桩腔预备的不同时机对两种根管封闭剂根尖封闭性的影响

目的：通过比较根尖微渗漏的长度来观察即刻桩腔预备和延迟桩腔预备对两种根管封闭剂根尖封闭性的影响。方法：将120颗上颌单根管牙齿以ProTaper手用镍钛根管锉逐步深入法根管预备,随机分为A、B两组,每组60颗。分别用AHplus糊剂、Cortisomol糊剂加牙胶尖热侧向加压法进行根管充填。根充后根据桩腔预备情况将A、B两组随机再分为A1、A2、A3和B1、B2、B3 3个亚组,每组20颗。A1、B1组即刻行桩腔预备,A2、B2组1周后行桩腔预备,A3、B3组为对照组未行桩腔预备。染料渗透法测量微渗漏距离并进行统计学分析。结果：两组牙齿根尖部均有微渗漏产生。采用单因素方差分析各实验组间微渗漏差异有统计学意义（F=19.2033,P＜0.01）,LSD-t检验对组间进行两两比较：两种根管封闭剂根充后延迟桩腔预备组和即刻桩腔预备组、对照组微渗漏差异有统计学意义（P＜0.01）。延迟桩腔预备不同封闭剂充填组之间微渗漏差异有统计学意义（P＜0.01）。其余各组之间微渗漏差异无统计学意义。结论：即刻桩腔预备对两种根管封闭剂的根尖封闭能力没有影响,延迟桩腔预备降低了根管封闭剂的根尖封闭能力;延迟桩腔预备中AHplus的根尖封闭性比Cortisomol好。     

The immediate and delayed effects of marathon running on renal function

Daily blood and 24-hour urine samples from 6 runners were studied for 2 days before and for 5 days after a 42.2 km. marathon footrace run in cool environmental conditions. Although the race caused muscle damage as shown by the increased post-race serum creatine kinase activity and C-reactive protein levels, renal function measured by urine flow rates, creatinine clearance and protein excretion was normal during the race. Sodium and fractional sodium excretion decreased during the race despite a maintained osmolar clearance, and remained low for the next 48 hours, whereas osmolar clearance decreased sharply for the remainder of the race day but it was significantly elevated on days 2 to 4 after the race. Creatinine clearance was increased significantly 24 hours after the race, and reached its peak 3 days after the race, while urine flow rates were elevated from days 2 to 5 after the race. Urea excretion was significantly decreased 3 to 5 days after the race, while creatinine excretion was increased significantly on day 3 after the race. Glomerular proteinuria occurred 24 hours after the race with no associated reduction in tubular reabsorption of the low molecular weight protein beta-2-microglobulin. This study shows previously unrecognized substantial delayed effects of prolonged exercise on renal function. The nature of these changes may reflect catabolic followed by anabolic processes in muscle as well as changes consequent on excess sodium retention and related fluid compartment shifts.     

Soft-tissue expander for delayed and immediate breast reconstruction

The soft-tissue expander is a new and clinically useful method for delayed and immediate reconstruction of the breast. Our experience and reported experience to date using submuscular implantation have resulted in an aesthetically satisfactory reconstructed breast without concomitant donor site morbidity.     

Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium.

This study documents the cost of immediate and delayed DIEP flap breast reconstruction. Immediate reconstruction is more attractive from an economic perspective since it only requires one operation, one anaesthetic procedure and one recovery period in hospital. From the perspective of healthcare budget management, assessing the possible cost savings from immediate reconstruction yields interesting results. Since charges do not reflect the real costs of providing care, we calculated resource costs using the micro-costing method. About 95% of the initial mastectomy costs could be saved when performing an immediate breast reconstruction. This was about 35% of total standard direct and indirect costs due to mastectomy and delayed breast reconstruction. In a growing cost conscious environment of managed care, the economic evaluation should, therefore, encourage the trend towards more immediate reconstructions.     

Onset of arterial 'steal' following proximal angioaccess: immediate and delayed types.

