Suction/irrigation for deep wound infection after spinal instrumentation: a case study

Deep wound infection after spinal instrumentation is a serious complication that is difficult to treat without removing the instruments and bone graft. Debridement and suction/irrigation is an effective method of treatment in these cases. It was performed on six patients in our department who developed this complication between 1985 and 1994. Four patients with early post-operative infection were cured by this method without removing the instruments and bone graft, and two patients with delayed post-operative infection were cured by this method with instrument removal. Debridement and suction/irrigation is a useful method of treatment for both groups of deep wound infection and gives good results when performed soon after infection onset together with additional antibiotic therapy.     

Fat suction versus abdominoplasty

The author describes his fat-suction technique for the treatment of abdominal adiposity. He stresses the importance of the proper selection of patients prior to surgery and the indications for such surgery, analyzing especially the accumulation of subcutaneous adiposity and muscular flaccidity. He divides surgical techniques into four separate groups: isolated fat suction; fat suction associated with infraumbilical cutaneous resection; fat suction associated with conventional abdominoplasty; and, conventional abdominoplasty. The criteria of indications for each separate procedure are strongly emphasized.     

Suction lipectomy of a congenital lipomatous hamartoma

A 4-month-old baby with a diffuse lipomatous hamartoma of the lower limb was operated upon by repeated suction lipectomies. The result 2 years later was satisfactory. Correspondence to: A. Franchella     

Telescopic suction tube for microsurgery

Summary An adjustable telescopic suction tube has been developed for microsurgery. Owing to this innovation, the surgeon can easily set the suction tube to a suitable length by gently pulling the end of the telescopic tube out or in.     

Acid hydrolases in experimental and spontaneous bullae

Summary The activities of eight acid hydrolases have been measured in blister fluid from various bullous disorders and from experimental suction blisters. The levels of all enzymes increased dramatically for at least 24 h after induction of the blister. No correlation was found between acid hydrolase activity and any individual disease. The levels of activity in spontaneous bullae were similar to those reached after 24 h in experimental suction blisters which had been raised on previously inflamed skin.We conclude that the release of acid hydrolases may be a consequence rather than the cause of blister formation. This conclusion is supported by the lack of inflammatory response to the i.c. injection of blister fluid into normal skin.     

Optimum vacuum pressures for lipolysis

The author presents a method to test the adequacy of any suction machine pump used in lipolysis surgery, regardless of the altitude and/or sea level of the operating room physical conditions. Surgeons can, therefore, subject any vacuum pump to a vaporization test and thereby ensure its adequacy for lipolysis techniques.     

Emergency management of epidural haematoma through burr hole evacuation and drainage. A preliminary report

Summary Background. Blood clot evacuation through an osteoplastic craniotomy, a procedure requiring neurosurgical expertise and modern medical facilities, is the accepted method for treatment of a pure traumatic epidural haematoma following closed head injury. In certain emergency situations and/or in less sophisticated settings, however, use of this procedure may not be feasible. The present study was undertaken to ascertain whether placement of a burr hole and drainage under negative pressure constituted a rapid, effective and safe approach to manage patients with simple epidural haematomas. Methods. Thirteen patients suffering from a traumatic epidural haematoma were treated from January, 1999 to October, 2002. Twelve patients presented with skull fracture but no fracture was depressed. Placement of flexible tubes through a burr hole, followed by continuous suction under negative pressure, enabled aspiration of the clot and drainage of the cavity. In 8 cases, the procedure was performed under local anaesthesia with 2% Xylocaine™ and with intravenous sedation with propofol as needed. The operative procedure was accomplished within 30 min, and the drainage tube was left in place for 3–5 days. CT scans were performed daily from days 1 to 5. Results. In 11 of 13 cases, clots were evacuated successfully and patients regained consciousness within 2 hours. Recoveries occurred without significant sequelae. In the remaining 2 cases, the drainage tube was found to be obstructed by a blood clot such that the haematoma was unaffected. A traditional craniotomy was performed within 8–12 hours, and these 2 patients recovered consciousness within the subsequent 6 hours. Conclusion. Burr hole evacuation followed by drainage under negative pressure is a safe and effective method for emergency management of a pure traumatic epidural haematoma. To assure safety patients given this procedure should be monitored by daily CT scans. Decompressive craniotomy should be performed if consciousness does not improve within several hours.     

