Relaparotomy in penetrating gunshot wounds of the abdomen]

The article studies the results of treatment of patients with abdominal wounds inflicted by modern small arms, who had laparotomy performed. Because of various postoperative complications these patients have undergone a relaparotomy. The most frequent complications were: peritonitis and acute occlusive ileus. Indications for relaparotomy at an early stage of diagnosis were the following: symptoms of intoxication, Blumberg's symptom, muscle tension in the front side of the abdomen. The article makes an analysis of medical errors that led to relaparotomy.     

Blood reinfusion in penetrating gunshot wounds of the abdomen]

On the basis of literature and their own experience in performing the reinfusion of bacteria-contaminated blood in 20 patients with gunshot penetrating abdominal injuries the authors make a conclusion that in critical cases there are no alternative to application of reinfusion. The article gives clinical examples and contains data concerning the character of lesions. Indications and counter-indications for reinfusion are enclosed.     

Postoperative intensive therapy in penetrating gunshot wounds of the abdomen]

The authors show that application of anticipated postoperative intensive care gives the possibility ot obtain more complete effect of compensation. The basic components of this therapy are the following: removal of hypovolemia and anemia, combined (central and regional) anesthesia, prevention of pneumonia, normalization of salt and water exchange, removal of excessive catabolism, adequate ensuring of organism with energy and plastic material for long-time compensation, prophylaxis and treatment of paresis of digestive tract, chemoprophylaxis of wound infection. The proposed program of intensive therapy gives the possibility to minimize the lethality among wounded with penetrating abdominal gunshot injuries and can be used as a basic one for the development of various schemes of intensive therapy for other categories of wounds.     

Postmortem ventilation in cases of penetrating gunshot and stab wounds to the chest

We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT).The study included 6 subjects (1 female, 5 male; age 32–67 years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results.In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium.The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required.     

The specialized treatment of the wounded with complications and unfavorable sequelae of gunshot wounds to the extremities

The article gathers the management experience of 367 cases of complications in gunshot injuries of extremities, including 165 patients with amputation stumps of extremities and 202 patients with complicated gunshot fractures. The analysed group was consisted of the patients with stump diseases, irregular knitting or ununited fractures, defects of bone tissue or heavy purulent complications. Using the modern methods of diagnostic and treatment the authors succeeded in 30.9% of cases: in 59.9% satisfactory results were obtained. Unsatisfactory results were marked at 9.2% of patients.     

Endovenous laser ablation for the treatment of varicose veins

Lower extremity venous insufficiency secondary to saphenous vein insufficiency is a common medical condition that decreases a patient's quality of life. Traditionally treated with high ligation and stripping, minimally invasive procedures using endovenous thermal ablation techniques, such as endovenous laser ablation, have evolved. The use of detailed imaging and advances in the understanding of the anatomy of truncal vein insufficiency are important for performing the endovenous laser ablation procedure successfully. Endovenous laser ablation eliminates reflux with less morbidity, faster recovery, and improved cosmetic results with high patient satisfaction. As such, it has become the preferred treatment method for varicose veins since it was first introduced a decade ago.     

Treatment planning for the breast patient: with or without lung correction?

Patients who have undergone a surgical lumpectomy for breast cancer are routinely referred to our clinic for a course of radiation therapy. This treatment consists of a pair of obliquely opposing radiation fields that encompass the breast and underlying structures. In order to treat the chest wall, a portion of lung must be included in this target volume, as breast tumours can invade the underlying chest wall due to direct invasion, blood invasion, or lymphatic permeation. At our clinic, we have always included this volume as normal tissue (with normal tissue density); thus, an inhomogeneity correction has never been generated on any breast plan. The aim of our study was to accurately measure the volume of lung within the treatment fields at time of simulation, using the simulator films and patient parameters, and to determine the point at which this volume of lung significantly altered the computer plan. This would necessitate the generation of a new distribution in order to produce a homogeneous dose to within +/- 5%. A table was constructed to identify those patients who had excessive lung volumes. At time of simulation it would be possible, using the table, to determine the type of treatment plan required for each patient. Those patients demonstrating an excessive lung volume would require a more extensive planning procedure utilizing CT (computerized tomography). An inhomogeneity correction could then be applied to the computerized distribution.     

