Hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm successfully treated by pancreatectomy: report of three cases

Hemorrhagic pseudoaneurysm of pancreatic pseudocyst is one of the serious complications of acute pancreatitis. We successfully treated three patients who had hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm by pancreatectomy. Case 1 was 43-year-old Japanese man who had had several episodes of acute pancreatitis and was diagnosed with hemorrhagic pseudoaneurysm of the splenic artery in a pseudocyst in the pancreatic tail, shown on computed tomography (CT) and angiography. Transarterial embolization (TAE) yielded hemostasis of the pseudoaneurysm, but rebleeding occurred 2 weeks after the TAE. Distal pancreatectomy and splenectomy was successfully performed. Case 2 was a 64-year-old Japanese man who presented to us with several attacks of acute pancreatitis. Imagings showed bleeding pseudoaneurysm of the transverse pancreatic artery in a pseudocyst in the pancreatic body. Because of marked stenosis in the proximal portion of the transverse pancreatic artery, TAE was unsuccessful. Distal pancreatectomy and splenectomy was performed successfully. Case 3 was a 40-year-old Japanese woman who had a history of abdominal trauma. Imagings showed bleeding pseudoaneurysm of the splenic artery in a posttraumatic pseudocyst in the pancreas. TAE of the pseudoaneurysm was unsuccessful because of the proximity of the pseudoaneurysm and the splenic artery. Distal pancreatectomy and splenectomy was successfully performed and her postoperative outcome was satisfactory. Whenever interventional radiology (IVR) is not indicated or has failed, aggressive and immediate surgical intervention should be considered for early and definitive recovery in these patients. Received: November 15, 1999 / Accepted: April 6, 2000     

Treatment of pseudobulbar paraly by acupuncture plus functional training

Sixty cases of pseudobulbar palsy were treated by puncturing Shuigou (GV 26), Lianquan (GV 23), Fengchi (GB 20), Wangu (GB 12), Yifeng (TE 17), Tongli (HT 5), Neiguan (PC 6) and Fenglong (ST 40) with the needling technique to refresh mind and open orifice, and by puncturing the retropharyngeal wall and palatine arch, plus training of swallowing function, the total effective rate reached 95.0%. Author: WANG Li-qun (1966-), male, attending physician Translator: HUANG Guo-qi     

误诊为腹水的肝癌局限性破裂出血36例临床分析

目的：探讨原发性肝癌发生局限性破裂出血的CT表现、早期诊断及治疗。方法：回顾性分析我院36例手术证实为肝癌局限性破裂出血的患的临床资料。结果：36例患术前CT误诊为腹水，35例存在上腹痛史，33例行手术切除，35例为肝细胞癌，36例肝肿瘤位于肝表面。结论：CT检查肝癌靠近于肝脏表面，肿瘤周围有局限性低密度区，临床上最近有上腹疼痛或腹部剧痛史，以往曾有乙型肝炎病史或HBsAg阳性，应考虑为肝癌局限性破裂出血的可能。能手术切除应尽力切除，不能手术切除应采用经皮肝动脉栓塞化疗或肝动脉结扎术，并结合瘤内无水酒精注射术。     

机械通气治疗新生儿肺出血的临床研究

目的:探索机械通气在新生儿肺出血抢救中的应用方法,为防治肺出血提供指导.方法:将十年来我院儿科收治的35例新生儿肺出血患儿分为对照组(非机械通气组)和治疗组(机械通气组),进行了对照观察,对两组患儿的临床表现、出血形式、治愈率及病死率分别作统计学处理.结果:对照组和治疗组的临床表现无明显差异(P＞0.005);对照组和治疗组的出血形式有明显差异,对照组从口鼻流出或涌出的比例明显升高(P＜0.01),治疗组经气管吸引的比例明显升高(P＜0.01);新生儿肺出血的治愈率,治疗组明显升高(P＜0.01),病死率治疗组明显降低(P＜0.05).结论:机械通气可以纠正新生儿肺出血造成的缺氧,增加肺部弥散和氧合功能,减少出血危险.气管吸引是早期发现新生儿肺出血的重要手段.     

