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1.
Unicompartmental knee arthroplasty (UKA) is an excellent operation provided the technique is properly applied and the indication is well established. Obesity (weight > 100 kg, or BMI > 32) is a contraindication. The shape of the femoral prosthetic condyle is a cause of loosening in the medium and long term. There is an important difference between medial UKA and lateral UKA. Indications are different and they correspond to different types of patients. UKA is not an alternative to osteotomy; it is in competition with both osteotomy and total knee prostheses and has its own indications. UKA without cement is possible provided sufficient primary stability is achieved. This appears difficult to achieve at the femoral level. The patella poses no problems provided the unicompartmental prosthesis is fitted correctly. The absence of anterior cruciate ligament, together with clinical or radiological anteroposterior laxity, is a contraindication to UKA. The average lifetime of a unicompartmental prosthesis is 8–10 years; lateral prostheses have a longer lifetime. Failure of UKA implies reoperation with conversion to the total knee prosthesis. Hypercorrection by lateral UKA is undesirable. In contrast, there is no objection to hypercorrection of less than 5° by medial UKA. After medial UKA, the recurrence of a varus deformity is possible only if lateral laxity has not been controlled or if one of the prosthetic components is displaced. UKA is not indicated if patellar surgery is required. Hypocorrection by lateral UKA is desirable. Medially, the residual varus should not exceed 5°. In medium and long-term failures, most complications affect the tibia (loosening, polyethylene wear).  相似文献   

2.
Although there is little doubt that the scapular flap is a versatile flap that is suitable for most tissue defects, it has failed to gain its proper place in the reconstructive armamentarium. This may be due to the perceived donor site morbidity. However, many published articles have shown that the donor site morbidity is limited and acceptable. The scapular free flap is accessible, relatively easy to dissect and has a long vascular pedicle with a constant position of artery and veins. The donor site may be closed primarily for flaps that do not exceed 10 cm in width. It is usually hairless, and is ideal for intermediate-sized defects. There is no functional donor site deficit and the resulting scar is acceptable. No major artery is sacrificed. The independent arc of skin flap rotation relative to the bone component is another major advantage over other flaps. Therefore, I believe that the scapular free flap is a superior and adaptable flap in most skin and/or bone defect reconstructions.  相似文献   

3.
Liposarcoma is a malignancy of fat cells and is the most frequent soft tissue sarcoma localized in the retroperitoneum. It can reach substantial proportions. It is a slow-growing tumor, and the most frequent symptom is nonspecific abdominal pain and diffuse abdominal enlargement. Treatment is radical surgery and complete resection is essential for local control of the disease. We present a case of giant right retroperitoneal liposarcoma, which was well-encapsulated and could be completely excised. The patient is currently in follow up and at 2 years is disease-free.  相似文献   

4.
The experience in treatment of 14 patients with focal cirrhosis of the liver is summarized. Clinical and morphological data is presented. It is noted that clinical picture is poor and non-specific. Ultrasonic examination is the main diagnostic tool. It is demonstrated that histological examination of removed specimen is often necessary for final diagnosis. Method of choice in the treatment of patients is surgical one. The scope of surgery depends on intraoperative features, extended hepatic resection is not usually indicated.  相似文献   

5.
The indications, techniques, and results of laparoscopic surgery for early rectal carcinoma are described in detail. Laparoscopic surgery is indicated when a mucosal tumor is too large to perform endoscopic or transanal resection or the tumor invades the submucosal layer. When the tumor is located in the Rs or Ra region, surgery can be completed laparoscopically. After dissection of the mesenterium and lymphadenectomy are performed, the anal side of the rectum is divided using EndoGIA II. When the tumor is located in the Rb portion, it is impossible to resect the rectum intracorporeally. In this situation, aperi anal maneuver is essential. The rectal mucosa is circumferentially incised just above the dentate line and the internal anal sphincter is dissected. Dissection is advanced to the intersphincteric space. Dissection between the rectum and the levator ani muscle is completed, and the rectum is pulled through the anus. After the oral side of the rectum is divided, a J-pouch is mase and J-pouch-anal anastomosis is performed. Forty-seven patients with rectal carcinoma were operated upon laparoscopically. Postoperative recovery was better than that after open surgery. Serious intraoperative or postoperative complications have not been encountered in this series. In conclusion, laparoscopic surgery is thought to be the procedure of first choice for early rectal carcinoma.  相似文献   

