Ergebnisse nach alloplastischem Bandersatz mit Kohlenstoffasern

During several years ligaments consisting of carbon-fibres have been tested in animal experiments. Recently this material was used in humans. Until today approximately 150 patients have been operated. The late results in 65 patients with instability in 66 joints are reported. Carbon-fibre-ligaments yielded good results, provided an expert surgical technic was applied and the follow-up care was optimal. Good results were achieved on the shoulder, the knee and the lateral ankle-joint. Initially there arose some problems due to technical difficulties. By using a modified surgical technic and improvements in the follow-up care still better results can be achieved. The present study is retrospective; a prospective study has been started.     

Bilateral traumatic dislocation of the hip

Bilateral traumatic dislocation of the hip joint is very rare but not new; Marquardt (1936) reported the first case and Wilson (1976) recently mentioned that only 50 cases have been reported so far. Here is another case with over a 6-year follow-up period.     

Long-term follow-up of the ulnar nerve repair: report of 42 cases

A long term follow-up for 42 cases of ulnar nerve repair was reported in this article, and the reason of bad function were analysed. They are: 1. As long as the injured ulnar nerve was sutured perfectly and without delay, the result would be satisfying. 2. The follow-up examination of the repaired nerve showed all the paralysed intrinsic muscles would recover in certain extent. Abductor digiti quinti, adductor pollicis and flexor digiti quinti brevis usually restored easily. Among the intrinsic muscles the best result of the first dorsal interosseous and the first palmar interosseous muscles were obtained. The functional recovery of the second and third palmar interosseous muscles usually was poor. 3. After repairing of the injured ulnar nerve, recovery of the claw hand deformity usually takes long time, so the operative correction of the deformity should not be performed until 2.5 years.     

Fracture-dislocations of all five carpometacarpal joints: a case report

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.     

Pemberton's acetabuloplasty for congenital dislocation or subluxation of the hip

The results obtained in a consecutive series of thirty-seven Pemberton operations for congenital dislocation or subluxation of the hip are reported. Over the period under review, 1967 to 1973, it was the only type of acetabuloplasty employed at Winford. Unless the mandatory concentric reduction could be obtained with ease, preliminary open reduction was favoured, especially in cases of primary care. Femoral rotation osteotomy was added for marked anteversion. The programme was designed to be complete inside fourteen weeks, and was so for eighteen hips. Secondary acetabuloplasty was performed on hips with instability or dislocation persisting despite previous treatment. The operations were performed from eighteen months to thirteen years of age. One initial failure required a repeat operation which was successful, but one severely dysplastic hip remained so. The average follow-up was six years.     

Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors

The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.     

Early experience with the Boerema button for bleeding oesophageal varices.

Early experience with the use of the Boerema button for bleeding oesophageal varices is reported. A simplified technique for its insertion is described, and of the 6 patients so treated, only 1 died. No patient has re-bled in the short follow-up period available, and oesophageal appearances suggest that prolonged relief from bleeding can be anticipated. Further exploration of the button ligation transection technique is suggested not only for control of acute bleeding, but also for patients unsuitable for shunt surgery.     

An intrapulmonary chondromatous hamartoma penetrating the visceral pleura: report of a case.

A 65-year-old woman had been followed up for a hamartoma-like mass in the right upper lobe of the lung since 1995. A follow-up CT scan showed an increase in the size of the lesion and a new lesion next to the old mass, which was highly suspected to be lung cancer. A right upper lobectomy was thus performed in May 2000. The hamartoma penetrated the visceral pleura, and adhered to the mediastinal pleura. Such a growing hamartoma with pleural invasion has so far rarely been previously reported.     

Retroperitoneale Lymphadenektomie – pro laparoskopisch

The functional and oncological results of laparoscopic retroperitoneal lymphadenectomy (L-RPLND) have proven to be as efficacious as open series (O-RPLND) after 5 year follow-up. In the most recent publication series from high-volume laparoscopy centres, there was a trend towards fewer complications in L-RPLND compared to O-RPLND. Up to now only two case series of four treated patients have been reported adopting a robotic-assisted retroperitoneal lymphadenectomy for testicular cancer so that it is not yet possible to judge whether it is useful tool or not.     

Long-term (10 to 23 years) clinical evaluation of quality of life in patients following open heart repair of tetralogy of Fallot

The quality of life of 78 patients out of 79 (99% follow-up rate) was evaluated 10 to 23 years following intracardiac repair of tetralogy of Fallot. Mean age at operation was 6 years of age. Their present ages ranged from 12 to 35, averaging 21 years old. Eighty three percent of patients are assessed to be in good quality of life so far in terms of physical development, life style, CTR values, Ekg findings and so on. Pregnancy and delivery in 5 patients were uneventful. On the other hand, 17% showed various degree of morbidity including significant residua necessitating reoperation in 3 patients, complications such as complete A-V Block requiring pacemaker implantation in 7 and sequela like postoperative life threatening cardiomyopathy in 3. There were 2 deaths due to this sequela comprising 2.6% of mortality rate. Although excellent results are reported in recent years, further efforts will be necessary to minimize residuum, complication and sequela after surgery especially for this particular disease with broad morphological spectrum.     

