INFECTION AFTER RETINAL DETACHMENT SURGERY

In 250 consecutive retinal detachment operations performed by the author, there were 14 cases (56%) of infection of the scleral buckle The commonest infecting organism was Staphylococcus aureus.
The surgery in these infected cases took longer than average, and utilized more than the usual amount of silicone sponge, a higher proportion were reoperations After an average follow-up of 22 months, only six of the 14 had vision of 6/36 or better and of these, two had persisting inferior traction detachments.
On the basis of this study and others, the preferred management of infected scleral buckles is to remove the sponge as soon as the diagnosis is made The risk of redetachment is a lesser evil than the sequelae of prolonged inflammation which include traction retinal detachment, massive perirebnal proliferabon, and premacular fibrosis.     

鼻内镜下再次行泪囊鼻腔吻合术联合丝裂霉素及明胶海绵疗效观察

目的:探讨鼻外进路泪囊鼻腔吻合术失败后,应用明胶海绵联合丝裂霉素在鼻内镜下再手术的效果。方法:自下泪小点导入泪道探针至骨窗,在鼻内镜下予镰状刀切开骨窗处黏膜,清除骨窗的瘢痕组织,扩大骨孔,放入浸有0.2g/L的丝裂霉素棉片5分钟后,用生理盐水清洗,再放入浸有皮质类固醇及抗生素的明胶海绵填入吻合腔,待膨胀的明胶海绵完全填塞吻合口后,下方鼻腔再填入明胶海绵。结果:术后随访6～22个月,治愈13例(81%),好转2例(12%),未愈1例(7%),总有效率93%。结论:丝裂霉素联合压缩明胶海绵对充填吻合道、止血防粘连、抑制纤维化及减轻吻合口收缩起重要作用     

凝胶材料制备方法及其反应动力学的研究进展

部分水凝胶材料具有良好的生物相容性、低细胞毒性和生物可降解性,广泛应用于组织工程和生物医药等领域,其中采用天然高分子明胶、壳聚糖和海藻酸钠制备复合凝胶材料,负载骨髓间充质干细胞用于修复和治疗骨缺损成为近年来的研究热点之一。因为水凝胶材料抗张强度低和化学稳定性差,所以研究凝胶反应机理和凝胶反应动力学对提高水凝胶的性能具有重要意义。本文总结了明胶、壳聚糖和海藻酸钠凝胶材料的制备方法和凝胶反应机理,比较了不同凝胶反应动力学研究方法,介绍凝胶复合材料在骨修复中的应用,为天然高分子凝胶材料的分子设计和临床应用提供思路。     

改良固定底物膜法对精子顶体透明质酸酶检测的研究

目的研制一种检测人精子透明质酸酶的改良底物膜法，以提高临床对男性不育的诊断水平。方法根据精子顶体透明质酸酶能溶解卵丘基质透明质酸的生化特性，通过改良透明质酸钠-明胶底物膜法，后进行孵育及染色来显示透明质酸酶的活性。本研究检测了70例人精子透明质酸酶活性，并结合临床精液常规检查结果选择和分组标本（生育组26例，不育A组13例，不育B组31例），对生育组与各不育组之间的平均酶活性进行统计学分析。结果在普通光镜下即可观察到在阳性反应区以深紫蓝色底膜为背景的清晰明亮的消化晕环，晕环数量及直径的大小与透明质酸酶活性成正比。生育组透明质酸酶平均阳性率为70．84％，酶活性亮区平均直径为78．17μm；不育A组酶平均阳性率为60．02％，酶活性亮区平均直径为76．92μm；不育B组酶平均阳性率为29．11％，酶活性亮区平均直径为8．22μm；经t检验，生育组酶活性两项指标均高于不育B组，差异有统计学意义（P〈0．01）。结论本研究检测方法简便、可靠，并可连续观察单个精子顶体透明质酸酶活性反应，很适合作为临床评价精子功能的有效指标，并提高对男性不育的诊断水平。     

胶原蛋白海绵治疗1例大面积压疮的疗效观察

压疮是由于身体局部组织长期受压,血液循环障碍,组织营养缺乏,致使皮肤失去正常功能,而引起的组织破损和坏死[1],尤其是大面积深度压疮,局部组织严重缺血缺氧,久治不愈.给患者带来巨大痛苦,延长病程,加重经济负担,增加护理工作量.2006年3月30日,我科收治1例大面积深度压疮患者,经47天的精心护理和治疗,痊愈出院.     

国产高膨胀性海绵用于鼻腔填塞的临床观察

目的:比较两种鼻腔填塞材料的疗效,选择理想的鼻腔填塞物。方法:将324例鼻出血及鼻腔鼻窦术后患者分为凡士林纱条填塞组(A组)、国产高膨胀性海绵填塞组(B组)。结果:两组在止鼻出血方面疗效无显著性差异,但在鼻腔填塞后头鼻胀痛、取出填塞物后渗血量及粘膜情况有显著性差异(P<0·01)。结果:高膨胀性海绵是较理想的鼻腔填塞材料。     

