应用肿胀吸脂器进行皮下超量灌注吸脂术

目的为减轻皮下超量吸脂术中注射肿胀液时的劳动强度,提高工作效率。方法在25例皮下超量吸脂术使用肿胀吸脂器,其中的连续注液器注射肿胀液,负压泵进行抽吸。结果注液过程缩短,肿胀液充分、均匀,麻醉效果肯定,负压泵吸力大,抽脂量多,术后效果肯定。结论肿胀吸脂器可以连续注液,提高肿胀麻醉工作过程的效率;同时可以负压抽吸,加快了手术过程,是一种全新的吸脂设备。     

Substance abuse and dependence in anaesthetists

The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. It is important therefore, that individual employers have a standing operating procedure to deal with the addicted doctor. It is essential that the initial approach is made by a competent panel, each of whom has experience of dealing with dependent doctors. This is an extremely stressful time for the doctor involved; it is therefore essential that active support is given. It is not always necessary to suspend the doctor from work whilst treatment is undertaken. In the dependent doctor sudden withdrawal of the substance of addiction can be life-threatening. It is therefore essential that the supervising physician has specialist knowledge of the treatment of addiction. Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.     

DIEULAFOY'S DISEASE—A DISTINCT CLINICAL ENTITY

Dieulafoy's disease is a condition characterized by massive gastric haemorrhage from an abnormal submucosal artery in the upper third of the stomach. The site of rupture is marked by a small mucosal erosion over the point of rupture. Identification of the lesion is made by endoscopy, angiography or operation. However, the diagnosis is not always easy, especially as the bleeding is intermittent. Once diagnosed, treatment by operation is simple. The disease is possibly not rare, but rarely recognized.     

Cystic lymphatic malformation of bladder presenting as a pelvic mass

We report a 5-year-old boy with a cystic lymphatic malformation (LM) of bladder, and the imaging characteristics of the lesion are reported. Cystic LM of the urinary system is rare, and a location in the bladder is extremely rare. The exact mechanism of the lesion that occurs in bladder is unknown. This case is different from the 3 cases reported before, for it is only presented with a palpable pelvic mass and the lesion did not penetrate full thickness of bladder. Although imaging examinations are helpful in the definition of cystic LMs, no characteristic findings are available to diagnose a cystic LM of the bladder before surgery. The diagnosis is always made after surgical intervention. Surgical excision is ideal, and an extensive operation is not warranted because the lesion is benign. Once excised completely, the prognosis of the disease is good.     

Mock Test Characteristic of Intraaortic Balloon Pump Using Linear Motor

Abstract: This article describes the composition of the intraaortic balloon pump (IABP) system, which uses a linear pulse motor, that is, the linear type of IABP, and the results of the mock test that was performed. The expansion time is 100–110 ms, and the contraction time is 85–95 ms at the balloon of the linear type IABP. This level is similar to that of the IABP system used in the market. When the speed of the mover is 0.3 m/s, the necessary thrust of the linear pulse motor to drive the balloon of the IABP is 200 N. The conversion efficiency from the bellows to the balloon is 5.6%, and the efficiency of the entire linear type IABP system is 0.6%. The volume of the entire system is 45 L, and the mass is 40 kg excluding the chassis. Therefore, there is an expectation that the IABP system can be miniaturized to about half of the conventional model.     

Ureteric trauma in gynecologic surgery

Nearly all gynecological procedures have been reported to cause ureteric injury, with an incidence of 0.4%–2.5% for non-malignant conditions. The incidence is rising as more ambitious operations are undertaken laparoscopically. Risk factors for ureteric injury include cancer, hemorrhage, endometriosis, adhesions and an enlarged uterus. Tyes of injury include ligation, crush, laceration, avulsion, stretch and devascularization. The diagnosis may be obvious intraoperatively, but postoperative presentation with loin pain, pyrexia, fistula or non-specific signs is more common. A significant number are asymptomatic. Early diagnosis is vital, and urological investigation should be considered in any patient who is not recovering as expected. Injuries recognized intraoperatively should be repaired during the same operation. Delayed recognized injuries are being managed conservatively with increasing success in selected cases. Early operative repair achieves good results unless the injury is severe. Litigation is less likely if the diagnosis is prompt, repair is successful and the patient is treated with consideration.     