Intracystic hemorrhage of pancreatic serous cystadenoma after renal transplantation: Report of a case

Immunosuppressive therapy after transplantation increases the risk of developing neoplasms, and neoplasms of the digestive organs are very common in Asia. We experienced a patient with an intracystic hemorrhage of pancreatic serous cystadenoma during the follow-up after renal transplantation. Pancreatic cystadenomas are not frequent. Only two cases, presenting with acute abdomen, have so far been reported in the literature. The intracystic hemorrhage in our case may have been related to a rapid tumor growth due to weakened antitumor immunity and azathioprine-induced pancreatitis. Received: May 8, 1998 / Accepted: March 24, 2000     

Neuropsychological assessment of a potential "euthanasia" case: a 5 year follow up

McMillan reported a neuropsychological assessment procedure which was used to determine whether or not there was evidence for sentience in a young woman who had been rendered tetraplegic and anarthric as a result of a road traffic accident. An application to court had been made to withdraw feeding and this was supported by medical evidence which gave the view that the individual was functioning little beyond vegetative state, had a poor quality of life and had little prospect of further recovery. Evidence for an ability to communicate reliably was found including for a wish to continue living, and as a consequence the application to court was withdrawn. This paper describes further recovery 2-4 years after the original assessment (i.e. 4-6 years post-injury). At follow-up, she remained dependent for all care, but was now feeding orally and was talking. She could learn new information, some of which she retained for at least 12 months and had greater insight into her condition. She now reported low mood and some pain. As before, she consistently reported a wish to live. The implications of the follow-up are discussed in the context of assumptions made about quality of life and decision making about euthanasia in brain injured people who are severely disabled, but are not in a vegetative state.     

Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease.

OBJECTIVE: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if so only because of complications. Although life-long anticoagulation therapy is indicated for mechanical prostheses, the chance of subsequent re-operations can be expected to be low. We report the results of 28 mechanical valve replacements in the pulmonary position. METHODS: A mechanical valve was implanted in 27 of 79 patients indicated for pulmonary valve replacement. Tetralogy of Fallot was the most common basic lesion. The results and follow-up were reviewed retrospectively, where death and re-operation were primary end points. Routine outpatient follow-up, including trans-thoracic echocardiography, was performed. RESULTS: Twenty-eight pulmonary valve implantations were done in 27 patients. Thirty-day hospital mortality was 1/28 (3.6%), because of a cerebro-vascular accident. One patient died late (2.8 years postoperatively). Median age was 33 years and the median interval between primary repair and insertion of the prosthesis was 26 years. Freedom from re-operation at 1 year was 100%. One valve had to be replaced 14 years after implantation because of malfunction due to ingrowth of endomyocardial fibrosis. No thrombo-embolic events were observed. CONCLUSIONS: Our series do not confirm the bad reputation of mechanical valvar prostheses in the pulmonary position. On the contrary they perform well and result in a much lower re-operation rate than can be expected and in fact is reported after allograft usage. No thrombo-embolic complications were noted. In our experience pulmonary mechanical valve prostheses do well.     

Chlorambucil therapy in childhood nephrotic syndrome.

Chlorambucil (Leukeran), a cytotoxic agent, was administered to 13 children with the nephrotic syndrome who had responded to steroid therapy, but frequently relapsed. In all patients corticosteroid therapy had become unsatisfactory. Eleven patients have so far remained in remission for an average follow-up period of 31 months since chlorambucil therapy. No side-effects of therapy were observed in this study, but several grave complications of high-dosage therapy have been reported in the recent literature. A dose of 0.2 mg/kg/d for 8 weeks should not be exceeded.     

A memory coiling spiral as nucleus pulposus prosthesis: concept,specifications, bench testing,and first clinical results

The intradiscal cavity left after a discectomy can be filled by a new nucleus prosthesis made of polycarbonate urethane in the form of a "memory coiling spiral." Biomechanical tests have demonstrated that this device compensates for the loss of disc height, decreases the compression of the facet joints, and restores the kinematics of the spinal segment, without deformation of the vertebral endplates or migration. The device is currently under clinical investigation. Inclusion and exclusion criteria of the pilot study are presented, and preliminary results of the first five patients supplied with the spiral are reported after an average follow-up time of 24 months. No migration of the device has been observed so far. With its easy application due to the standardized approach and the memory coiling mechanism, this device represents an advance within the nonfusion techniques.     

