Anterior sacral meningocele in pregnancy

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We present the case of a 26-year-old patient with an anterior sacral meningocele which had been discovered during gynaecologic surgery because of a cystic pelvic mass. Subsequently, the patient underwent two pregnancies. The management of a pregnancy complicated by a coexisting anterior sacral meningocele presents a challenging problem for the obstetrician. Because of the high maternal mortality due to rupture of the meningocele under labor, primary cesarean delivery is indicated as soon as fetal lung maturity is established and was performed in our patient in both pregnancies in the 35 week, without complications for mother and children.     

Anterior sacral meningocele simulating ovarian cyst

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We report a case of an anterior sacral meningocele that was mimicking an ovarian cyst.     

Sonography in the diagnosis and management of anterior sacral meningocele

Four cases of anterior sacral meningocele (ASM) are described, with comparisons between radiological and sonographic findings. On plain films, 2 cases showed the classic scimitar sign, and 1 case showed a defect in the anterior sacrum. The other lesion appeared radiologically to be a purely intrasacral meningocele. Myelography outlined part of the ASM in two cases. Sonography demonstrated the anterior sacral cysts in all cases. Sonography is a noninvasive method of monitoring progress or contraction of a lesion, and it can be used to demonstrate any associated pathology. The combination of plain-film appearances and sonographic findings should be sufficient for diagnostic purposes. If an operative procedure is contemplated, then myelography may be performed in an attempt to outline the stalk.     

成人骶前脊膜膨出1例

患者男,29岁,B超普查发现盆腔肿块.既往体健,除偶感腰痛外无其他不适.查体:脐下大片皮肤色素沉着并大量毛发生长,双下肢肌力V级,肢体感觉正常,生理反射存在,病理反射未引出.     

新生儿骶脊膜膨出围手术期护理

骶脊膜膨出是常见的新生儿神经系统发育畸形，脊柱椎管发生闭合不全而形成的膨出囊性肿物，可致肢体瘫痪、大小便失禁、脑积水、智力障碍，其发病率为0．13％，男女比例为3：2。随着产前诊断率提高，手术方式改进，术后呼吸道管理加强，静脉营养使用以及新生儿围手术期护理技术的提升，新生儿骶脊膜膨出的手术疗效明显提高。我科1998年-2006年4月共收治骶脊膜膨出9例，均早期手术治疗，切口甲级愈合出院。现将围手术期护理介绍如下。     

新生儿骶脊膜膨出围手术期护理

骶脊膜膨出是常见的新生儿神经系统发育畸形,脊柱椎管发生闭合不全而形成的膨出囊性肿物,可致肢体瘫痪、大小便失禁、脑积水、智力障碍,其发病率为0.13%,男女比例为3∶2[1]。随着产前诊断率提高,手术方式改进,术后呼吸道管理加强,静脉营养使用以及新生儿围手术期护理技术的提升     

Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.     

提高妇科手术后留置导尿管相关管理水平的循证实践

目的评估目前与留置导尿管相关管理的循证实践,将留置导尿管相关管理的最佳证据应用到护理实践中,通过质量审查促进临床护理质量的改进。方法 2015年7-10月在一个妇科病房完成留置导尿管管理质量审查。用澳大利亚乔安娜·布里格斯研究中心(Joanna briggs institute,JBI)根据最佳证据制订的4条审查标准,进行临床留置导尿管相关管理的基线审查,制定相应的循证实践方案。并运用JBI临床证据实践系统,将现有的最佳证据整合到护理实践中,再实施干预后的审查。结果将最佳证据引入护理实践后,四条审查标准的依从性均达到100%,妇科术后留置导尿患者的知识水平显著提升。结论本次循证护理实践项目改进了导尿管管理的护理实践,但仍需结合临床实际,不断完善,以促进护理质量的提升。