied bot invétéré demeure un problème mal résolu en raison de la complexité des facteurs étiologiques et anatomiques et il est encore bien souvent rencontré, notamment dans les pays en voie de développement. La rétraction cutanée postéro-interne représente un puissant élément de la déformation, qui est responsable de bon nombre d'échecs ou de récidives. Nous rapportons les résultats d'une opération qui associe un lambeau cutané de rotation à la libération des parties molles. L'âge des enfants était compris entre neuf mois et dix ans. Le recul est de un à neuf ans, avec une moyenne de 43 mois. Cinquante enfants ont été suivis plus de cinq ans. Les résultats sont excellents ou bons dans 94% des cas.

     

应用皮瓣移植修复足跟部皮肤软组织缺损

目的通过8种不同皮瓣的临床应用,总结足跟部皮肤软组织缺损的修复效果。方法采用了游离足背皮瓣、游离背阔肌皮瓣、游离肩胛皮瓣、桥式胫后动脉岛状皮瓣、桥式携带背阔肌皮瓣或桥式携带肩胛皮瓣、胫后动脉岛状皮瓣、胫后动脉皮支岛状皮瓣、跖底内侧动脉岛状皮瓣,对足跟部皮肤软组织缺损进行修复的临床应用。结果95块皮瓣修复足跟部皮肤软组织缺损,成活93块,成功率为97.9%。随访1～15年,治疗效果满意。结论应用皮瓣移植的方法,才能使足跟部皮肤软组织缺损得到有效的修复。     

应用膀胱三角区壁瓣成形尿道治疗女性外伤性尿道缺损(附5例报告)

目的：探讨膀胱三角区壁瓣成形尿道治疗女性外伤性尿道损伤的疗效。方法：自膀胱颈后唇向上，取梯字形壁瓣，形成锥状管，经膀胱颈口，自阴道前壁外拉至外阴部，在原尿道外口处固定，替代尿道。结果：3例随访8年，1例6年，1例5年，平均随访7年，均排尿通畅，无尿失禁和尿道狭窄。结论：女性外伤性尿道缺损，应用膀胱三角区壁瓣形成锥状管替代尿道法治疗，手术简单，对患者打击小，成功率高，远期效果好。     

Skin test results and self-reported symptom severity in allergic rhinitis: the role of psychological factors

BACKGROUND: In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity. OBJECTIVES: To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors. METHODS: One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism. CONCLUSIONS: The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.     

Presence of beta human papillomaviruses in nonmelanoma skin cancer from organ transplant recipients and immunocompetent patients in the West of Scotland

Background  Nonmelanoma skin cancer (NMSC) has been linked to cutaneous human papillomaviruses of the genus beta (betaPV).
Objectives  We sought to assess the presence of betaPV in NMSC biopsies from a group of Scottish skin cancer patients, both immunocompetent (IC) patients and immunosuppressed (IS) organ transplant recipients.
Methods  One hundred and twenty-one paraffin-embedded skin tumours (27 actinic keratosis, 41 intraepidermal carcinoma, 53 squamous cell carcinoma) and 11 normal skin samples were analysed for the presence of betaPV by a polymerase chain reaction–reverse hybridization assay designed to detect the presence of the 25 known betaPV genotypes.
Results  In IC patients, betaPV was detected in 30 of 59 (51%) tumours and two of 11 (18%) normal skin samples ( P  =   0·046). In IS patients, betaPV was found in 27 of 62 (44%) tumours; no normal skin samples were available for comparison. The most frequently found genotypes were HPV-24, HPV-15 and HPV-38. Of those tumours infected with betaPV, 28 of 57 (49%) were infected with more than one genotype (range 2–8). Tumours from IS patients were from a younger age group (mean age 57·4 years) than IC patients (mean age 73·8 years). Multiple infections were more common in tumours from IC patients (21 of 30; 70%) compared with those from IS patients (seven of 27; 26%) ( P  <   0·001). In the IC group, age did not appear to influence the distribution of single and multiple infections whereas in IS patients the proportion of multiple infections to single infections increased with age. There were no multiple infections in normal skin.
Conclusions  A wide spectrum of betaPV types was detected in our samples. Further characterization of betaPV in vivo is needed in order to determine the mechanisms by which the virus contributes to cutaneous carcinogenesis.