睾丸微石症2例报告及文献复习

目的:认识睾丸微石症(TM)的临床意义和诊断方法。方法:回顾性报告2例TM病例的临床资料,结合文献进行讨论。结果:2例分别因左精索静脉曲张和附睾炎就诊的患者行阴囊超声检查时发现睾丸内散在多发点状强回声,如针尖样,1～2mm,后无声影。分别诊断为局部TM、左精索静脉曲张和TM,左附睾炎。甲胎蛋白、人绒毛膜促性腺激素、乳酸脱氢酶和睾酮等检查均正常。对睾丸微石症未做特殊处置,随访6～8个月,体检和睾丸瘤标未见异常,阴囊超声睾丸图像无特征性改变。结论:TM是一种少见、无明显临床症状、相对稳定的疾病。多因阴囊其他疾病行超声检查时偶然发现,其是否属于癌前病变尚有争议,但是定期随访和阴囊超声检查是必要的。     

血液恶性肿瘤CAR-T〖WT〗治疗后患者报告结局的范围综述

目的 对血液恶性肿瘤嵌合抗原受体T细胞(CAR-T)治疗的急性、亚急性及长期随访期间患者报告结局研究进行范围综述,为临床早期判断和实施干预提供参考。方法 检索中英文数据库中血液恶性肿瘤CAR-T治疗后患者报告结局的相关研究,检索时限为建库至2023年3月20日。对纳入文献进行筛选及汇总分析。结果 共纳入16篇文献。现有研究共使用18种评价工具测量CAR-T治疗后患者报告结局,测量范围包括症状、功能性及心理状态评估。CAR-T治疗后急性期患者突出报告症状领域恶化;亚急性患者突出报告社会及角色功能的持续限制以及疲劳、疼痛、睡眠障碍症状;长期随访患者报告神经系统症状或焦虑、抑郁情绪。结论 不同时期CAR-T治疗患者报告结局存在差异,提示医护人员应长期监测。未来可开发CAR-T治疗血液恶性肿瘤患者特异性评价工具,利用电子化患者报告结局建立数字健康监测系统。     

Juvenile-type granulosa theca cell tumour producing precocious pseudopuberty. A case report

The juvenile-type of granulosa theca cell tumour in a young girl is reported. The child presented with pain, vaginal bleeding, distension of the abdomen and enlarged breasts and exhibited pubic and axillary hair, i.e. signs of oestrogenic and androgenic effects and overproduction of luteinizing hormone--an unusual phenomenon. Discussion includes the differences between the juvenile and adult types of this tumour. Salpingo-oophorectomy of the affected side is recommended in such cases. A recurrence many years after surgery has been reported, so long-term follow-up is envisaged in this case.     

Diagnostic value of CEA in neoplasms fo the colon and rectum. Review of cases

A personal series of colo-rectal tumours from 1979 to 1987 has been examined so as to check the validity of CEA as a marker in the diagnosis of these tumours. The data confirmed what has already been reported, namely its poor diagnostic sensitivity even though its utility for prognosis and in the follow-up of these patients remains confirmed, as is shown by the literature.     

Laparoscopic inguinal hernia repair: optimal technical variations and results in 1700 cases

A follow-up series of 1700 laparoscopic inguinofemoral herniorrhaphies by a single surgical team is presented (1381 patients). Two standard techniques were used: transabdominal preperitoneal (1452 cases) and totally extraperitoneal (248 cases). Mean follow-up was 5.3 years. There were 348 patients with bilateral hernias, 121 with recurrent hernias, and 27 with incarcerated hernias. Numerous technical variations were used as the study progressed. A SurgiPro mesh (USSC, Norwalk, CT) with staple/tack fixation was used in all patients. Average operating time was 41 minutes for unilateral repairs, and 97.3 per cent of the procedures were outpatient procedures. Five recurrences were reported. The postoperative permanent neuropathy rate was found to be negligible, but a 5.1 per cent rate of uncomplicated ipsilateral postoperative seromas is reported. All patients were instructed to return to unrestricted physical activities on postoperative day one. Ninety per cent of the patients were able to do so within 5 days versus 93 per cent in 7 days. Ninety-six per cent of all patients felt minimal pain and discomfort after 72 hours. There was no significant difference in recovery or morbidity between the transabdominal preperitoneal and totally extraperitoneal repairs. To date laparoscopic inguinal herniorrhaphy continues to be a difficult procedure with a significant learning curve. The reported surgical performance data and the described optimal technical variations make this procedure a viable and competitive repair in the surgical management of inguinofemoral hernia.