双侧无铆型房间隔缺损封堵器的实验研究

目的在犬房间隔缺损(ASD)模型上评价双侧无铆型ASD封堵器的疗效、安全性和生物相容性。方法自行设计封堵器是由镍钛合金丝编织成的网状结构,外形呈双盘状,其左房面平整,右房面中间凹陷,中央有与推送杆相接的连接袢,内衬有三层聚酯膜。犬ASD模型建立采用房间隔穿刺结合球囊扩张方法,模拟临床经导管封堵ASD过程,闭合人工制备的ASD。用心脏超声观察封堵器位置及封堵器对右、左房室瓣功能的影响。术后1、2、3、6个月分别处死动物行组织学检查,观察封堵器周围及表面的组织学反应。结果8条犬成功制作ASD模型并封堵,超声显示封堵器位置固定良好,不影响右、左房室瓣功能。各观察时间点肉眼见所有封堵器表面光滑均覆有薄层的新生内膜。3个月后封堵器表面完全内皮化,光镜和电镜检查显示封堵器置入部位周围组织无明显的炎症反应。6个月扫描电镜观察金属丝无腐蚀。HE染色显示肺、肝、脾、肾、胰等组织无血栓栓塞、炎症表现。结论双侧无铆型ASD封堵器操作简便、使用安全及有良好的生物相容性,提示自制的ASD封堵器将可安全地应用于临床。     

镍钛形状记忆合金血管内支架组织相容性实验研究

将锥形记忆合金支架分别植入６只猪右侧髂动脉。用以研究镍钛形状记忆合金血管内支架生物相容性，支架植入前入植入后８个月，观测动物血常规，肝肾功能以及毛发中镍钛元素含量，均无明显变化（Ｐ〉０．０５），支架植入后８个月处死动物，全身重要脏器（肝、脾、肾、肺、心、脑等）病理学检查结构正常，无淋巴细胞和单核细胞浸润，支架植入部位上游血管壁内膜光滑，内皮细胞结构正常，内弹力板完整，支架植入段为完整肉芽组织阻塞，     

Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1–6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6–24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related. Correspondence to: P. Rossi     

Technical Points in Vertical Gastroplasty for Morbid Obesity

The success of vertical gastroplasty may be jeopardized by gastric leakage or ulceration due to failure of the technique. Reports of band erosion and staple-line leakage have led us to seek technical improvements to reduce technical failures. We describe a modification to the technique of band placement and a manoeuvre to aid the placement of staples when the TA90 staple gun is used.     

Protein‐energy intakes in a malnourished population after increasing the supply of the dietary staples

This paper examines the extent to which food intake in malnourished populations is affected by increasing the availability of the dietary staples. Free amounts of corn and beans were supplied to 47 families in a rural Guatemalan community during eight weeks. Relative to a six‐week baseline period, adults increased their intakes by about 400 kcal (1.68 MJ) and 15 gof protein per day. The average changes for pre‐school children were 198 kcl (0.83 MJ) and 5.8 g of protein per day. The findings suggest that it is possible for adults to satisfy their energy and protein needs by consuming more corn and beans. In children, bulk may be a limiting factor and it may be necessary to resort to additional measures, such as increasing the energy density of the diet, to satisfy needs.     

A comparison of balloon- and self-expanding stents

This paper summarizes some of the key differences between self-expanding and balloon-expanding stents, aligning engineering and design differences with clinical performance. While neither type of stent can be considered universally superior, the differences are significant enough to make each type more appropriate in specific circumstances. Many of the differences concern long-term outcome, for which there is still insufficient data.     

Effect of Slip Time in Forming Neo‐Esophageal Stenosis After Replacement of a Thoracic Esophagus With Nitinol Artificial Esophagus

Attempts have been made to investigate the effect of slip time of nitinol artificial esophagus for forming neo‐esophageal stenosis after replacement of a thoracic esophagus with nitinol artificial esophagus in 20 experimental pigs. The pigs whose slip time was less than 90 days postoperatively had severe dysphagia (Bown's III) immediately after they were fed, and the dysphagia aggravated gradually later on (Bown's III–IV). The pigs whose slip time was more than 90 days postoperatively had mild/moderate dysphagia (Bown's I–II) immediately after they were fed, and the dysphagia relieved gradually later on (Bown's II‐I‐0). The ratios between the diameter of neo‐esophagus in different slip time and normal esophagus were 25% (at 2 months postoperatively), 58% (at 4 months postoperatively), and 93% (at 6 months postoperatively), respectively. The relationship between nitinol artificial esophagus slip time and neo‐esophageal stenosis showed a positive correlation. After replacement of a thoracic esophagus with nitinol artificial esophagus, the artificial esophageal slip time not only affected the original diameter of the neo‐esophagus immediately, but also affected the neo‐esophageal scar stricture forming process later on. The narrowing of neo‐esophagus is caused by overgrowth of scar tissue. But there is the positive correlation between artificial esophagus slip time and neo‐esophageal stenosis, so this can be a way of overcoming neo‐esophageal stenosis by delaying slip time of artificial esophagus.     

An Unusual Finding in the Follow-Up of a Transabdominal Pre-Peritoneal (TAPP) Implanted Mesh for Inguinal Hernia

Background: Abnormalities around titanium stapled sites are not well described in the literature. Existence

of staple granulomas or neoplasms on titanium stapled sites used in TAPP procedures is unknown.

Case: We report a case in which differentiation of suspected staple granuloma or neoplasm around a titanium staple,

used to secure the mesh in a TAPP procedure, could not be made other than by pathologic examination.

Conclusion: This case emphasises that although the appearance of the lesion may be suspected for staple granuloma,

the possibility of a malignant neoplasm should always be considered.     

不同内固定方式治疗儿童肘内翻畸形的疗效

目的探讨不同内固定方式治疗儿童肘内翻畸形的疗效。方法将47例儿童肘内翻畸形患者按固定方法分成两组,均先行肱骨髁上不全楔形截骨,然后分别采用传统克氏针内固定(A组,24例)和骑缝钉内固定(B组,23例)。比较两组术后骨性愈合时间及术后3个月肘关节功能恢复幅度。结果患儿均获得随访,时间12~24个月。无一例出现肘内翻复发。骨性愈合时间:A组3~3.5(3.1±0.2)个月,较B组的2.2~3.2(2.7±0.4)个月长(P0.05);术后3个月肘关节功能恢复幅度:A组135°~154°(144.5°±7.7°),较B组的155°~175°(164.3°±7.3°)小(P0.05)。结论采取骑缝钉内固定治疗儿童肘内翻内固定可靠,骨折端愈合较快,肘关节功能恢复快,安全有效。     

Comparison between suture and staple fixations as internal fixation techniques for Akin osteotomy

BackgroundSuture and staple fixations are commonly used methods for Akin osteotomy; however, there has been a paucity of studies comparing these methods without bias.Patients and methodsWe retrospectively compared the outcomes of 58 Akin osteotomies performed by a single surgeon using suture fixation and 39 Akin osteotomies performed by the same surgeon using staple fixation during the same period.ResultsBone union at the osteotomy site was achieved in all cases with no cases of complications related to the materials used. Occurrence of breakage of the lateral cortex of the proximal phalanx showed no significant difference between the suture and staple groups. The lateral cortex breakage produced greater instability at the osteotomy site with the staple fixation compared to the suture fixation.ConclusionsComparison of suture and staple fixations of Akin osteotomy demonstrated the superiority of suture fixation against staple fixation in terms of stability and cost-efficiency.