A型肉毒杆菌毒素治疗麻痹性斜视

采用眼外肌注射A型肉毒杆菌毒素的方法,治疗17例(18只眼)麻痹性内斜视患者。最大的肌肉麻痹作用发生于注射后7～14天,最大斜视矫正度为50-,随访时间为4～20周,5例最终获得双眼视。未见全身副作用。认为,这种疗法可在部分患卉中替代斜视矫正术。     

Percutaneous needle trephination. Experience in 200 cases

Summary For many years percutaneous needle and classic burr-hole trephination with insertion of plastic catheters for external ventricular drainage are in use. The shortcomings of the conventional puncture needles were compensated for by the development of a modified instrument in recent years.In this prospective study we tried to define advantages and disadvantages of percutaneous ventriculostomy with this modified needle in a large number of patients. We treated and followed a total number of 200 patients with external ventricular drainage for various reasons (42% obstructive hydrocephalus, 27% haematocephalus, 11% malresorptive hydrocephalus, 11% elevated ICP and 9% infections). The ventriculostomy is performed — after percutaneous trepheication with a 1.5 mm drill and 1.2 mm needle under the local aesthesia as a bedside procedure. The modified blunt needle is provided with markings and a set screw which allows insertion to a prefixed depth and a sharp guide which is withdrawn after penetration of the dura. It is then bent rostrally and fixed by a plaster cast. The mean duration of drainage was 9 days (1–30 days). Mean operating time for the whole procedure including fixation and connection to the drainage system was 20 minutes. Overall complication rate was 13% (N=26). Two intracerebral haemorrhages (1%) occurred, of which one was caused by overdrainage. Five (3%) infections in primarily not infectious cases (N=182) were seen. Only one case of infection occurred without loosing of the needle on day 17. In 19 patients (10%) the needles had loosened. Fifteen times this complication was repaired in time and no infection occurred. The overall complication rate (13%) and the needle related risk of bleeding (0.5%) seem average. The true risk of infection with correct handling (0.5%) is very low despite the very long average duration of drainage. The main risk lies in the markedly high danger of loosening (10%), which entails a disproportionally high demand for nursing care. Nevertheless, we regard percutaneous needle trephination as the ventriculostomy method of choice because of its better practicability and low infection rate.     

血浆中高级糖化终产物的水平与糖尿病并发症的关系研究

目的 探讨高级糖化终产物与糖尿病并发症的关系。方法 采用本实验室自行研制的竞争性酶联免疫吸附分析方法，测定了糖尿病有并发症组病人血浆95例，糖尿病无并发症组人血浆65例，正常对照65例。结果：在糖尿病有并发症组中，高级糖化终产物（AGEs）浓度[（6．625（1．691）U／mL，n=95]明显高于糖尿病无并发症组[（5．904（2．071）U／mL，n=65，P=0．017]，也明显高于正常人组[（5．337（1．138，n=65，p〈0．005]。以有无并发症为应变量进行多元logistic回归分析显示，血浆AGEs浓度〉6．085U／ml者，糖尿病并发症发生的危险性增加（OR值为2．989，95％可信限为1．407—6．350）。多元逐步线性回归显示：糖尿病病程、冠心病史与血浆AGEs浓度之间有线性关系。结论血浆AGEs浓度是糖尿病发生并发症的独立危险因素。     

后房型人工晶体植入术后早期并发症临床分析及处理

报告468例500眼后房型人工晶体植入术后2周内出现的并发症发生率,其中角膜水肿73.6％,色素膜炎症反应88.4％,瞳孔变形12.8％,人工晶体表面渗出膜3.8％,后囊混浊13.8％,短暂性高眼压5.2％,晶体皮质残留5.8％,人工晶体偏位2.6％,前房出血3％。提高术后视力的关键是提高手术技巧以减少并发症的发生。     

前不均倾位51例临床分析

目的:探讨前不均倾位的诊断及处理方法,以期提高临床医师对前不均倾位的认识。方法:对我院1995年1月~2006年11月收治的51例前不均倾产妇的发病年龄、胎产次、发病原因、临床表现、母儿产时产后并发症及诊治方法进行分析。结果:50例前不均倾均以剖宫产结束分娩、母婴安全。1例自然分娩。结论:前不均倾位产时并发症多,不易做出早期诊断,对母婴危害大,难以经过阴道分娩,诊断一旦明确,应及时行剖宫产终止妊娠。     

