Wounds and intraoperative injuries of the inferior vena cava

An analysis of 1054 acts of medicolegal examinations of corpses of people who died from injuries of major vessels has been made. It was established that wounds of the v. c. i. took place in 0.7% of the cases. The experience with the treatment of 9 patients with thrust-cut wounds of v. c. i. and 14 patients with iatrogenic trauma of v. c. i. is described. Methods of help in the prehospital period, specific operative interventions, methods of postoperative management of patients with injuries of v. c. i. are described.     

结核感染T细胞斑点试验结合MRI诊断足踝部结核有效性分析

目的评价结核感染T细胞斑点试验（T-SPOT.TB）结合MRI诊断足踝部结核的有效性。方法180例疑似足踝部结核患者接受体检、MRI榆查、T-SPOT．TB检测及组织病理检查,并以组织病理检查阳性作为确诊的金标准。结果180例疑似患者中21例确诊为足踝部结核。T-SPOT．TB检测诊断足踝部结核的敏感性和特异性分别为85．71％和96．86％,MRI柃查分别为76．20％和94．34％,T-SPOT．TB联合MR1俭奄分别为71．43％和伽．37％。结论TSPOT．TB结合MRI检查是一种可有效地诊断足踝部结核的方法。     

Double fractures of the bones of the crus and their treatment

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.     

护理人员乳房保健知识问卷调查分析

目的探讨护理人员对乳房常识、乳房相关保健知识以及乳癌相关知识的知晓情况,以便对护理人员进行相关知识讲座,提高其保健知识水平.方法自行设计问卷表,调查三家三级甲等医院各层次在岗护理人员,共发出调查问卷100份,回收有效问卷97份.问卷内容包括三大项目共24个问题.结果护理人员中仍有22.7%不知哺乳对母体的好处;9.3%不了解月经周期与乳房不适的关系;14.5%不知应行乳房自查;19.6%不知道乳房自查的最佳时间;47.4%不了解副乳;对乳房检查手段、乳房常见就诊症状知晓率仅为43.3%～87.6%;对乳癌四种常见的危险因素的认识分别为30.9%、39.2%、58.8%和94.8%.结论护理人员缺乏对乳房功能的正确认识,对乳房保健知识和乳癌相关知识也较缺乏;护理人员需要加强对相关保健知识的学习,只有具备各种医疗知识,方能在对病人的健康教育中发挥其应有的作用.     

Arthrolysis of the elbow and reconstruction of the collateral ligaments using a fascial strip of the triceps

Objective  Anatomic reconstruction of the collateral ligament of the elbow. Restoration of stability and function of the elbow. Reduction of pain. Improvement of range of motion. Indications  Instability of elbow. Insufficiency of ulnar or radial collateral ligament. Loss of the capsuloligamentous apparatus as seen after extensive resection of heterotopic ossifications involving ligaments and capsule. Contraindications  Unfavorable skin condition. Local infection. Damage to or previous operation of triceps tendon. Surgical Technique  Posterior, posterolateral or posteromedial approach. Dissection while always protecting the ulnar nerve. A neurolysis or a subcutaneous transposition may become necessary. Resection as complete as possible of ossifications and removal of ossified radial/ulnar capsuloligamentous apparatus. Exposure of the superficial fascial of triceps up to the olecranon. Harvesting of a fascial strip of the triceps 12 cm long and 1.5 cm wide on either the radial or ulnar side or both, left attached to the olecranon. Anatomic triangular reconstruction of the collateral ligaments with the fascial strip. Transosseous fixation. Wound closure in two layers. Results  In five patients, aged 25–59 years, an open arthrolysis combined with an ulnar triceps fascioplasty was done. In one instance it was combined with radial fascioplasty and once with a reconstruction of the radial collateral ligament using the tendon of the palmaris longus. Average duration of follow-up 2.2 years (8 months to 4.4 years). Assessment criteria and results: Function: marked improvement. Subjective assessment: no instability. Joint stability: laxity of ulnar collateral ligament grade I in one patient. Pain: excellent pain reduction. Range of motion: marked increase.     

