Bilateral stapedotomy in patients with otosclerosis: a disability-orientated evaluation of the benefit of second ear surgery

This study reports the evaluation of the results of 80 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a database and analysed retrospectively. A new approach has been developed in order to evaluate the benefit of second ear stapes surgery in a more disability-orientated way using the AMA-criteria in the Guides to the Evaluation of Permanent Impairment. In all patients the percentage of Binaural Hearing Impairment (BHI) and the percentage of Impairment of the Whole Person (IWP) were determined according to the AMA-criteria. In patients who had both operations at the Academic Medical Centre it was found after the first operation that there was an important decrease in the BHI-percentage (from 26% to 10%) as well as for the IWP-percentage (from 9% to 4%). In addition, the percentages dropped significantly after the second operation (from 11% to 7% and from 4% to 2%, respectively). During follow-up there were no serious complications. It is concluded that bilateral stapedotomy is a safe procedure with good results.     

Eureka-project: ‘totally implantable artificial larynx’: progress report

Objective. The European Eureka project ‘Artificial larynx’ aims at realizing an implantable artificial larynx, consisting of artificial vocal folds, artificial epiglottis, tissue connector for tracheal fixation and valve mechanism to switch between breathing and speaking. The last part has been realized. Because its functioning is identical to a tracheostomal valve, it was tested as such. Materials and methods. The device consists of two valves: a speech valve, that will be open during normal breathing and closed by strong expiration and a cough valve that opens during coughing and closes automatically during inhalation. Magnets keep the valves in the breathing position. The magnetic force can be varied. Several prototypes have been tested in vitro and in situ. Results. The prototypes showed good in vitro behaviour. The range of adjustability of speech and cough was wide enough, flow resistance acceptable. This was confirmed by preliminary in vivo experiments. Patients were enthusiastic; hands-free speaking and coughing is possible. Conclusion. Numerous problems have to be solved to produce an artificial larynx. Each solution generated up till now, however, can already be applied to improve the existing rehabilitation process of laryngectomized patients.     

Ocular torsion induced by static visual stimulation and static whole body roll

Objective. This study was aimed to improve the reliability of clinical statolith testing by quantifying the influence of visual orientation and stimulation on the statolith-ocular reflex. Materials and methods. Ocular torsion was induced in 12 healthy adults by visual stimulation and by static whole body roll with and without simultaneous visual orientation. Visual stimulation was achieved by a horizontal grating oscillating sinusoidally in a frontal plane. Visual orientation during whole body roll was established by mounting an illuminated horizontal grating either on a tilting device (head-fixed) or on the wall in the frontal plane (earth-fixed). Results. No eye torsion was observed in static visual tilts of the grating. Dynamic visual stimulation elicited substantial eye torsion. Static whole body roll in the dark induced static ocular counter-rolling. Visual orientation either head- or earth-fixed did not affect the amplitude or gain of the body roll induced ocular counter-rolling. Conclusion. Dynamic visually induced torsional eye movements can be used to test the ability of the oculomotor system to generate torsional eye movements prior to quantifying the statolith-ocular reflex. Simultaneously visual information does not affect the gain of the static statolith-ocular reflex.     

Primary intramedullary spinal melanoma: Diagnostic and treatment problems

A 76-year old female patient with 9 year history of right mastectomy for an infiltrating ductal breast cancer and no evidence of recurrent nor metastatic disease, was admitted due to pain in the lower thoracic area radiating bilaterally to the posterior aspect of the chest wall at the same level, difficulties in micturition, urinary hesitancy, and progressive weakness of the lower limbs. Primary intramedullary spinal tumor was demonstrated by a MRI study of the spine, partially resected, and found to be a malignant melanoma on pathological study. Postoperative irradiation and administration of dexamethasone did not improve the neurologic status.     

