先天性心脏病儿体外循环的再氧合损伤

目的 研究高氧分压体外循环对先天性心脏病儿的再氧合损伤。方法 选择20例先天性心脏病患者，按照病种随机分成2组，第一组：非紫绀型先天性心脏病（n=10）；第二组：紫绀型先矢性心脏病（n=10）。体外循环均采用100％氧气预充和转流，在体外循环开始前、1min、5min和10min，分别测定颈内静脉血心肌肌钙蛋白（cTnI）、S100卢蛋白（S100）和丙二醛（MDA）含量，同时观察临床指标。结果体外循环前，两组cTnI、S100卢和MDA含量均在正常水平，无显著差别。体外循环开始三者均明显上升，血清cTnI含量在体外循环开始1min，5min时，紫绀型组升高水平均高于非紫绀型组，差异具有极显著性（P〈0．01）；血清S100口含量在体外循环开始1min、5min和10min时，紫绀型组均高于非紫绀型组，5min和10min差异具有显著性（P〈0．05）；血清MDA含量在体外循环开始1min、5min和10min时，紫绀型组均高于非紫绀型组，1min、5min和10min差异均具有显著性（P〈0．05）。临床指标无明显差异。结论 高氧分压体外循环再氧合可导致心肌和脑组织氧自由基介导的再氧合损伤；而且紫绀型先天性心脏病患者再氧合损伤比非紫绀型先天性心脏病患者更严重。     

护理质量检查中反复发生的质量缺陷分析

目的探讨如何提高护理质量，降低缺陷发生的管理方法。方法将，2004年护理质量检查情况进行汇总分析。结果发现缺陷共425项次，针对发生缺陷的原因，规范各种操作流程及监督、检查措施；加大护理人员护理相关法律法规及护理文件书写规范的培训。结论提高护理管理人员的整体素质，使护理监督、检查工作规范化、护理工作尽快步入科学化管理轨道。     

外鼻部分缺损的手术治疗

目的：评价外鼻部分缺损的治疗方法及手术效果。方法：总结5例外伤致外鼻部分缺损的临床资料。5例患者分别用带蒂鼻唇沟及鼻根部皮瓣转移修复鼻背缺损，耳郭中上部复合软骨组织修复鼻翼缺损，耳垂缘皮肤脂肪复合组织修复鼻尖缺损。5例均一期修复成功。结果：随访6～12个月，5例转移瓣均成活，外鼻形态修复满意，无并发症发生.结论：在保证血供原则下，采用相应的成形方法修复外鼻不同类型的缺损，可收到满意效果。     

Heart luxation through a right-sided traumatic pericardial defect

A traumatic defect of the pericardium is a rarely diagnosed entity. We present a patient with a right-sided luxation of the heart which was incidentally diagnosed during a thoracic CT performed for other reasons. Despite of the threatening strangulation of the great vessels, the patient had a stable circulation until surgical repair of the pericardial defect. Received: 20 April 2000 Revised: 24 July 2000 Accepted: 25 July 2000     

多孔碳酸钙陶瓷修复骨缺损的生物力学评价

目的:评价多孔碳酸钙陶瓷(PCCC)修复骨缺损后的生物力学性能。方法:取20只新西兰大白兔,采用兔桡骨干1.5 cm缺损的动物模型并植入多孔碳酸钙陶瓷,分别于术后12及16周处死后取材,分成术后12周弯曲试验组和压缩试验组、术后16周弯曲试验组和压缩试验组,另取正常桡骨为正常对照组。在万能材料力学试验机上行三点弯曲和压缩试验。结果:12周组、16周组分别与对照组比较。12周组和对照组比较,三点弯曲试验各指标比较差异有统计学意义,12周组各指标小于对照组(P<0.05);压缩试验各指标比较差异无统计学意义(P>0.05);16周组与对照组比较,三点弯曲试验及压缩试验各指标差异无统计学意义(P>0.05)。结论:多孔碳酸钙陶瓷具有良好的力学特征,有望成为骨组织工程中修复骨缺损的理想支架材料。     

Familiärer mangel und α 1

Zusammenfassung Es wird über zwei Kinder aus zwei Familien mit Mangel an ₁ berichtet. Homozygote Defektträger wiesen etwa 15–25%, heterozygote 50–75% des mittleren normalen Serumspiegels auf. Unter 100 Blutspendern fanden sich 5 mit erniedrigten ₁ wie bei heterozygoten Defektträgern.Klinische Auswirkungen des Gendefektes waren im Kindesalter nicht zu erkennen, insbesondere keine Enthemmung der Fibrinolyse.

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₁ deficiency in two families

Two children from two different families with ₁ deficiency are described. Deficient subjects had 15–25% of normal serum ₁ levels in case of homozygosity and 50–75% in case of heterozygosity. Among one hundred healthy blood donors five had serum ₁ levels below 150 mg% corresponding to the levels found in heterozygous deficiency carriers.In the two children described the gene defect had no clinical consequence; fibrinolysis, in particular was not increased.

