The role of the endoscopic extraperitoneal approach in large inguinal scrotal hernias

The role of endoscopic extraperitoneal herniorrhaphy (EEPH) in the management of giant scrotal hernias has not been well defined, and the technical details relating to operations on such hernias have not been described. We present our experience with 17 patients undergoing repair of giant scrotal hernias. Foley catheter bladder decompression was routinely employed. The Retzius space was developed early in the procedure and hernia sac contents were reduced in all cases. The inferior epigastric vessels were likewise divided in all patients. The average operative time was 76 min and all patients were discharged home the same day. There have been no recurrences on follow-up. There was no mortality, and morbidity was limited to seroma formation in two patients. We conclude that with certain technical modifications, EEPH can be safely employed for the treatment of giant scrotal hernias. Received: 7 May 1996/Accepted: 12 July 1996     

Compartment syndrome. Exclusively the result of increased pressure in the muscular compartment?

Summary The compartment syndrome (cs) is characterized by an increased tissue pressure in a limited space. Pathophysiologically, it is a multifactorial disease that is potentially induced by an initial trauma and develops according to the existence of cofactors. Cofactors are, for instance, the circulation of the patient and the initial treatment of the impending cs. In particular, the microcirculation is altered with endothelial destruction, development of a capillary leak, protein loss from intravasal space and the development of an interstitial and intracellular third space. An impaired drainage of the lymphatic and venous system causes a venous infarction. An arterial infarction results if the tissue pressure exceeds the arteriolar pressure. An accompanying ischemia reperfusion mechanism increases the trauma load. In disadvantageous cases, the patients are in danger of developing a multi-organ deficiency syndrome (MODS) by an uncontrolled inflammatory reaction, by intravasal volume loss and by a myonephropathic systemic reaction. Clinically, the patients suffer a disproportionate amount of pain, followed by neurological signs. Especially in noncompliant patients, tissue pressure measurement is useful. Resuscitation of the circulation as well as splitting of casts is important. In case of a manifest cs, dermatofasciotomy has to be performed as an emergency operation. Even if cs is diagnosed early and fasciotomy is carried out early, the development of sequellae cannot be avoided in every single case.      

汽车安全气囊所致的眼外伤

目的：报告了因汽车安全气囊造成的眼外伤及化学性烧伤。希望引起眼科同仁的高度重视．方法：４例病人均是进口高档小卧车，在发生碰撞时因汽车安全气囊高速膨胀打开及气囊破裂所致的眼损伤及化学烧伤．分析了汽车型号及种类，事故发生时的速度，眼损伤的类型和视力情况．结果：第一例病人为碱性化学性角膜炎伴虹膜根部离断及瞳孔括约肌破裂而造成瞳孔扩大；第二例病人为近视镜片致角巩膜板层撕裂伤；第三例病人为广泛角膜擦伤伴前房出血；第四例病人为视网膜水肿出血伴后极部脉络膜裂伤．结论：安全气囊能保护生命降低致伤率，但因气囊的冲击力量引起的机械损伤和气囊中强碱性气体导致的化学烧伤更要引起国内眼科医生的注意．     

蛛网膜下腔出血后正常颅压脑积水(附20例分析)

本文分析了20例有明确蛛网膜下腔出血病史的正常颅压脑积水患者的临床表现,其中有智能、步态障碍、尿失禁三联征典型表现者占11例(55％),有其中二个症状者4例。CT是诊断脑积水的首选检查。本文还结合文献对正常颅压脑积水的发生发展,与之有关的因素及临床表现进行讨论。     

Neuroblastoma-like epidural localization in non-Hodgkin's lymphoma

Summary We report a case of non-Hodgkin's lymphoma with CNS involvement confined to the epidural space causing cranial suture diastasis. Cerebrospinal fluid and bone marrow were normal. Two cases only of cranial epidural lymphoma have been reported in the literature; in both cases, the leptomeninges were also involved but without suture diastasis.     

