Unilateral multifunctional external fixator in replantation of severed bilateral lower limbs.

Replantation of severed bilateral lower limbs was successfully performed for a patient on 24 May,1993. Two unilateral multifunctional external fixators were used to resconstruct bony frameworks. Six young doctors with an average age of less than 30 years performed the operation. CASE REPORT A 60-year-old man sustained complete severance of bilateral lower limbs by a reaping machine at 3 PM on 24 May, 1993. Three hours later, the patient arrived at our hospital. He was restless and anxious, his face pallor, and the pulse weak and rapid. The blood pressure was 8/5.3 kPa (60/40 mmHg). Following administration of 3500 ml of blood and 2000 ml of intravenous fluid, the blood pressure rose to 16/10.7 kPa (120/80 mmHg) and hypovolemic shock was corrected. At 8 PM, replantation of severed bilateral lower limbs was performed under extradural anesthesia. Badly contaminated wounds were debrided thoroughly. The ends of bilateral tibiae and fibulae were shortened by 3 cm to maintain proper tension of the muscles, bl     

Surgical treatment of 82 patients with diabetic lower limb ischemia by distal arterial bypass

Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus. This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients （type 2） with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene （PTFE） and graft-tibial autologous grafts was performed on 31 limbs （32.3%）. Popliteal-tibial artery bypass alone was performed on 22 limbs （22.9%）. Combined lilac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs （12.5%）, and femoro-tibial artery graft bypass was performed on 10 limbs （10.4%）. Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs （7.3%）. Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs （3.7%） died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% （79/82）. Graft patency rate of patients on discharge was 95.8% （92/96）. The short-term total effectiveness rate was 83.3% （80/96）. Foot ulcer healing rate was 35.7% （10/28）. 97.4% （75/77） patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% （71/88）. The total amputation rate was 4.5% （4/88）. Mortality was 4.5%. The total graft patency rate was 90.9% （80/88）. Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient＇s quality of life.     

Experimental Study on the Cryopreservation of LLC-PK1 Epithelial Cells with Hypoxic UW Solution

The effects of oxygen partial pressure on cryopreservation of the cells with organ preservation solution were explored. Hypoxic UW solution was made by purging the UW solution with argon. The pig proximal tubule epithelial cells （LLC-PK1 cells） were cryopreserved in hypoxic UW solution （Ar-UW group） or standard UW solution （UW group） at 4℃ for 48 h. Trypan blue staining and LDH detection were performed to evaluate the injury of the cells. The results showed that the oxygen partial pressure in Ar-UW group was significantly declined from 242±6 mmHg to 83±10 mmHg. After cryopreservation at 4℃ for 48 h, LDH leakage rate and Trypan blue-stained rate in Ar-UW group were （11.3±3.4）% and （10.5±4.7）%, respectively, which were significantly lower than in UW group [（49.5±6.9）% and （47.6±9.3）% respectively, both P〈0.01]. It was concluded that lower oxygen partial pressure of UW solution was more beneficial to the cryopreservation of LLC.     

An Epidemiological Investigation on the Efficacy of Tubal Ligation in Henan Province

An analysis was made of the data from a retrospective epidemiological study of 8766 cases of tubaf tigation performed between 1978 and 1983. Life-tabte statistcal analysis showed a cumutative pregnancy rate of 0.40 / 100 women in the first year, 1.07 / 100 women in the sixth year after tubal ligation. The incidence of complications was 2.66%, among which infection was the first in order. The results of multiple stepwise diseriminant analysis showed that the main factors af[ecting the operations were. the type of operation, and the hospital where the operation was performed. Premeroy rate after Madlener‘s operation was significantly higher than that after Pomeroy, modified Pomerov and Uchida operations. Signfieantlv higher pregnaney rate was observed in cases operated in hospitals below the county level than in those performed above cotatty level. The results of investigation indicated that tubal tigation is a safe, reliable, life-long cotraceptive measure.     