Langerhans Cell Histiocytosis of Thyroid—A Diagnostic Dilemma

Langerhans cell histiocytosis (LCH) is a rare disease of antigen presenting cells and involvement of thyroid is really uncommon. The thyroid if involved is usually seen in multisystem disease but isolated thyroid involvement is very rare. The diagnosis of Langerhans cell histiocytosis of the thyroid is very challenging due to its rarity and is usually misdiagnosed as benign goiters, undifferentiated carcinoma, lymphoma, etc. Management of Langerhans cell histiocytosis of the thyroid also remains controversial. Prognosis in an isolated Langerhans cell histiocytosis of the thyroid is usually good but as it may precede a multisystem involvement, prolonged follow-up is required. We present a rare case of Langerhans cell histiocytosis of the thyroid, with variable diagnoses on fine needle aspiration cytology.     

Pubertas praecox and hypothalamic hamartoma

Summary Precocious puberty of cerebral origin is classified into pseudoprecocious puberty and true precocious puberty. Pseudoprecocious puberty is caused by HCG secreting tumours. True precocious puberty is caused by various hypothalamic diseases. Among them, hypothalamic hamartoma is the most common cause. Precocious puberty is caused by elevated blood pituitary gonadotropin concentration, secondary to the elevated hypothalamic LHRH secretion. The hypothalamic hamartoma is not infrequently associated with laughing (gelastic) seizures as well as convulsions. Diagnosis of a hypothalamic hamartoma is easily made by CT. Although the hypothalamic hamartoma is difficult to operate on, the value of surgery is stressed for treatment of precocious puberty. This is also confirmed by recent reports.     

A decision-analysis model to diagnose feigned hand weakness

Malingering is a condition in which patients exaggerate incapacity. Feigned hand weakness is one form of malingering, and it is often seen after work-related hand injuries. Malingering is prevalent in the workers' compensation system, which devotes a large proportion of valuable resources to unwarranted claims. Feigned hand weakness must be detected early because it is relatively prevalent and expensive to society. Clinical evaluation is the first step in detecting feigned hand weakness, but it is not very specific. Therefore, every suspected positive clinical result must be followed up with a more advanced test that has better specificity. Three advanced tests are (1) five-rung grip test, (2) rapid grip tests (rapid exchange grip and rapid simultaneous grip), and (3) computerized measure of grip. Among these, computerized measure of grip is the most specific; therefore, it is the best second-line test.     

Membranous nephropathy in childhood and its treatment

Membranous nephropathy is predominantly a disease of middle-aged and elderly individuals, and is thus rather an uncommon finding in proteinuric and nephrotic children. In children, it differs in several important respects from the disease as seen in adults: an apparent associated cause is more common, macroscopic haematuria is seen quite frequently, a relapsing course is more often noted, renal venous thrombosis is not found and evolution into renal failure is the exception. Nevertheless, a proportion of children with membranous nephropathydo evolve into renal failure, and their management is discussed with particular reference to recent papers on the treatment of membranous nephropathy in adults. An aggressive search for associated disease is worthwhile in children, and one should wait to see what the evolution or proteinuria and renal function may be. If a progressive course becomes evident, then a trial of treatment with corticosteroids is worthwhile, but if this is ineffective then a more aggressive approach involving the use of alkylating agents may be justified. It remains undetermined what the best regime in children and adolescents may be.     

A real-time solution for preventive and repair maintenance

A deterministic approach to a single-machine maintenance problem is presented which is solved forward in real-time. The importance of real-time solutions is particularly evident in new manufacturing environments, where fast decisions reflecting the most current information are vital to obtain high utilization of expensive equipment and to avoid bottlenecks in the production process. A sequential decision-making process in introduced. First, the model presented is solved at the initial time when the machine is purchased. Then, each time a breakdown occurs, the model is solved again using the updated breakdown information. The initial solution contains the optimal preventive maintenance policy and the optimal resale time of the machine assuming it remains functional. At each breakdown time, the optimal breakdown-repair policy is obtained indicating whether a repair should be made or whether the broken machine should be junked. If a repair is made, then the optimal preventive maintenance policy and resale time of the machine are derived. It is shown that if a breakdown occurs following the interval in which preventive maintenance is optimally applied, then a repair is not advocated and the machine is junked. In addition, a method for deriving the future expected times of machine failures is presented. Therefore, in addition to the optimal decisions corresponding to the realized behaviour to the machine, optimal policies are derived which consider its future expected performance.     

