超声引导下经皮穿刺无水乙醇硬化治疗甲状腺囊性病变

目的 探讨超声引导下经皮穿刺无水乙醇硬化治疗甲状腺囊性病变的临床价值.方法 对108例甲状腺囊性病变患者共126个病灶,包括56个甲状腺单纯性囊肿(单纯性囊性病变)及70个甲状腺结节或腺瘤出血或液化所形成的继发性囊性病变(复杂性囊性病变),于彩色高频超声引导下徒手经皮穿刺进行囊液抽吸及囊内注射无水乙醇硬化治疗;术后超声随访1年,评价其疗效.结果 总有效率97.62％(123/126),治愈率96.03％(121/126);术后3个月,单纯性囊性病变与复杂性囊性病变的有效率及治愈率差异均无统计学意义(P均＞0.05).未出现明显并发症.结论 超声引导下经皮穿刺无水乙醇硬化治疗甲状腺囊性病变疗效确切,安全可靠,且操作简便,不良反应少,可作为治疗良性甲状腺囊性病变的首选方法.     

彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化法治疗单纯性肾囊肿

目的 探讨彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化法治疗单纯性肾囊肿的治疗方法 和临床应用价值.方法 对58例原发性肾囊肿患者进行了彩色多普勒超声引导经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化法治疗.结果所有患者均一次性穿刺成功,成功率100%,术后均放置中心静脉导管.经引流管共注射无水乙...     

超声引导下卵巢囊肿穿刺术36例临床分析

目的观察超声引导下卵巢囊肿穿刺术的临床疗效。方法对36例卵巢囊肿患者(43个囊肿)实施经彩色多普勒超声引导穿刺抽液及无水乙醇硬化治疗。观察治疗效果。结果本组1例患者出现头晕、恶心,2例患者出现面部潮红,均经休息后缓解。未发生内出血等并发症。30例(34个)囊肿治疗1次后消失,随访12个月无复发。6例(9个)囊肿穿刺治疗2次后消失,无复发病例。5例不孕患者随访期间3例成功妊娠。结论彩色多普勒超声引导穿刺抽液及无水乙醇硬化治疗卵巢囊肿,创伤小、并发症发生率低、有效率高,复发少。     

超声引导下无水乙醇硬化治疗伴有射精管梗阻症状的苗勒管囊肿

目的:评价经直肠超声引导下无水乙醇硬化治疗伴有射精管梗阻症状的苗勒管囊肿的安全性和有效性,探讨该方法的临床价值。方法:对3例伴有射精管梗阻症状的前列腺苗勒管囊肿行超声引导下20 G针穿刺无水乙醇硬化治疗,超声随访评价疗效。结果:治疗后6个月全部囊肿均消失,超声检查射精管梗阻解除,无严重并发症发生。结论:超声引导下的无水乙醇硬化治疗安全有效,可成为临床治疗伴有射精管梗阻症状的前列腺苗勒管囊肿的新方法。     

彩超引导无水乙醇硬化治疗卵巢囊肿效果观察

目的观察彩色多普勒超声引导无水乙醇硬化治疗卵巢囊肿的效果。方法对40例卵巢囊肿患者实施经彩色多普勒超声引导无水乙醇硬化治疗。结果本组36例患者经一次治疗后痊愈,3例患者经两次治疗后痊愈,1例巧克力囊肿患者经2次治疗无效后改行腹腔镜手术治疗,总有效率97.50%。治疗中出现头晕、恶心6例,患侧坠痛感8例,休息3~8 h后症状自行消失。随访12个月复查彩超均无复发。结论彩色多普勒超声引导无水乙醇硬化治疗卵巢囊肿,创伤小、操作简便、有效率高、复发率低、安全性高。     

超声引导置管大剂量无水乙醇硬化治疗巨大肝囊肿

目的探讨超声引导下置管大剂量无水乙醇硬化治疗巨大肝囊肿的疗效和安全性。方法 2001年5月～2011年5月,巨大肝囊肿24例,均为单发囊肿,直径102～180 mm,先在超声引导下穿刺囊肿并置入引流管,通过引流管抽尽囊液,使用大剂量无水乙醇注入囊腔硬化治疗,再用生理盐水冲洗囊腔,保留导管引流4～7天。结果治疗后3、6个月囊肿缩小率分别为(68.8±13.2)%、(86.3±12.4)%,术后12个月24例囊肿均完全消失,囊肿治愈率100%(24/24)。囊肿消失后随访2～5年,平均3年,无复发。结论该方法治疗巨大肝囊肿安全、微创,效果确切。     

