激光眼袋整形术的围手术期护理

目的:总结利用CO2激光器对眼袋进行整形手术的围手术期综合护理措施。方法:对116例患者进行术前及术后的心理护理、常规护理,特别是术后的术区局部护理,以及术后随访、健康指导。结果:本组病例无1例感染,均为一期甲级愈合。患者对手术效果基本满意,心理状态稳定。结论:加强围手术期综合护理对激光眼袋整形术的患者极其重要。     

超脉冲CO2激光法切开重睑术及护理

目的:探讨超脉冲CO2激光在切开重睑术中对减少术中出血、改善术后淤血和水肿的效果观察。方法:对485例重睑术患者,利用激光刀切割或剥离,去除脂肪、止血等。结果:484例患者手术效果满意,1例患者不太满意。超脉冲CO2激光作为手术刀时,术后淤血和肿胀持续时间短,疼痛和不适也减轻,术后恢复快,成型效果好。结论:运用超脉冲CO2激光代替手术刀切除,术中出血少、术野可见度提高以及术后淤血和肿胀减少,疼痛反应明显减轻,效果优于使用手术刀的传统手术,且操作简单、易行、值得推广,护士监测激光是保障患者安全的重要因素之一。     

不同类型眼袋的术式选择及疗效分析

目的探寻不同类型的眼袋最有效且合适的外科治疗方法,并进行疗效分析。方法收集进行眼袋整复的患者98例,其中24例为单纯眶脂肪疝眼袋,52例为下睑膨隆伴皮肤松弛型眼袋,22例为皮肤松弛伴眶下缘凹陷型眼袋,分析这三种类型手术方式、并发症的差异,并比较术后疗效。结果单纯眶脂肪疝出型眼袋结膜入路眶隔后及眶隔前入路手术的效果差异无统计学意义(χ2=0,P>0.05)。且行结膜入路切口≥1 cm时,应于内、中、外三点定位缝合结膜下组织,以利于创口对合生长。对于下脸膨隆伴皮肤松驰型患者皮瓣法术后效果优于肌皮瓣法(χ2=5.30,P<0.05)。对于重度下睑松弛患者,处理外眦可以减少术后下睑外翻、下睑退缩的发生率(P<0.05)。对于有眶下缘凹陷的患者,行Hamra术可以有效预防术后眶下缘凹陷(χ2=6.29,P<0.05)。结论不同类型的眼袋应选用不同的手术方法,增加手术成功率,减少手术创伤和并发症的发生。     

Functional MRI shows activation of the medial preoptic area during sleep

Changes in the activity of the basal forebrain sleep regulating areas were studied noninvasively in conscious rats by employing functional magnetic resonance imaging (fMRI). Sleep-wakefulness (S-W) stages were identified with the help of electrophysiological recordings carried out simultaneously. An increase in the signal intensity was observed in the medial preoptic area (mPOA) during sleep indicating a heightened activity of neurons in this area. In some rats, there was a decrease in the activity of the fronto-parietal cortex. The sleep-induced increase in activity in the mPOA and decrease in the fronto-parietal cortex are in relation to their levels in the awake state. The findings helped to localize the critical area for the maintenance of slow wave sleep at the mPOA. These results further corroborate some of the previous suggestions based on neurotoxic lesion, chemical stimulation and electrophysiological recordings.     

髋关节置换股骨偏心距和下肢长度重建方法

背景:人工髋关节置换股骨偏心距和下肢长度的重建直接影响患者术后功能的恢复和假体的使用寿命,目前多采用术前模板测量来预测股骨假体的型号及置入位置,估计股骨颈的截骨水平,但是测量比较繁琐,欠精确.目的:设计通过股骨头假体长度和股骨颈截骨平面的选择来重建股骨偏心距和下肢长度的计算方法.设计、时间及地点:探索性实验,于2008-08/2009-02在单县中心医院完成.对象:选择单县中心医院接受髋关节置换的22例股骨颈骨折和股骨头缺血坏死患者.方法:术前测算健侧股骨偏心距E和髋关节旋转中心至小转子最高点的垂直距离D(下肢内旋15°).设股骨假体偏心距为E,垂降为H.设股骨颈截骨平面最下缘距小转子最高点的垂直距离为h,标准股骨头假体+0,其余为+L.股骨假体颈干角的补角为A.通过数学方法推导髋关节置换股骨偏心距和下肢长度重建股骨头长度及股骨颈截骨平面选择的计算公式.主要观察指标:股骨偏心距、髋关节旋转中心至小转子最高点的垂直距离、股骨假体偏心距、股骨假体颈干角、股骨假体垂降.结果:①E=E'+LsinA.②D=h+H+LcosA.结论:成功推导出髋关节置换股骨偏心距和下肢长度重建股骨头长度及股骨颈截骨平面选择的计算公式,该公式简单准确.     