BACKGROUND: Critical hand ischaemia following angioaccess is a potentially devastating complication and timely surgical repair is necessary to prevent permanent sequelae. However, the duration of the post-operative surveillance needed to exclude its occurrence has not been determined. METHODS: A retrospective review conducted over a 10-year period revealed 28 patients with critical hand ischaemia following access and surgical repair. The initial access that resulted in the limb-threatening 'steal' included 10 autologous brachiocephalic arteriovenous (AV) fistulae and 18 AV bridge grafts. The two groups of patients, those with autologous AV fistulae and those with AV bridge grafts, were compared regarding the time elapsed from the initial access to the correction procedure, the systolic pressure index between the two forearms and the existence of tissue loss. RESULTS: There was a highly significant difference in the time elapsed from the creation of the initial access to the revision procedure among the two groups, the median time being 2 days in the AV graft group and 165 days in the autologous group (P < 0.00001). The method of treatment was the distal revascularization-interval ligation (DRIL) procedure in the majority of patients (23 of 28), with immediate relief of ischaemic symptoms in all and a mid-term 1 year patency of 69%. CONCLUSIONS: Severe steal develops immediately following AV bridge grafting and patients should be closely monitored during the first 24 h; surveillance is not indicated beyond 1 month. In contrast, steal following formation of proximal autogenous fistulae may be either of immediate or of 'late' onset, months or years after the creation of the fistulae, and lifelong monthly surveillance is recommended. Close monitoring is also recommended after any subsequent surgical or interventional correcting procedure for all access types. DRIL is the procedure of choice in limb-threatening severe steal.     

Early experience with the crescent expander in immediate and delayed breast reconstruction.

Traditional breast expanders have known drawbacks, such as undesirable fullness at the upper pole, inadequate expansion of the residual breast tissue, and poor ptosis of the reconstructed breast. Crescent-shaped expanders are thought to improve the result in that expansion is concentrated at the basal breast pole. The aim of this prospective pilot study was to evaluate our results with the crescent-shaped expander in immediate and delayed breast reconstructions. Twenty-five patients, median age 51 (27-75) years, underwent 28 operations. The median follow-up time was 8 (4-15) months. Four patients developed complications including superficial infections, capsular contractions (Baker III-IV), and fullness of the upper pole. Three of these patients had been given irradiation. Breast reconstructions with the crescent-shaped expander allowed expansion of the lower pole and led to an anatomical breast shape. Patients' satisfaction during expansion was good. Our data indicate a correlation between complications and radiotherapy.     

即刻及延期乳房再造方法的选择

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣（TRAM）移植、扩大背阔肌肌皮瓣（ELDF）移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例：单纯假体植入38例、Becker可扩张假体植入16例、单蒂TRAM移植2例。延期乳房再造11例：单蒂TRAM移植6例、ELDF移植4例、Becker可扩张假体植入1例。结果手术效果满意,优良率超过90％。5例患者出现轻微并发症：皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM和ELDF皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。     

Nerve tension and blood flow in a rat model of immediate and delayed repairs.

In vivo studies of rat sciatic nerves in models of immediate and delayed repairs demonstrated the viscoelastic properties of the nerve and the inverse correlation between nerve blood flow and tension. In both the proximal and distal segments of the divided nerve in models of immediate and delayed repairs, the nerve blood flow decreased approximately 50% with substantial recovery in 30 minutes after 8% elongation, whereas 15% elongation produced approximately an 80% reduction in blood flow with minimal recovery. However, the baseline blood flow of the nerves in the delayed-repair model was nearly two times higher than that of the acutely injured nerves. Maximal decrease in nerve tension and corresponding increase in blood flow occurred within the first 20 minutes after elongation. The suture pull-out with failure of the repairs occurred at more than 15% elongation for all nerves. The previously divided nerves had a sixfold greater decrease in length than the acutely divided nerves (p less than 0.02). For repairs of large nerves where vascular ingrowth is likely to be incomplete, elongation of more than 8% may cause ischemia that is detrimental to nerve regeneration. Mechanical failure of the repairs occurs after elongation of 16% to 17%. The combination of nerve ischemia and mechanical failure of suture repairs suggests that surgeons should be careful to limit the use of elongation in acute and delayed repairs.     

