Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

成人结肠冗长症的诊治(附42例分析)

目的：探讨成人结肠冗长症的诊断与围手术期处理经验，提高对该病的诊治水平。方法：回顾性分析42例成人结肠冗长症的临床资料，并作了随访观察。结果：32例患者（75．7％）有顽固性便秘，18例患者（42．9％）存在反复不完全肠梗阻，16例患者（38．1％）便秘与腹泻交替出现，以便秘为主。39例经X线钡剂灌肠透视确诊。急诊手术3例，择期手术39例。41例（97．6％）病理检查于镜下可见典型改变。42例均行不同长度的肠段切除，4例加行乙状结肠固定术。术后随访率为83．3％（35／42），28例症状消失，4例仍有症状，保守治疗有效果，3例再次手术，术后症状消失。结论：典型的病史和X线钡剂灌肠可确诊成人结肠冗长症，外科手术是治疗本病的最终有效措施。     

上颌骨Le Fort I型截骨进路切除巨大鼻咽纤维血管瘤

目的:探讨上颌骨LeFortI型截骨进路切除累及翼腭凹、颞下凹巨大鼻咽纤维血管肿瘤的可行性。方法:采用矫正上颌骨先天或后天畸形的LeFortI型截骨术式进路,切除位于鼻咽部、筛窦等深在部位的纤维血管瘤。结果:该进路术野显露充分,取得了理想的治疗效果。结论:上颌骨LeFortI型截骨进路是切除鼻咽、颅底部纤维血管瘤的理想进路。     

Experimental laparoscopic aortobifemoral bypass

The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass.Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor.Using this approach, we performed four aortobifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.     

房间隔入路的解剖学研究及临床应用

对３３具尸体的房间隔的大小、构成及周围重要组织结构进行观察和测量。提出房间隔切开时的正确方向、安全长度及可能发生的危险。结合４６６例临床应用，讨论了避免切口合并症发生及发生后的正确处理方法。     

整体护理改善护患关系的体会

整体护理的实施,重塑了护士的职业价值观,增加了护患之间的接触。护士能够在自己的专业范围内积极主动地解决病人的问题,挖掘了护理人员的自身潜力,加深了护患交流,使护患关系明显改善。     

The callous elbow and aging of the upper arm

The author describes his surgical approach to the problems of the aging upper arm and elbow region. Surgery at an appropriate age can prevent the progressive wrinkling of the elbow which is further aggravated by aging of the upper arm. The author's operation is aimed at correcting both portions of the arm anatomy at the same time.     

A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.