Water imbibition in the rat prostate during castration-induced regression

The present study was conducted to examine changes in water concentration in the ventral prostate of adult rats at different intervals following castration. The prostatic dry weight was obtained by drying the fresh prostate at 70 degrees C for at least 110 hr and the prostatic water content was calculated from its wet and dry weight. Under normal conditions, the prostatic water concentration ranges from 81.9 to 82.7% in uncastrated rats. The prostatic water concentration started to increase at 8 hr postcastration (83.1%) but this increase was not statistically significant. By 16 hr postcastration, the prostatic water concentration (83.8%) became significantly higher than that of the uncastrated animals. In rats of day 1 to day 10 postcastration, the prostate contained significantly more water (84.4%-84.7%) than those in uncastrated animals. By day 21 postcastration, the prostatic water concentration (81.5%) was not significantly different from that of uncastrated rats. Unlike the prostate, the skeletal muscle did not significantly change the water concentration following castration. The 51Cr-EDTA space in the prostate was not significantly different in rats before and after castration. These results indicate that water imbibition in the rat prostate is associated with an active period of prostatic regression and that the change in the 51Cr-EDTA space during prostatic regression is not the major cause of water imbibition in the tissue. Therefore, the present findings suggest that castration-induced water imbibition in the rat prostate is caused by an increase in the intracellular water space.     

云南阳春砂仁的质量与生态环境关系的探讨

当前云南阳春砂仁产量,占全国总产量的65.5％,商品有左右全国砂仁市场之势。经调查云南产区生态环境较原产区广东阳春县为优,故表现出植株生长较高,果实较大,每室籽粒数较多等性状特征之差,这些差异并非是物种的变异,而是生态环境较好所致。从两地商品中的精油成分和微量元素分析结果也基本一致,认为影响云南阳春砂仁质量的酸味,两地商品均有,并都来源于假种皮,只不过云南商品果实较大,假种皮较厚,总酸含量较高,但是总酸均为无毒副作用的低分子有机酸,不影响砂仁的质量。因此我们认为云南引种区的阳春砂仁质量,与广东原产区的阳春砂仁质量应基本一致。     

Changes in hepatic lymph vessels in endotoxaemia.

This study was undertaken into rats to investigate changes in the hepatic lymph vessels and the space of Disse in endotoxaemia and to examine their relationship with the development of endotoxin-induced hepatic injury. Lymph stasis, namely dilatation of the lymph vessels and oedema, developed rapidly in the medium-sized portal canals, the large portal canals, and the liver hilum after endotoxin injection, but not in the small portal canals. Such changes reached their maximum 4-8 h after endotoxin injection and had recovered markedly by 16 h after the injection. The space of Disse remained within normal limits during this period. These findings suggest that the intrahepatic lymph stasis in endotoxaemia may be caused by a reduction in the pumping activity of the extrahepatic and the intrahepatic large lymph vessels rather than by an increase of lymph formation in the liver lobules. There was no evidence suggesting a direct relationship between the disturbance of hepatic lymph flow and the development of hepatic injury in endotoxaemia.     

The treatment of sulphur mustard burns with laser debridement.

The chemical warfare agent, sulphur mustard (SM), is a potent blistering agent in man. Skin exposure can produce partial-thickness burns which take up to three months to heal. The aim of this study was to investigate the use of early laser ablation as a means of accelerating this exceptionally slow rate of healing. Four circular partial-thickness SM burns were induced on the dorsum of nine large white pigs (under general anaesthesia). At 72 h post-exposure, three burns per animal were ablated with a single pass of an UltraPulse 5000C CO(2) laser, at a fluence of 5-6 J cm(-2). All the burns were dressed with silver sulphadiazine and a semi-occlusive dressing. At one, two and three weeks post-surgery three animals were culled and all lesions excised for histological analysis. Burn depth was confirmed and measurements of the radii of regenerative epithelium were performed allowing the area of the zone of re-epithelialisation in each lesion to be calculated. Laser-treated lesions showed a significant increase (350%) in healing rates compared to controls (p<0.005). At two weeks, the laser-treated sites were 95% healed in comparison with control sites (28% healed). These data suggest that laser ablation may be effective in the treatment of partial-thickness SM-induced skin injury.     

蒲氏间隙的高分辨率CT测量

目的:在HRCT图像上测量正常成人蒲氏间隙(Prussak space)的宽度,为胆脂瘤早期诊断提供参考。材料和方法:60例正常成人耳部(男性和女性各30例)做冠状位HRCT扫描,测量锤骨颈外缘至鼓室盾板尖端的距离(相当于蒲氏间隙宽度),并作统计学分析。结果:测量值在1-1.5mm之间,平均1.22±0.098mm。平均值分别为:男性左耳1.193±0.021mm;男性右耳1.227±0.019mm;女性左耳1.213±0.016mm;女性右耳1.233±0.015mm,统计分析显示男女之间和左右耳之间均无明显差异(t=0.255,t=1.137和t=0.845,均P>0.05)。结论:正常成人蒲氏间隙宽度在HRCT图像上约为1-1.5mm,性别与双耳之间无明显差异,此间隙宽度>1.5mm可作为诊断上鼓室胆脂瘤的一个重要依据。