16G穿刺针用于囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿

目的观察16G穿刺针用于超声引导下囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿的价值。方法回顾性分析44例接受超声引导下经皮穿刺冲洗及无水乙醇硬化治疗的甲状腺潴留性胶质囊肿患者,根据穿刺针规格分为16G组(n=20)与18G组(n=24),比较组间患者一般资料及手术时间差异,记录术后当天及1、6个月囊肿缩小率。结果18G组中3例应用18G穿刺针治疗失败,改用16G穿刺针后完成治疗,最终16G组与18G组治疗成功23例及21例;组间患者年龄、性别、术前囊肿最大径和体积(即单次硬化治疗无水乙醇用量)差异均无统计学意义(P均>0.05),而手术时间差异有统计学意义(P<0.05)。术后不同时间点16G组囊肿缩小率均高于18G组(P均<0.01)。16G组术后6个月囊肿体积缩小率较术后当日及1个月明显升高(P均<0.05),术后1个月囊肿体积缩小率与术后当日差异无统计学意义(P>0.05)。18G组不同时间点囊肿体积缩小率差异无统计学意义(P>0.05)。结论采用16G穿刺针行超声引导下囊腔冲洗及无水乙醇硬化治疗甲状腺胶质潴留囊肿可缩短治疗时间,且有利于提高效果。     

直肠超声下前列腺囊肿置管硬化治疗探讨

目的　探讨直肠超声引导穿刺并置管在前列腺囊肿硬化治疗中的应用。　方法　在直肠超声引导下 ,对前列腺囊肿进行穿刺置管 ,抽尽囊液、冲洗囊腔、注入无水酒精。　结果　 2 1例均成功置管并进行硬化治疗。随访 6月～ 18个月 ,2 1例囊肿均消失。　结论　直肠超声引导穿刺前列腺囊肿准确可靠 ,置管硬化治疗方便、安全、有效     

经皮穿刺抽吸硬化治疗肝囊肿

目的探讨经皮穿刺抽吸硬化治疗肝囊肿治疗方法及疗效。方法回顾分析我院经皮穿刺抽吸硬化治疗肝囊肿28例临床资料。结果全组硬化治疗均获成功,在超声(20例)或CT(8例)引导下,28例患者共治疗36较大个囊腔,随访6个月～13年。疗效指数无0级病例,Ⅰ级为2个囊肿,Ⅱ级为19个囊肿,Ⅲ级为15个囊肿,其中囊腔消失5个。结论超声或CT引导下经皮穿刺抽吸硬化治疗肝囊肿是一种相对安全、有效的方法。     

彩色多普勒超声引导介入治疗肾囊性病变387例

目的：总结彩色多普勒超声引导下介入治疗肾囊性病变的远期疗效。探讨彩色多普勒超声引导下介入穿刺治疗肾囊性病变的穿刺要点。方法：对387例良性肾囊性病变（其中单纯性肾囊肿291例、多囊肾96例）,其中男229例,女158例,年龄11岁～91岁,平均48.6岁。囊肿直径最大143mm×129mm,最小32mm×30mm。对387例良性肾囊性病变采用实时彩色多普勒超声引导穿刺硬化治疗,对直径〉80mm及囊内感染者治疗后保留导管持续引流。结果：单纯性肾囊肿中77例治疗后随访2年,214例随访6个月,266例囊肿完全消失、无复发;25例治疗后囊肿直径小于30mm,随访期内囊肿无明显增大。96例接受穿刺抽液硬化治疗多囊肾患者,治疗后随访6～24个月,肾功能得到不同程度改善或未继续恶化者70例,26例患者肾功能进行性下降。结论：实时超声引导可提高穿刺治疗肾囊肿的准确性,该法简便易行、创伤小、疗效可靠、并发症少,有较高的应用价值。     