米索前列醇预防产后出血的临床疗效观察

目的:探讨米索前列醇口服预防产后出血的疗效。方法:选择无米索前列醇禁忌,单胎头位经阴道分娩的485例孕产妇,随机分为三组:米索前列醇组205例,胎儿娩出后即予口服米索前列醇400μg;米索前列醇加缩宫素组148例,胎儿娩出后即予口服米索前列醇400μg,同时给予缩宫素10U肌注;缩宫素组132例,胎儿娩出后即予肌注缩宫素10U,同时静脉注射缩宫素10U,观察三组产妇第三产程时间、产时及产后出血量、产后24h出血总量、发生产后出血的例数。结果:第三产程时间、产时及产后出血量、产后24h出血总量、发生产后出血例数米索前列醇组与米索前列醇加缩宫素组比较,差异无显著性(P>0·05);米索前列醇组与缩宫素组比较,差异有极显著性(P<0·001),产后出血的发生率明显下降。同时口服米索前列醇无严重不良反应发生。结论:米索前列醇对预防阴道分娩时的产后出血效果良好,对子宫的收缩作用强于缩宫素,且用药方便、简单、经济、安全,值得推广。     

Reconstructive surgery for massive rotator cuff tear

Surgical Principles The rotator cuff is repaired with transosseous sutures if possible. If the defect is too large for direct repair, local muscle or tendon transfers are used. An anterior acromioplasty with resection of the coraco-acromial ligament is performed in every case. In absolutely irreparable tears the authors recommend an open or arthroscopic debridement combined with an anterior acromioplasty and a resection of the lateral end of the clavicle. Should a cuff tear arthropathy exist, shoulder replacement or an arthrodesis should be considered. Revised Version from: Operat. Orthop. Traumatol. 4 (1992), 161–178 (German Edition).     

肾血管平滑肌脂肪瘤自发性出血的CT诊断

目的:探讨肾血管平滑肌脂肪瘤(AML)自发性出血的CT征象及诊断价值。方法:搜集经手术病理证实的肾AML并发出血10例,分析其CT表现。结果:全部病例均为多脂肪型,右肾6例,左肾4例,肿瘤直径8.5~25.0 cm,均有不同程度肾实质破坏。其中急性出血8例,肿瘤内出血表现为瘤体内片状或地图样高密度区,肾周血肿显示片带状软组织密度环绕在肿瘤和肾脏周围或脂肪密度混杂在软组织中,肾旁出血表现为血液在腹膜后间隙广泛延伸,慢性腹膜后血肿2例,表现为较大的混杂密度团块增强后包膜中度强化。结论:自发性出血是肾AML常见而严重的并发症,CT是诊断本病最好的影像学检查方法之一,能明确出血部位、范围,估计出血量和肾组织破坏程度,为临床诊断和治疗提供有价值的信息。     

In vitro testing of a novel limb salvage prosthesis for the distal femur

Objective. The aim of this paper was to define strain pattern in the host bone following distal femoral resection and implantation of a massive prosthesis. Two methods of coupling the prosthesis to the bone were compared: the Compliant Pre-Stress device, and a standard cemented tumour prosthesis.

Design. The composite femur model was selected to minimize variables. Four femurs were tested before and after implantation. Both coaxial and cantilever loading were applied.

Background. Cemented distal femoral replacement following resection of malignant tumours has a high failure rate at 5 years and is associated with extensive bone resorption thought to be secondary to stress shielding.

Methods. Strain was measured in the medial and lateral sides at four levels with physiologic loads applied, in the intact, Compliant Pre-Stress, and cemented femurs. Repeated measurements were taken. Strains in the implanted femur were calculated as percentage of the intact, and statistically analyzed.

Results. The most reproducible results were noted in cantilever bending (variability <5%). The Compliant Pre-Stress device demonstrated a more physiologic strain pattern than the cemented stem. The most significant difference between the two implants was in the area adjacent to the interface.

Conclusion. The Compliant Pre-Stress device shows less stress shielding than a standard cemented implant. The protocol described and the use of composite femurs demonstrated reproducible results.     

肝外伤34例诊治体会

分析近16年间收治的34例肝外伤(治愈率88.2％,病死率11.8％)发现:早期确诊,迅速复苏,及时正确的手术,充分有效的腹腔引流,积极防治合并伤和并发症,均是抢救成功的关键。