远外侧入路治疗颅颈交界腹侧病变的探讨

目的 探讨远外侧人路在处治中下斜坡、颈延交界区腹侧及颈静脉孔区病变的应用。方法对23例患者采用远外侧入路显微外科手术,其中枕髁后入路12例,经部分枕髁入路5例,经C1-2关节面侧方联合经部分枕髁入路3例,经颈静脉结节入路2例,经完整枕髁入路1例。结果20例肿瘤全部切除15例,近全部切除5例,3例椎一基底动脉瘤均顺利夹闭,3例行枕颈融合,无手术死亡率,结果满意。所有患者术后均未出现寰枕关节不稳定的症状,手术并发症主要是后组颅神经损伤、椎动脉损伤、脑脊液漏以及脑干、小脑或脊髓缺血。结论远外侧入路是脑干和上段颈髓腹侧、腹外侧病变的理想入路,但手术操作较复杂,具有一定的潜在风险,应根据病变性质、位置和延伸范围来选择入路,进而最低限度切除颅底骨质。     

Quality of life from the viewpoint of patients with dementia in Japan: nurturing through an acceptance of dementia by patients, their families and care professionals

The quality of life (QoL) of patients with dementia was investigated from the patient's viewpoint, and the role of an acceptance of dementia in maintaining important and distinctive elements of QoL was analysed by questionnaire and interview methods. The subjects of the present study were 18 patients, 21 family members and eight members of staff at a day-care facility in Japan. Patients with dementia hoped to maintain an 'ordinary' way of life. Living peacefully, living together, living healthily and helping each other were considered by patients with dementia to be the important elements of their QoL. Living happily in the present is important, but hopes and expectations for the maintenance of human values in their future lives are of greater importance in their estimation of QoL. Through recognizing these needs, a culture and understanding of 'living with dementia' can be nurtured. A dynamic process involving the mutual acceptance of dementia in the relationships between patients with dementia, their families and care professionals enabled elderly people to surmount their initial troubles, and to recoup and activate their former humane attitudes. Positive thinking reappeared and new forms of relationships emerged. The patients, their families and the care professionals came to understand each other better and gained the sense of 'living together'. The process began with 'confronting' the situation and progressed to the final stage of 'acceptance': the patient with dementia was confronted with the dementia itself, the family was confronted with the elderly person as a human being, and the care professional was confronted with her or himself. At first, the care professionals had felt a sense of social responsibility for delivering justice, but they had gradually noticed that they were themselves relieved of the strain resulting from these attitudes. Acceptance of dementia by the care professional was important in carrying forward this dynamic process, which helps to ensure the desired QoL for the patient with dementia.     

Inguinal neurectomy for nerve entrapment after open/laparoscopic hernia repair using retroperitoneal endoscopic approach

Background Inguinal neuralgia after open and laparoscopic hernia, repair occurs in about 0.5% of treated patients. If the pain and the functional inability persist, it is possible that the genitofemoral nerve and ileoinguinal nerve are involved in entrapment, and surgical treatment is a possible option. This paper reports a personal endoscopic retroperitoneal approach for ileoinguinal and genitofemoral branches neurectomy.Methods A 12-mm trocar is inserted into the lower retroperitoneum and insufflated to create a work space. Neurectomy is performed under endoscopic guidance.Results Six patients were treated using this technique. The operating time was 55 min, and all patients were completely pain-free after surgery. All patients were discharged the first day after operation and there were no complications.Conclusion This retroperitoneal endoscopic approach is proposed as a new surgical technique for treating inguinal entrapment neuralgia. It is simple and feasible.     

Spinal Cord Protection During Thoracoabdominal Aneurysm Repair

Spinal cord injury after thoracoabdominal aortic surgery remains a devastating and unpredictable complication, caused by clamping of the thoracoabdominal aorta, resulting in exclusion of blood flow in critical and essential intercostal arteries. Various protective methods against spinal cord ischemia have been proposed and performed clinically. These include preoperative spinal angiography, distal aortic perfusion, hypothermia, reattachment of the intercostal artery, cerebrospinal fluid drainage, administration of neuroprotective agents, and monitoring of somatosensory and motor-evoked potentials. The information to date suggests that multimodality approaches should be used to prevent spinal cord injury after thoracic and thoracoabdominal aneurysm repair.     

Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches

We devised a special instrument to assess intraoperative pelvic motion and used this device to measure intraoperative pelvic motion in three dimensions. A total of 100 total hip arthroplasties (THAs) were performed using this device. Two approaches were utilized: 52 THAs were performed with the posterolateral approach and the remaining 48 with the translateral approach. The average angle of pelvic tilt in the THAs with the translateral approach was less than that with the posterolateral approach. The average internal rotation angle was 1.75° with the translateral approach and 14.25° with the posterolateral approach. With the posterolateral approach, the internal rotation of the pelvis frequently occurred during retraction of the femur using a Hohmanns retractor placed at the anterior rim of the acetablum, with flexion and internal rotation of the affected hip.     

Transatrial resection of a left ventricular thrombus after acute myocarditis

A mobile and pedunculated left ventricular thrombus developed after acute myocarditis in a 49-year-old woman. Surgical removal is recommended for cases such as this, especially when the ventricular thrombus is pedunculated or mobile. The thrombus was successfully removed by left atriotomy. There was no evidence of recurrent thrombus formation on the 50th day after surgery.     

Mutagenicity test systems for the detection of chromosome aberrations in vivo

In mutagenicity testing of pharmaceuticals it is advisable, whenever possible, to use in vivo mammalian systems where the pharmacokinetic properties of a drug would be more or less similar to those in man. However, although there are a number of different genetic endpoints which are important in mutagen testing, sufficiently validated, practical and well documented in vivo test systems exist only for stuctural chromosome aberrations.This paper provides an overview of existing in vivo test systems for the detection of chromosome aberrations. Emphasis has been laid on the functions, advantages and limitations of the three tests recommended in the guidelines of the European Community; first, the metaphase analysis assay, and, as alternatives, the micronucleus test and the dominant lethal test.These three test are then also discussed from the viewpoint of our own practical experience. Chemical Substances Mentioned: Trisethylenemelamine (TEM), Trenimon, Cyclophosphamide, Mitomycin C, Colchicine, Benzimidazol carbamate, Azathioprine     

A new surgical approach to the third ventricle with interruption of the striothalamic vein

Summary In the removal of tumours that develop within the third ventricle, most approaches are not entirely satisfactory. Therefore, a new approach has been devised: transfrontal exposure of the anterior portion of the frontal horn; coagulation and section of the striothalamic vein in order to open up the roof of the third ventricle; use of a blunt spatula introduced in the foramen of Monro and pushed backwards under the choroïd plexus. This approach has been used in ten cases. Postoperative mortality has been nil; the surgical approach has not apparently been responsible for any sequelae. It is simple and gives a good view of the third ventricle.     

Evaluation of the Isoconversional Approach to Estimating the Hoffman‐Lauritzen Parameters from the Overall Rates of Non‐Isothermal Crystallization of Polymers

Summary: The isoconversional approach proposed by Vyazovkin for evaluating the Hoffman‐Lauritzen parameters from overall rates of non‐isothermal crystallization was critically applied to two new and fast crystallizing polymers, poly(propylene terephthalate) and poly(butylene naphthalate), which are used for the production of fibers. Non‐isothermal crystallization data were corrected for the effect of the thermal lag and the effective activation energy as a function of temperature was calculated using the method of Friedman. The estimated Hoffman‐Lauritzen parameters, U* and K_g, were consistent with corresponding values from isothermal crystallization experiments obtained either from DSC measurements or using polarized optical microscopy (POM). It was found that the proposed method could simulate the experimental data very well, and the temperature interval under consideration did not allow the detection of any critical breakpoints denoting regime transitions.

Dependence of the effective activation energy on average temperature for PPT.