残胃癌的外科治疗

目的 探讨残胃癌的病理特点及合理的外科治疗。方法 回顾性分析近十年我院收治32例残胃癌的临床资料。结果 残胃癌多在良性胃十二指肠疾病行胃大部分切除术10年后发病，Billroth—Ⅱ式癌发生率显著高于Billroth—Ⅰ式（P〈0．01），残胃癌的组织学分化差。根治性手术切除23例，切除率为71．8％，根治性切除23例中患者5年生存率17．4％，3年生存率47．8％。结论 根治性手术切除是残胃癌首选的治疗方法，能有效提高患者的生存时间和生存质量。晚期病例应该争取行姑息性切除手术。     

谈日语二外教学中实际运用能力的培养

学习外语的第一目的是与人交流，二外亦是如此。特别是当前中国经济快速发展，对日语人才的需求越来越大的环境下，如何提高日语二外学习者的语言实际运用能力成为一个重要课题。结合笔者的实践，本文着重从听、说以及跨文化交际三方面探讨了日语实际运用能力的培养。     

肝素在治疗妊娠中晚期脐动脉血流异常的临床探讨

目的探讨肝素对妊娠中晚期脐动脉血流异常的影响,以便寻找改善脐动脉血流异常的有效治疗方法。方法采用脐动脉血流收缩期最大血流速度(S)与舒张末期血流速度(D)的比值,将脐动脉血流S/D比值大于相应孕周的第95百分位以上的83例妊娠中晚期妇女共85例胎儿(2例双胎)分为研究组(41例孕妇,42例胎儿)和对照组(42例孕妇,43例胎儿)。研究组应用肝素6 250 u+5%葡萄糖500 mL;对照组应用低分子右旋糖酐500 mL,丹参30 mL+10%葡萄糖500 mL。定期复查脐动脉血流S/D比值(每天1次)。结果研究组平均每天脐动脉血流S/D比值下降0.39,对照组平均每天脐动脉血流S/D比值下降0.12,两组结果比较差异具有显著性(t=3.45,P<0.05)。研究组所需治疗时间显著短于对照组(3.5±2.7 vs 7.3±3.1d),两组比较差异具有显著性(t=5.83,P<0.01)。研究组脐动脉血流S/D比值下降率为100%,对照组为68.3%,两组比较差异有统计学意义(χ2=4.12,P<0.05)。结论肝素可显著改善妊娠中晚期脐动脉血流异常,效果显著,疗程缩短,值得推广。     

特重型颅脑损伤84例救治探讨

目的 探讨特重型颅脑损伤救治的方法与效果.方法 对我科自1996年8月～2005年7月救治的84例特重型颅脑伤患者临床资料进行回顾性分析.结果 本组存活55例(65.48%).随访并经ADL统计,恢复良好30例(54.55%),中、重残21例(38.18%),植物生存4例(7.27%).结论 尽早明确诊断,及时开颅清除血肿、去大骨瓣充分减压是救治特重型颅脑伤的关键;颞肌敷贴、早期使用亚低温及钙离子阻滞剂等对脑的保护、损伤可逆脑细胞的修复和脑功能的恢复有良好的促进作用;脱水,止血,抗感染、营养脑神经、维持水电解质及酸碱平衡等亦是提高特重型颅脑伤患者的生存率的保证.     

第二产程时限与新生儿结局的关系

目的探讨第二产程时限对新生儿预后的影响。方法将216例单胎、足月、无阴道分娩禁忌证的初产妇按照第二产程持续时间(t)分为4组,比较4组间新生儿结局情况。结果手术产率、脐动脉酸血症发生率及新生儿转入新生儿加强监护病房(NICU)的发生率在t>90 m in组明显高于t≤30m in组、3090 m in,新生儿不良结局发生率增加,故应重视和积极处理第二产程。     

以风湿样症状为首发的恶性肿瘤、肿瘤复发或转移26例临床分析

目的提高对以风湿样症状为首发的恶性肿瘤、肿瘤复发或转移的认识。方法回顾性分析住院患者中以风湿样症状为首发,最后确诊为恶性肿瘤、肿瘤复发或转移的26例临床资料。结果以风湿样症状为首发而确诊为恶性肿瘤者19例,肿瘤转移或复发者7例,大部分患者年龄均超过50岁;起病时血沉均明显增快,其中约70%超过100 mm/h;所有患者均对非甾体类抗炎药(NSAIDs)、激素治疗效果不好。结论应重视以风湿样症状为首发的恶性肿瘤、肿瘤复发或转移的诊断,尤其是对老年、难以解释的血沉极度增快、以及对NSAIDs、激素治疗无效的患者。