止血海绵覆盖治疗腰椎后路减压术中硬膜囊撕裂的临床疗效观察

目的 :观察止血海绵覆盖治疗腰椎后路减压术中硬膜囊撕裂导致显性脑脊液漏的临床疗效,探讨其治疗硬膜囊撕裂的疗效。方法:回顾性分析2014年1月～2016年6月在我院行后路腰椎手术治疗的1896例患者资料(初次手术1850例,翻修手术46例),术中发现硬膜囊撕裂86例(初次手术78例,翻修手术8例),其中男35例,女51例,年龄18～72(53.8±8.3)岁,所有硬膜囊破口术中均行缝合修补。根据是否适用止血海绵覆盖分为两组,A组(46例)术中使用止血海绵覆盖硬膜囊联合明胶海绵加压处理缝合后的硬膜囊破口,B组(40例)术中常规皮下深筋膜覆盖硬膜囊联合明胶海绵覆盖加压处理缝合后的硬膜囊破口。收集患者一般资料、疾病类型、手术时间、硬膜囊撕裂长度、术中失血量,记录两组患者术后脑脊液漏的发生率及其每日引流量、引流管留置时间、起床活动时间、术后脑脊液漏早期并发症情况。术后出现脑脊液漏患者末次随访均复查腰椎MRI,观察术后脑脊液漏远期并发症,是否形成硬膜囊假性囊肿或脑脊液窦道形成。结果 :A组与B组之间性别、年龄、疾病类型、术中硬膜囊撕裂大小、手术时间、术中失血量无统计学差异(P0.05),A组术后脑脊液漏发生率15.2%(7/46)低于B组35.0%(14/40),两组间有统计学差异(P0.05);A组中术后出现脑脊液漏患者引流管留置时间(3.5±1.3d)及平均每日脑脊液引流量(125.0±59.3ml)明显低于B组(10.5±2.1d;329.0±103.1ml),两组间有统计学差异(P0.05);A组中术后出现脑脊液漏患者起床活动时间7.5±1.6d,B组为14.5±2.2d,两组间有统计学差异(P0.05);末次随访时A组出现低颅压性头痛(2/7)、切口渗漏不愈(0/7)、切口感染(0/7)等早期脑脊液漏并发症低于B组(8/14、2/14、1/14)(P0.05)。术后出现脑脊液漏患者术后随访复查腰椎MRI,A组未见明确硬膜外脑脊液囊肿或皮下窦道形成,B组存在硬膜外脑脊液囊肿1例,无皮下脑脊液窦道形成。结论:应用止血海绵覆盖硬膜囊治疗后路腰椎减压术中硬膜囊撕裂导致的显性脑脊液漏有效,可减少脑脊液漏引流管留置时间及引流量,降低术后脑脊液漏的发生率及其相关的早期并发症。     

鼻内窥镜下行改良式鼻中隔黏骨膜瓣移位修补术治疗鼻中隔穿孔

目的探讨鼻内窥镜下行改良式鼻中隔黏骨膜瓣移位修补术治疗鼻中隔穿孔效果。方法使用0°,30°鼻内窥镜行改良式鼻中隔黏骨膜瓣移位修补术中应用医用生物蛋白海绵作为贴补材料,不必缝线。结果7例鼻中隔穿孔病例一次性修补愈合。结论鼻内窥镜下行改良式鼻中隔黏骨膜瓣移位修补术中应用医用生物蛋白海绵治疗鼻中隔穿孔是行之有效治疗方法。     

肠球菌部分致病基因和表型的检测

目的 调查临床分离的肠球菌6种致病基因和2种表型的分布。方法 应用聚合酶链反应和斑点杂交技术检测临床分离的145株肠球菌的6种致病基因，用7％兔血平板和3vA，明胶平板检测B溶血和明胶溶解表型。结果 粪肠球菌和屎肠球菌6种致病基因的检出率分别为gelE 72．9％、30．6％；efaA 79．2％、36．7％；cylA 54、2％、34．7％；esp 34、4％、36．7％；agg 18．8％、0；ace28．1％、0。粪肠球菌和屎肠球菌β溶血分别为45．8％、20．4％；明胶溶解分别为35、4％、16．3％。结论 粪肠球菌6种致病基因和2种表型的检出率高于屎肠球菌；尿标本比痰标本肠球菌致病基因的检出率高；gelE、efaA和cylA在粪肠球菌中的检出率高于其他致病基因。     

The efficacy of a novel collagen–gelatin scaffold with basic fibroblast growth factor for the treatment of vocal fold scar

Vocal fold scar remains a therapeutic challenge. Basic fibroblast growth factor (bFGF) was reported to have regenerative effects for vocal fold scar, although it has the disadvantage of rapid absorption in vivo. A collagen–gelatin sponge (CGS) can compensate for the disadvantage by providing a sustained release system. The current study evaluated the efficacy of CGS combined with bFGF on vocal fold scar, using rat fibroblasts for an in vitro model and a canine in vivo model. We prepared fibroblasts from scarred vocal folds (sVFs) in rats and showed that bFGF accelerated cell proliferation and suppressed expression levels of cleaved caspase 3 and α‐smooth muscle actin. Has 1, Has 3, Fgf2, Hgf and Vegfa mRNA levels were significantly upregulated, while Col1a1 and Col3a1 were dose‐dependently downregulated, with a maximum effect at 100 ng/ml bFGF. In an in vivo assay, 6 weeks after lamina propria stripping, beagles were divided into three groups: CGS alone (CGS group); CGS with bFGF (7 µg/cm²; CGS + bFGF group); or a sham‐treated group. Vibratory examination revealed that the glottal gap was significantly reduced in the bFGF group and the two implanted groups, whereas the CGS + bFGF group showed higher mucosal wave amplitude. Histological examination revealed significantly restored hyaluronic acid and elastin redistribution in the CGS + bFGF group and reductions in dense collagen deposition. These results provide evidence that CGS and bFGF combination therapy may have therapeutic potential and could be a promising tool for treating vocal fold scar. Copyright © 2015 John Wiley & Sons, Ltd.