家庭康复训练对慢性阻塞性肺疾病患者的影响

目的通过考察家庭康复训练对慢性阻塞性肺疾病(COPD)患者的影响,以探讨家庭康复锻炼的方法和效果。方法组织在1998-01/2002-12吉林军医学院附属中心医院接受治疗的COPD患者进行为期12周的以步行为主要锻炼内容的家庭康复训练。训练强度以往复运动实验(SWT)为准。测量记录肺功能、运动能力和呼吸困难等内容。结果训练12周后,康复训练组的FVC(%预期值),FEV(%预期值)和FEV1/FVC比率明显高于对照组(t=1.851～2.892,P<0.05);康复组患者SWT与对照组相比有明显改善(t=2.137～2.938,P<0.05);康复组患者的运动时间和距离明显高于对照组(t=2.892～2.912,P<0.01),心率和呼吸困难程度明显低于对照组(t=2.268～2.938,P<0.05)。结论简单的家庭康复训练,在COPD患者中取得了很好的训练效果,患者的运动能力和呼吸困难程度得到改善。     

Delayed repair of large myelomeningoceles

Introduction Repair of myelomeningoceles larger than 5 cm in diameter is not easy. We describe a simple technique.Patients and methods The patients with a large myelomeningocele sac were included in this study. Ten patients with a large myelomeningocele underwent surgical repair using this technique. The skin was incised in the midline proximal to the myelomeningocele sac. The incision was carried caudally and away from the midline to open the sac after identifying the fascia. The incision is carried circumferentially around the neural placode and the skin is saved as much as possible. About a 1-cm-width of the dura mater beneath the skin is left to ease the subcutaneous suturing. The dura is sutured in the midline. The skin is undermined bilaterally in the plane between the muscle and subcutaneous fat and closed with interrupted sutures in the midline.Conclusion This simple technique is appropriate for the closure of large myelomeningoceles and does not need more extensive and complex procedures.Presented at the 31st Annual Meeting of the International Society for Pediatric Neurosurgery, 14–18 September 2003, Monaco     

Embolisation of both fistulae through the same carotid artery tear in a patient with bilateral traumatic caroticocavernous fistulae

Endovascular treatment of traumatic caroticocavernous fistulae (CCF) may present technical difficulties with specific angiographic dilemmas. We report endovascular techniques used in a patient with bilateral post-traumatic CCF, high-flow on one side, and slow-flow on the other. Complete closure of both was achieved through the same carotid artery tear. To our knowledge, transarterial venous coil embolisation of a low-flow fistula through a contralateral carotid artery tear, with transarterial detachable balloon embolisation of the ipsilateral high-flow fistula has not been described previously.     

组织工程新材料蜘蛛拖丝蛋白的重组培养

目的通过对重组蜘蛛拖丝蛋白基因工程菌pNS2生长的培养基进行优化,为获取大量蜘蛛拖丝蛋白提供条件。方法采用单因子试验和正交试验对培养基进行优化。结果获得优化的培养基组成:葡萄糖5.0g/L、蛋白胨5.0g/L、磷酸二氢钾(KH2PO4)15.0g/L、微量元素母液15.0g/L、硫酸镁(MgSO4)0.8g/L、柠檬酸1.7g/L。培养基优化后,工程菌的生长量提高了60.6%。结论优化的培养基为基因工程菌pNS2大规模生产蜘蛛拖丝蛋白奠定了基础。     

保存羊膜移植治疗中、重度眼化学烧伤和热烧伤急性期的作用

目的讨并分析保存羊膜在眼中、重度化学烧伤和热烧伤急性期的治疗作用以及对晚期并发症的预防作用。方法选择兰州医学院第二附属医院急性化学烧伤和热烧伤的住院患者19例(21眼)根据病情分为中度组(14眼烧伤为Ⅱ～Ⅲ度)和重度组(7眼烧伤为Ⅳ度),入院1周内分别行单纯羊膜移植术和羊膜移植术+自体(异体)角膜缘上皮干细胞移植术。观察早期眼表重建时间,晚期角膜血管化,睑球粘连,视力改善情况。结果中度组的眼表重建时间较重度组短,视力提高较后者明显,差异有显著性意义(P<0.001)。在角膜血管化,睑球粘连等方面也较后者轻。结论羊膜可用于眼中、重度化学烧伤和热烧伤的急性期治疗,其预后效果同眼部损伤程度有直接关系。     

椎管内、外性腰腿痛患者软组织病损评价及实施物理治疗的效果

目的观察腰腿痛患者软组织病损的评价情况和物理治疗的效果。方法应用作者编制的腰腿痛评价表作为评价方法,对比椎管内性腰腿痛(30例)和椎管外腰腿痛(39例)患者各组软组织评价得分和压痛点阳性率的差异。给予两组患者的软组织病损以超短波。调制中频电流和按摩治疗。结果所有患者(69例)均有不同程度的软组织病损。但两组间仅骶棘肌压痛的平均得分有非常显著差异(P<0.01)。其余软组织的平均得分对比无显著差异(P>0.05)。两组各软组织压痛点阳性率对比无显著差异(P>0.05)。两组物理治疗前和治疗后腰腿痛评价表各分项得分和总分对比均有显著差异(P<0.05～0.01)。结论椎管内性腰腿痛或椎管外性腰腿痛患者均存在一定程度的软组织病损,影响患者的症状和功能。     

