示指双血管蒂岛状皮瓣急诊拇指再造1例

０　引言　拇指外伤后的急诊修复十分重要,以往各种方法各有其优缺点,我们介绍一种新的尝试．１　病例报告　患者男性,４２岁,左拇指机器绞伤２ｈ就诊．查体：全身情况好,左拇指近节中段以远皮肤软组织大部分撕脱,只有背部约１ｃｍ皮肤相连,但已受挤压,远端无充血...     

进展期胃癌合并幽门梗阻内镜治疗103例

目的:探讨进展期胃癌合并幽门梗阻内镜治疗的方法及其疗效.方法:103例进展期胃癌合并幽门梗阻患者,按就诊顺序随机分为4组进行内镜下治疗.A组内镜下局部注射化疗药物;B组内镜下微波消融治疗;C组内镜下微波消融治疗加局部注射化疗药物;D组内镜下微波消融治疗加局部注射化疗药物后4wk放置金属内支架.另选择同期拒绝任何治疗的患者25例作为对照组.结果:D组内镜治疗的显效率为84.62%,较B、C两组的33.33%和44.44%明显提高(P<0.01);同时,D组内镜治疗后半年,幽门再梗阻发生率为38.46%,显著低于A、B、C三组的88.46%、79.17%、59.26%(P<0.01).D组患者半年,或1a的生存率明显提高,中位生存期达9.37mo,其生存情况好于其他各组患者结论:内镜下微波消融加局部注射化疗药物,并放置金属内支架是一种治疗进展期胃癌合并幽门梗阻积极的姑息疗法,能明显提高患者的生存质量,延长其生存时间.     

腰椎间盘突出伴侧隐窝狭窄症的微创治疗破

0引言 腰椎间盘突出症伴侧隐窝狭窄症目前最有效的方法依然是椎间盘突出髓核摘除及神经根通道减压清理术. 如何减少创伤,保持脊柱稳定,尽快康复,以最少的并发症和最低的经济负担,获得优良的中远期疗效一直是脊柱外科的目标[1-3]. 2000-09/2004-03我院开展显微内窥镜椎间盘切除(MED)手术375例,其中120例有椎间盘突出伴侧隐窝狭窄,进行椎间盘摘除及神经根通道清理术. 现将随访到的98例作一短中期疗效的总结报道.     

Sitosterol xanthomatosis

BACKGROUND: Sitosterolaemia is a lipid disorder in which plasma plant sterol levels are extremely elevated. Sitosterolaemia is clinically characterized by tuberous and tendon xanthomas, premature vascular disease and arthritis. OBJECTIVE: To report a case of sitosterolaemia diagnosed by cutaneous manifestations and to review this rare disease. METHODS: We report the case of a 60-year-old woman who presented with cutaneous xanthomas, arterial hypertension and polyarthralgias. The patient had had hypercholesterolaemia for many years without reduction of serum cholesterol, despite treatment with fenofibrate. RESULTS: Ezetimibe therapy was started, decreasing sitosterol plasmatic levels and tuberous xanthomas after 3 months of treatment. CONCLUSION: It is important to detect levels of sitosterol in plasma in patients with premature vascular disease, presence of xanthomas, and uncontrolled hypercholesterolaemia. Ezetimibe therapy is effective.     

Segond tibial condyle fracture: lateral capsular ligament avulsion

Avulsion fractures in the appendicular skeleton are a result of stress on a specific structure that is firmly attached to bone. A small avulsion fracture from the directly lateral surface of the lateral tibial condyle results from excessive tension on the lateral capsular ligament of the knee joint. Recognition of this fracture on an anteroposterior radiograph of a traumatized knee represents substantial evidence of major injury to the lateral joint capsule. This fracture also has a strong association with rupture of the anterior cruciate ligament. The avulsed tibial fragment is remarkably constant in site and appearance. The typical fragment is isolated by a longitudinal fracture line separating a small piece of bone from the lateral tibia. It is elliptical in outline (10 X 3 mm), with its proximal border lying 4 mm distal to the subarticular cortex of the lateral tibial condyle. A hemarthrosis of the knee joint is consistently visible.