Recording of action potentials and polarization of a single crayfish motor axon through a sucrose-gap capillary suction electrode

Summary A capillary suction electrode was developed which contains in its tip a sucrose-gap. The nerve fiber is pulled by negative pressure through the closely fitting openings of an outer and an inner capillary. The space between these openings is o.1 mm wide and can be perfused with sucrose solution. Because of the small physical size of the electrode tip the electrode can be used to record from single unmyelinated nerve fibers in small preparations in combination with other electrodes or transducers.Action potentials were recorded from branches of the motor axon of the opener muscle of the crayfish claw. The amplitude of the recorded action potentials was 7–22 mV, and all records were monophasic positive. The action potential showed depolarizing but not hyperpolarizing afterpotentials.Hyperpolarization of the nerve fiber by –0.05 to –0.2 A current injected through the recording electrode led to about 50% increase in the amplitude of the recorded action potentials and to a marked prolongation of the depolarizing afterpotentials. Depolarization of the fiber decreased the amplitude of the action potential.This work was supported by the Deutsche Forschungsgemeinschaft.     

周期性眼外负压吸引对兔视网膜超微结构的影响

目的探讨不同强度的周期性眼外负压吸引对兔视网膜超微结构的影响。方法以新西兰大白兔为实验动物分为对照组和实验组,对实验组分别应用改良准分子激光原位角膜磨镶术负压吸引环置于兔角巩膜缘,以眼球外负压每3s100mmHg(1mmHg=0.133kPa)的速度升高至负压(200±20)mmHg(实验组Ⅰ)、(300±20)mmHg(实验组Ⅱ)、(400±20)mmHg(实验组Ⅲ)、(500±20)mmHg(实验组Ⅳ)。即时眼压分别为35、45、55及75mmHg,维持约5s后释放压力至0,间隔1min后重复上述操作共10个循环,隔日实验1次。2周后电镜观察不同部位兔视网膜超微结构,并比较实验组和对照组的差异。结果实验组Ⅰ与对照组相比未见到明显变化,实验组Ⅱ视网膜超微结构与对照组相比发现细胞器略有增多,提示细胞代谢增强。Ⅲ、Ⅳ组视网膜超微结构有一定变化,其中Ⅳ组超微结构破坏,细胞有坏死征象。结论不同终点眼压的周期性眼外负压吸引对视网膜超微结构影响不同,小于45mmHg基本无影响,55mmHg左右有一定影响,大于75mmHg有明显的破坏作用。     

鼻内镜下吸切器治疗小儿腺样体肥大的疗效观察

目的探讨鼻内镜下吸切器治疗小儿腺样体肥大的疗效和安全性。方法对63例4～12岁腺样体肥大的患儿行鼻内镜下吸切器吸切治疗,所有病例鼻咽侧位片示腺样体厚度/鼻咽腔前后径≥0.71,纤维鼻咽镜检查腺样体阻塞后鼻孔的程度Ⅲ°52例;Ⅳ°11例。其中以鼻塞、流涕首诊15例,睡眠打鼾、憋气、张口呼吸39例,听力下降9例。11例并发扁桃体Ⅲ°,肥大者予以切除,3例鼓室积液同期行鼓膜置管术。结果 9例伴分泌性中耳炎复查声导抗鼓室功能曲线均呈A型,语频听力恢复到发病前水平,12例鼻腔通气正常,3例明显改善,37例睡眠打鼾和张口呼吸症状消失,2例好转。全部患儿术后无大出血、无鼻咽粘连和损伤等症状。结论手术是治疗临床症状明显的腺样体肥大的较好手段,鼻内镜下吸切器行腺样体切除与传统方法相比具有视野清晰、创伤小、出血少、不易残留、治疗效果好等优点,可以推广。