Fresh Frozen Plasma for the Treatment of a Chinese Patient with Hereditary Angioedema

HEREDITARY angioedema （HAE） is an autosomal dominant inherited condition which was initially described by Osier in 1888.1 Patients with HAE can develop rapid subcutaneous or submucosal edema involving the hands, feet, limbs, face, intestinal tract, even larynx and trachea. The mortality of an acute attack of HAE without treatment was reported as high as 30%.2 HAE is caused by the deficiency of Cl esterase inhibitor （CIINH） which results in episodes of edema in parts of the human body,     

Role of MR imaging in the diagnosis of intracranial germinoma

Objective: To investigate the role of MRI in the diagnosis of intracranial germinoma. Methods: MRI features of 19 cases of intracranial germinoma confirmed by operations and pathological findings were analyzed retrospectively. Results: Germinomas were found in the seUar region in 10 patients (including 5 males and 5 females), in the pineal region in 6 and in the thalamus and basal ganglia in 3, the 9 patients in the latter 2 groups all being males. The characteristic MRI findings of intracranial germinomas were as follows : ( 1 ) Lesions were isointense or slightly hypointense on TlWI while isointense or slightly hyperintense on T2WI. The germinomas in the seUar region and pineal region showed no edema, but lesions in the thalamus basal ganglia showed mild to moderate edema and space-occupying effects. (2) Homogeneous or inhomogeneous Gd-DTPA enhancement were seen in most of the tumors. Conclusion:Muhiaxial imaging and Gd-DTPA enhancement in MRI are helpful in the diagnosis and differentiation of intracranial germinomas on the basis of the patients gender, the location of the tumor and its imaging characteristics.     

Doppler ultrasonic diagnosis for deep venous thrombosis of lower limbs.

Seventy-one patients with 80 lower limbs clinically suspected of deep venous thrombosis (DVT) were investigated by both Doppler ultrasound and venography. Sixty-seven lower limbs demonstrated by venography to have DVT, in 5 the thrombus was confined to the calf, and all were detected by the Doppler ultrasound. In 62 limbs thrombus extended into the popliteal and more proximal veins, the Doppler ultrasound detected 61 of them, a sensitivity of 98%. Venography showed a deep venous system without any evidence of thrombosis in 13, the Doppler findings were normal in all of the 13 lower limbs, a specificity of 100%. We found that the examination of the popliteal vein with patient in a semi-lateral prone position was important in detecting the presence of thrombosis in popliteal and more proximal vein.

     

The Effects of Chinese Medicines on Micro-circulation of Nail Folds and Blood Flow Velocity of Limbs in the Patients with Arteriosclerotic Obliteration

The effects of Chinese medicines on micro-circulation and blood flow velocity in arteries of the lowerlimbs were observed in 33 patients with arteriosclerotic obliteration(ASO).The results showed that theintegral values of micro-circulation after treatment were obviously higher than those before treatment(P<0.05 or P<0.01).Blood flow velocity in arteries of the lower limbs determined with the color Dopplerultrasound detecting method after treatment were also obviously higher than those before treatment(P<0.05 or P<0.01).In tbis series of 33 ASO patients,the markedly effective rate was 36.36%,and thetotal effective rate was 63.64%.The observation indicates that the recipe prescribed according to theprinciple of supplementing qi and activating blood circulation can effectively improve micro-circulation inASO patients,and accelerate blood flow in arteries of the lower limbs.     

Survey of the use of epidural analgesia in China.

It is generally believed that epidural blocks are most widely used in China. However, there is yet no substantial study in this respect. A nation-wide survey appears to be necessary. Questionnaires were sent to 237 hospitals located in 6 geographically wide-scattered areas and to some military hospitals as well. 90 answers were obtained with complete data necessary for this survey. There are 1,304,214 administrations of epidural blocks documented in these 90 hospitals. Of which 38.8% are lumbar, 32% lower thoracic, 23% middle thoracic, 4.6% upper thoracic and 1.6% cervical blocks. These data showed that operations from the neck down to the lower extremities were performed under epidural block without discrimination of puncture location. 98.33% of the blocks were satisfactory to meet the need of operations. Persisting paresthesia occurred in 0.013% of these cases. The incidence of accidental puncture of dura was 0.32%. About 2/3 of these dura punctured cases received 1-4 times of repuncture. No correlation was found between repuncture and development of total spinal anesthesia. Among the complications, incidence of respiratory depression was 0.54%. However, only 5% of these depressed cases needed intubation and artificial ventilation. No signs of dura puncture were noticed, but subarachnoid block did appear in 0.04 of cases. Incidence of total spinal anesthesia was 0.013%. Not all, but a little more than half (54.6%) of the total spinal cases needed intubation and artificial ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

