Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail.

BACKGROUND: The question of which colloid (albumin or synthetic colloids) used for plasma expansion following paracentesis or other complications requiring fluid loading in patients with cirrhosis remains controversial. AIMS: To compare outcome and hospital-related cost in patients with cirrhosis treated with 20% human albumin with those treated with a synthetic colloid (3.5% polygeline). METHODS: The primary end point was occurrence of a first liver-related complication. RESULTS: When the trial was prematurely discontinued because of safety concerns about bovine-derived products, 30 patients were assigned to receive albumin and 38 were assigned to receive a synthetic colloid. Sixty-three patients were included for ascites removal by paracentesis and five patients for ascites removal by paracentesis and renal impairment. The median time to first liver-related complication was not significantly longer in the albumin group (20 vs. 7 days). However, the total number of liver-related complications adjusted to a 100-day period was significantly lower in the albumin group. The median hospital cost for a 30-day period was significantly lower in the albumin group (1915 euros vs. 4612 euros). CONCLUSIONS: In patients with cirrhosis and ascites, human albumin appears to be more effective in preventing liver-related complications than synthetic colloid. This may be associated with decreased hospital costs.     

Class III malocclusion and bilateral cross-bite in an adult patient treated with miniscrew-assisted rapid palatal expander and aligners

This case report describes the use of a miniscrew-assisted rapid palatal expander and aligners to correct bilateral cross-bite and crowding in an adult patient with a Class III skeletal pattern. A digitally designed surgical guide was three-dimensionally printed and used to accurately insert four miniscrews into the palate; these were employed to anchor a novel miniscrew-assisted rapid palatal expander appliance without any dental anchorage. Cone-beam computed tomograms before and after miniscrew-assisted rapid palatal expander treatment demonstrated the orthopedic expansion of the maxilla without dental tipping. The patient was then fitted with aligners to correct crowding and malocclusion. This case report demonstrates the successful treatment of an adult patient with a narrow maxilla and bilateral cross-bite using a nonsurgical, conservative treatment.     

皮肤软组织扩张器置入术感染的病例对照研究

目的分析影响患者皮肤扩张器置入术后感染的危险因素,为制订干预措施提供科学依据。方法采用自行设计的调查问卷,通过查阅病历结合电话询问获取相关资料,采用病例对照研究方法进行统计分析。结果共调查532例扩张器置入患者,其中发生术后感染22例,感染率为4.14%,病例组共纳入14例感染患者。单因素条件logistic回归分析结果显示,扩张器置入个数(OR=1.58,95%CI:1.20~2.32)、埋置部位(OR=1.75,95%CI:1.30~2.32)、患者居住环境(OR=1.87,95%CI:1.84~2.65)、是否常规消毒(OR=2.66,95%CI:1.76~4.32)差异均有统计学意义(均P0.05)。多因素条件logistic回归分析结果显示患者居住环境(OR=1.55,95%CI:1.15~2.25)、是否常规消毒(OR=3.66,95%CI:2.86~3.22)是进入回归方程的2个主要因素,均P0.01。结论患者居住环境以及是否常规消毒是影响患者皮肤软组织扩张器置入术后感染的主要危险因素,临床上应重点加强对围手术期患者及主要照顾者预防感染知识教育,建立患者出院后延续护理体系。     

几丁糖对扩张后皮瓣纤维包膜中胶原含量影响的研究

目的：在临床实践中应用几丁糖干预扩张后皮瓣纤维包膜的形成过程,观察应用前后纤维包膜中胶原含量及扩张后皮瓣回缩率的变化规律,从而分析几丁糖对纤维包膜中胶原含量的影响。方法：2006年以来,对每位患者同时应用二个扩张器修复病变部位,共对24例患者行皮肤软组织扩张术,每个患者均在病变周围两侧（选取行皮肤软组织扩张术时,同一区域适于同时应用二个100lm扩张器修复病变的患者24例）,两侧各埋置100ml皮肤软组织扩张器一枚;均将其中一侧设为治疗组,另一侧设为对照组（并做标记）,取材进行Masson染色后,随机选取光镜100倍Masson染色切片治疗组与对照组各15个视野,应用捷达病理图像彩色分析系统测量平均灰度。对两组间平均灰度进行比较。了解两组之间有无统计学意义。结果：治疗组和对照组24例,全部取材成功。治疗组纤维包膜组织平均灰度值显著高于对照组：169.935±16.015,156.945±13.546,P〈0.05。结论：应用几丁糖干预扩张器置入后纤维薄膜形成的过程中,几丁糖可以使扩张后皮瓣纤维包膜中的胶原纤维含量降低,从而降低扩张后皮瓣的收缩率。     

扩张器重叠扩张技术在临床中的应用

目的:探讨提高皮肤软组织扩张器扩张效果的有效方法。方法:在同一腔隙内埋置两个大小不同的扩张器,对重叠放置的扩张器按照先浅后深的顺序逐步扩张至额定容积的1.5倍。结果:自2003年1月以来,采用重叠扩张术修复各种类型的皮肤软组织缺损36例,均获得良好的手术效果。结论:与传统组织扩张技术相比,重叠扩张技术在同等剥离腔隙、同等时间内可以获得更多地有效扩张面积,同时可以减少扩张术的并发症。     

Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: the importance of completion

IntroductionTissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction.MethodsTwenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities.ResultsEighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process.ConclusionSatisfaction with tissue expander reconstruction is significantly affected by the patients’ stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases.     

