The clinical significance of gallstones and their radiological investigation

The symptoms of 122 patients with gallstones were correlated with the radiological findings. No specific indigestion was present which could be termed 'flatulent dyspepsia'. Sensitivity to fatty foods occurred in 69 per cent, heartburn in 42 per cent, regurgitation of of acidtasting or bitter fluid to the mouth in 31 per cent and increased passage of flatus from the stomach upwards in 38 per cent. If the gallbladder concentrated contrast medium or an oral cholecystogram but did not contract after a fatty meal, the patients suffered less heartburn than if the gall bladder functioned normally. However, since surgeons rarely perform a cholecystectomy for flatulent dyspepsia alone, knowlege of gallbladder function may be unnecessary.     

Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques

Background

Emergency devices for pelvic ring stabilization include circumferential sheets, pelvic binders, and c-clamps. Our knowledge of the outcome of these techniques is currently based on limited information.

Methods

Using the dataset of the German Pelvic Trauma Registry, demographic and injury-associated characteristics as well as the outcome of pelvic fracture patients after sheet, binder, and c-clamp treatment was compared. Outcome parameters included transfusion requirement of packed red blood cells, length of hospital stay, mortality, and incidence of lethal pelvic bleeding.

Results

Two hundred seven of 6137 (3.4%) patients documented in the German Pelvic Trauma Registry between April 30th 2004 and January 19th 2012 were treated by sheets, binders, or c-clamps. In most cases, c-clamps (69%) were used, followed by sheets (16%), and binders (15%). The median age was significantly lower in patients treated with binders than in patients treated with sheets or c-clamps (26 vs. 47 vs. 42 years, p = 0.01). Sheet wrapping was associated with a significantly higher incidence of lethal pelvic bleeding compared to binder or c-clamp stabilization (23% vs. 4% vs. 8%). No significant differences between the study groups were found in sex, fracture type, blood haemoglobin concentration, arterial blood pressure, Injury Severity Score, the incidence of additional pelvic packing and arterial embolization, need of red blood cell transfusion, length of hospitalisation, and mortality.

Conclusions

The data suggest that emergency stabilization of the pelvic ring by binders and c-clamps is associated with a lower incidence of lethal pelvic bleeding compared to sheet wrapping.

Level of evidence

Level III.     

Assessment of fecal incontinence by manometric and radiological techniques

An assessment by anorectal manometry and defecograms has been made of 11 children born with anorectal agenesis (supralevator) in whom several surgical procedures and clinical measures were used in an attempt to minimize their incontinence.     

A comparison of three different techniques for measuring glomerular filtration rate

The clearance of inulin, creatinine and radioactive tracers from the blood may be used to measure glomerular filtration rate (GFR). These techniques, however, are usually invasive and time-consuming. Although the clearance of a radioactive tracer is usually applied in nuclear medicine for the determination of GFR, it is also possible to convert the concentration of the tracer in the kidneys to absolute GFR by means of a regression equation. As this new technique is much faster, we have compared it with the conventional technique. A good correlation was found with the standard radionuclide techniques (r = 0.91), but the reference method was under-estimated on the average by 14 ml/min. The new regression equation derived in our clinic will ensure future accurate GFR measurements within 6 minutes.     

三种子宫切除术的临床分析

目的：探讨3种子宫切除术的临床效果。方法：回顾分析为598例非脱垂式子宫疾病患者行不同途径子宫切除术的临床资料,其中腹腔镜鞘膜内子宫切除术（laparoscopic intrafascial supercervical hysterectomy,LISH）198例,腹腔镜辅助阴式子宫切除术（laparoscopic assisted vaginal hysterectomy,LAVH）200例,传统腹式全子宫切除术（total abdominal hysterectomy,TAH）200例,比较3组患者的手术时间、出血量、术中术后并发症、术后发热率、肛门排气时间、留置尿管时间、下床活动时间、术后住院时间、术后恢复满意性生活的例数及时间等。结果：平均手术时间LISH组显著短于LAVH组、TAH组（P〈0.05）。术中平均出血量LAVH组最多,LISH组最少（P〈0.05）。术后拔尿管时间、下床活动时间LISH组最短（P〈0.05）。术中、术后主要并发症盆腔血肿LAVH组高于其他两组,TAH组切口延期愈合、肠梗阻发生率明显高于其他两组（P〈0.05）,无其他严重并发症发生。术后发热率TAH组显著高于其他两组（P〈0.05）。术后肛门排气时间、住院时间TAH组明显长于其他两组（P〈0.05）,LISH组时间最短。3组患者均于术后3个月恢复性生活,LISH组绝大部分于术后4个月恢复术前性生活的感觉,明显早于其他组,差异有统计学意义（P〈0.05）。结论：LISH组手术时间、出血量、下床活动时间、住院时间、恢复满意性生活时间等指标优于LVAH、TAH组。排除宫颈病变的患者行LISH是保留盆底结构完整,更安全可靠、干扰小、康复快的微创术式。     

