Endoscopically controlled surgical decompression of the orbit in malignant ophthalmopathy

From May 1988, an endoscopically controlled endonasal orbital decompression was performed in 17 patients with malignant ophthalmopathy. Indications were exclusively acute loss of visual acuity or visual field defects, when medical and radiation therapy had failed. The new minimal invasive technique proceeds in three steps. First, an endonasal, endoscopically controlled ethmoidectomy with resection of the middle turbinate is done and the medial wall of the maxillary sinus is widely opened. Second, the medial and inferior orbital walls are removed, preserving the infraorbital nerve. In the last step, the periorbita is incised and the orbital fat herniates. The advantages of this procedure consist of the absence of exterior scars, the avoidance of lacrimal duct stenosis and bony defects in the maxilla and the prevention of the known morbidity of a Caldwell-Luc antrotomy with hypesthesia, dysesthesia and oro-antral fistula. The results were documented by computerized tomographic scans (CT), magnetic resonance imaging (MRI), Hertel measurements, evaluation of ocular motility and ophthalmoscopy. All patients had a postoperative improvement of visual acuity. An average of 3–4 mm improvement in Hertel measurements was reached. Four patients who had a diplopia before the interventions developed a more significant diplopia postoperatively, whereas in all other patients ocular motility either improved (five patients) or remained the same.

In conclusion, the endoscopically controlled endonasal procedure enables greater preservation of normal structures and provides results comparable with the common extranasal and transantral procedures without the disadvantages of the latter.     

Editorial: The 5th International Symposium on Orbital Disorders in Amsterdam,September 8-11, 1985

Controversy surrounds the selection of orbital implants used for the repair of orbital blow-out fractures. No less than 20 alloplastic, autogenous, resorbable or integrated materials have been reported for use in these repairs. Little information is available comparing the benefits, complications or selection criteria for these materials. This brief review will address the types of implants available, their reported complications, and potential clinical advantages and disadvantages to construct a rational approach for the selection of an implant for orbital fracture repair.     

老年外科急腹症诊治

老年外科急腹症是一组严重疾病，往往需要进行外科急症手术或在病程中接受外科手术处理。若得不到及时有效的治疗，患者相当危险，且有可能威胁生命。本文对老年外科急腹症的临床特点、诊断、处理原则、手术、微创治疗进行系统阐述。     

Introduction: Non-invasive thermometry for thermotherapy

Cancer of the cervix is the second most common cancer in women worldwide and the fourth leading cause of cancer mortality in women. Early cervical cancer stage IB1 includes a broad range of disease from clinically undetectable microinvasive cancer to bulky tumours that infiltrated the entire cervix. This article reviews the literature about risk factors and surgical radicality and fertility-sparing surgery in early cervical cancer. The review evaluates selection criteria, preoperative management and the most frequent surgical procedures used for individually tailored surgery for cervical cancer.     

危险区骨骼肌肉系统肿瘤的外科治疗

目的:介绍一种安全处理危险区骨骼肌肉系统良性或低度恶性肿瘤的外科治疗方法。方法:对骶2脊索瘤先施行前路经腹结扎双侧髂内动脉,然后再切除肿瘤,可减少出血。对腹股沟区或腘窝区较大肿瘤与股、腘大血管及神经紧密粘连者,先从肿瘤远近端血管、神经正常部分解剖出血管神经,再向病变区解剖,容易完整切除肿瘤。对锁骨上区肿瘤,先截除一段锁骨,然后从肿瘤远近端正常锁骨下动、静脉及臂丛神经处,向肿瘤部游离并保护好胸膜,可较安全地切除肿瘤。而对于腓骨头、颈及其周围部肿瘤,先解剖出腓总神经及其各肌支,尽可能保留肌支。结果:11例危险区(紧邻大血管、神经区域)良性或低度恶性骨骼肌肉系统肿瘤,采用先从肿瘤远近端正常血管、神经处游离出神经、血管,再向肿瘤部解剖,均顺利解剖出大血管及神经,并完整切除肿瘤。所有病例无复发,亦无肢体功能障碍。结论:对紧邻重要血管及神经的较大良性或低度恶性骨骼肌肉系统肿瘤,先从正常段血管、神经向肿瘤部解剖游离,既可彻底切除肿瘤,又可避免损伤血管、神经引起肢体功能障碍,是一种较好方法。     

Motor developmental delays of institutionalised preschool-aged children

The aim of this study was the examination and the detection of differences in the motor developmental profiles between preschool-aged children living in conventional institution facilities and in natural family environment. The psychomotor development of 50 children, aged four to six years, was assessed using the two motor subscales (A, locomotor; and D, eye–hand coordination) of the Griffiths Test No II. It appears from the results that the family-reared children had better performance in both motor scales compared to children living in conventional institutions. The findings reinforce the need for the evaluation of motor performance in preschool-aged children raised in institutions, in order to change institution environments into more supportive ones for the most benefit of children's fine and gross motor development.     

