经胸乳径路腔镜甲状腺手术180例的临床研究

目的探讨经胸乳径路腔镜甲状腺手术技巧及其并发症的防治。方法回顾分析2005年3月至2009年12月经胸乳径路腔镜甲状腺手术180例患者的临床资料。结果本组178例腔镜甲状腺手术顺利完成,2例中转开放手术,其中1例为结节性甲状腺肿,因甲状腺体积大,空间狭小中转开放手术,另1例为原发性甲状腺功能亢进,因粘连严重、创面广泛渗血中转开放手术。全组手术时间70～190 min,平均110 min。术中出血量5～75 ml。术后出现皮肤瘀斑2例,抽搐1例,均于2周后恢复正常。声音嘶哑1例,1个月后恢复正常。住院时间3～6 d,平均4.5 d。结论经胸乳径路腔镜甲状腺手术是一种极富技巧性的手术,甲状旁腺损伤和喉返神经损伤是其严重并发症,规范手术操作能有效减少并发症的发生。     

数字化导航模板辅助全膝关节置换的模拟研究

 目的 探讨数字化导航模板辅助全膝关节置换的准确性和可行性。方法 取成年尸体下肢标本 20具,随机分为导航模板组和传统方法组,每组 10具 20个膝关节。导航模板组术前行下肢全长 CT扫描,利用逆向工程软件对 CT数据进行处理,设计与股骨远端和胫骨近端匹配的可定位截骨平面和外旋轴的导航模板,通过快速成型机制作模板实物用于尸体标本的全膝关节置换手术操作。传统方法组按常规全膝关节置换手术操作。术后通过 CT扫描比较两种方法定位的截骨准确性。结果 导航模板与股骨髁和胫骨平台贴合紧密,无明显移动。导航模板组 18个膝关节的股骨远端和胫骨近端截骨面与下肢机械轴垂直,2个膝关节内翻; 17个膝关节后髁截骨面与通髁轴完全平行,3个膝关节有成角。传统方法组 20个膝关节均出现下肢机械轴内外翻,其中 5个膝关节大于 5°; 20个膝关节均出现后髁截骨面与通髁轴成角,其中 10个膝关节大于 3°。结论 导航模板法的股骨远端、胫骨近端和股骨外旋截骨准确性均高于传统手术方法。     

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Introduction

The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach.

Methods

A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data.

Findings

A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46–7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31–3.80 and 0.59–225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79–11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31–5.21 and 0.25–6.50).

Conclusions

Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.     

Myopathies with finger flexor weakness: Not only inclusion-body myositis

Muscle disorders are characterized by differential involvement of various muscle groups. Among these, weakness predominantly affecting finger flexors is an uncommon pattern, most frequently found in sporadic inclusion-body myositis. This finding is particularly significant when the full range of histopathological findings of inclusion-body myositis is not found on muscle biopsy. Prominent finger flexor weakness, however, is also observed in other myopathies. It occurs commonly in myotonic dystrophy types 1 and 2. In addition, individual reports and small case series have documented finger flexor weakness in sarcoid and amyloid myopathy, and in inherited myopathies caused by ACTA1, CRYAB, DMD, DYSF, FLNC, GAA, GNE, HNRNPDL, LAMA2, MYH7, and VCP mutations. Therefore, the finding of finger flexor weakness requires consideration of clinical, myopathological, genetic, electrodiagnostic, and sometimes muscle imaging findings to establish a diagnosis.     

PLS—紫外分光光度法同时测定复方阿斯匹林片中三组分含量

本文研究了复方阿斯匹林片中阿斯匹林、非那西丁和咖啡因含量同时测定的紫外分光光度法的最佳实验条件,并简述偏最小二乘法(PLS)在多组分同时测定中的基本原理和应用。三组分模拟试样回收率平均值的置信区间分别为100.1±0.23%,100.0±0.25%和100.1±0.33%(置信度95%)。PLS法是一种理想的多组分测定方法,计算速度较快,结果更准确可靠,尤其适用于成批试样的分析,为微机控制的紫外可见分光光度计提供了一种新方法。     

Benign infantile seizures followed by autistic regression in a boy with 16p11.2 deletion

Benign infantile seizures (BIS) are usually a self‐limiting condition, which may be associated with heterozygous mutations in the PRRT2 gene at chromosome 16p11.2. Here, we report a boy with a deletion in 16p11.2, presenting with BIS and typical neurodevelopment in the first year of life, unexpectedly followed by severe autistic regression. 16p11.2 deletions are typically associated with intellectual disability, autism, and language disorders, and only rarely with BIS. This clinical report shows that the neurodevelopmental prognosis in BIS patients may not always be benign, and suggests that array CGH screening should be considered for affected infants in order to rule out deletions at 16p11.2 and long‐term clinical follow‐up.     

Sporadic late onset nemaline myopathy responsive to IVIg and immunotherapy

Sporadic late onset nemaline myopathy (SLONM) is a progressive myopathy of indeterminate etiology and poor outcome. If associated with a monoclonal gammopathy, SLONM carries a more unfavorable prognosis. Immunotherapy was unsuccessful. We report two HIV‐negative SLONM/monoclonal gammopathy patients who improved following intravenous immunoglobulin (IVIg) treatment alone or in combination with immunosuppressant agents. This favorable response to treatment suggests that a dysimmune mechanism is operative in some SLONM individuals. We suggest that IVIg deserves initial consideration for SLONM therapy. Muscle Nerve, 2010     

Breast specimen radiography: evaluation of a compression device

The irregular shape and uneven tissue thickness of excised breast specimens makes radiographic evaluation difficult, especially when calcifications are not present. Xeroradiographs before and after compression of 20 separate excised breast specimens were compared, and 17 of the same specimens were compared after compression combined with immersion in water. Specimen compression improved visibility of the lesion on average in 88% of cases, and visibility was equal in 12%. Combined compression/immersion further improved visibility of the lesion on average in 37% of cases. More significantly, evaluation of the compressed specimen led to a change in interpretation of the radiographs in 45% of cases. Compression of the specimen in specimen radiography is recommended in all cases in which pre-biopsy localization is performed.