Malignant lesions of the eyelid

Malignant tumors of the eyelid and ocular adnexa are often detected during routine examinations. Basal cell carcinoma is the most common of these tumors, followed by squamous cell carcinoma. Sebaceous gland carcinoma and malignant melanoma are seen less frequently. Malignant eyelid tumors may mimic a number of benign conditions. Early diagnosis requires a high index of suspicion, and biopsy of the lesion is often necessary.     

重睑成形术的重睑线设计及术式选择

随着人们生活水平的提高 ,要求作各种美容手术的人亦不断增加。重睑术 (双眼皮 )是近几年比较流行的一种美容手术 ,将单眼皮修整为活泼、潇洒的双眼皮 ,可使人的眼型增加迷人的魅力。现将笔者所行 55例 1 0 8只眼重睑成形术报告如下。资料与方法1 1 一般资料55例中 ,男 6例 ( 9 1 % ) ,女 50例 ( 90 9% ) ;双眼53例 ( 96 4 % ) ,单眼 2例 ( 3 6 % ) ;年龄最小 1 8岁 ,最大 4 1岁 ,见表 1。表 1接受双重睑术者年龄分布年龄人数 %<2 0岁 132 3 62 0～ 2 5岁 2 5 45 52 6～ 2 9岁 12 2 1 8≥ 30岁 5 9 1　　 1 2 重睑线的设计双重睑一般…     

Distal sensory nerves of the lower extremity in peripheral neuropathy: comparison of medial dorsal cutaneous and sural nerve abnormalities

This study investigates the sensitivity and usefulness of medial dorsal cutaneous nerve (MDCN) conduction studies in patients with peripheral neuropathy. Two hundred twenty-three patients with clinical signs and symptoms of peripheral neuropathy in their lower extremities were evaluated. Nerve conduction velocity studies of the MDCN were compared to those of the sural and peroneal motor nerves. Fifty-eight percent of the patients had no measurable sensory nerve action potential (SNAP) from either the MDCN or sural nerve or both, indicating moderate to severe neuropathy. Of the remaining patients with mild neuropathy, 12% had a normal sural nerve and an abnormal MDCN, whereas 7% had a normal MDCN and an abnormal sural nerve. Fifty-one percent of the mild cases had normal peroneal motor nerve studies. It is concluded that the MDCN is equal to the sural nerve as a sensitive indicator in all stages of peripheral neuropathy; in mild or early neuropathy approximately 12% of patients will have normal sural nerve studies; and it is important to examine both distal sensory nerves of the leg. Addition of the MDCN study to the standard sural study increases diagnostic accuracy in mild peripheral neuropathy from 88% to nearly 100%.     

D2/D1 ratio in the medial preoptic area affects copulation of male rats

The D1/D2 dopamine agonist apomorphine, microinjected into the medial preoptic area (MPOA), facilitates male rat sexual behavior and the D1/D2 antagonist cis-flupenthixol in the MPOA impairs it. The present study investigated the roles of D1 and D2 receptors in the regulation of copulation by microinjecting drugs selective for these receptors into the MPOA. The D2 agonist LY-163502 delayed the onset and slowed the rate of copulation and also reduced the number of vaginal intromissions required to trigger ejaculation (reduced ejaculatory threshold). The D1 agonist SKF-82526 had no effect, either alone or together with LY-163502. The D1 antagonist SCH-23390 delayed the onset of copulation and decreased ejaculatory threshold, as had the D2 agonist. A low dose of the D2 agonist alone and together with the D1 antagonist delayed the onset of copulation and reduced ejaculatory threshold; the combination of drugs was more effective than LY-163502 alone. Only the combination of drugs slowed the rate of copulation and delayed the resumption of copulation after an ejaculation. Thus, increasing the D2/D1 ratio in the MPOA, by selective stimulation of D2 and/or antagonism of D1 receptors, delays the onset of copulation and reduces ejaculatory threshold, possibly by altering autonomic control of penile reflexes.     