Dysplasia epiphysealis hemimelica of the talus

Dysplasia epiphysealis hemimelica is a rare developmental disorder with unknown etiology affecting epiphysis in childhood. The lesion is an osteochondroma arising from the epiphysis and increasing in size until skeletal maturity is reached. Surgical treatment is mandatory when symptoms such as pain, joint impingement or deformation are present, and yields good results when the mass is juxtaarticular or extraarticular. In those cases where articular symptoms are not present and only mass evolution is observed, surgical treatment is not recommended before skeletal maturity has been reached. A case of DEH located in the talus and successfully treated with surgery is presented.     

Current concepts of Charcot foot in diabetic patients

The Charcot foot is an uncommon complication of neuropathy in diabetes. It is a disabling and devastating condition. The etiology of the Charcot foot is unknown, but it is characterized by acute inflammation with collapse of the foot and/or the ankle. Although the cause of this potentially debilitating condition is not known, it is generally accepted that the components of neuropathy that lead to foot complications must exist. When it is not detected early, a severe deformity will result in a secondary ulceration, infection, and amputation. Immobilization in the early stages is the key for success, but severe deformity may still develop. When severe deformity is present, bracing may be attempted but often patients will need surgical intervention. Good success has been shown with internal and external fixation. In patients with concomitant osteomyelitis, severe deformity, and/or soft tissue infection, a high amputation may be the best treatment of choice.     

Intestinal endometriosis. Current status

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.     

Ethics and meningiomas: From prudence to obstinacy? The position of the neurosurgeon (for treatment or insurance purposes) in the case of complaints concerning post-operative clinical deterioration

To treat or not to treat an asymptomatic or pauci-symptomatic benign meningioma, that is the question. And if treatment is necessary, what is the best technique: radical resection, sub-total resection or radiotherapy? This question is also pertinent for meningiomas of the skull base, posterior part of the sagittal sinus, anterior part of the foramen magnum and cerebellopontine angle. When the results of the treatment are good, the patient and the surgeon are satisfied. But when a new neurological deficit appears after the treatment, the patient is entitled to obtain compensation. What should be the position of the specialist medical assessor in this situation when the prognosis of these benign tumors is unknown? Is the preoperative information that is due to the patient complete, objective and sufficient? Is the therapeutic indication unquestionable? Is the technique irreproachable? For meningiomas, there is no “evidence-based medicine”; the therapeutic option is often based on the personal experience and/or the education of the surgeon and thus is, in fact, highly subjective.     

术后认知功能障碍的研究进展

术后认知功能障碍(postoperative congnitire dysfunction,POCD)是一种严重的术后并发症,高发于老年人和心脏手术,严重可降低术后生存质量,临床上一般难以准确预测和诊断.普遍认为POCD的诱发与年龄、麻醉方法、药物、心肺转流术、低氧因素等有关.其发病机制尚未明了,可能与中枢炎症、乙酰胆碱、β-淀粉样蛋白、ApoE基因有关.     

One sided bypass for bilateral Moyamoya disease,a case report and review of the literatures

BackgroundMoyamoya disease (MMD) is a rare condition, where the most appropriate treatment for it is yet to be determined. Surgery remains an important method of choice although it is considered a form of palliative care. The outcome following surgery is very difficult to judge, and there is no standardised measurement to assess it. It is therefore important to know which approach for such patient is adequate.Clinical presentationA 21-year-old male patient presented with signs and symptoms of intracranial haemorrhage. Upon investigation, a diagnosis of bilateral MMD was made, and one sided direct bypass surgery was subsequently performed. At 3-year follow-up, there is no evidence of recurrent cerebral vascular event.ConclusionThis case provided further evidence that direct bypass surgery is beneficial for patient in terms of blood flow improvement and symptom relieve. Although there is no consensus on whether bilateral surgical intervention is mandatory for patient with bilateral MMD, unilateral bypass might be sufficient enough. Further study is required to evaluate the best approach for such group of patient.     

