经纤维支气管镜注入凝血酶治疗咯血23例

为观察凝血酶对咯血的治疗效果，经纤维支气管镜注入凝血酶治疗２３例中等量以上的咯血．结果，２３例咯血中，显效１２例（５２％），有效８例（３５％），总有效率为８７％．     

Repetitive and ritualistic behaviour in children with Prader–Willi syndrome and children with autism

Background Recent research has shown that the range of repetitive behaviour seen in individuals with Prader–Willi syndrome (PWS) extends beyond food‐related behaviour. Methods The presence and intensity of repetitive, rigid and routinized behaviour in children with PWS was compared with that seen in children with another neurodevelopmental condition in which repetitive behaviour is common: children with autism. Parents completed the Childhood Routines Inventory (CRI). Results Contrary to our predictions, controlling for developmental level, children with PWS and children with autism showed similar levels of repetitive and ritualistic behaviour overall and on the two CRI factors measuring ‘just right’ and ‘repetitive’ behaviour. Indeed, the majority of the sample of parents of children with PWS endorsed most items on the CRI. However there was some specificity at the level of individual items with parents of children with PWS more frequently endorsing an item on ‘collecting and storing objects’ and parents of children with autism more frequently endorsing ‘lining up objects’, ‘has a strong preference for certain foods’ and ‘seems aware of detail at home’. Conclusions These findings confirm the range of repetitive behaviours that form part of the behavioural phenotype of PWS, including insistence on sameness and ‘just right’ behaviours, and uncover a surprising overlap with those seen in children with autism. Clinical management for children with PWS should include advice and education regarding management of repetitive and rigid behaviour. Future research should investigate whether the repetitive behaviours that form part of the behavioural phenotype of both PWS and autism are associated with a common neuropsychological, neurotransmitter or genetic origin.     

Titanium miniplate fixation for osteotomies in facial fibrous dysplasia — a histologic study of the screw/bone interface

In four patients who had osteotomies of the jaws affected by fibrous dysplasia (FD), screws embedded in bone blocks were removed at a re-entry operation 20 months postoperatively. Morphometric measurement of the bone density and calculation of the bone contact percentage were performed. Both normal and dysplastic bone were found to have some direct bone contact with the titanium screws. Although the bone contact percentage was higher in the normal bone when compared with FD, statistics failed to show any significant difference (P>0.05). The dysplastic bone healed well around the titanium screws without inflammatory reaction and direct dysplastic bone/screw contact was noted. Longer screws should be used in facial FD in order to compensate for the reduced bone contact percentage.     

Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring

Objective: Prosthetic annuloplasty rings play an important role in mitral valve repair. This clinical study was undertaken to evaluate the midterm results obtained with the Carpentier-Edwards rigid ring. Methods: Between October 1991 and March 2005, 112 patients (mean age 53.0 years) underwent mitral valve repair with a Carpentier-Edwards rigid ring at our institution. Degenerative disease was the most frequent cause and a small number had other conditions such as endocarditis and rheumatic disease. Ten patients were in Carpentier’s functional class Type I, 101 patients in Type II and 1 patient in Type III, based on valve pathology. Ischemic mitral regurgitation was excluded. The mean followup time was 5.3±3.6 years (range: 8 days to 12.3 years). All patients were completely followed by echocardiography. Results: The rigid ring ranged from 26 to 36 mm in diameter and the most common size was 30 mm. Although the mitral orifice area was decreased after mitral valve repair in all patients, none of them required reoperation because of mitral stenosis or left ventricular outflow tract obstruction (systolic anterior motion). Reduction of both systolic and diastolic left ventricular volumes was observed postoperatively. Ejection fractions were preserved in all cases. The actuarial survival rate was 92.0±3.0% at 10 years and the reoperation-free rate at 10 years was 96.0±2.0%. Conclusion: The rigid ring has produced promising midterm results in terms of reoperation-free and survival rates.     

颌面部骨折应用坚硬固定技术的应用回顾

目的　总结 2 0 6例颌面部骨折应用坚硬固定技术治疗的经验。方法　利用外伤创面或手术切开行骨折间的坚硬固定 ,部分病例辅以颌间或颅颌牵引。结果　 2 0 6例坚硬固定病例术后咬合及面部外形等功能恢复与伤前一致或兼顾外科正畸疗效者 2 0 0例 ,有效率达 97.0 %。结论　坚硬固定技术操作简单 ,具有加速骨折愈合 ,减少并发症等优点 ,是治疗颌骨骨折的理想方法。     

Penetrating eye injury from a rigid infant pacifier

Background: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported.
Case report: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous.
Conclusion: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasises the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.     

Photodynamic therapy (PDT) for bronchial carcinoma with the use of rigid bronchoscope

Endoscopic PDT was undertaken in nine patients with inoperable bronchial cancer. Eight patients had advanced metastatic disease and one was unsuitablefor surgery on account of age, respiratory function and location of tumour. Patients were injected with Photofrin II (no. 7) or Polyhaematoporphyrin derivative (no. 2) at 2 mg kg⁻¹ of bodyweight before being irradiated 48 h later by 630 nm red light generated by a copper vapour laser (Oxford Lasers) for 200 J cm⁻¹ tumour tissue. Treatment was undertaken under general anaesthetic using a rigid bronchoscope for ventilating and suction purposes with the fibre optic instrument introduced through the rigid bronchoscope for localization of tumour and placement of the diffusing fibre. One patient died 2 months after treatment from carcinomatosis. One patient had total response with negative histology for 10 months. All other patients with substantial endobronchial obstructive lesions had partial response with significant reduction in percentage obstruction and improved pulmonary function. There have been no post-operative complications.     

经支气管针吸活检获取组织学标本的应用技术及意义

目的　探讨在日常气管镜检查中 ,经支气管针吸活检获取组织学标本的应用技术及对单纯纵隔肿物进行穿刺活检的意义。方法　在气管镜室 ,对 52例CT扫描提示单纯纵隔肿物或肿大淋巴结的患者分别进行细胞学及组织学的穿刺活检。结果　 52例患者中 ,有 47例获得可供切片诊断的组织学标本 ,其中 30例为良性肿物 ,5例未获得组织学标本。结论　在气管镜检查过程中 ,较好地运用组织学穿刺活检针 ,可以较好地对良性肿物的诊断提供准确的组织学标本 ,在相当程度上可避免纵隔镜的使用     

Laser-assisted removal of a foreign body in the bronchial system of an infant

Background and Objective: Foreign body aspiration is an important cause of acute respiratory distress in children. Removal by use of rigid tracheo-bronchoscopy under general anesthesia is usually the treatment of choice, but this technique is sometimes unsuccessful. Thoracotomy in these instances often cannot be avoided. Study Design/Patients and Methods: Case report with review of the literature. The patient was 19 months old with an aspirated foreign body. A Neodym:YAG laser with a special small-size delivery system was inserted into the rigid “baby” bronchoscope. The NeodymiumrYAG laser with a wavelength of 1,064 nm and a Helium-Neon 630 nm light guide provided an aiming beam to weaken and cut the aspirated chicken bone. Results: The foreign body could be easily removed with a regular biopsy forceps. Conclusion: We discuss a patient in whom laser-assisted rigid tracheobronchoscopy obviated the need for thoracotomy. © 1995 Wiley-Liss, Inc.