     

颅内压增高视神经乳头改变的临床观察

目的探讨颅内疾病导致颅内高压后视神经乳头改变的临床特点及意义。方法对颅内肿瘤934例（包括胶质瘤、脑膜瘤、垂体瘤、神经纤维瘤、颅咽管瘤等）,颅脑外伤360例（均为重型以上颅脑损伤）,脑血管病58例（动脉瘤及AVM破裂出血）,直接采用眼底镜进行动态观察。结果颅内肿瘤视乳头改变发生率达64%,多为视乳头水肿;颅脑损伤视乳头改变发生率为28%,其中多发生于外伤后1周以后;脑血管病视乳头改变发生率为55%,多发生于出血后10～30 d内。结论急性颅内压增高短期内很少发生视乳头水肿,亚急性颅内压增高视乳头水肿发生率高,慢性颅内压增高视乳头水肿发生率较低,而且视神经萎缩的发生率高于视乳头水肿。     

早期微孔手术对30例脑出血后继发性脑损伤和预后的影响

目的探讨早期微孔手术对中小量基底节脑出血后脑水肿及预后影响。方法选择2008年6月至2010年6月该院收治的高血压基底节脑出血患者60例。分为保守组(30例)和微孔组(30例),两组患者入院后予常规控制血压、营养神经、降颅压、防治感染等治疗。微孔组于入院后24h内采用YL-1型一次性颅内血肿粉碎穿刺针按"颅内血肿微孔穿刺引流操作常规"行微孔穿刺清除血肿。比较两组患者第1、2、3周意识、肢体活动、语言及日常生活活动量表增量(BS)影响。结果第1、2、3周微孔组(0.162±0.374、0.026±0.367、0.087±0.337)各时间点脑水肿相对增量(RE)均小于保守组(0.472±0.232、0.338±0.292、0.067±0.205);第2、3周RE与第3周和第3个月BS呈直线关系。结论早期微孔手术主要通过减小中小量基底节脑出血RE改善预后。     

急性肢体动脉栓塞的疗效观察

本文报告近25年来诊治的急性肢体动脉栓塞124例,栓塞138条动脉(腹主动脉下端20例)156条肢体。除3例未治外,共施行125例次治疗,其中施行传统取栓术41例42次,溶栓药尿激酶和一般药物分别治疗36和47例次。治疗结果以肢体计算:优41,良28,差29,截肢35(22.4％),总死亡率为13.6％。对59例67条肢体的远期效果是:优44.8％良35.8％,差19.4％。对选择治疗方法和提高治效果问题进行了讨论。     

540例妊娠高血压综合征眼底改变临床分析

目的：探讨妊娠高血压综合征（PIHs）患者高血压，蛋白尿和水肿与眼底视网膜改变的关系。方法：分析眼底改变与PIHS患者血压、蛋白尿、水肿的关系，用直接检眼镜检查眼底。结果：在540例患者中发现正常眼底342例（占63．3％），视网膜病变198例（占36．7％），在轻、中、重患者中PIHS越重其眼底改变越重。结论：PIHS与血压高低、眼底改变程度相一致，眼底改变越重，蛋白尿、视网膜水肿发生率越高，说明眼底改变是反应全身多处器官受损，一但出现重度PIHS及时终止妊娠有利于视网膜较好恢复。     