     

Primary Hypothyroidism with Pituitary Enlargement and a Visual Field Abnormality

A 23 year old man presented with classical hypothyroidism of 9 years duration. This was associated with pituitary enlargement, documented on magnetic resonance imaging (MRI), and abnormal half-field visual evoked responses (VERs). Following the initiation of thyroxine therapy the pituitary enlargement and the VER abnormalities resolved. The final diagnosis was of primary hypothyroidism with secondary pituitary hyperplasia.     

一种修复股骨近段骨缺损的新方法

本文报道了５例股骨近段良性和恶性肿瘤，年龄２０～３２岁，平均２６．７岁。瘤段切除后骨缺损最长为１６．２ｃｍ，最短１０．８ｃｍ，平均１２．４ｃｍ。均采用冷冻异体骨段移植修复骨缺损、加压钢板内固定、髋关节融合术治疗。经１２～３７个月随访，Ｘ线片显示：无螺钉松动及钢板断裂，其中４例达骨性融合，融合率为８０％。本术式的最佳指征为股骨近段良性或低恶性肿瘤切除后骨缺损的年轻患者。该手术具有内固定牢靠、不需外固定、护理方便和融合率较高等优点。     

Chirurgische Behandlung infizierter Knochendefekte

Zusammenfassung Die unhappy triad der Knochenchirurgie, Infekt, Defekt und Instabilität stellt uns auch heute noch vor schwer zu lösende Probleme. Das Vorgehen der Wahl scheint uns die Stabilisierung der Fragmente mittels einer internen (Osteosynthese) oder externen (äußere Spanner) Fixation, die radikale Ausräumung des Herdes, die vorübergehende Spüldrainage nach Willenegger [26, 27, 28] und schließlich das Auffüllen des Defektes mit autologer Spongiosa zu sein. Bei allen unseren in dieser Studie erfaßten 25 Patienten kam es zum knöcherner Einbau des Transplantates und Abheilung des Haut- und Weichteildefektes, bei vier Patienten be schleunigte eine Spalthautverpflanzung die Heilung. 23 Fälle sind 1 bis 6 Jahre nach der Behandlung vom Infekt her rezidivfrei geblieben, bei sämtlichen Patienten konnte die Belastungsstabilität erreicht werden.Durch das beschriebene Vorgehen konnte in allen Fällen die Gelenkfunktion erhalten oder verbessert werden. Das aktive Eingreifen gestattet zudem Achsen- und Längenkorrekturen.Klinische, szintigraphische und histologische Untersuchungen zeigen, daß der Einbau des spongiösen Transplantates unmittelbar nach der Verpflanzung einsetzt und nach 3 Monaten soweit fortgeschritten ist, daß die Belastungsstabilität erreicht wird.

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Autogenous cancellous bone in osteomyelitis with defects of bone, soft tissue and skin

Summary Surgeons are still confronted with the grave problem of the unhappy triad of bone surgery, i.e. infection, osseous defect and instability. To us the stabilisation of fragments by means of internal or external fixation, the radical saucerization and packing of the cavity with autogenous cancellous bone with preceding irrigation drainage seems to be the procedure best suitable. 25 patients with infected defects of bone, soft tissue and skin were treated accordingly and followed up 1 to 6 years later: In all cases the graft had been integrated and the skin- and soft tissue defects had healed. In 23 cases osteomyelitis had not re-occured, weight bearing stability had been achieved in all 25 cases.The described procedure had either maintained or even improved articular function. Additionally the active intervention allowes correction of axis and length.It is demonstrated by radiological, scintigraphical and histological examinations, that the integration of the cancellous bone transplant begins immediately after transplantation and is advanced within three months to such a point that weight bearing becomes possible.

     

Infected Segmental Defect Pseudarthrosis of the Tibia

Abstract Objective: The purpose of this study was to evaluate a consequent and protocolized approach of infected segmental defect pseudarthrosis of the tibia. Patients and Methods: During the period 1993–2000, we treated 18 patients for infected tibial pseudarthrosis with additional segmental bone loss. The method of bone reconstruction was chosen depending on the size of the segmental defect and other factors such as condition of the soft tissues and the patients age. The following treatment procedures were performed: primary shortening (five patients), one or more cancellous bone grafting procedures to bridge the skeletal defect (nine patients), bone segment transport according to Ilizarov (three patients), and free vascularized transplantation of the contralateral fibula (one patient). The number of complications, operative procedures and hospital admissions differed between the four patient groups with different bone defect reconstructions, however, the differences were not significant. Results: In twelve patients, limb salvage was successful. Most of these patients had no or little limitations in daily life and returned to work. The mean lower extremity impairment score was 13% (range: 0–43%). Six patients underwent amputation, due to various reasons. Conclusions: The problem of infected tibial pseudarthrosis with segmental bone loss remains important despite advances in diagnostics and management. If limb salvage is successful, the ultimate functional outcome will be good in the majority of cases. In selected cases, amputation is still indicated.