Burdened by training not by anaesthesia

Editor—Larsson and colleagues¹ have investigated importantbut often ignored aspects of anaesthetic practice. However,they imply that specialist anaesthetists experience reducedlevels of stress when compared with trainees because they havedeveloped successful coping mechanisms over the years. Thisconclusion cannot be drawn because the specialists' attitudesto work were identified at a particular time and cannot showa progression in learned coping abilities. To demonstrate thedevelopment of these skills, the specialists would have hadto be interviewed     

Bladder carcinoma treated by preoperative radiotherapy followed by cystectomy

Summary In 1969 a clinical trial was started where patients with bladder carcinoma stage T2 and grade 3 were subjected to preoperative radiotherapy followed by cystectomy. The survival rate in this series was higher than in a previous series of comparable patients who were given full irradiation without cystectomy.     

Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography

Bilateral seminal vesicle puncture and injection of drugs with ultrasound guidance were performed in patients with hemospermia resistant to conservative therapy and with dilated seminal vesicles. Of 7 patients 6 had resolution of hemospermia for 2 to 3 months and then relapse. No side effect was noted.     

Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.     

Direct plexus repair by grafts supplemented by nerve transfers

This article reviews the Louisiana State University Health Sciences Center experience with direct repair of brachial plexus lacerations, gunshot wounds, and stretch/contusive/avulsive injuries. In the stretch category, limited outcomes with direct repair have led to addition of nerve transfers rather than their exclusive use. It is important to per-form direct plexus repair in conjunction with nerve transfers in the same patient when-ever possible. The intent of such a "pants-over-vest" approach is to maximize axonal input to denervated structures.     

Lavage by laparoscopy fares better than lavage by laparotomy

Background: Although carbon dioxide (CO2) pneumoperitoneum is proposed increasingly for treatment of secondary peritonitis, associated deleterious effects have been reported in experimental models, with the hypothesis that increased intraperitoneal pressure might facilitate bacterial translocation. The purpose of this study was to compare the outcome (and qualitative microbiologic analysis) from peritonitis in rats after lavage by laparoscopy with the outcome after lavage by laparotomy. Methods: After determination of the standard innoculum for this study in 30 animals, 120 male Wistar rats received 1 ml of Escherichi coli 106 colony-forming unit (CFU), Bacteroides fragilis 107 CFU, Enterococcus faecalis 107 CFU in a sterile rat feces-barium sulfate suspension adjuvant, were anesthetized with intramuscular ketamine, and then underwent peritoneal lavage by either laparotomy (n = 60) or laparoscopy (n = 60). The duration of peritonitis defined two groups: group A: duration less than 3 h (n = 20) and group B: duration 3 h or more (n = 40). Both groups underwent successive lavage with 10-ml aliquots (total, 50 ml) of 0.9% saline solution at 37°C. Five 2-ml samples of liquid lavage were drawn for culture and microbiologic analysis. Blood (0.2 ml) and peritoneal liquid lavage samples were incubated 48 h at 37°C and cultured. Results: All the animals survived. Mean duration of peritoneal lavage was 13.2 min (range, 6-25 min) for laparoscopy and 9.7 min (range, 6-15 min) and for laparotomy. The difference was not statistically significant. The mean duration of operation was significantly longer with laparoscopy than with laparotomy: 44.5 min (range, 35-62 min) and 25 min (range, 16-40 min), respectively (p = 0.0001). The collected lavage volumes were not statistically different: 48.5 ml (range, 40-54 ml) and 46.7 ml (range, 37-56 ml), respectively. No statistically significant differences were found between the laparoscopy and laparotomy groups in terms of E. coli bacteremia, irrespective of peritonitis duration. The rates of positive blood culture for B. fragilis and E. faecalis were signficantly lower after laparoscopy than after laparotomy, both in the overall group (p = 0.025 and p = 0.045, respectively) and when duration of peritonitis exceeded 3 h (p = 0.001 and p = 0.044, respectively). Conclusions: In this animal model of secondary peritonitis, lavage by laparoscopy was associated with less bacteremia for B. fragilis and E. faecalis than peritoneal lavage by laparotomy.