Correlation between Transient Hypotension and Exclusively Exercise-induced Symptoms of Two-to-One Atrioventricular Block

A 62-year-old woman with activity-dependent two-to-one atrioventricular block (2:1AVB) and a normal left ventricular ejection fraction was referred to our department for the evaluation of exclusively exercise-induced marked symptoms. The treadmill test helped establish a clear correlation between 2:1AVB and symptoms. The test results demonstrated that exercise-induced marked symptoms were attributed to abrupt transient hypotension combined with relative bradycardia, probably due to increased diastolic mitral and tricuspid regurgitation because of 2:1AVB during moderate-to-heavy exercise. After pacemaker implantation for 2:1AVB, the symptoms and transient hypotension disappeared, and her exercise capacity improved.     

桡骨远端手术B超引导下不同入路神经阻滞的效果

目的 分析B超引导下腋路、肌间沟及锁骨上不同入路神经阻滞在桡骨远端手术中的应用效果.方法 将我院收治的90例桡骨远端骨折患者随机分为A组、B组及C组,每组30例;A组采用肌间沟入路臂丛神经阻滞术治疗,B组采用腋路臂丛神经阻滞术治疗,C组采用锁骨上入路臂丛神经阻滞术治疗;观察三组患者操作时间及手术时间;统计所有患者痛觉消...     

局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补术

目的探讨局部神经阻滞麻醉下的腹膜前无张力修补在腹股沟区疝中的应用。方法采用美国强生公司生产的普理灵疝装置、美国巴德公司生产的可固(Kugel)补片及网塞补片、德国贝朗公司或美国艾瑞公司生产的大号自主成型补片和北京天助畅运公司的善愈补片作为疝修补材料,对2002年2月至2008年1月6年间收治的3126例腹股沟区疝患者进行局部神阻滞麻醉下的腹膜前腹股沟无张力疝修补,观察手术时间,手术后疼痛程度,术后各种并发症的发生情况、手术费用、平均住院日和近期随访情况。结果手术时间平均25分钟,术后疼痛轻微,未出现尿潴留,阴囊浆液肿56例。本组患者围手术期死亡3例,切口感染2例,切口下血肿18例,术后慢性疼痛6例,平均住院日3天,平均手术费用4644元。平均随访69个月,复发10例,所有患者异物感均不明显。结论局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补是一种安全、可靠的手术方式,尤其适用于疝环或腹横筋膜缺损较大的腹股沟疝老年患者。     

缺血预处理对家兔低位腹主动脉阻断后再灌注损伤的保护作用

目的研究缺血预处理对家兔低位腹主动脉阻断后再灌注损伤的保护作用。方法健康家兔24只,雌雄不拘,随机分为三组,每组8只。Ⅰ组：低位腹主动脉阻断2 h后开放;Ⅱ组：低位腹主动脉阻断3 h后开放;Ⅲ组：阻断腹主动脉5 min,开放10 min,重复3次后低位腹主动脉阻断3 h后开放。分别于阻断前（T1）、阻断后2 h（T2）、阻断后3 h（T3）、开放后2 h（T4）及开放后24 h（T5）抽取静脉血测定天冬酰胺转移酶（AST）、肌酸激酶（CK）、超氧化物歧化酶（superoxide dismutase,SOD）和丙二醛（malondialdehyde,MDA）,并于开放后24 h观察动物后肢运动功能,处死家兔并留取股神经行电镜检查。结果所有动物均存活。T4、T5时,Ⅱ组和Ⅲ组CK、AST明显高于Ⅰ组（P〈0.05）;T1-T3时,各组SOD活性和MDA变化不明显,T4、T5时,各组SOD活性明显下降,MDA含量显著升高,Ⅱ组较Ⅰ组、Ⅲ组变化更明显（P〈0.05）;Ⅰ组和Ⅲ组动物术后后肢活动良好,Ⅱ组中有3只动物肌力差,其余未见明显异常;股神经电镜检查结果显示,Ⅰ组结构基本正常,Ⅲ组缺血性损害轻微,Ⅱ组最重。结论缺血预处理对腹主动脉阻断后再灌注损伤具有保护作用。     

Management of glaucoma in the implanted patient

Implanting an intraocular lens in an eye with controlled open angle glaucoma or angle closure glaucoma does not adversely affect the eye's status. Furthermore, it is extremely rare for primary glaucoma to develop in an eye postimplantation. Secondary glaucoma is certainly more common, although its incidence is not substantially greater than that in nonimplanted eyes. Special considerations with respect to medical therapy and surgical treatment of secondary glaucoma in pseudophakia are discussed.     