急性低血压对清醒大鼠前庭神经内侧核区谷氨酸和牛磺酸含量的影响

目的：利用脑部微量透析法和高效液相色谱分析法，测定静脉注射硝普钠诱发急性低血压后清醒大鼠前庭神经内侧核区细胞外液标本中谷氨酸和牛磺酸含量的变化。 方法：实验于2005-02／09在延边大学基础医学院生理学教研室进行。选用Wistar系雄性大鼠，查随机数表法随机分为正常组、单侧迷路破坏损伤同侧组、单侧迷路破坏损伤对侧组，每组6只。单侧迷路破坏组左侧中耳注入对氨基苯胂酸盐损伤外周前庭器官，2周后进行实验。正常组左侧中耳注入生理盐水。腹腔注射水合氯醛麻醉，行股动静脉插管，用于血压监测和静脉给药，动、静脉插管经皮下向后背穿到头部。经股静脉注射硝普钠使动脉血压下降约30％左右。参照Paxinos＆Watson大鼠脑图谱将透析膜的外套管插入到前庭神经核，透析膜的外套管内插八自制的透析导管，利用脑部微量透析法收集样本。参照Jin等方法配制诱导剂，高效液相色谱分析法观察静脉注射硝普钠诱发急性低血压后，前庭神经内侧核区细胞外液标本中谷氨酸和牛磺酸含量的变化。 结果：实验纳入18只大鼠中，18只是透析探针准确进入预定区域的动物。正常组动物，静脉注射硝普钠使血压平均下降30％时，前庭神经内侧核区谷氨酸含量明显增加（P〈0．01），而牛磺酸含量却明显降低（P〈0．05）；单侧迷路破坏损伤同侧组，诱发急性低血压后前庭神经内侧核区谷氨酸含量则无明显变化（P〉0．05），牛磺酸含量明显下降（P〈0．05）；单俱十迷路破坏损伤对侧组，诱发急性低血压后谷氨酸和牛磺酸含量都明显增加（P〈0．05）；诱发急性低血压后，损伤侧前庭神经内侧核区谷氨酸无显著性变化，而牛磺酸含量却明显下降，与正常组动物诱发急性低血压时前庭神经内侧核区两种氨基酸含量变化值相比谷氨酸含量变化差异显著（P〈0．05），牛磺酸含量变化则不明显（P〉0．05）。 结论：清醒动物急性低血压影响前庭神经内侧核功能活动的过程中可能有兴奋性氨基酸一谷氨酸神经递质参与。     

重睑成形术联合V-Y内眦赘皮矫正术治疗单睑伴内眦赘皮临床研究

目的 分析眼轮匝肌-上睑提肌固定(Park)重睑成形术+V-Y内眦赘皮矫正术治疗单睑伴内眦赘皮患者的效果.方法 选取我院78例单睑伴内眦赘皮患者(2018年10月～2020年5月),依照随机抽签法将其分为两组,各39例.两组均接受Park重睑成形术治疗,同时,对照组接受Z成形术,观察组接受V-Y内眦赘皮矫正术,比较两组...     

Site-specific enhancement of gamma-aminobutyric acid-mediated inhibition of neural activity by ethanol in the rat medial septal area

Because of uncertainty concerning the interaction of ethanol with gamma-aminobutyric acid (GABA) receptor-mediated events, the present work was designed to investigate the effect of ethanol on GABA transmission in the rat septal area using behavioral and electrophysiological techniques. Microinjection of the GABAA agonist muscimol into the medial septal area (MSA) enhanced, and bicuculline administration antagonized, ethanol-induced impairment of the aerial righting reflex. Microinjection of these drugs into the lateral septum (LSi) did not influence this measure of ethanol-induced sedation. Furthermore, intraseptal injections of muscimol or bicuculline in saline-treated rats had no effect on the aerial righting reflex. These data suggest that the MSA plays a critical modulatory role in the sedative actions of ethanol. To assess the effect of ethanol on muscimol responses in the MSA and LSi at the cellular level, GABA was applied by iontophoresis to rhythmically bursting neurons of the MSA and to cells in the LSi. The magnitude of the resultant inhibition by GABA on these cells was assessed before and after systemic administration of ethanol. Ethanol enhanced GABA-mediated inhibition of MSA neural activity, but did not alter GABA-mediated inhibition of cellular activity in the LSi. In contrast, the inhibition of cellular activity in the MSA, caused by a maximally effective concentration of the benzodiazepine flurazepam, was not altered by ethanol. Other work in the MSA demonstrated that electrical stimulation of the fimbria caused an inhibition of ongoing single unit activity that was reduced by concurrent application of bicuculline. The duration of this electrically elicited inhibition in the MSA was enhanced after ethanol injection and then recovered to base-line levels. In addition, ethanol (1.5 mg/kg) caused an enhancement of the inhibition induced by nipecotic acid, a GABA uptake inhibitor. These findings demonstrate that GABA-mediated neural inhibition is enhanced by ethanol in the MSA but not the LSi, indicating that the actions of ethanol on GABA-induced inhibition can be site specific. It is proposed that the cellular action of ethanol may depend upon a specific molecular composition of the GABA receptor complex which may vary at selected sites in the brain.     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