内括约肌部分切断对减轻痔术后疼痛水肿的临床观察

目的:观察内括约肌部分切断的手术方法对减轻痔术后疼痛水肿的临床疗效。方法:将68例痔患者随机分为治疗组(外剥内扎加内括约肌部分切断)和对照组(单纯外剥内扎)各34例,观察痔术后疼痛水肿的发生情况。结果:治疗组5例发生剧烈疼痛,5例发生肛缘水肿;对照组有18例发生剧烈疼痛,20例发生肛缘水肿,两组疼痛、水肿例数经比较有显著性差异(P<0.05)。结论:外剥内扎加内括约肌部分切断的手术方法对减轻痔术后疼痛水肿具有显著的疗效。     

原发性中枢神经系统淋巴瘤MRI表现

目的探讨原发性中枢神经系统淋巴瘤（PCNsL）的MRI表现特征。方法回顾性分析经病理证实的4例PCNSL患者的MRI表现,所有患者均行MR平扫及增强扫描。结朵1例术前误诊为脑膜瘤,2例位于幕上,1例位于幕下,1例同时生长于幕上及幕下。4例肿瘤边缘均可见明显分叶或浅分叶。所有病灶实质内均未见钙化。T1WI以等、稍低信号为主,T2WI序列以等或稍高信号,3例周围水肿较轻、1例水肿明显。3例病灶信号均匀、1例信号不均。增强扫描后所有病灶均匀明显强化,3例呈明显团块状或斑片状均匀强化,1例出现“脑膜尾”征。结论PCNsL的MRI表现具有一定特点,当脑内肿瘤明显分叶,周围水肿较轻,信号较均匀,并明显均匀团块状或斑片状强化时,结合临床可以对原发性中枢神经系统淋巴瘤作出诊断,具有很高的诊断价值。     

引流方式对乳腺癌改良根治术后皮下积液的影响

目的探讨不同引流方式对乳腺癌改良根治术后皮下积液的影响。方法60例行乳腺癌改良根治术的患者均采用Stewart横切口,术后随机采用两种方式进行引流。A组采用单纯闭式持续负压引流＋胸壁绷带加压包扎;B组采用双管闭式持续负压引流＋胸壁绷带加压包扎。结果A组30例患者中,8例发生皮下积液,积液发生率26.7%;皮瓣坏死3例,坏死率10%。B组30例患者中,2例发生皮下积液,积液发生率6.7%;皮瓣坏死1例,坏死率3.3%。比较两组皮下积液发生率差别有显著意义（P〈0.05）,皮瓣坏死两组间差别无显著意义（P〉0.05）。结论乳腺癌改良根治术后行双管闭式持续负压引流＋胸壁绷带加压包扎,能明显减少皮下积液的发生率。     

Oral administration and external application of Chinese drugs combined with micro-invasive operation for the treatment of varicose ulcers in the lower extremities

Objective:To evaluate the clinical therapeutic effects of oral administration and external application of Chinese drugs combined with micro-invasive surgery for the treatment of varicose ulcers in the lower extremities(ecthyma).Methods:A total of 152 patients(163 limbs) suffering from varicose ulcers on the lower limbs were assigned to two groups according to the patients' willingness.The 102 cases(109 limbs) in the treatment group underwent the method of endovenous microwave closure of communicating vei...     

微创经皮肾造瘘输尿管镜钬激光碎石术并发症的预防及处理

目的探讨微创经皮肾造瘘输尿管镜取石术(MPCNL)治疗上尿路结石中出现的并发症及相应处理。方法回顾性分析接受MPCNL治疗194例复杂性上尿路结石患者的临床资料,总结出现的并发症,采取的治疗方法及转归。结果首次手术后结石总体清除率为78.8%(153/194),其中单纯肾盂结石和输尿管上段经石清除率为89%(150/168)。急性肺水肿1例,水中毒(容量负荷增加)发生率32%(63/194),手术时间超过1.5小时发生率明显增加。输尿管支架管不到位3例,术后脱落入膀胱3例,术后复查并及时拔除双J管。肾周血肿1例,3个月后腹腔镜开窗引流术,肾周水肿3例。心肺功能障碍1例,及时心肺复苏好转。术后全身炎性反应综合征发生率8.9%,积极抗炎后好转。结论提高手术技能、选取合适适应证、及时发现病情变化有助于减少并发症,当并发症不可避免时,应及时处理,必要时行手术防止症状进一步恶化。