自发性食管破裂1例

患者，男，51岁，2005年6月10日入院。入院前2h进食早餐后，突然呕吐少量血性胃液，自觉胸痛，呼吸困难，遂入我院。入院后查体：T36℃，P82次／min，R30次／min，BP100／80mmHg，呈急性痛苦面容，呼吸困难，面色苍白，口唇发绀，左上腹压痛阳性，左胸部饱满，叩诊呈鼓音，左下肺叩诊呈浊音，呼吸音消失，肠鸣音弱。X线胸片示：纵隔向右移位，左肺中下野无肺纹理，并可见多个液平，左膈及左心缘不清。右肺、右膈无异常。提示：左侧液气胸，肺压缩2／3。B超示：左胸液性暗区位于腋中线以前，直径3cm，可见肺影，     

疝环充填式无张力疝修补治疗腰疝一例

患者男,36岁.因外伤后致左腰部出现可复性肿物3年入院.患者三年前从2.5米高处摔下,2个月后即于左腰部出现一可复性包块,站立及咳嗽时增大,并有下坠感,右侧卧位时消失.三年前曾于外院行"疝修补术",术后1周复发.查体:一般情况可,心肺无异常.左腰部髂骨嵴上,见一椭圆形肿物,5cm×5cm×3cm大小,无红肿及压痛,内容物可还纳入腹,可闻及肠鸣音,还纳后可及4cm×3cm大小的疝环口,病人咳嗽有冲击感,透光试验阴性.入院诊断为:1.外伤性左腰疝;2.左腰疝修补术后复发.     

难复性半月线疝一例

患卷女，56岁，因腹部包块外突伴隐痛2年入院。约2年前始，自觉左下腹饱满，站立和（或）增加腹压后明显，平卧时有部分减小，伴隐痛，近一段时间包块明显，平卧时无明显变化，大便规律，无明显影响。既往：腰椎骨折行内固定术。体格检查：一般情况尚可，站立检查发现，左下腹部有一约11cm×10cm的质软包块，平卧时左下腹部包块减小，轻度压痛，无反跳痛和肌紧张，触诊可扪及腹壁薄弱，直径约2．5cm，包块内可闻及肠鸣音。     

新生儿先天性左侧膈肌膨升症一例

患儿　女,出生后2小时。患儿出生后哭声弱,全身皮肤紫绀,有明显的呼吸困难,口吐白沫,于生后2小时入院。查体:体温37℃,脉搏132次/分,呼吸54次/分。体重3.56kg,足月儿。胸廓无畸形,左胸呼吸动度减弱;左肺呼吸音粗,左胸下部可闻及肠鸣音,右肺呼吸音正常。心脏听诊无异常,心?..     

自发性左髂静脉破裂二例

患者1,女性,55岁.因腹痛3小时于2004年5月8日入院.患者晨练后蹲下时,突感左下腹部剧痛,继而下腹部胀痛进行性加重,排正常大小便一次.排便后下腹部胀痛无好转,且疼痛向左腰部及左大腿根部放射,伴有恶心.患者否认既往有高血压、动脉硬化及外伤史.查体:神志清楚,血压20/0 mm Hg( 1mm Hg=0.133 kPa),脉搏136次/分,腹部中度膨隆,左中下腹肌轻度紧张,压痛、反跳痛明显,叩诊无明显移动性浊音,左肾区叩击痛阳性,肠鸣音5次/分.血常规检查:白细胞总数21×109/L,红细胞总数3.20×1012/L,血红蛋白86 g/L,红细胞压积21％,尿常规潜血(++).B超检查:左下腹、左肾下极团块状强回声,范围广,界限不甚清晰,无包膜,腹腔内血管探查不清.入院诊断为失血性休克,当时考虑怀疑为左髂总动脉瘤破裂出血.入院后即刻行探查手术.进入腹腔后,可见有约150 ml淡红色血性液体存留,后腹腔广泛血肿膨隆,尤以盆腔为重.手术清除大量凝血块及暗红色血性液体共约3000 ml左右.术中见左髂总静脉前壁有一纵行长约2.0 cm的不规则破裂口,有血液自创口涌出,左髂总静脉近心侧受右髂总动脉压迫前后径变窄.缝合静脉破裂口,恢复髂静脉的血液回流.术后给予抗凝、祛聚治疗.10天后患者痊愈出院.     

