脑卒中患者步行功能的恢复

目的：探讨康复治疗对脑卒中患者行步功能恢复的影响，方法：采用以Ｂｏｂａｔｈ和Ｂｒｕｎｎｓｔｒｏｍ方法为主的康复治疗技术，并配合传统按摩疗法和功能性电刺激，对急性脑卒中患者进行了临床对照性研究，对恢复期患者进行了临床观察。结果康复治疗后，病程在１个月的患者的独立步行恢复率为７２．００％，与对照组（１４．７１％）相比差异显著（Ｐ〈０．００１）；恢复早期（病后１～３月）患者的独立步行恢复率为７７．７８％     

Robotic Trans‐Abdominal Transplant Nephrectomy for a Failed Renal Allograft

Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans‐abdominal transplant nephrectomy (TN). A 34‐year‐old male with Alport's syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra‐abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235 min and the estimated blood loss was less than 25 cm³. There were no peri‐operative complications observed and the patient was discharged to home less than 24 h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans‐abdominal TN.     

Serology and ultrasound for diagnosis of choledocholithiasis

Introduction

Magnetic resonance cholangiopancreatography (MRCP) is not a routine investigation to exclude choledocholithiasis unless there is clinical or biochemical suspicion of common bile duct (CBD) stones. This study attempted to determine which radiological or serological parameters best predicted CBD stones.

Methods

All patients undergoing MRCP from 2005 to 2011 were selected. Patients with pancreatitis were excluded. Liver function tests (LFTs) at admission and prior to MRCP were recorded, as was abdominal ultrasonography and MRCP results. Parameters measured routinely on LFTs included alkaline phosphatase (ALP), alanine transaminase (ALT) and bilirubin. Receiver operating characteristic curve area analysis (area under the curve [AUC]) and chi-squared analysis were undertaken.

Results

Overall, 195 patients were identified, 71 of whom had CBD stones on MRCP. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones.

Conclusions

Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography.     

Changes in motor function in the unaffected hand ol stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.     

Analgesic effect of intrathecal bumetanide is accompanied by changes in spinal sodium-potassium-chloride co-transporter 1 and potassium-chloride co-transporter 2 expression in a rat model of incisional pain

Accumulating evidence has demonstrated that the sodium-potassium-chloride co-transporter 1 and potassium-chloride co-transporter 2 have a role in the modulation of pain transmission at the spinal level through chloride regulation in the pain pathway and by effecting neuronal excitability and pain sensitization. The present study aimed to investigate the analgesic effect of the speciifc sodium-potassium-chloride co-transporter 1 inhibitor bumetanide, and the change in spinal sodium-potassium-chloride co-transporter 1 and potassium-chloride co-transporter 2 expression in a rat model of incisional pain. Results showed that intrathecal bumetanide could decrease cumulative pain scores, and could increase thermal and mechanical pain thresholds in a rat model of incisional pain. Sodium-potassium-chloride co-transporter 1 expression in-creased in neurons from dorsal root ganglion and the deep laminae of the ipsilateral dorsal horn following incision. By contrast, potassium-chloride co-transporter 2 expression decreased in neurons of the deep laminae from the ipsilateral dorsal horn. These ifndings suggest that spinal sodium-potassium-chloride co-transporter 1 expression was up-regulated and spinal potassi-um-chloride co-transporter 2 expression was down-regulated following incision. Intrathecal bumetanide has analgesic effects on incisional pain through inhibition of sodium-potassi-um-chloride co-transporter 1.     

手术病人麻醉后恢复的特点

分析１９９５年８月至１９９６年１１月麻醉恢复室接收４３３例病人的情况，以期了解手术后麻醉恢复期护理的特点。其中男性４０．６％，女性５９．４％，平均年龄５４．１±１４．７岁（６～８２岁），平均停留时间４４ｍｉｎ（５～２６５ｍｉｎ），９８．８％的病人平稳恢复后送回病房，１．２％的病人转入ＳＩＣＵ。实施麻醉方法除６例为连续硬膜外麻醉或腰麻外，余为全麻或强化麻醉。根据Ｒａｍｓａｙ评分法，入室时９５％以上病人５～６分，出室时９２％的病人是４分以下，所有病人血压、心率无显著变化，没有给予任何血管活性药物。入室时６３．３％的病人自主呼吸已经恢复。由于麻醉药和肌肉松弛药对中枢和呼吸肌的残留抑制作用，术后早期病人最易出现缺氧。因此全麻术后必须认真监测病人呼吸功能恢复情况，提高吸入氧浓度，根据病情需要保留气管导管，或短时间的机械通气，提高吸入氧浓度，以保证病人呼吸道通畅，避免ＣＯ２的潴留，特别是缺氧的发生。从观察病例可以看出，全麻术后未能立即清醒，平均约４５ｍｉｎ后意识方能满意恢复。