胸段硬膜外阻滞对心力衰竭兔血液动力学、神经内分泌和肺水通道蛋白AQP4影响

目的:探讨胸段硬膜外阻滞(TEB)对心力衰竭兔血液动力学、神经内分泌及肺组织水通道蛋白-4(AQP4)基因表达的影响.方法:将60只胸段硬膜外穿刺置管成功的兔随机分为3组(n=20);假手术组(S组),左冠状动脉前降支(LAD)仅置缝线,但不结扎,从硬膜外腔注入生理盐水0.5ml/kg,每天2次,连续4周;心力衰竭组(HF组),结扎LAD后第2天开始,从硬膜外腔注入生理盐水0.5ml/kg,每天2次,连续4周;TEB治疗组(TEB组),结扎LAD后第2天开始,从硬膜外腔注入0.1%罗哌卡因0.5ml/kg,每天2次,连续4周.术后4周经股动脉和颈总动脉直接插管测定血液动力学参数;用放免法测定血浆心钠素及内皮素浓度;逆转录一聚合酶链反应(RT-PCR)法半定量检测肺组织AQP4mRNA的表达.结果:心力衰竭组MAP、LVSP、±dp/dt max明显下降,LVEDP、HR明显升高;血中内皮素和心钠素的浓度升高,肺AQP4mRNA的表达下降.经TEB治疗MAP、LVSP、±dp/dt max有升高,LVEDP、HR显著降低;血中内皮素和心钠素的浓度降低,肺AQP4mRNA的表达增加.结论:胸段硬膜外阻滞可以改善心力衰竭兔血液动力学参数,降低血中ANP、ET-1的水平,并能部分纠正肺组织AQP4mRNA的异常表达.     

Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe

ObjectiveTo analyse the oncological results of a salvage total laryngectomy in patients with a laryngeal carcinoma.Material and methodsRetrospective review of a cohort of 241 patients treated with a salvage laryngectomy after a local recurrence. The initial treatment received by these patients was radiotherapy (n = 201, 83.4%), chemoradiotherapy (n = 19, 7.9%), and partial surgery (n = 21, 8.7%),ResultsTotal laryngectomy as salvage treatment achieved local control of the disease in 81.3% of cases, with a 5-year specific survival of 65.3%. The variables related with specific survival in a univariate analysis were the location of the primary tumour, the local extension of the initial tumour and of the recurrence, the resection margins, and the pathological status of the neck dissections. According to the results of a multivariate analysis, the variables related to specific survival were the status of the resection margins, the presence of simultaneous regional recurrence, and the local extension of the recurrence.ConclusionThe 5-year specific survival of patients treated with a salvage laryngectomy was 65.3%. The variables related with the control of the disease were the status of the resection margins, the presence of simultaneous regional recurrence and the local extension of the recurrence.     

消肿愈溃散外敷治疗小儿疱疹性口炎临床观察

目的观察消肿愈溃散外敷治疗小儿疱疹性口炎的临床疗效。方法将213例疱疹性口炎患儿随机分为2组。治疗组115例予消肿愈溃散外涂,对照组98例予锡类散外涂。观察2组疗效及2组6~8岁患儿各45例用药后疼痛消退时间。结果治疗组痊愈率为66.1%,总有效率为99.5%;对照组痊愈率为39.1%,总有效率为59.1%,2组比较均有显著性差异(P均<0.01)。治疗组疼痛消失时间为(1.08±0.36)日,对照组为(2.06±0.53)日,2组比较有显著性差异(P<0.01)。结论消肿愈溃散治疗小儿疱疹性口炎疗效较好,止痛效果理想。     

Local lymph node recurrence after central neck dissection in papillary thyroid cancers: A meta analysis

BackgroundProphylactic central neck dissection (CND) at the time of total thyroidectomy (TT) remains controversial in clinically node-negative (cN0) papillary thyroid carcinoma (PTC). This systematic review and meta-analysis was performed to compare the local recurrence between patients who underwent TT plus CND and those who underwent TT alone.MethodsThe publicly available literature published from January 1990 to October 2017 concerning TT plus prophylactic CND versus TT for PTC was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process.ResultsTwenty-five studies with comparison between TT + CND and TT alone were eligible and included in this meta-analysis. For both PTC and papillary thyroid microcarcinoma (PTMC), the overall recurrence in TT + CND group was significantly lower than that in TT alone group. The central compartment recurrence was significantly higher in TT alone group than TT + CND group (OR = 3.41, 95% Cl [2.00 ～ 5.80], P < 0.00001), while no significant difference of lateral compartment recurrence was observed between the two groups (OR = 1.19, 95%Cl [0.81 ～ 1.77], P = 0.38). We compared ipsilateral CND + TT with TT alone and found that the recurrence was not significantly different between the two groups (OR = 1.44, 95%Cl [0.74 ～ 2.81], P = 0.28). On the other hand, bilateral CND + TT showed significantly low recurrence (OR = 2.48, 95%Cl [1.75 ～ 3.53], P < 0.00001).ConclusionsThe addition of CND to TT resulted in a greater reduction in risk of local recurrence than TT alone, especially preventing central neck recurrences. Additionally, we discovered that bilateral CND in patients with PTC > 1 cm was necessary.