Comparison of three techniques for calculation of target coordinates in functional stereotactic procedures

We compared three techniques of target coordinate determination for various functional stereotactic procedures. All procedures were based on preoperative MRI with contiguous 3-mm cuts. The first technique involved determination of anatomical landmarks and fiducial markers of the stereotactic frame on the monitor screen of an MRI scanner and calculation of the target point using a series of formulas; the second technique used a Leksell tabletop localizer, and the third technique is a part of 'Stealth' stereotactic navigation software. Final coordinates for the procedure were derived from all three techniques and subsequently adjusted using intraoperative electrical macrostimulation. We found that difference between techniques was on average 0.9 +/- 0.4 mm in each of three directions, and 1.8 +/- 0.9 mm in absolute distance. There were 7 cases in which one of the techniques had a discrepancy of more than 3 mm (more than 1 MRI slice thickness) compared with the other two, indicating a potential error in coordinate determination. This difference could potentially result in inappropriate placement of the electrode, thus affecting the procedure outcome. In 6 cases, such an error apparently occurred with the first or second technique of calculation. The average number of mapping trajectories decreased from 1.8 to 1.4 since this stereotactic software became a part of operative planning. We conclude that use of computerized planning software increases the precision of target coordinate calculation and improves the accuracy of functional stereotactic procedures.     

三种包皮环切术的临床应用比较

目的:比较包皮环切缝合器手术、包皮环切吻合器手术与传统包皮环切术治疗包皮过长或包茎患者的临床疗效。方法:回顾性分析我院泌尿外科门诊采用包皮环切缝合器手术(110例)、包皮环切吻合器手术(105例)、传统包皮环切术(520例)治疗包皮过长或包茎的735例患者的临床资料,比较三种术式的手术时间、术中出血量、术后并发症等指标。结果:包皮环切缝合器手术、包皮环切吻合器手术在手术时间和术中出血量等方面要优于传统包皮环切术(P0.05);且三种术式在手术并发症上的差异均有统计学意义(P0.05)。结论:三种术式各有优缺点,最后的术式选择需根据患者的病情、年龄、经济状况、对美观的要求和手术者对不同术式的手术技巧的熟悉程度等多方面来综合考虑决定。     

三种不同术式治疗腕管综合征的疗效比较

目的分析比较微创技术（内窥镜、腕部小切口）与传统切开方法治疗腕管综合征的术后疗效。方法对60例（72侧）腕管综合征的患者，采用内窥镜、腕部小切口及传统切开方法进行治疗。采用Kelly评价、两点分辨觉的改善、手术时间及并发症的发生情况，对3组术式的疗效进行分析比较。结果术后随访时间平均为12个月，3种手术方法术后疗效的优良率基本相同，差异无统计学意义（P〉0．05），但内窥镜和小切口组在手术时间、住院天数、瘢痕痛方面均明显少于传统切开组，差异有统计学意义（P〈0．01）。结论微创手术在手掌部残留的瘢痕小、手术耗时短，与传统腕管切开减压术疗效等同。     

Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases

Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3–6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5–6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.     

Indications for surgery and stabilization techniques of the occipito-cervical junction

Occipito-cervical (OC) instrumentation and fusion is indicated in traumatic atlanto-occipital dissociation and type III Anderson-Montesano occipital condyle fractures. The goals of surgery are to stabilize the mechanically compromised OC junction, correct deformity or displacement, and decompress compromised neural structures. The goals of instrumentation are to provide immediate stability, improve fusion rate, diminish the need for postoperative external immobilization, and decrease rehabilitation time. To successfully instrument the occipito-cervical spine, a working knowledge of the anatomy of the occipital-cervical junction is imperative. A wide variety of stabilization techniques and instrumentation systems are currently available, each with its own advantages and disadvantages. With familiarity of the constraints and benefits of the available instrumentation systems, the individual fixation needs of a clinical situation can be fulfilled and successful patient outcomes can be achieved.     