GARLIC IN CRYPTOCOCCAL MENINGITIS A PRELIMINARY REPORT OF 21 CASES

Of 21 cases of cryptococcal meningitis en- countered in a 5-year period, 16 were treated with garlic alone and 5 with garlic and other drugs. Among the 16 cases, 6 were cured and 5 im- proved, giving an effective rate of 68.75%. Pre- liminary experimental studies of the mechanism of the pharmacologic action of garlic show that it may have fungistatic action and improve the patient's immunologic function. It is also obviously cheap, plentiful and causes no major side-effects.     

Anatomy of the clinoidal region with special emphasis on the caroticoclinoid foramen and interclinoid osseous bridge in a recent Turkish population

In this study we present the incidence of caroticoclinoid foramen and interclinoid osseous bridge and some topographic aspects regarding the clinoidal internal carotid artery (ICA) in a recent Turkish population to provide a guide for neurosurgeons in any surgical approach, especially to the cavernous sinus. One hundred nineteen adult dry skulls and 52 adult cadaveric heads were used for this purpose. Caroticoclinoid foramen and the interclinoid osseous bridge were divided into three types based on the classification of Keyers [13]. Caroticoclinoid foramen was observed in 35.67% of the specimens, unilaterally in 23.98%, and bilaterally in 11.69%. The complete-type caroticoclinoid foramen was observed in 4.09% of the specimens, the contact type in 4.68%, and the incomplete type in 14.91%. Transverse diameter of the foramen was 5.32±0.52 mm for the incomplete type. The incidence of interclinoid osseous bridge was 8.18%. The middle clinoid process was prominent in 15.12% of cases and rudimental in 13.23%. The mean distance between the proximal and distal dural rings of the clinoidal ICA was 4.51±0.44 mm, and mean diameter of the distal ring was 5.25±0.59 mm. Right-left differences were assessed for each parameter, and populational differences are discussed.     

Simultaneous bilateral tibial tubercle avulsion fracture in a basketball player

A 16-year-old male basketball player had sustained an injury upon landing after a forceful jump. Plain radiography demonstrated bilateral tibial tubercle avulsion fracture involving partially proximal physis. Open reduction and internal fixation were performed at once. Continuous passive motion was started immediately after operation, and the patient was ambulated with hinged knee extension braces. After 27 months follow-up his knees completely regained normal range of motion except a 3 degrees extension loss in the left knee. He resumed all daily functional activities (Lysholm functional score of 99), but he slightly lost his level of activity (Tegner activity level from 7 to 6). No angular deformity at all on the frontal plane was determined upon radiological examination. Tibial slope angles were symmetrical and within the normal range. There were visible small bone fragments inside the left patellar tendon.     

Morphologic features of the acetabulum

Introduction: The embryology and development of the hip joint are complex. The acetabulum is not always of the same shape, width, or depth. Minor anatomical abnormalities in the acetabular shape, joint congruences are frequent. Controversies still exist on the importance of these variations and help to prevent problems following in surgical procedures such as acetabular reconstruction and femoracetabular impingement. Material and methods: The aim of this study is to provide the location of the unusual facets, the acetabular point, and the anterior ridge of the acetabulum based on a morphological study of human pelvic bones. Morphologic features of the acetabulum, particularly determination of unusual facets, were studied in 226 human coxal bones. Results: In adult coxal bones the acetabular fossa has an irregular clover-leaf shape, the superior lobe being smaller than the anterior and the posterior lobes. Measured lunate surface area varied between 14.5 and 30.5 cm². A smooth unusual facet was found antero-inferior to the lunate surface in 62 acetabulums. Measured along the long axis, its size varied between 11 and 17 mm. Three different shapes of the unusual facet were as follows: oval (32.26%), piriform (45.16%), and elongated (22.58%). The prevalence of the piriform facet shape was higher in males. In 59.68% of the bones it extended to the superior ramus of the pubis, and in the remaining 40.32% it was limited within the acetabular margin. It is postulated that this facet could be a consequence of a particular posture, which results in traction of the ligaments attached to this area. Four distinct configurations were identified relative to the anterior acetabular ridge. The majority 98 (43.36%) were curved; 64 (28.33%) were angular; 37 (16.37%) were irregular; and 27 (11.94%) were straight. Conclusion: There have been no reports on details such as unusual facets, acetabular point, and anterior ridge of the acetabulum in a single research. These findings will be of help in planning reorientation procedures, using spikes, screws, and press-fitting for fixation.