6.
A method is presented in which the rat testis is extensively mobilized through a low abdominal incision, but in which its blood supply is carefully preserved. Localized hyperthermia is induced in this mobilized testis by water bath immersion. The tissue temperature is measured during and after immersion by means of a thermocouple inserted into the tissue. The relative sensitivity of spermatogenic tissue to increased temperature is confirmed and the relative resistance of Sertoli and Leydig cells is noted. Minimal or absent inflammatory reaction to thermal destruction of testicular cells is found as long as the tubule is intact. A marked peritesticular inflammatory response is noted when the total testicular tissue is destroyed at the highest temperature tested.  相似文献   

7.
The abdomen is involved in 10% to 30% of patients with pulmonary tuberculosis. The diagnosis is not difficult in societies where the disease is common and clinicians are aware of it. While previously rare in Western countries, the incidence is now rising among immigrants, and patients with AIDS. In HIV-infected patients, the disease is of a rapidly progressive nature, often fatal through usually treatable, but the diagnosis is difficult and often delayed. Treatment is essentially medical but occasionally surgical operation is necessary.  相似文献   

8.
The practical electric light bulb was invented by Thomas Alva Edison in 1879. Halogen lamp is the toughest and brightest electric light bulb. With light filter, it is used as a source of near infrared light. Super Lizer and Alphabeam are made as near infrared light irradiator using halogen lamp. The light emmited by Super Lizer is linear polarized near infrared light. The wave length is from 600 to 1,600 nm and strongest at about 1,000 nm. Concerning Super Lizer, there is evidence of analgesic effects and normalization of the sympathetic nervous system. Super Lizer has four types of probes. SG type is used for stellate ganglion irradiation. B type is used for narrow area irradiation. C and D types are for broad area irradiation. The output of Alphabeam is not polarized. The wave length is from 700 to 1,600 nm and the strongest length is about 1,000nm. Standard attachment is used for spot irradiation. Small attachment is used for stellate ganglion irradiation. Wide attachment is used for broad area irradiation. The effects of Alphabeam are thought to be similar to that of Super Lizer.  相似文献   

9.
10.
We describe an arthroscopic technique by which to reconstruct both the calcaneofibular ligament and anterior talofibular ligament anatomically. The ankle joint is examined through the anteromedial portal and a lateral portal close to the talar insertion of the anterior talofibular ligament. The subtalar joint is examined through the anterolateral portal and the middle portal. Associated intra-articular pathology (e.g., osteochondral defect) is evaluated and addressed. The calcaneofibular ligament is an extracapsular structure that can be examined arthroscopically through the anterolateral portal in the extra-articular plane. The peroneal tendon sheath is stripped with a small periosteal elevator through the middle subtalar portal, and the calcaneal insertion of the calcaneofibular ligament is identified. The plantaris tendon is identified and freed through multiple small wounds at the medial calf, and the tendon is cut proximally and retrieved to its calcaneal insertion. A calcaneal bone tunnel (tunnel 1) is created between the plantaris tendon and the calcaneofibular ligament insertions by use of a 3.5-mm drill bit. The tendon graft is then looped onto a suture, and the suture is passed through the tunnel to the calcaneofibular ligament insertion and retrieved to the middle subtalar portal. Through the anterolateral subtalar portal, the fibular insertion of the calcaneofibular ligament is identified. Another bone tunnel is created from this point to the posterior edge of the fibula (tunnel 2) with a 3.5-mm drill through the middle subtalar portal. The fibular insertion of the anterior talofibular ligament is identified on ankle arthroscopy. Tunnel 3 is created from this point to the exit point of tunnel 2 through the lateral ankle portal. The tendon graft is retrieved to the lateral ankle joints through the second and third tunnels and is pierced through the lateral ankle capsule and course from intracapsular to extracapsular. The tendon graft loop is anchored to the insertion point of the anterior talofibular ligament by a 4.0-mm cancellous screw with a spiked washer. The tendon graft is tensioned by pulling the free end of the tendon graft while tightening the screw. The free end of the tendon graft and the stay stitch are sutured to surrounding soft tissue or anchored with another 4.0-mm cancellous screw and spiked washer. The procedure is then completed, and a short leg cast is applied. The patient is advised to perform non–weight-bearing walking for 6 weeks.  相似文献   