不同部位骨骼肌失神经支配后超微结构变化的实验研究

目的：探讨长期失神经支配后萎缩骨骼肌神经修复手术疗效欠佳的机制。方法：12例臂丛神经损伤后1、2、3、6、12和18个月患者，术中切取小指展肌和肱二头肌的失神经骨骼肌，以相同部位的正常骨骼肌作对照，观察失神经骨骼肌超微结构和计数肌卫星细胞数量变化。结果：失神经支配后2个月，骨骼肌细胞的超微结构基本正常，肌纤维周围无明显增生的胶原纤维，可见到运动终板，肌卫星细胞数量多；6个月，肌丝断裂，排列紊乱现象明显增多，细胞核体积变小，染色加深，细胞核固缩，肌纤维周边出现较多的成纤维细胞和脂肪细胞以及增生的胶原纤维；12个月后，未见类似运动终板的结构，肌卫星细胞体积缩小，数量减少，小指展肌较肱二头肌中肌卫星细胞含量下降速度快。结论：失神经经支配晚期骨骼肌纤维中运动终板消失和胶原增生以及肌卫星细胞含量的迅速下降可能是影响疗效的主要因素之一。     

Prognostic value of DNA ploidy of colorectal tumor cells

The analysis of ploidy provides valuable information allowing a more precise diagnosis, a more dependable prognostic and the choice of appropriate therapy. With ploidy analysis one can assess the aggressiveness of a given tumor. Aneuploidy of tumors clearly indicates a significantly lower patient survival index. Ploidy analysis of tissue sections yields a clear overall indication of the proportion of cells exhibiting hyperploidy within the tumor mass. The application of this approach is amenable to diverse types of tumors including colo-rectal neoplasias. Additionally, it provides a correlation with the histological presentation of each tumor. The study includes DNA ploidy analysis of 212 patients with primary adenocarcinoma. Sixty-four of the cases examined had follow-ups of a least 2 years. Eighteen of this group had diploid non-proliferating tumors, of which 2 (11%) subsequently died. Nineteen of the 64 had proliferating diploid tumors, 11 (58%) of whom died within the follow-up periods. Twenty-seven patients had tumors which were clearly aneuploid, 12 (45%) of whom later died. Our study demonstrates the prognostic value of ploidy analysis. The preliminary results indicate that mortality of patients with proliferating tumors is approximately 50% after 2 years. This prognostic is independent of other more classical criteria of tumor staging, namely Dukes' classification, histological differentiation and size of tumor. In the near future, ploidy analysis should be introduced as a standard part of tumor assessment. It clearly provides a valuable prognostic allowing the selection of patients requiring a careful follow-up.     

Uretero-ureterostomy,transuretero-ureterostomy

The authors describe various possibilities of using uretero-ureterostomy in cases of healthy bladder and in cases of supracystic urinary diversion. The history and the technique of the operation are described. Attention is called to the direction of anastomosis in case of ureters differing in the width of their lumen. Clinical observations of 21 cases of uretero-ureterostomy are reported. In 17 cases transuretero-ureterocutaneostomy was done. Stenosis of the recipient ureter did not develop in any of these cases. The main complication in transuretero-ureterostomy was stenosis of the foramen of ureterocutaneostomy. For avoiding this complication of transureteroureterocutaneostomy only wide-lumen ureters should be anastomosed to the skin.     

Epidemiologic data of rupture of the fibular ligament of the upper ankle joint]

Epidemical studies of fibular ligament lesions of the ankle joint lateral ligamentous lesions at the ankle joint are one of the most accidental injuries. It is necessary to bestow great care on prevention and therapy to avoid after effects. We report about 150 cases of acute injuries of the fibular ligament lesions of the ankle joint in 1987 treated by surgery and followed up to explore the cause of injury, its dimensions, the groups of patients and time of accident. Corresponding to literature sports activities were mostly the reason of accidents followed by casional accidents and industrial accidents. Mainly young people suffered from this injury preferring men. The part of reruptures was 14%. In 61.3% both Lig. fibulotal. ant. and Lig. fibulocalc. were ruptured followed by isolated rupture of the Lig. fibulotal.ant. in 32.7% of the cases.     

胰腺实性假乳头状瘤的诊断和治疗

目的 总结胰腺实性假乳头状瘤的临床诊治经验,并提出较符合我国国情的诊治流程.方法 回顾性分析2001年1月至2007年3月收治的50例胰腺实性假乳头状瘤患者的临床资料.其中男3例,女47例;中位年龄24岁(13～60岁).术前B超、CT等检查均有特征性影像学表现,血清肿瘤标志物多为阴性.肿瘤位于胰头部23例、胰颈部3例、钩突部2例、胰体部3例、胰尾部18例、原发病灶位置不明1例.48例患者行手术切除肿瘤,1例行剖腹探查术,1例行CT引导下转移病灶穿刺活组织检查术.结果 50例患者中49例获得了"胰腺占位"的术前诊断.32例肿瘤包膜完整的患者有18例、16例肿瘤包膜不完整患者有11例未行冷冻病理检查而直接选择相应术式.32例患者随访3～55个月,均未发现肿瘤复发、转移.结论 胰腺实性假乳头状瘤多发于青年女性,CT检查结果最具诊断价值,外科手术切除肿瘤是首选治疗方式,预后良好.常用的术式为保留十二指肠的胰头切除术与胰体尾+脾切除术.肿瘤包膜是否完整,决定是否行术中冷冻病理检查和指导手术方式的选择.最常见的并发症为胰瘘.     