Expansion of Blood Volume Increases the Primary Patency Rate of Arteriovenous Fistulas for Hemodialysis in Patients With Critical Arterial Quality

The aim of our prospective study was to find out if the expansion of blood volume can improve early arteriovenous fistula (AVF) function after construction in patients with marginal vessel quality. Before AVF construction, the arteries of the upper arm were examined by duplex sonography. Patients with critical values of internal artery diameter (IDA) <1.6 mm, resistance index (RI) at reactive hyperemia (RH) >0.7 and feeding artery blood flow (ABF) <24 mL/min were divided into two groups by random sampling. One group received plasma expander (hydroxyethyl starch) during surgery and the other did not. During the surgical procedures to construct 43 AVFs in 37 patients with critical artery quality, the patients received a mean volume of 720 mL (range 320–1000 mL) of plasma expander. The primary patency rate in this group was 86% (37/43). In the other group of 37 patients with critical artery quality, 42 AVFs were constructed and no plasma expander was given during surgery. The primary patency rate was 26.2% (11/42, P > 0.001). The two‐year survival of the AVF in the group given plasma expander was 66.3%, and in the other group it was 13.3%. In our study, the infusion of plasma expander in patients with critical artery quality increased the primary patency rate after AVF construction. Based on the morphological and functional characteristics of arteries determined by pre‐operative duplex sonography, the need for blood volume expansion could be predicted.     

SKy骨扩张器治疗老年椎体压缩性骨折

目的探讨SKy骨扩张器治疗老年椎体压缩骨折的临床应用价值。方法采用SKy骨扩张器治疗老年椎体压缩骨折11例（13个椎体）,观察手术时间、骨水泥注入量、骨水泥分布及外漏情况;术前、术后3d及随访时测定患者疼痛视觉类比评分（VAS）和并发症情况。结果11例（13个椎体）均单侧穿刺成功,手术时间45～65（50±15）min。骨水泥注射量3～6（4.5±1.5）ml/椎体。骨水泥分布均超过中线,沿针道返流1个椎体,无椎管内渗漏,均无临床症状。11例术后疼痛均缓解,VAS术前为8.9分±1.4分,术后3d为3.4分±1.9分,术前、术后比较差异有显著性（P〈0.01）。11列均获随访,时间3～6个月,随访时VAS为2.6分±3.1分。结论SKy骨扩张器具有可控定向扩张优点,安全有效,且价格较低,值得临床推广。     

A型肉毒毒素辅助额部皮肤软组织扩张的实验研究

目的：通过动物实验明确A型肉毒毒素对额部皮肤软组织扩张的辅助扩张效果。方法：于小型猪胸腹部两侧皮肌下置入扩张器,一侧皮肌注射A型肉毒毒素,另一例注射生理盐水,对比两侧扩张器的扩张前基础囊内压、每次扩张器注水量及扩张时间。结果：实验组平均注水时间为（28±4．5）天,对照组平均注水时间为（42±3．5）天,扩张时间平均缩短（13±5．5）天（P〈0．01）;实验组平均注水（8±0．5）次,平均每次注水量为（26．1±3．5）ml;对照组平均注水（12±0．8）次,平均每次注水量为（16．7±0．9）ml（P〈0．01）;实验组平均基础囊内压为（3．4±0．6）mmHg,对照组平均基础囊内压为（10．1±0．8）mmHg（P〈0．01）。结论：注射A型肉毒毒素于猪胸腹部皮肌,可使放置于皮肌下的扩张器扩张阻力减小,扩张器基础囊内压下降,每次注水量增加,扩张时间缩短,对临床中应用A型肉毒毒素辅助额部皮肤软组织扩张有重要的指导意义。     

以ADSCs附着ADM植入促进扩张皮瓣真皮修复的实验研究

目的观察脂肪干细胞对扩张皮瓣的影响。方法将雌性SD大鼠制备成扩张器模型,皮肤下方与扩张器之间放置着附着大鼠脂肪干细胞(ADSCs)的脱细胞真皮基质(ADM)。培养3周后获取扩张皮瓣,免疫组化分析组织形态变化,使用western blot分析作用部位皮瓣内ColⅠ、ColⅢ和fibronectin蛋白表达情况,使用QPCR检测作用部位皮瓣内转化生长因子β1(TGF-β1)的表达量。结果三周后组织切片提示ADSCs促进扩张皮瓣真皮内TGF-β1表达升高;术后第一周及第二周,在ADSCs的作用下,扩张皮瓣中ColⅠ和fibronectin蛋白表达明显上升,第三周有一个明显衰减,而ColⅢ表达量平稳,无明显变化趋势;QPCR提示术后第一周TGF-β1高表达,之后其表达量随时间衰减。结论 ADSCs诱导皮肤组织中的TGF-β1增加,进而促进真皮层下层成纤维细胞分泌更多的胶原结构与蛋白,促进扩张皮瓣真皮层修复。