Repair of a ruptured aortic arch aneurysm complicated by postoperative paraplegia: Report of a case

We report herein the rare case of a 79-year-old man who suffered permanent paraplegia after undergoing an otherwise successful total arch replacement for a ruptured aortic arch aneurysm. During cardiopulmonary bypass, perfusion to the distal aorta was maintained from the femoral artery, and postoperative aortography showed intact tributaries from the aorta including the intercostal arteries. Postoperative paraplegia is an extremely rare complication of operations on the aortic arch; however, we speculate that the paraplegia in this patient could be attributed either to a steal phenomenon involving the radicular artery, or to the anatomical particularity of the spinal cord artery described by Cole and Gutelius as the segmental system.     

Bilateral subcapital loss of arms following high-voltage electrical injury in the child: a new method for stump distalisation

Summary Bilateral loss of arms following high-voltage electrical injury results in severe problems for prosthetic replacement. To allow a unilateral myoelectric prosthetic fitting directed by contralateral contact switches, stump construction was achieved by bilateral tissue expansion and free non-vascularized double-fibula transplantation. Indications, technical details and functional results are presented.     

Inhibition of mixed lymphocyte reaction by thoracic duct lymph: removal of inhibitory effect by thoracic duct drainage in lung cancer.

The inhibitory effect of the thoracic duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the thoracic duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of thoracic duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of thoracic duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of thoracic duct lymph collected 1 week after the thoracic duct drainage on mixed lymphocyte reaction is significantly lower than that of thoracic duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of thoracic duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, thoracic duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases.     

多沙唑嗪及其手性对映体对离体兔血管α_1 受体的拮抗特性(英文)

目的　分析α1 肾上腺素受体阻断药多沙唑嗪手性对映体对兔胸主动脉和颈总动脉的选择性作用 ,以探讨作为良性前列腺增生症治疗药物的可能性。方法　测定去甲肾上腺素 (NE)诱发兔离体胸主动脉和颈总动脉收缩反应 ,并采用Schild作图法计算rac 多沙唑嗪、R 多沙唑嗪和S 多沙唑嗪的pA2 值。结果　在兔胸主动脉和颈总动脉 ,0 .0 3 ,0 .1和 0 .3μmol·L-1 的rac 多沙唑嗪、R 多沙唑嗪和S 多沙唑嗪均使NE诱发的血管收缩反应量效曲线平行右移 ,Emax不变 ;由Schild作图法计算得到的多沙唑嗪及其手性对映体的斜率值 ,经统计学分析符合竞争性拮抗。3种拮抗剂pA2 值的强度顺序为 :R 多沙唑嗪 >rac 多沙唑嗪 >S 多沙唑嗪。结论　与多沙唑嗪及其手性对映体对人前列腺组织作用的报道结果不同 ,S 多沙唑嗪对兔胸主动脉和颈总动脉α1 肾上腺素受体拮抗作用的选择性显著低于rac 多沙唑嗪和R 多沙唑嗪     

乳腺癌术中保护胸前神经对胸大肌功能的意义

目的:提高乳腺癌改良根治术后患侧上肢的运动功能。方法:对1997～2001年间所施行的乳腺癌改良根治术进行回顾性分析,观察两种方法腋窝淋巴结清扫数量,术后患侧胸大肌外缘厚度变化及胸大肌功能,与对照组比较。结果:观察组术后胸肌功能全部良好,胸大肌外缘厚度变化无显著差异(P>0.05),对照组大部分胸肌功能欠佳,胸大肌外缘厚度变化有显著差异(P<0.05),腋窝淋巴结清扫数量两组无显著差异(P>0.05)。结论:保留胸前神经可有效地提高患者术后患侧上肢功能,对手术疗效无不良影响。     

胸主动脉瘤手术体外循环管理

目的总结我院1993年8月至2004年5月29例胸主动脉瘤手术体外循环(CPB)经验。方法29例胸主动脉瘤患者,实施Bentall’s手术、主动脉次全弓及全弓置换术及升或胸降主动脉人工血管置换术。根据术式分别采用常规中低温CPB,中、深低温停循环加选择性脑灌注,选择性脑灌注加下半身灌注、部分股股转流等灌注方法。结果平均CPB时间(179·8±78·1)min。并发症以出血和感染为主。早期死亡2例,晚期死亡4例。死亡率20·7%。结论正确选择CPB方法及良好的CPB管理是胸主动脉瘤手术成功的保障。     

Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery. Effects on pulmonary mechanics

BACKGROUND: A lasting impairment of pulmonary function is common after cardiac surgery. Pain from the sternotomy may contribute to the impairment. Thoracic epidural analgesia (TEA) can efficiently relieve pain in the postoperative phase, but may also affect respiratory muscle function if local anaesthetics are used. We examined the effects of TEA on pulmonary function and ventilation at rest, before and after coronary artery bypass graft surgery (CABG). METHODS: Thirty patients scheduled for CABG were randomized to receive either general anaesthesia alone or general anaesthesia with TEA. Before and after the operation the patients were examined by respiratory inductive plethysmography and spirometric tests. RESULTS: Before the operation, TEA caused significant reductions in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), maximal inspiratory (PImax) and expiratory (PEmax) pressure. The rib cage contribution to tidal volume decreased significantly but the co-ordination of the thoracic and abdominal movements remained essentially unaffected. Minute volume and respiratory frequency did not change significantly. On the first postoperative day a decrease in maximal breathing efforts was found in both groups. No differences between the groups in FVC, FEV1 and PImax were found, but PEmax was significantly greater in the TEA group. Despite the impairment, breathing at rest was largely normal in both groups. CONCLUSIONS: A better pain-relief from TEA after CABG may improve the ability to cough by a greater expiratory muscle strength. FVC, FEV1, PImax and breathing at rest are not affected by TEA after cardiac surgery.     

颅脑伤后双瞳散大62例临床分析

目的探求颅脑损伤后双瞳散大的救治措施,提高其生存率与生存质量。方法自1996年8月￣2005年4月,对因颅脑伤后双瞳散大的62例患者救治转归情况回顾性分析。结果62例经多方及时抢救和恢复治疗,存活41例(66.13%),死亡21例(33.87%)。经ADL统计,其中恢复良好25例(60.98%),中、重残13例(31.71%),植物性生存3例(7.32%)。结论对颅脑伤患者的动态密切观察是提高此类患者成功救治的关键,查明原因、果断决策、针对病因、紧急稳妥的处理是成功救治的保证。     

开胸手术后肺炎危险因素分析与对策

目的探讨开胸手术后肺炎危险因素及其防治对策。方法回顾性分析380例开胸手术患者的病历资料,按术后是否发生肺炎分为肺炎组(30例)和对照组(60例)。应用单因素和多因素分析方法,分析各变量与肺炎发生的关系。结果术前吸烟史≥10年(每日吸烟量>20支)、慢性支气管炎病史、慢性肺气肿病史、双腔气管插管、留置鼻胃管、术后使用呼吸机>6 h、有明显排痰困难等是开胸手术后发生肺炎的危险因素。结论开胸手术后肺炎的危险因素较多,我们应针对其危险因素予以防控。     

颅脑损伤颅内多发血肿的治疗

目的总结颅脑损伤颅内多发血肿的治疗经验,提高此类患者的疗效.方法回顾我科近10年425例颅脑伤后颅内双侧多发血肿的临床资料.按照主要血肿的分布,将病员分为硬膜外血肿组(EDH)、硬膜下血肿脑挫裂伤组(SDH BCL)和脑挫裂伤脑内血肿组(BCL ICH).对于不同类型血肿在合适的时机采取合适的手术方法,及时实行ICP监测,不行双侧大块脑组织切除,术中或术后立即复查头颅CT.结果 121例未经手术治疗,其中死亡4例(3.3%);手术304例,死亡17例(5.6%).EDH组127例,全经手术治疗,无死亡;SDH BCL组143例,手术116例,11例死亡(7.7%);ICH组155例,手术61例,10例死亡(6.4%).结论颅脑损伤颅内双侧多发血肿应采取综合治疗,选择合适的手术时机和方法治疗可提高治愈率,改善预后.