整形修复手术对唇裂术后继发畸形患者体像与人格状态影响的研究

目的：调查唇裂术后继发畸形患者的体像障碍特点及人格状态,探讨整形修复手术对唇裂术后继发畸形患者体像与人格状态的影响。方法：采用体像障碍自评量表及艾森克人格问卷,对75例唇裂术后继发畸形患者于整形手术前后进行问卷调查,分析结果。结果：体像障碍状态术前的检出率为13．3％（10例）。75例患者体像障碍自评量表评分手术前为（23．488±11．192）分,手术后下降为（15．846±11．219）分（P=0．000）;术后躯体缺陷感、情绪受损度和社会交往度3个方面改善明显,表现为评分较术前明显降低（P〈0．05）。患者术前艾森克人格问卷中的神经质或情绪的稳定性量表（N量表）、精神质量表（P量表）及掩饰量表（L量表）的分值分别为（49．381±11．754）分、（49．102±8．569）分和（45．781±9．826）分,术后分别为（45．833±12．802）分、（47．689±7．758）分和（47．939±11．083）分,术后与术前比较,差异均有显著性（P〈0．05或P〈0．01）。结论：唇裂术后继发畸形患者体像障碍状态的比例较高、整形修复手术可明显纠正患者的消极体像,提高患者的自信心;术后患者情绪稳定性明显提高,社会适应性显著增强,心理防御显著提高。     

Die Rückfußarthrodese durch retrograde Marknagelung

BACKGROUND: Simultaneous arthrodesis of the ankle and subtalar joints and correction of axial malalignment of the hindfoot in cases of bony defects and/or circulatory disturbances of the talus after multiple previous interventions. Internal stabilization with a short distal femur nail. Restoration of pain-free weight bearing. Failure of arthrodesis of the ankle and subtalar joint in patients with severely altered bone structure particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of the ankle and subtalar joint. Poor skin or soft-tissue condition. Acute osteitis/osteomyelitis. METHODS: Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and posterior facet of the subtalar joint. Interposition of bone grafts harvested from the posterior iliac crest. Correction of malalignment of the hind- and forefoot. Locked nailing with a short distal femur nail. RESULTS: All 21 prospectively enrolled patients were followed-up clinically and radiographically at an average of 1.2 years (0.6-2.1 years) postoperatively. The average age of the 4 women and 17 men at the time of surgery was 53.4 years (38.9-73.7 years). The goal of the surgery was achieved in all patients. Subjective assessment was good in 14 patients and satisfactory in 3 patients. Complications occurred in 5 patients; these included loss of nail purchase (2), dislocation of locking screw (1), breakage of locking screw (1), and nonunion (1).     

Clinical observation of bacterial isolates from urine specimens of outpatients

Changes of bacterial isolates from urine specimens of outpatients with urinary tract infections (UTI) from 1977 through 1984 were studied. Organisms which were isolated from patients with bacteriuria of over 10(3) bacteria per ml of urine regardless of grade of pyuria were studied. The incidence of UTI, especially that of acute cystitis was decreased during the recent 8 years. E. coli was the most predominant isolate in acute UTI with an isolation frequency of over 70% every year, followed by S. epidermidis nearly every year. Citrobacter spp., Klebsiella spp., P. mirabilis and S. aureus were also isolated steadily every year. Bacterial isolates in acute UTI were generally composed of these six species of bacteria. Although many kinds of bacteria were isolated in chronic UTI, E. coli was the most frequent species with an isolation frequency of 17-37%, followed by E. faecalis except in 1981 and 1982. The tendency of gram-negative rods to increase in acute and chronic UTI was observed except in 1981 and 1982. A slight decrease in sensitivity of E. coli and P. mirabilis against ampicillin (ABPC) and sulbenicillin (SBPC) was observed in acute UTI. In chronic UTI, the tendency of the sensitivity of E. coli against ABPC, SBPC and nalidixic acid to recover and the tendency of the sensitivity of P. aeruginosa against dibekacin to decrease were observed. E. faecalis was estimated to be sensitive to gentamicin, cefazolin, minocycline and fosfomycin. However, unlike those species mentioned above, many strains of E. faecalis showed a positive disc sensitivity to these drugs.     