Study of laser ablation in the in vivo rabbit brain with MR thermometry

PURPOSE: To investigate the peak temperature and thermal dose (T(43)) as tissue damage indicators for thermal therapy. MATERIALS AND METHODS: The proton resonant frequency (PRF) shift thermal coefficient was calibrated on six in vivo rabbit brains during interstitial laser ablation. The peak temperature and T(43) were correlated with the lesion boundary observed on T2-weighted spin-echo (SE) MRI at 4 hours post-heating in seven thermal lesions using direct MR measurement and analysis based on a binary discriminate model. RESULTS: The peak temperature and T(43) were 48.3 +/- 1.7 degrees C and 191 +/- 219 minutes, respectively, from the direct MR measurement. The values derived by the binary discriminate analysis were 47.8 +/- 2.2 degrees C and 28 +/- 41 minutes, respectively. CONCLUSION: Our results suggest that tissue damage in rabbit brain 4 hours after thermal ablation can be predicted reliably from a threshold temperature of approximately 48 degrees C.     

子宫内膜剥除术治疗子宫腺肌病预后相关因素分析

 目的 探讨子宫内膜剥除术治疗子宫腺肌病的可行性,并评估其适应证.方法 行子宫内膜剥除术,包括子宫内膜热球剥除术(uterine balloon therapy,UBT)和宫腔镜子宫内膜电切术(transcervical resection of endometrium,TCRE)治疗子宫腺肌症患者,收集临床资料同时采用免疫组织化学染色方法观察子宫在位和异位内膜MMP-3、MMP-9、TIMP-1表达的变化.结果 对痛经的疗效与手术时患者的月经分期、术前痛经程度、异位内膜MMP-3的表达有关;月经过多的疗效与手术时内膜分期、术前月经量、术前血红蛋白、在位内膜MMP-9的表达有关.结论 MMPs有可能成为子宫内膜剥除术治疗子宫腺肌症疗效评价和预测的实验室指标.     

Liver metastases in rats: chemoembolization combined with interstitial laser ablation for treatment

PURPOSE: To assess the effect of transcatheter arterial chemoembolization (TACE) combined with laser-induced thermotherapy (LITT) for treatment of liver metastases in an animal model. MATERIALS AND METHODS: All experiments were approved by the German government and the institutional animal research review board. After subcapsular liver implantation of colorectal cancer cells in 30 WAG rats (on day 0), the animals were randomly assigned to three interventional treatment groups. In the 10 rats in group A, TACE was performed: Fourteen days after cancer cell implantation and within 20 minutes after laparotomy and retrograde placement of a microcatheter into the gastroduodenal artery, these rats were injected with mitomycin (0.1 mg), iodized oil (0.1 mL), and degradable starch microspheres (5.0 mg). In the 10 rats in group B, LITT was performed: Also on day 14, the tumors in these animals were exposed to Nd:YAG laser light of 1064 nm at 2 W for 5 minutes. In the 10 rats in group C, combined treatment was administered: TACE was performed on day 14, and LITT was performed on day 21. Tumor volumes were measured before (on day 13) and after (on day 28) treatment with magnetic resonance (MR) imaging, and the mean tumor growth ratio (day 13 tumor volume divided by day 28 tumor volume) was calculated. RESULTS: The mean tumor volumes measured before and after the treatments were, respectively, 0.11 and 0.60 cm(3) in group A, 0.11 and 0.68 cm(3) in group B, and 0.11 and 0.35 cm(3) in group C. The mean tumor growth ratio was 5.42 in group A, 6.14 in group B, and 3.15 in group C. According to Bonferroni test results, compared with the rats in groups A and B (controls), the group C rats had significantly inhibited tumor growth (P < .01 for both comparisons). CONCLUSION: Use of combined TACE-LITT treatment, compared with the use of TACE or LITT alone, significantly inhibits tumor growth.     

准分子激光原位角膜磨镶术治疗高度近视

目的：评价准分子激光原位角膜磨镶术（Lasik）治疗高度近视的效果。方法：用法国产Moria板层角膜切割刀和美国Lasersight2000型准分子激光治疗仪对术前屈光度在－6．00D～-18.00D（平均－9．10D）的82例162眼行Lasik，随访3个月以上。按屈光度分为A（－6．00D～－10．00D）、B（－10．00D－18．00D）二组。结果：术后裸眼视力及屈光度均在1－3个月稳定。术后3个月裸眼视力均高于术前。A、B两组裸眼视力0．5以上者分别为96．7％、94．4％。1．0以上者为92．3％、81．7％。结论：Lasik手术矫正高度近视安全、有效，屈光度数越高治疗的准确性越低。