11.
INTRODUCTION: Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is a difficult process with a long learning curve. Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. Many different instruments and methods have been described for laparoscopic suturing and knot tying. We have developed a new technique for laparoscopic knot tying. TECHNIQUE: The long end of the suture is held with a left-hand instrument, and the instrument is rotated for 360 degrees in a clockwise direction to make a forward-direction loop. The end of the loop is grasped with the right-hand instrument, and the other end of the suture is grasped with the left-hand instrument. The suture end, held by the left hand, is pulled though the loop and tied, thus making a half-knot of a square knot. The second half-knot is made by using the right-hand instrument with the same technique. DISCUSSION: Laparoscopic suturing and knotting is difficult to perform, especially when the angle between the working instruments is narrow and working space is limited. In all these situations, knot tying using this technique makes knotting more simple and easy to perform, especially for those who have limited experience in intracorporeal suturing and knot tying. No special instrument is required to perform knot tying with this technique.  相似文献   

12.
Alveolar carcinoma of the lung is a rare form that is often discovered casually, and may well be asymptomatic. Four personal cases are presented. The view is advanced that this is a distinct form that is clearly distinguishable from bronchogenic adenocarcinoma. It has a single site and is derived from the type II pneumocyte. Particular attention is given to the clinical and diagnostic features of alveolar carcinoma. It is felt that early diagnosis followed by radical surgery leads to a marked improvement in prognosis.  相似文献   

13.
Intercostal chest tube drainage with an underwater seal is a simple and effective method to eliminate air in the pleural space. The patient is then positioned lying, shoulder elevated and undressed to the waist, with the arm abducted at 90°. The fourth intercostal space just anterior to the mid-axillary line is usually chosen. The surgical field is prepared with antiseptic solution, and lidocaine is injected to create a transverse wheal to demarcate the length and position of the skin incision. The tip of the scalpel blade is used to make an incision large enough to comfortably admit the index finger. Blunt dissection is undertaken using a Roberts clamp. Once the deep fascia is reached, the intercostal space becomes distinctive. Further lidocaine is used to create a field block by injecting multiple intercostal nerves. After leaving adequate time for the intercostal block to work, the Roberts clamp is then used with gentle but firm pressure spreading the intercostal muscles apart. When the Roberts clamp enters the pleural cavity, a gush of air is normally audible. The jaw of the Roberts clamp is opened to dilate the puncture site, and then followed by the index finger to dilate a tract into the pleural space. Once satisfied that there is no lung tissue adhering to the chest wall, a 28 French gauge drain is introduced into the pleural space without a trocar. Once the drain is sited, it is attached to an underwater seal, and the drain is then secured with a silk suture.  相似文献   

14.
Total or near-total esophageal stricture results from multiple processes. Traditional treatment with wire cannulation followed by serial dilation is often contraindicated due to poor visualization and the risk of perforation. We seek to demonstrate that combined antegrade and retrograde endoscopy are useful for treatment of total or near-total esophageal strictures. The gastrostomy tube is removed and the tract dilated. A standard endoscope is passed retrograde to the stricture. An antegrade endoscope is advanced until transillumination across the stricture is visualized. A biopsy forceps or needle is used to traverse the stricture in an antegrade fashion. The tract is cannulated with a stiff wire that is then brought out through the gastrostomy site. The stricture is serially dilated. The gastrostomy tube is replaced, and a nasogastric tube is left across the stricture for 3 to 4 weeks. The endoscope is withdrawn and an 18 or 20 Fr gastrostomy tube is left in place. A total of three patients with total esophageal strictures were treated using combined antegrade and retrograde esophagoscopy. All three patients regained the ability to swallow secretions. Importantly, there were no instances of esophageal perforation. This technique has broader application, including combination with minilaparotomy for patients without retrograde access. Further research is needed to determine durability of stricture dilation.  相似文献   

15.
Surgery during pregnancy is complicated by the need to balance the requirements of two patients. Under usual circumstances, surgery is only conducted during pregnancy when it is absolutely necessary for the wellbeing of the mother, fetus, or both. Even so, the outcome is generally favourable for both the mother and the fetus. All general anaesthetic drugs cross the placenta and there is no optimal general anaesthetic technique. Neither is there convincing evidence that any particular anaesthetic drug is toxic in humans. There is weak evidence that nitrous oxide should be avoided in early pregnancy due to a potential association with pregnancy loss with high exposure. There is evidence in animal models that many general anaesthetic techniques cause inappropriate neuronal apoptosis and behavioural deficits in later life. It is not known whether these considerations affect the human fetus but studies are underway. Given the general considerations of avoiding fetal exposure to unnecessary medication and potential protection of the maternal airway, regional anaesthesia is usually preferred in pregnancy when it is practical for the medical and surgical condition. When surgery is indicated during pregnancy maintenance of maternal oxygenation, perfusion and homeostasis with the least extensive anaesthetic that is practical will assure the best outcome for the fetus.  相似文献   