Estimation of twenty days treatment of neck pain by McKenzie method]

The aim of our study was to define the most common reasons for chronic neck pain and to state a connection between correction of posture by McKenzie and the character of pain. We investigated 30 people with chronic neck pain. They were patients of Out-Patients Unit of Rehabilitation. The average age was 43 +/- 6. Our group consisted of 21 women and 9 men. We used McKenzie protocol as a basis on the beginning and the end of treatment. The most important reason of neck pain in this study was frequent flexion of the neck and long-lasting flexion position. Pain often was activated by flexion and rotation of the neck. Above 70% of our patients stated that a character of pain changed towards better profile. Method of McKenzie is looked a quite successful in a correction of a posture of the body itself. Probably this method is capable to resolve a large portion of neck-pain problems. It should be used more frequently in clinical practice.     

新西兰大白兔桡骨的解剖学观测

目的 获取新西兰大白兔桡骨的解剖学数据,为其相关的实验研究提供参考.方法 选取成年新西兰大白兔20只,观察桡骨外形,并测量桡骨长度,前曲度,桡骨中点矢状径及横径.结果 新西兰大白兔桡骨外形与人类相似,稍前曲,前曲度(26.08±2.54)度;桡骨长(70.66±1.91)mm;桡骨中点横径(4.18±0.37)mm;桡骨中点矢状径(3.07±0.29)mm;桡骨中点横径/桡骨全长(0.059±0.005);桡骨中点矢状径/桡骨全长(0.043±0.004);平均体质量:(2.88±0.22)kg;桡骨长度与体质量呈正相关,横径与体质量、矢状径与体质量、桡骨横径与长度比较均无明显相关.结论 新西兰大白兔桡骨的解剖特点及测量数据,可为其相关实验研究提供参考.     

Autologous osteochondral transplantation for talar lesions

Objective  Replacement of cartilaginous defects of the talus by autologous osteochondral cylinders allowing restoration of form and function of ankle. Elimination of pain and joint irritation, delay of osteoarthritis. Indications  Localized osteochondral defects not exceeding a diameter of 2 cm. Circumscribed cartilage damage of grade III and IV according to Bauer & Jackson. Osteochondritis dissecans of grade III and IV. Localized avascular necrosis not exceeding a diameter of 2 cm. Contraindications  Osteoarthritis involving the entire ankle. Defects exceeding 2 cm in diameter. Surgical Technique  Transmalleolar approach, either medial or lateral. Determination of size of defect, removal of defect with a punch covering the entire lesion. Harvesting of osteochondral cylinder from the ipsilateral lateral femoral condyle, its diameter exceeding the diameter of the defect zone by 0.3 mm. The harvested cylinder is press-fit into the surgical defect. Results  In a prospective study between 04/1997 and 12/2000, this technique was used in 39 patients (20 men, 19 women, average age 28.7 [16–57] years). Involvement of the medial aspect of the talar dome 31 times, of the lateral six times, and of the tibial articular surface twice. At average follow-up of 15.9 months, Lysholm score improved from an average of 62 points to an average of 92 points. Postoperative MRIs with gadolinium i.v. showed perfect incorporation of the cylinders in all patients. Complications: transient patellofemoral symptoms at the area of harvesting, slight pain over the osteotomy site of the medial malleolus which disappeared after implant removal. One instance of synovitis; a wound infection proved to be transient.     

Hydrodynamic of the C.S.E. under experimental occlusion of superior sagittal sinus (author's transl)]

It is recognized that absorption of C.S.F. occurs mainly at the superior sagittal sinus through arachnoid villi after study of the Retzius (1875) and Weed (1914). We are interested in C.S.F. circulation and pathway on the obstructed superior sagittal sinus. At the border of middle one third and posterior one third of the superior sagittal sinus was obstructed experimentally. 1. When evans blue 0.5 to 1.0 ml was injected into lateral ventricle or cisterna magna, the evans blue was recognized on basal surface in either normal and obstructed dog of the superior sagittal sinus. Evans blue stained the convexity of normal dog, however, did not stain the convexity in the dog of obstructed superior sagittal sinus contrally. This was caused by the disturbance of C.S.F. circulation toward superior sagittal sinus. On the intraventricular injection of evans blue, it infiltrated into parenchym from ventripcle due to C.S.F. circulatory disturbance. 2. Study of radioactivity in the peripheral blood after intracisternal or intraventricular injection of RISA 100 muCi revealed that the radioactivity in the blood lowered with day after obstruction of superior sagittal sinus comparing with normal dogs. 3. Macroautoradiography after intracisternal or intraventricular injection of P 2mCi showed lower RI activity at the convexity, but increased activity at the basal brain in the obstructed dogs of superior sagittal sinus. These results showed that C.S.F. in normal dog was absorbed through the brain surface, expecially the basal surface of brain, other than through the superior sagittal sinus. Absorption of C.S.F. through the convexity of brain was disturbed significantly in the obstructed dogs of superior sagittal sinus. C.S.F. absorption into peripheral blood decreased in chronic stage after occlusion of surperior sagittal sinus and it suggested that the absorptive function of C.S.F. through the basal surface of brain was restricted.     