Open Frontal Lift: A Conservative Approach

This study aimed to demonstrate that during an open frontal lift, transection of the galea is not necessary. The forehead is elevated, and the ptotic brow is raised after a strip of skin or scalp is removed by folding of the galea. The marcation is penciled on the skin according to the amount of skin–scalp the surgeon estimates it is necessary to remove. Local anesthesia is profusely injected, separating all layers and facilitating surgery. The skin is stripped off the galea, and then through a small incision in the middle, a large dissector separates the galea from the periosteum of the forehead and temporal regions. This dissection can be completed from the temporal area or from the blepharoplasty incisions. With a long pair of scissors, the orbital borders are reached and opened perpendicularly to the bone, releasing the fascia and muscle attachments from the orbital rim without anything being cut. During the coronal approach, once the scalp and forehead are completely mobile, the galea is folded with a continuous running 3/0 Vicryl suture, which after five or six big bites is strongly pulled to fold the galea. The wound then is sutured without tension using staples. When the incision is precapillary, the folding is fixed with Vicryl 3/0 uncolored thread, and the skin is sutured with mononylon 6/0. Complementary corrugator transections are performed from the blepharoplasty incision or by use of the endoscope. With the coronal approach, the surgery requires about 20 min, whereas the precapillary approach requires about 40 min. When only the skin is removed, bleeding is scarce and frontal postoperative edema is minimal. The author has used these techniques in 22 precapillary cases and the intracapillary procedure in 28 cases, some of which had a 4-year follow-up period. With the precapillary approach, temporary paresthesia occurred in some cases, but in all cases, sensibility was recovered within the first 2 to 6 months. With this simple and brief technique, the galea is not transected, no branches of the sensitive nerves are sectioned, and temporal and frontal arteries and veins that supply the scalp are not interrupted. Thereafter, wound healing is fast, allowing a quick recovery without areas of permanent numbness. As a result of this technique, the position of the eyebrows is the same as when frontal lifts are performed with transection of the galea and eversion of the flap, but without the side effects.     

超声诊断睾丸微石症与睾丸相关疾病的关系研究

目的探讨睾丸微石症(testicular microlithiasis,TM)与睾丸相关疾病的关系。方法回顾性分析6 622例有阴囊症状、经阴囊超声检查发现睾丸微石症(TM)患者的临床资料。结果检出率为3.35%,其中双侧为多,占比为89.1%,TM组与非TM组中睾丸附睾炎的发生率分别为13.45%,14.09%,2组比较P为0.82,x2为0.051,隐睾发生率分别为2.70%,2.37%,2组比较P为0.753,x2为0.098,差异无统计学意义;TM组与非TM组精索静脉曲张发生率分别为49.5%,40.21%,2组比较P为0.0053,x2为7.75,2组差异有统计学意义。结论睾丸微石症发生率不低,其为常见病,其与睾丸附睾炎、隐睾无明确相关关系,而与精索静脉曲张明显相关,超声检查是睾丸微石症确诊和随访的主要工具。     

Radiopathological correlations: Masses,non-masslike enhancements and MRI-guided biopsy

MRI-guided biopsy is a recent interventional breast technique. Validating the procedure poses a new problem because the signal targeted is created by the injection of a paramagnetic contrast agent and is thus transitory. In the first instance, the procedure is validated by the radiologist, who checks that targeting is accurate and inserts a clip at the end of the procedure, and secondly by analysis of the histopathological results, which should be representative of the lesion. The pathologist needs to know the nature of the image, i.e. whether it is of mass or non-masslike enhancement, and its BI-RADS classification. The objective is that the image and the pathological result should concur. If the result is non-specific and benign, a follow-up MRI is required six months later.