成人巨大膈疝1例

病人 女，21岁。自幼活动后胸闷、憋气、干咳。10余日咳嗽、胸闷加重。查体：气管略右偏、胸廓无畸形，左胸语颤减弱。左胸中下部叩诊浊音，间有彭音区，呼吸音消失，可闻及肠鸣音，左上胸呼吸音减弱。腹部平坦空虚。X线胸片见左下肺野大片高密度影，纵隔右移（图1）。     

心脏穿透伤术后并发急性阑尾炎一例

患者 男，26岁。被人用刀扎伤左胸部及左上臂，即出现伤口出血伴胸部疼痛、胸闷，随后逐渐意识模糊。伤后40min入院，查体：脉搏110次／分，呼吸18次／分，血压75／40mmHg（1kPa=7．5mmHg），于左锁骨中线第5肋间有1cm创口，左肺呼吸音减弱，并于左上臂有3cm和1．5cm两处创口。胸部CT示：左侧血气胸、心包积血。即刻人手术室行前外侧切口开胸探查，术中可见胸腔积血500ml，肺被压缩，心脏搏动微弱，心脏压塞，切开心包见有凝血块和积血150ml，左心房前壁有0．8cm刀伤口，向外喷血，准备缝合时，心脏突然停搏，即刻心脏按压，3min后心跳恢复，抬起心尖，食指按住破口，无损伤Alice钳钳夹破口，3-0无损伤缝线缝合破口，出血停止。     

外伤性腹壁疝二例报告

例1。男，37岁。车祸中左下腹被铁棒撞伤1小时于1995年4月4日入院。查体：腿软稍胀，左下腹、会阴部及阴茎皮肤挫擦伤，左下腹触及10cm×5cm皮下腹壁缺损，左侧卧位或用力咳嗽时有较大肿块突出，质较，表面可闻及肠鸣音，平卧时消失或用手可还纳肿块入腹腔，右下腹腹腔穿刺抽得     

子宫肌瘤及左卵巢囊肿合并乙状结肠肠脂垂扭转1例

1 临床资料 肥胖女性患者，49岁。因月经量多5年，左下腹隐痛不适1个月于2005年4月人院。月经周期规则，但经量较多，经期延长。约1个月前感左下腹隐痛不适，呈持续性，无阵发性加重，自服止痛剂后疼痛尚能缓解。查体：T37℃，P6j次／min，R20次／min，BP150／90mmHg，神清，精神略萎，无明显痛苦貌。心、肺无异常，腹隆，肝脾肋下未及，上腹部无压痛，耻骨联合上及左下腹均有轻压痛，无反跳痛及肌紧张，叩诊无移动性浊音，肠鸣音正常。     

罕见肠多发恶性间皮瘤一例

患者，男．57岁。胃胀、返酸2月余伴黑便1月于2006年4月17日入院。2年前因左肺大泡在我院行肺大泡修补、胸膜固定术、查体：贫血貌．双肺呼吸音正常，腹软，全腹无压痛，无移动性浊音，肠鸣音正常。辅助检查：血常规：红细胞2．69×10^12／L．血红蛋白53g／L，红细胞压积19．6％，淋巴细胞0.61×10^9／L，淋巴细胞百分比11．4。入院前大便潜血（＋＋），入院后大便潜血（-），白细胞5～6／HP。结肠镜检查：结肠多发平滑肌瘤？腹部超声：肝脏左叶肝囊肿，直径0．8cm；脾脏厚4．3cm，表而和边缘光滑，切迹明显，实质均匀，提示：脾大，肝囊肿。胸片：胸部术后改变，侧位左肺可见小结节影。     

Repair and reconstruction of peripheral nerve injuries

Axonal regeneration after transection is a complex biological process. It is not merely a process of tissue repair, but rather of cellular repair of a large number of nerve cells. Regeneration involves restoration of the original morphology of each single cell, rather than proliferation. Techniques in microneurosurgical reconstruction of peripheral nerve injuries have improved over the last two decades, with subsequent improvement in functional results. Nerve autografts are now routinely used to guide the regrowth of the proximal nerves to distal nerve segments. However, the limited source of expendable cutaneous nerves restricts the use of nerve grafting techniques and is associated with significant morbidity. With extensive injuries there is an insufficient quantity of nerve autograft material to facilitate optimal repair. In future, the use of artificial conduits or nerve allografts could provide a limitless source of material to reconstruct otherwise irreparable traumatic nerve injuries. Establishment of appropriate strategies to suppress host-immune reaction or donor antigenicity would facilitate clinical allogeneic nerve transplantation. Guest lecture presented at the 69th Annual Meeting of the Japanese Orthopaedic Association in Tokyo on April 13, 1996.     

Repair of peripheral nerve defect with direct gradual lengthening of the proximal nerve stump in rats.

We investigated the effect of direct gradual lengthening on the proximal nerve stump and subsequent nerve regeneration in rats. A 10-mm-long nerve segment was resected from the sciatic nerve of each rat. The proximal nerve stump was directly lengthened at a rate of 1 mm/day using an original external nerve distraction device. Experiment I: After distraction periods of 10, 15, and 20 days, the length of each nerve was evaluated, and the lengthened nerve stump was also examined by immunohistochemical analysis. Experiment II: After a distraction period of 20 days, both nerve stumps were refreshed and direct end-to-end neurorrhaphy was performed. For control, 10-mm nerve grafting was immediately performed after nerve resection. Nerve regeneration was evaluated electrophysiologically and histologically 7, 9, and 15 weeks after nerve resection in both groups. The whole proximal nerve stump, including the endoneurium and the axon, could be lengthened in proportion to the distraction period. There were no significant differences in motor nerve conduction velocity and tetanic muscle contraction force between both groups. Histologically, the total number of myelinated fibers was significantly greater in the nerve lengthening group than in the autografting group. This study demonstrated that the whole proximal nerve stump including the endoneurium and the axon could be lengthened by direct gradual distraction, and that this method might have potential application in the repair of peripheral nerve defects.     

Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve

In this paper the recovery after repair of the median nerve has been used to compare different assessment tools for evaluation of peripheral nerve function: touch (moving 2-point discrimination (2PD); Semmes-Weinstein (SW) monofilament, motor (Medical Research Council (MRC) scale), combined motor and sensory (Dellon modification of the Moberg pick up test; Moberg Recognition test), and pain (visual analogue scale; pinprick-test). The mean (SD) age of our 28 patients was 28 (12) years. The mean (SD) follow-up period was 5 years, 2 months (2 years, 8 months). On the operated side three patients (11%) had a moving 2PD of less than 4 mm. The results of the moving 2PD were compared with those of the SW monofilaments, but with a poor correlation. The MRC score correlated well with opposition movement of the thumb and muscle wasting (p<0.01). We recommend a number of tests to evaluate (the chronological return of) peripheral nerve function.     

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.     

Indication,technique and results of facial nerve reconstruction

Summary 160 patients with various intraor extracranial pathologies were treated by microsurgical facial nerve reconstruction at Nordstadt Neurosurgical Clinic between 1978 and 1993. Facial nerve reconstruction was accomplished along the anatomical course of the facial nerve from its origin at the brainstem, within the mastoid, at the stylomastoid foramen and within the face. Mostly, reconstruction was indicated because of nerve discontinuity (n=61), whereas facial nerve reanimation with a donor nerve such as the contralateral facial nerve or the ipsilateral hypoglossal nerve was indicated in 99 cases of loss of a proximal nerve stump. Depending on the site of the lesion reinnervation started at 5 to 15 months postoperatively lasting for 2 to 3 years with overall satisfactory results. 69% of all the patients regained good symmetry on rest, complete eye closure equivalent to House-Brackmann-Score III: Patients with complete failures either suffered of non-related diseases such as cancer leading to death before the estimated time of recovery or were exposed to radiation or received facial nerve reconstruction after long-standing facial deficit and marked muscular atrophy. The indication of the adequate method depends on the clinical course with or without preexisting facial paresis, on considering the intraoperative state of the facial nerve, the identification and microsurgical preparation of adequate nerve stumps, as well as on the adaptation techniques and the postoperative guidance of the patient. We conclude that facial nerve reconstruction by transplantation at either site of the nerve course or by reanimation with a donor nerve are effective and reliable procedures of treatment leading to satisfactory functional and cosmetic results.     

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.     

Anatomie fonctionnelle du nerf trijumeau

The cranial nerve (CN) V is a mixed nerve that consists primarily of sensory neurons. It exits the brain on the lateral surface of the pons, entering the trigeminal ganglion within a few millimeters. Three major branches emerge from the trigeminal ganglion. The first division (V1, the ophthalmic nerve) exits the cranium through the superior orbital fissure, entering the orbit to innervate the globe and skin in the area above the eye and forehead. The second division (V2, the maxillary nerve) exits through a round hole, the foramen rotundum, into a space posterior to the orbit, the pterygopalatine fossa. It then re-enters a canal running inferior to the orbit, the infraorbital canal, and exits through a small hole, the infraorbital foramen, to innervate the skin below the eye and above the mouth. The third division (V3, the mandibular nerve) exits the cranium through an oval hole, the foramen ovale. The third division also has an additional motor component, which may run in a separate fascial compartment. Most fibers travel directly to their target tissues. Sensory axons innervate skin on the lateral side of the head, the tongue, and the mucosal wall of the oral cavity. Motor fibers innervate the muscles that are attached to the mandible. Some sensory axons enter in the mandible to innervate the teeth and emerge from the mental foramen to innervate the skin of the lower jaw.     

双神经卡压综合征

目的：研究双神经卡压征的病因及手术治疗方法。方法：分析了自１９８８年以来同时诊断为腕管综合征和肘管综合征２６例３４侧的临床资料。全部患者均作两处神经松解术，平均随访１７个月。疗效评定标准，根据术后症状、体征的改善程度分优、良、可和无效四级。结果：２５侧术后疗效优良，占７３．６％（２５／３４）。结论：双神经卡压征手术治疗效果较好。当双神经卡压同时合并颈部神经卡压时，建议优先考虑远端的神经减压。当远端神经减压后未能改善近端神经卡压症状时，才考虑近端神经减压