肠-颈转流术在布-加综合征中的应用（附2例报道）

1病例资料例1男性患者,26岁,2010年1月因工作期间不慎被机器轧伤,后因全身多发伤入院治疗。既往无肝炎病史。入院诊断：①开放性颅脑损伤;左侧额叶硬膜外血肿;左侧额骨骨折,颅内积气;面部多发骨折;②右侧第2～7肋骨骨折;③肝脏挫伤、包膜下积血;④右侧肩峰骨折;⑤全身多发软组织及皮肤撕脱伤。     

Postoperative Heart Block in Children with Common Forms of Congenital Heart Disease: Results from the KID Database

Postoperative Heart Block in Congenital Heart Disease. Introduction: Cardiac conduction system injury is a cause of postoperative cardiac morbidity following repair of congenital heart disease (CHD). The national occurrence of postoperative complete heart block (CHB) following surgical repair of CHD is unknown. We sought to describe the occurrence of and costs related to postoperative CHB following surgical repair of common forms of CHD using a large national database. Methods and Results: Retrospective, observational analysis performed over a 10‐year period (2000–2009) using the Kids’ Inpatient Database (KID). Visits for patients ≤24 months of age were identified who underwent surgical repair of ventricular septal defects (VSD), atrioventricular canal defects (AVC), and tetralogy of Fallot (TOF). Patients were identified who were diagnosed with postoperative CHB, further identifying those requiring a new pacemaker placement during the same hospitalization. Costs associated with visits were calculated. There were 16,105 surgical visits: 7,146 VSD, 3,480 AVC, and 5,480 TOF. There was a decrease in postoperative mortality (P = 0.0001) with no significant change in postoperative CHB. Hospital stay and cost were higher with CHB and placement of a permanent pacemaker. Repair of AVC (OR 1.77; [1.32–2.38]) was associated with a higher rate of postoperative CHB. Length of hospital stay and total cost were significantly increased with the development of postoperative CHB and increased further with placement of a permanent pacemaker. Conclusion: There has been little change over time in the frequency of postoperative CHB in patients undergoing repair of VSD, AVC, and TOF. Postoperative CHB results in major added cost to the healthcare system. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1349‐1354, December 2012)     

无纺布包装不耐高温高压手术器械灭菌效果的观察

目的探讨无纺布包装不耐高温高压手术器械采用过氧化氢低温等离子灭菌器消毒的效果。方法采用无纺布包装150份不耐高温高压的手术器械,包装后进行过氧化氢低温等离子灭菌。在灭菌后当天、第7d、第14d、第21d、第28d进行细菌培养。结果 150份器械灭菌后当天、第7d、第14d、第28d细菌培养均为阴性;存放时间28d,未发现细菌生长。结论采用无纺布包装不耐高温高压手术器械进行过氧化氢等离子灭菌,其灭菌效果好,值得临床推广应用。     

Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention

Conclusions. The clinical and surgical findings of this study indicated advanced cholesteatoma in many patients with facial paralysis. The outcome of facial paralysis was good. Poor outcomes were observed in cases with petrosal cholesteatoma and in those who underwent surgery ≥2 months after the onset of paralysis. Objective. To investigate clinical features of cholesteatoma associated with facial paralysis. Material and methods. Sixteen patients with facial paralysis due to middle ear cholesteatoma were reviewed. After removal of the cholesteatoma lesion, a limited area of the fallopian canal, that in which facial nerve edema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. Results. Initial paralysis was incomplete in 11 patients (69%). The onset of paralysis was sudden in 12 patients (75%). Labyrinthine fistulae (n=9; 56%) and bone destruction in the cranial fossa (n=10; 63%) were frequently observed. Six patients (38%) were totally deaf due to labyrinthitis. The outcome of facial paralysis was good in 13 patients (81%). Patients who underwent surgery ≥2 months after the onset of paralysis frequently had a poor outcome. Paralysis was not improved in two cases with petrosal cholesteatoma.