良性前列腺增生症（BPH）尿动力学研究：术后排尿困难的原因分析

21例BPH手术治疗后仍有排尿困难,经内窥镜等检查不能明确原因者,19例经尿动力学检查明确了原因。其中前列腺残留8例,后尿道办膜样梗阻4例,逼尿肌/无力2例,逼尿肌尿道外括约肌协同失调3例,假性排尿困难2例。尿动力学检查对病因诊断和指导治疗均有很大的价值。     

Comparative study of two customary cerebrospinal fluid shunting systems in early childhood hydrocephalus

Summary The validity of clinical studies on shunt-treated hydrocephalic patients is often hindered by inhomogeneity of the patient population examined, technical devices used, or by other specific factors. In an effort to introduce a homogeneous clinical study on hydrocephalic patients 66 hydrocephalic newborns and infants have been treated exclusively with CORDIS Orbis-Sigma Valve (OSV) System (CORDIS Corporation, Miami, USA) in 1990–1995. The results are compared with an equivalent group of 53 children treated with CODMAN Holter Valve (HV) System (CODMAN Inc., Randolph, USA) during a similar 5-year-period (e.g., 1986–1991). Searching for different reasons of shunt insufficiency in both groups demonstrates a more than double risk of shunt complication for ventriculo-atrial HV treated patients (VA-HV) in comparison with those treated ventriculo-peritoneally with OSV System (VP-OSV): 4.22 versus 1.98 mean surgical procedures per person. The different revision and survival rates are discussed and specific problems are mentioned.     

小梁切除联合丝裂霉素术后晚期滤泡相关并发症的临床分析

目的：探讨小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率及处理。 方法：1994-05／2000．05接受小梁切除手术联合丝裂霉素治疗青光眼65例65眼，采用Kaplan-Meier生存分析法估计晚期滤过泡渗漏、滤泡炎、眼内炎的发生概率。 结果：随访2．5～7．1（平均5．6）a，发生滤过泡渗漏16眼（16／65，24．6％），出现滤泡炎5眼（5／65，7．7％），发生眼内炎1眼，出现复合性滤泡并发症1眼，出现持久性低眼压9眼（9／65，13．8％）。Kaplan-Meier生存分析法估计晚期滤泡并发症5a发生概率为40．0％。多数眼通过门诊处理获得成功，部分眼需手术治疗。 结论：小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率可高达40．0％，单纯滤过泡渗漏是一相对良性的状况，只要及时处理，可被修复，滤泡炎或眼内炎可以被控制，而获得正常眼内压。一相对良性的状况，只要及时处理，可被修复，滤泡炎或眼内炎可以被控制，而获得正常眼内压。     

肝移植术后并发症的影像学评价

目的:采用多种影像学措施评价肝脏移植术后并发症。材料和方法:16例背驮式原位肝移植术患者,术后7天内每日行胸片及胸腹部超声检查。术后2周～12个月,当患者出现发烧、皮肤巩膜黄染及异常B型超声发现时,行上腹部CT检查5例8次、同时行胸部CT检查2例、上腹部MRI及MRCP检查6例、ERCP检查4例、PTC检查2例、“T”管造影2例和下腔静脉造影1例。结果:术后1周内诊断胸腔积液14例(14/16);术后1～2周诊断肺部感染7例(7/16);肺不张4例(4/16)。术后4个月和8个月诊断右肺和移植肝多发转移瘤各1例(2/6);术后3周～10个月诊断胆总管吻合口狭窄、胆管炎、胆泥形成等5例(5/16)。术后2周诊断下腔静脉狭窄1例(2/16)。结论:运用多种影像学检查方法有助于及时诊断肝移植术后并发症。     

浅论CT引导下肺穿刺术临床应用

探讨 CT引导下肺穿刺活检术的应用及常见漏诊原因 ,提高阳性率及减少并发症的方法。结果 2 85例有细胞学或病理结果 ,检出率 95 %。15例无细胞学或病理结果。CT引导肺穿刺术对肺周围占位性诊断率高 ,并发症少 ,是临床医师不可缺少的诊断手段