阴茎拉直衡量去皮法在成人包皮环切术中的应用探讨

目的:研究寻找一种在包皮环切术中衡量去皮适度的最佳方法。方法:对2010年4月~2014年5月收治的220例成人包皮过长患者分别采用传统的包皮环切术及阴茎拉直衡量去皮法包皮环切术。术后观察对比阴茎外观、水肿、伤口恢复、功能及勃起疼痛情况。结果:阴茎拉直衡量去皮法包皮环切术患者术后水肿、外形及勃起疼痛明显好于传统包皮环切术。结论:阴茎拉直衡量去皮法包皮环切术是一种简单、有效的术中衡量包皮去皮量多少的较理想方法,值得临床推广。     

气管内插管全麻患者术后咽喉部并发症研究进展

全麻手术中采用气管内插管常常造成咽喉部的创伤和病变,并导致咽喉部术后并发症的产生,如咽喉炎、声嘶和吞咽困难等。本文针对气管内插管的全麻患者术后咽喉部并发症的发生原因及其主要干预措施进行综述,为临床治疗及护理此类患者,提高患者舒适度提供理论依据。     

远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损

目的探讨远端筋膜蒂第一跖背动脉皮瓣修复蹰趾皮肤缺损的临床效果。方法回顾性分析2008年10月～2013年10月采用远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损患者9例,供区行中厚皮片移植。结果9例患者均获得随访,随访时间平均6（3～12）个月。皮瓣全部成活,皮瓣颜色、质地、厚薄与受区皮肤相近。1例皮瓣少许皮肤坏死,经换药3周后Ⅱ期愈合。供区植皮均Ⅰ期愈合。两点辨别觉为6～13mm,患者行走正常,皮瓣及供区植皮处皮肤无破溃。患者对外观、功能满意。结论相较于传统第一跖背动脉皮瓣,远端筋膜蒂第一跖背动脉皮瓣血管蒂长,转移覆盖范围增大,皮瓣血供更有保障,供区影响小,术后外形良好,是修复躅趾皮肤缺损的一种较好的方法。     

Cochrane协作网结直肠癌组的结直肠肿瘤证据

截至Cochrane图书馆2008年第2期，Cochrane协作网结直肠癌组目前已完成的25篇与结直肠肿瘤相关的系统评价涉及结直肠肿瘤预防、镜检诊断、内外科治疗、预后、随访等方面。Cochrane系统评价肯定了非甾体抗炎药的预防作用，染色内镜的诊断价值，腹腔镜手术的短期效果，全直肠系膜切除术辅助腹腔镜手术的疗效等；质疑了纤维素在结直肠肿瘤预防、结直肠癌术前机械肠道准备、术后常规引流的意义。某些课题如中药在化疗中的作用，由于所纳入的研究质量不高而未能得出非常可靠的证据。本文试图通过介绍Cochrane协作网结直肠肿瘤的系统评价成果，向国内同行传递目前结直肠肿瘤的高级别临床证据，并提示结直肠肿瘤领域的研究方向。     

超声导引下介入治疗继发孔型房间隔缺损及合并畸形428例临床报告

目的:报告我院1998年10月~2004年10月超声导引下介入治疗ASD合并畸形428例,主要讨论介入适应证,操作原则及临床效果。方法:住院患者继发孔型ASD 428例,男150例,女278例(男∶女=1∶1.9),年龄2~74岁(平均26.6±16.6)。428例ASD为中央型,其中单一ASD 416例,多发型ASD 12例,合并畸形70例,其中合并肺动脉瓣狭窄(PS)14例,肺动脉高压(PH)11例,二尖瓣狭窄(MS)(芦停巴赫综合征)3例,合并室上速3例,合并心房纤颤14例,其它25例。使用日本东芝6000型和美国惠普1500型彩色多普勒血流显像仪和食道超声(TEE)探头频率分别为2.5MHz和5MHz。术前用TTE诊断,术中用TEE配合,儿童<10岁用TTE配合。结果:介入术中超声导引导入球囊导管测量最大ASD伸展直径,用TTE或TEE测量ASD直径及确定ASD位置、大小及数目。428例ASD患者成功介入425例,介入技术成功率99.3%。介入手术并发症总发生率2.1%。合并畸形的治疗,超声导引介入治疗合并畸形,待合并畸形治愈后方再行ASD介入治疗,本组合并畸形介入治疗成功率100%。结论:ASD及合并畸形的介入治疗,必须要在超声导引和监测下主要掌握ASD及合并畸形疾病的适应证,操作规范化,成功率很高,而且是安全有效的。     

Clinical features and surgical outcomes of intramedullary schwannomas

Object

Intramedullary schwannomas are exceedingly rare. Most previous studies are case reports with an associated literature review. The aim of this study was to discuss the clinical features and the outcomes of microsurgery for these rare lesions.

Methods

The authors retrospectively reviewed the data of twenty patients with intramedullary schwannomas. All patients had performed preoperative and postoperative magnetic resonance imaging (MRI) and underwent microsurgery. The diagnosis of intramedullary schwannomas was based on radiological and pathological criteria. Modified McCormick classification was applied to assess neurological function.