痤疮丙酸杆菌培养滤液对THP-1细胞增殖和吞噬功能的影响

目的:探讨外伤后细菌性致死性肉芽肿病原菌-痤疮丙酸杆菌培养滤液对单核巨噬细胞株THP-1细胞增殖、吞噬功能的影响。方法:采用MTT比色法、DAF比色法观察比较痤疮丙酸杆菌标准株与从本病患者皮损分离菌株在相同浓度培养滤液及相同菌株不同浓度的培养滤液对THP-1细胞增殖、吞噬功能的影响。结果:1、痤疮丙酸杆菌培养滤液作用于THP-1细胞,可见细胞在12h时增殖明显,48h增殖达到高峰,和空白对照组相比有显著性差异(P<0.05);而标准株较患者分离株培养滤液的刺激增殖作用强(P<0.05);2、培养滤液均能促进THP-1细胞的吞噬功能,并且促进作用的强弱与滤液浓度有关。标准株在20%浓度时刺激作用最强,分离株均表现为100%浓度时刺激作用最强。但各菌株滤液间无显著性差异(P>0.05);结论:本病致病菌及标准株培养滤液对THP-1细胞均有明显促进增殖的作用;对THP-1细胞有促吞噬作用且与浓度有关。     

Experimental model of infantile obstructive cholangiopathy using 1,4-phenylenediisothiocyanate

Inflammatory processes on the hepato-biliary system may play an important role in the pathogenesis of infantile obstructive cholangiopathy (including biliary atresia, neonatal hepatitis and bile duct dilatation). A model of the disease was produced in rats using 1,4-phenylenediisothiocyanate (P.D.T.). P.D.T. was given to five groups of rats of different developmental stages from the fetal stage. Changes in the hepato-biliary system due to P.D.T. were compared histo-pathologically in 97 rats. Three groups of rats given P.D.T. after birth showed characteristic dilatation of the extra-hepatic bile ducts with inflammation. One group, of rats given P.D.T. during the fetal period showed thickening and fibrosis of the wall of the extrahepatic bile ducts without dilatation. The last group, of rats given P.D.T. during the fetal period and again at thirty days postnatally showed stenosis or almost atresia of the ductal lumen due to severe fibrosis and thickenig, of the extra-hepatic bile ducts. This experimental model suggests that the difference in developmental stages of the pathogenic processes may play an important role in the production of different pathogenic features of infantile obstructive cholangiopathy. Presented at the 79th Annual Congress of the Japanese Surgical Society, Sapporo, May 1979.     

大鼠器官移植术后的弓形虫感染及特异性抗体的检测

目的 观察大鼠器官移植术后弓形虫感染发病情况及环抱素A(CsA)对感染的影响，并探讨该病的诊断方法。方法 以Wistar大鼠为供者，SD大鼠为受者，按供、受者术前弓形虫的感染情况分为供者隐性感染组(20只)和受者隐性感染组(20只)，两个组均接受异位心脏移植，术后每组各有10只接受CsA治疗，另10只不用。术后观察动物的存活情况、发病表现，监测弓形虫特异性抗体IgM、IgG滴度和弓形虫循环抗原(CAg)的变化。结果移植术后供者隐性感染组的弓形虫感染死亡率、CAg阳性率、弓形虫感染发病率均高于受者隐性感染组；使用CsA可使弓形虫感染危险性增高；弓形虫特异性抗体IgG、IgM的测定结果有时受CsA的影响，而CAg不受CsA影响，且较抗体出现早。结论 CsA使用可使大鼠心脏移植后的弓形虫感染发病率升高；弓形虫特异性抗体IgM、IgG和循环抗原(CAg)的测定，并结合临床表现，对于弓形虫感染的早期诊断有帮助。