目的报告应用侧副韧带修补重建并桡骨小头切除手术方式治疗青年肘关节恐怖三联征、桡骨小头粉碎骨折患者的疗效观察。方法自2005年11月至2009年10月,本院共收治肘关节三联征损伤3例。桡骨小头骨折按Mason法分类均为Ⅲ型。3例患者均行冠状突固定、肘内外侧副韧带、关节囊修补、内侧副韧带加强、重建并桡骨小头切除术,术后克氏针辅助固定肱尺关节于屈肘90°前臂旋转中立位,石膏固定3周,然后拔除克氏针,去除石膏,开始屈伸和旋转康复训练。结果3例患者均随访1年以上,骨折愈合,按照Broberg和Morrey的肘关节功能评分2例为良,1例为可。结论肘关节恐怖三联征伴有桡骨小头粉碎骨折的青年患者,韧带及关节囊的重建异常重要,桡骨小头置换应当审慎,在确保韧带重建满意的情况下切除桡骨小头并未造成肘关节明显功能障碍。     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.     

Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics

Background

Lateral wedges reduce the peak knee adduction moment and are advocated for knee osteoarthritis. However some patients demonstrate adverse biomechanical effects with treatment. Clinical management is hampered by lack of knowledge about their mechanism of effect. We evaluated effects of lateral wedges on frontal plane biomechanics, in order to elucidate mechanisms of effect.

Methods

Seventy three participants with knee osteoarthritis underwent gait analysis with and without 5° lateral wedges. Frontal plane parameters at the foot, knee and hip were evaluated, including peak knee adduction moment, knee adduction angular impulse, center of pressure displacement, ground reaction force, and knee-ground reaction force lever arm.

Findings

Lateral wedges reduced peak knee adduction moment and knee adduction angular impulse (− 5.8% and − 6.3% respectively, both P < 0.001). Although reductions in peak moment were correlated with more lateral center of pressure (r = 0.25, P < 0.05), less varus malalignment (r values 0.25-0.38, P < 0.05), reduced knee-ground reaction force lever arm (r = 0.69, P < 0.01), less hip adduction (r = 0.24, P < 0.05) and a more vertical frontal plane ground reaction force vector (r = 0.67, P < 0.001), only reduction in knee-ground reaction force lever arm was significantly predictive in regression analyses (B = 0.056, adjusted R² = 0.461, P < 0.001).

Interpretation

Lateral wedges significantly reduce peak knee adduction moment and knee adduction angular impulse. It seems a reduced knee-ground reaction force lever arm with lateral wedges is the central mechanism explaining their load-reducing effects. In order to understand why some patients do not respond to treatment, future evaluation of patient characteristics that mediate wedge effects on this lever arm is required.     

Common eyelid and orbital problems

Several pathologic processes can disturb the complex structures of the eyelids and orbital tissues and the muscles that enable their proper function. Some disorders, such as entropion and ectropion, are usually acquired in later years from laxity of supporting structures. Blepharoptosis has a range of causes, from aging to an intracranial aneurysm, and its severity varies, from mild to almost complete closure of the lid fissures. Graves' orbitopathy can produce lid retraction, lid lag, and proptosis and can cause vision-threatening conditions. Orbital cellulitis produces pain, swelling, proptosis, and redness of the lids and conjunctivae and, if severe, can compromise ocular motility and visual acuity. Early recognition of the specific disorder and prompt and adequate treatment are essential to spare the patient discomfort and ensure preservation of vision.