Intraoperative cerebral blood flow monitoring in neurosurgery: A review of contemporary technologies and emerging perspectives

Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.     

改良(足母)趾腓侧皮瓣修复拇手指指腹缺损

目的介绍改良躅趾腓侧皮瓣修复拇、手指指腹缺损的手术方法。方法对15例拇、手指指腹缺损的患者，采用改良的躅趾腓侧皮瓣移植修复。该皮瓣在传统躅趾腓侧皮瓣设计方法基础上，将皮瓣腓侧缘及近端分别向背侧及趾蹼侧移动，从而避开口径细小又紧贴于皮下的躅趾腓侧浅静脉，直接游离第一跖背浅静脉；皮瓣的动脉和神经游离仍以常规方式进行。结果术后15例皮瓣全部成活，未发生动、静脉危象。12例获得4～11个月随访，3例失访。手功能评定：优10例，良2例。皮瓣两点分辨觉为4～8mm，12例对皮瓣外形满意。供区行走无影响，步态正常。10例对供区外观满意，2例欠满意，其中1例蹲趾腓侧偶有触痛。结论应用改良躅趾腓侧皮瓣可显著降低手术难度，提高成功率。     

心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.     

三块游离组织组合移植I期修复复杂手外伤

研究复杂性手外伤的修复方式和游离组织组合移植的方式。方法：对36例严重手外伤采用在块游离组织组合移植修复。共有4种组合类型。结果：36例108块游离组织组合移植，全部成活，所覆盖的创面全部愈合，经过1年以上随访，移植足趾和Mu甲瓣恢复触痛、温度觉，两点瓣别觉在6-12mm，所有病例恢复了对掌、对指功能，能完成日常生活功能。结论：用三块游离组织组合移植修复复杂手外伤，虽手术时间长、创伤大，但可减少手术次数和减轻患者精神和经济负担，缩短疗程，并能早期进行康复训练，最大程度恢复手指的功能治疗。     

Comparison of responses of melanocyte lineages from p75(+) and p75(−) human scalp-derived neural crest stem cells under phototherapy

Lasers in Medical Science - Phototherapy is an effective therapeutic option in the treatment of vitiligo; however, responses varied among the different types. The underlying mechanism has scarcely...     

A contemporary prospective review of 205 consecutive patients with penetrating colon injuries

BackgroundManagement of colon injuries has significantly evolved in the recent decades resulting in considerably decreased morbidity and mortality. We set out to investigate penetrating colon injuries in a high-volume urban academic trauma center in South Africa.MethodsAll patients with penetrating colon injuries admitted between 1/2015 and 1/2018 were prospectively enrolled. Data collection included demographics, injury profile and outcomes. Primary outcome was in-hospital mortality. Secondary outcome was morbidity.ResultsTwo-hundred and five patients were included in the analysis. Stab and gunshot wounds constituted 18% and 82% of the cases, respectively. Mean age was 28.9 (10.2) years and 96.1% were male. Median injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 16 (9-25) and 19 (10-26), respectively. A total of 47.8% of the patients had a complication per Clavien-Dindo classification. Colon leak rate was 2.4%. Wound and abdominal organ/space infection rate was 15.1 and 6.3%, respectively. Overall in-hospital mortality was 9.3%. Risk factors for mortality were higher ISS and PATI, shock on admission, need for blood transfusion, intra-abdominal vascular injury, damage control surgery, and extra-abdominal severe injuries.ConclusionsContemporary overall complication rate remains high in penetrating colon injuries, however, anastomotic leak rate is decreasing. Colon injury associated mortality is related to overall injury burden and hemorrhage rather than to colon injuries.     

介入化疗对消化道肿瘤患者血清sICAM和bFGF的影响及临床意义

目的:探讨消化道肿瘤患者介入治疗前后血清可溶性细胞间黏附分子(sICAM-1)及碱性成纤维细胞生长因子(bFGF)的变化和临床意义。方法:采用双抗体夹心法(ELISA)测定35例中晚期消化道肿瘤患者介入化疗前后血清sICAM-1和bFGF的改变,并与30例健康对照组比较分析。结果:介入化疗组治疗前sICAM-1和bFGF均明显增高,与健康对照组比较差异显著(P<0.01),伴有转移者显著高于不伴转移者(P<0.05);化疗后介入化疗组sICAM-1和bFGF显著降低,治疗前后差异显著(P<0.01)。其中介入化疗前sICAM-1和bFGF高表达者,半年后全部出现新的转移灶、病情恶化。结论:介入化疗能显著降低肿瘤患者血清sICAM-1和bFGF的水平,联合检测sICAM和bFGF有助于判断肿瘤患者的预后。     

急性胰腺炎120例临床分析

目的本文对120例急性胰腺炎患者临床资料进行回顾性分析,以探讨急性胰腺炎诊治相关问题。方法对120例急性胰腺炎病例进行回顾性分析,比较轻重两组的病因及多项实验室指标,并进行统计学分析。结果胆石症、饮酒、高脂血症为本组病人的主要病因,并发症主要为ARDS、急性肾功能衰竭、腹腔间室综合征、休克等,重症组死亡率为25%。结论急性胰腺炎病因中高脂血症值得关注。早期准确评估病情在胰腺炎的治疗中非常重要,其中CRP、HCT等有一定的预测价值且较为便捷。治疗采取以生长抑素为主的内科综合疗法,早期尽可能避免手术。     

Evaluation of 118 Thyroid Cancer Patients Who Underwent a Re-operation after Local Resection

OBJECTIVE To evaluate the incidence of residual thyroid cancer and cervical lymph node metastasis following a previous local resection for thyroid cancer, and to discuss methods of a reoperation.METHODS From 1994～2005, 118 patients with thyroid cancer who had previously been treated with a nodule-resection or subtotal Iobectomy in other hospitals underwent a surgical re-operation.RESULTS The incidence of residual cancer at the primary site was 38.1%. The lymph node metastasis rate at the central area was 39.8%.The rate of lymph node metastasis in patients with enlarged lymph nodes in the ipsilateral internal jugular chain was 37.5%. The rate of laryngeal recurrent nerve injury was 15.2% in other hospitals while that of the second operation in our hospital was 1.6%.CONCLUSION Nodule-resection or subtotal Iobectomy alone is not indicated for patients with thyroid cancer because of the high rate of local residual cancer. It is important to be familiar with the anatomy of the laryngeal recurrent nerve for thyroid surgery. Exploration to the central area is necessary for differentiated thyroid cancer.