Results

There were 15 males and five females with a mean age of 44.7 years. Ten tumors were located in the cervical cord, five in the thoracic cord, two in the cervicothoracic cord, two in the thoracolumbar cord and one in the conus medullaris. Patients presented with nonspecific symptoms and the mean duration of symptoms was 37.4 months. Intraoperatively, the tumor was connected to the dorsal rootlet in four cases. Gross total resection (GTR) of the tumor with a well-demarcated dissection plane was achieved in 16 cases, and subtotal resection (STR) was achieved in four cases. No patients received postoperative radiotherapy. During a mean follow-up period of 67.9 months, no recurrence or regrowth of the residual tumors was observed on MRI. Ninety percent of patients experienced an improvement in the McCormick grade and 10 % of patients maintained their preoperative status.

Conclusions

Intramedullary schwannomas are benign but clinically progressive lesions. The accurate diagnosis depends on pathology. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. When GTR cannot be achieved, STR of the tumor for decompression is advised. Postoperative radiotherapy is not recommended for these benign tumors. A good clinical outcome after GTR or STR can be expected.     

Fish-oil emulsion (omega-3 polyunsaturated fatty acids) attenuates acute lung injury induced by intestinal ischemia–reperfusion through Adenosine 5′-monophosphate-activated protein kinase–sirtuin1 pathway

Background

Activated macrophage infiltration into the lungs is paramount in the pathogenesis of acute lung injury (ALI) induced by intestinal ischemia–reperfusion (I/R). Omega-3 polyunsaturated fatty acid (ω-3 PUFA) is a potent activator of the Adenosine 5′-monophosphate-activated protein kinase–sirtuin1 (AMPK/SIRT1) pathway against macrophage inflammation. We aimed to evaluate whether ω-3 PUFAs may protect against ALI induced by intestinal I/R via the AMPK/SIRT1 pathway.

Methods

Ischemia in male Wistar rats was induced by superior mesenteric artery occlusion for 60 min and reperfusion for 240 min. One milliliter per day of fish-oil emulsion (FO emulsion, containing major ingredients as ω-3 PUFAs) or normal saline (control) was administered by intraperitoneal injection for three consecutive days to each animal. All animals were sacrificed at the end of reperfusion. Blood and tissue samples were collected for analysis.

Results

Intestinal I/R caused intestinal and lung injury, evidenced by severe lung tissue edema and macrophage infiltration. Pretreatment with FO emulsion improved the integrity of microscopic structures in the intestine and lungs. Intestinal I/R induced the expression of macrophage-derived mediators (macrophage migration inhibitory factor and macrophage chemoattractant protein-1), inflammatory factors (nuclear factor κB, tumor necrosis factor α, interleukin 6, and interleukin 1β), and proapoptosis factor p66shc. There was a decrease in the expression of AMPK, SIRT1, and claudin 5. FO emulsion significantly inhibited macrophage infiltration into the lungs, inflammatory factor expression, and p66shc phosphorylation. Importantly, FO emulsion restored AMPK, SIRT1, and claudin 5 in the lungs.

Conclusions

Pretreatment with ω-3 PUFAs effectively protects intestinal and lung injury induced by intestinal I/R, reduces macrophage infiltration, suppresses inflammation, inhibits lung apoptosis, and improves the lung endothelial barrier after intestinal I/R in a manner dependent on AMPK/SIRT1. Thus, there is a potential for developing AMPK/SIRT1 as a novel target for patients with intestinal I/R–induced ALI.     

Cavernous Angiomas of the Cauda Equina: Clinical Characteristics and Surgical Outcomes

Cavernous angioma (CA) is a rare hamartomatous vascular lesion, consisting of abnormal, dilated, and packed sinusoidal vascular channels without interposed nervous tissue. CAs of the cauda equina are exceedingly rare and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these rare lesions. We retrospectively reviewed the records of 10 patients who underwent microsurgery for CAs of the cauda equina. All patients had performed pre- and postoperative magnetic resonance imaging (MRI). CAs of the cauda equina generally exhibited mixed intensity on T₁- and T₂-weighted images. Contrast-enhanced T₁-weighted images showed heterogeneous enhancement. The hemosiderin ring which surrounded the cauda equina CA was rare. Gross total resection was achieved in all cases. All patients were followed up, with a mean duration of 41.1 months. Long-term neurological function was improved in nine patients and remained stable in one patient. No recurrence was observed on MRI. CAs should be considered in the differential diagnosis of cauda equina tumors. Because of the excessive vascularity of CAs, en bloc resection is recommended. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate.     

总额预付下定点医院加强医保管理实践探索

定点医院不仅是参保人员获取基本医疗服务和实现基本医疗消费的主体,又是直接控制医疗费用的载体,还是具体与参保人员接触、沟通、落实医保政策的场所。定点医院成为基本医疗保险管理体系中极为重要的组成部分,总额预付下如何加强医保管理与政策落实是否到位,直接关系到控制医保费用的关键所在。     

儿童哮喘危险因素及防治状况临床分析

目的 了解儿童哮喘发病的危险因素和《全球哮喘防治创议》（GINA方案）在基层医院的执行情况。方法抽取2003年6月至2005年5月在本院“儿童哮喘之家”确诊并登记的哮喘患儿116例，分析首诊时的发病原因及防治现况。结果儿童哮喘的发病原因与环境因素、呼吸道病毒感染、过敏体质及遗传等有关；GINA方案在基层医院，尤其是在社区医院、农村乡镇卫生院的执行存在严重的空白。结论加强对基层医务工作者哮喘知识的继续教育和指导，才能很好地执行GINA方案，控制儿童哮喘。