Secretory meningiomas: systematic analysis of epidemiological,clinical, and radiological features

Background  

Secretory meningiomas are known as a rare histological subtype within the meningioma family. In contrast to benign intracranial meningiomas, they are dreaded for causing an extensive perifocal cerebral tumor edema and life-threatening complications. The objective of the present study is a systematic, retrospective analysis of epidemiological, clinical, and radiological features of secretory meningiomas to predict potential patterns prior to surgery to reduce associated morbidity.     

The radiological investigation and treatment of the critically ischemic limb--a review

The contribution of radiological investigation and treatment in the management of the critically ischemic lower limb is reviewed. The methods of classifying and assessing the cause, level, and severity of the arterial disease causing the ischemia are discussed with comparison of the relative merits of the various invasive and noninvasive techniques of investigation. The development of the methods of interventional radiological management is described with an indication of the relative success of the different techniques. Newer interventional developments, including intravascular brachytherapy and gene therapy are discussed.     

改良三联术治疗复发性髌骨不稳疗效分析

目的探讨采用改良三联术治疗复发性髌骨不稳的效果。方法对21例复发性髌骨不稳患者采用关节镜下髌骨内侧支持带紧缩术和外侧支持带松解术,辅以改良Fulkerson截骨治疗复发性髌骨不稳。了解髌骨不稳复发、患膝主观症状以及患肢整体功能康复情况。结果术后随访1.5-12（6.75±5.25）个月,髌骨不稳无复发,4例仍有膝前疼痛,但症状较术前明显改善,手术前后IKDC膝关节功能主观评分分别为（36.2±4.7）分和（91.8±5.2）分（P〈0.01）,Lysholm膝关节功能综合评分分别为（41.9±6.2）分和（92.7±6.3）分（P〈0.01）,所有患者运动能力均较术前有所改善。术后X线检查对比：髌骨-股骨滑车适合角由术前的28.1°±7.9°改善为1.6°±8.1°（P〈0.01）,髌骨外侧关节面张开角从术前的-1.2°±7.3°改善为11.6°±4.2°（P〈0.01）。结论改良三联术治疗复发性髌骨不稳具有微创、可一并处理膝关节内其他病变、同时进行胫骨结节内移及抬高、减轻髌股关节压力、从根本上矫正解剖性或生理性股四头肌角（Q角）、手术技术易于掌握等优点。     

Quantitative analysis of the functionality and efficiency of three surgical dissection techniques: a time-motion analysis.

The increasing technological complexity of surgery demands objective evaluation of surgical techniques. In particular, alternatives for laparoscopic ligation, such as monopolar coagulation and the relatively new bipolar scissors combining dissection with coagulation, should be analyzed and compared. This study tests the efficacy of quantitative time-motion analysis in evaluating and comparing the functionality and efficiency of dissection and ligation techniques in a clinical setting. Standard dissection with ligation of vessels, bipolar scissors, and monopolar coagulation were consecutively applied to dissect 4 of the small bowel mesentery of pigs, in random order. All actions performed were recorded and analyzed, using a standard action list. The efficiency of each technique was expressed in mean dissection time and number of actions, and the safety in occurrence of complications and severity of microscopic damage. Time-motion analysis evaluated the efficiency objectively and reproducibly (ICC 0.98). Bipolar scissors were significantly more efficient (time 7 +/- 2 min, actions 129 +/- 33) than the standard technique (28 +/- 6, 771 +/- 185) and monopolar coagulation (14 +/- 5, 368 +/- 32) (p < 0.01). Furthermore, bipolar coagulation needed significantly less recoagulation of an oozing vessel (0.5% of the total dissected vessels) than did monopolar coagulation (10.4%), and the damaged zone was significantly smaller (p < 0.05). Significantly less time was spent waiting or exchanging instruments with bipolar scissors than with the standard technique (p < 0.05). This time-motion analysis objectively compared the efficiency and functionality of three surgical dissection techniques during clinical use. Bipolar scissors were more efficient than were both other techniques, and they coagulated vessels more safely than did monopolar coagulation.