Morbidity after immediate and delayed opening of sigmoid end colostomy: a randomised trial.

OBJECTIVE--To see if sigmoid end colostomies that were opened immediately carried a higher early morbidity than those in which opening was delayed for 10 days. DESIGN--Randomised trial. SETTING--University department of surgical gastroenterology. SUBJECTS--All patients for whom a temporary or permanent end sigmoid colostomy was done between December 1986 and May 1989. INTERVENTIONS--51 patients had their colostomies opened immediately, and in 49 opening was delayed. MAIN OUTCOME MEASURES--Presence of ischaemia, retraction, separation or infection, and length of stay in hospital. RESULTS--Two patients from each group died within the first week; none of the deaths was associated with complications of the colostomy. One patient whose colostomy had been opened immediately developed gangrene of the stoma, and one in whom the opening had been delayed developed retraction. There was no difference between the groups in length of stay in hospital. CONCLUSION--As we could find no differences in morbidity whether the colostomy was opened immediately or whether it was delayed, we now recommend that it should be done immediately. The question of late complications (stenosis and hernia), however, cannot be answered yet.     

Influence of bowel preparation and antimicrobials on colonic microflora.

The influence of three types of preoperative mechanical bowel preparation on colonic microflora has been studied in 88 patients undergoing elective bowel resection and compared with 21 controls. Neither conventional bowel preparation (CBP) using oral magnesium sulphate, enemas and rectal washouts nor whole bowel irrigation (WBI) via a nasogastric tube influenced the type or number of organisms in the colon at the time of operation. The administration of an elemental diet (ED) was associated with only a small reduction the numbers of Escherichia coli (P less than 0.02). The addition of oral neomycin and metronidazole for 48 h before operation to all three methods of bowel preparation was associated with a highly significant reduction in the counts per ml of E. coli (P less than 0.001) and Bacteroides fragilis (P less than 0.001) in the colon. There was no correlation between the diameter of the lesion being resected with the numbers of bacteria in the colon even when oral neomycin and metronidazole were added to the bowel preparation.     

纳米羟磷灰石糊剂封闭根管效果的实验研究

目的：利用实验研究纳米羟磷灰石糊剂结合牙胶尖封闭根管的效果。方法：选取46颗直根管的上前牙,其中40颗随机分为A、B两组（各20颗）,分别用纳米羟基磷灰石糊剂、AH-plus糊剂结合牙胶尖侧向加压技术充填根管。另外6颗牙齿用于阳性对照组c组（n=3）和阴性对照组D组（n=3）。采用染料渗透法测四组标本的染料渗入距离。结果：4组染液从根尖孔向冠方渗漏的直线距离分别为A组：（0．98±0．53）mm、B组;（1．46±0．32）mm、C组：（8．16±0．19）mm、D组：0mm,B组微渗漏值高于A组,两组间比较有显著差异性（P〈0．05）。结论：新型纳米羟基磷灰石糊剂封闭根管能力优于AH-plus糊剂,能够有效防止根尖微渗漏。     

即刻乳房再造与延期乳房再造的心理调查

目的 探讨乳腺癌术后行乳房再造术的最佳时机。方法 2001年5月至2004年3月，共行乳腺癌手术3660例，其中52位患者接受了乳腺癌术后即刻或延期乳房再造术。通过问卷调查，了解其对外观和性吸引力的满意程度，以及有关焦虑和沮丧、自我体象和自尊等方面的心理状态。结果 即刻再造组有97％的患者表明她们非常或比较满意，而延期再造组则仅为75％(P=0．026)。即刻再造组中只有6％的患者感觉自己的性吸引力受到明显的损伤，而延期再造组则为30％(P：O．043)。即刻再造组焦虑(P=0．014)和沮丧(P=0．006)的发生少于延期再造组，而自我体象(P=0．012)和自尊(P=0．003)的评分较高。结论 在肿瘤性质和健康情况允许的前提下，乳腺癌术后应进行即刻乳房再造。