16.
IntroductionTrigger wrist is a rare entity and is usually seen in adults. Trigger wrist in children and teenagers is extremely rare.Presentation of caseA case of Trigger wrist and carpal tunnel syndrome in a 16-year-old male is reported. Surgical exploration revealed a ganglion related to the flexor superficialis tendon. After surgical excision, there was complete resolution of symptoms.DiscussionThis is a very rare case and there are no similar cases in the literature. The literature is reviewed and a classification of the causes of triggering at the wrist level is offered. The management approach and outcome are also discussed.ConclusionTrigger wrist with concurrent carpal tunnel syndrome is a rare entity. It is usually caused by space occupying lesions. Excision is usually curative.  相似文献   

17.
The most clinically useful system of classification of neck lymph nodes is grouping into levels I-V. Anatomical, clinical and pathological studies demonstrate that although generally lymphatic flow is from above downwards, level I is often bypassed and level V is seldom involved. Neck dissection is classified into radical, modified radical, selective and extended radical neck dissections. Recent studies demonstrate that elective neck dissection is beneficial to the outcome of oral cancer patients, but not necessarily to laryngeal and pharyngeal cancer patients. Modified radical neck dissection is as effective as radical neck dissection when performed in the elective situation. Selective neck dissection in the form of supra-omohyoid neck dissection is useful as a staging procedure. Modified radical neck dissection is acceptable for the N1 neck provided postoperative radiotherapy is given.  相似文献   

18.
Intercostal chest tube drainage with an underwater seal is a simple and effective method to eliminate air in the pleural space. The patient is then positioned lying, shoulder elevated and undressed to the waist with the arm abducted at 90°. The fourth intercostal space just anterior to the midaxillary line is usually chosen. The surgical field is prepared with antiseptic solution, and lidocaine is injected to create a transverse wheal to demarcate the length and position of the skin incision. The tip of the scalpel blade is used to make an incision large enough to admit the index finger comfortably. Blunt dissection is undertaken using a Roberts clamp. Once the deep fascia is reached, the intercostals space becomes distinctive. Further lidocaine is used to create a field block by injecting multiple intercostal nerves. After leaving adequate time for the intercostal block to work, the Roberts clamp is then used with gentle but firm pressure, spreading the intercostals muscles apart. When the Roberts clamp enters the pleural cavity, a gush of air is normally audible. The jaw of the Roberts is opened to dilate the puncture site, and then followed by the index finger to dilate a tract into the pleural space. Once satisfied that there is no adherent lung tissue to the chest wall, a 28 F drain is introduced into the pleural space without a trocar. Once the drain is sited, it is attached to an underwater seal, and the drain is then secured with a silk suture.  相似文献   

19.
Fournier's gangrene is remarkebly rare but severe, life threatening condition. Thanks to better earlz recongnition of disease in past few years, the percentage of patients which survive this condition is considerable, but consequence of this fact is large number of patients with defects of cutis and subcutis in perineal and scrotal reigions. Reconstruction of this defects is cimplicate and require helathy, well vascularised tissue from another anatomical region which is not involved in gangreneous process. Authors present two cases of reconstruciton of defects in perineal and scrotal regions. First case is large defect which is covered by transposition of musculus gracilis musculo-cutaneous flap. Second case is lesser defect which is enclosed by mobilisation of local skin flaps.  相似文献   

20.
目的 采用新标准更科学地评估中西医结合治疗少弱精子性不育症的疗效。方法 采用 2 0 0 2年国内最新的分度诊断标准和分度疗效标准对中西医结合治疗的 110例少弱精子性不育症的疗效进行评估。结果 ①少精子性不育症 :轻度总有效率85 .71% ,妊娠率 4 6 .4 2 % ;中度总有效率 6 5 .2 1% ,妊娠率 2 1.73% ;重度总有效率 4 1.6 6 % ,妊娠率 8.33%。②弱精子性不育症 :轻度总有效率 6 2 .96 % ,妊娠率 4 8.15 % ;中度总有效率 4 7.5 0 % ,妊娠率 2 5 .0 0 % ;重度总有效率 2 7.91% ,妊娠率 6 .98%。结论 中西医结合治疗可明显提高少弱精子性不育症的精子密度、精子活力和妊娠率 ,特别是对轻度和中度少弱精子性不育症疗效较高 ,而对重度少弱精子性不育症疗效较低。  相似文献   

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