Open surgery of giant paraclinoid aneurysms improved by intraoperative angiography and endovascular retrograde suction decompression

Summary In three consecutive cases of giant left sided paraclinoid aneurysms we employed an endovascular retrograde suction decompression technique in combination with intra-operative angiography. A double-lumen balloon catheter was placed in the left internal carotid artery by the transfemoral route. After balloon inflation and placement of a temporary clip distal to the aneurysm blood was aspirated and the aneurysm collapsed. Thus further dissection of the aneurysm could easily be achieved and clips could be placed. Afterwards real-time digital subtraction angiography was performed. Intra-operative angiography led to clip repositioning in all cases either due to a clip induced stenosis of the parent vessel, or because of incomplete aneurysm obliteration. Afterwards successful clipping could be confirmed in all cases. Outcome was excellent in one case, good in the other. The third case, extremely complicated by an accompanying craniopharyngioma, showed a satisfactory outcome, but presented new neurological deficits.     

皮肤发疱仪的研制与临床应用

目的：研制皮肤发疱仪，并临床应用于自体表皮移植治疗白癜风，分析治疗效果。方法：根据局部皮肤双控发疱理论，应用负反馈原理，研制出皮肤双控发疱仪；该仪器应用于自体表皮移植治疗白癜风，通过控制局部发疱部位的压力和温度，实现发疱时需要的恒压和恒温。结果：皮肤发疱仪能恒定控制局部皮肤发疱时的压力和温度，使自体表皮移植治疗白癜风的总成活率达到98．01％。结论：皮肤发疱仪性能稳定，操作方便，临床应用效果好，值得推广。     

Endotracheal suctioning causes right upper lobe collapse in intubated children

Objective: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors. Methods : The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period ( n = 102). Graduated suction catheters and suction vacuums of < 165 cm H₂O were then introduced. Another prospective audit was carried out 3 months later ( n = 60). Results : We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures, a significant reduction in the incidence of RUL collapse, to 7%, was observed ( p < 0.05). Conclusions : We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.     

A randomized, double blind, placebo-controlled study to investigate the use of conscious sedation in conjunction with paracervical block for reducing pain in termination of first trimester pregnancy by suction evacuation

BACKGROUND: This study evaluated the role of conscious sedation in pain relief during termination of first trimester pregnancy by suction evacuation (SE) under local anaesthesia. METHODS: A hundred women undergoing SE before 12 weeks gestation were randomized by computer using the sealed envelope method to receive placebo (saline) or conscious sedation (2 mg midazolam and 25 microg fentanyl) i.v. 5 min before cervical dilatation. Paracervical block was given to all patients, 2 min later. Pain scores during and after SE, post-operative side-effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores were found between the two groups. Post-operative side-effects such as dizziness (P = 0.015) and drowsiness (P < 0.001) were significantly more severe in the conscious sedation group. However, patients in the conscious sedation group reported better satisfaction levels than the control group (P = 0.003). CONCLUSION: The use of conscious sedation significantly improved patient satisfaction during termination of first trimester pregnancy by SE under local anaesthesia, despite a lack of improvement in pain relief and the presence of increased severe dizziness/drowsiness in the post-operative period.     

Low resting potentials in single isolated heart cells due to membrane damage by the recording microelectrode

Single myocytes from adult rat hearts were prepared following the method of Powell and co-workers (9, 10, 11). Low resting potentials (E_m) could be improved by three techniques. (i) Elevation of Ca_o to 7.2 mM which, however, mostly resulted in spontaneity and irreversible contracture. (ii) Pre-incubation in a KB medium (6). (iii) Use of suction pipettes instead of tapered microelectrodes for intracellular recordings (2). It is concluded that low E_m measured previously (11) were due to membrane damage upon microelectrode impalement accopanied by insfufficient healing of the membrane around the electrode insertion.     

口服米索前列醇联合宫腔吸引管在剖宫产术后无痛人流的应用

分析口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流的临床效果及机制。120例患者随机分为对照组(n=60)和观察组(n=60)。对照组患者接受宫腔吸引管处理,观察组患者口服米索前列醇(0.6 mg)后接受宫腔吸引管。结果显示观察组患者的手术时间和苏醒时间明显缩短(P<0.05),术中出血量和异丙酚用量明显减少(P<0.05);观察组患者的宫颈扩张效果总有效率明显升高(P<0.05)而不良反应发生率明显降低(P<0.05);两组患者治疗后血清中白细胞介素1β(IL-1β)和IL-2水平明显升高,且对照组患者的上述白细胞介素水平升高更显著(P<0.05)而雌激素促黄体生成素(Luteotropic hormone,LH)、促卵泡激素(Follicle stimulating horman,FSH)和雌二醇(Estradiol,E2)水平无明显变化(P>0.05)。实验表明口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流临床效果明显,且不引起白细胞介素和雌激素水平的剧烈变化。     

浅层吸痰法对人工气道患者气道黏膜影响的研究

目的探讨人工气道不同吸痰方法对患者的影响。方法将2010年1月～2011年8月在本院ICU行人工气道患者,根据建立人工气道的日期进行分组,单号建立为观察组,运用浅层吸痰法,双号建立为对照组,运用常规吸痰法。通过两组吸痰方法的比较,观察两组患者吸痰操作时的患者状态及气道损伤情况。将两组患者得出的数据进行统计学分析。结果两组患者的研究指标有显著差异;常规吸痰法造成患者气道黏膜损伤的例数较多,吸痰管插入长度较深,对气管产生的刺激较大,引起患者明显的烦躁及呛咳较多。两种吸痰方法在患者的刺激、气道损伤等方面,观察组优于对照组（P〈0.05、P〈0.01）。结论浅层吸痰法可以避免或降低对建立人工气道患者的气道损伤,减少对患者的刺激,提高人工气道疗效,减低并发症,有效地提高患者的人工气道护理质量,是建立了人工气道患者的一种较为理想的、人性化的吸痰方法,值得临床推广及应用。     

封闭式负压吸引、氧气、臭氧联合治疗软组织缺损的疗效观察

目的探讨封闭式负压吸引、氧气、臭氧联合治疗软组织缺损的临床疗效。方法 40例软组织缺损患者随机分为对照组（根据病情分别给予游离植皮覆盖、二期缝合、局部皮瓣移位修复等手术治疗）和观察组（对照组手术治疗基础上,给予封闭式负压吸引、氧气、臭氧联合治疗）,每组各20例,对两组住院时间、肉芽组织覆盖创面时间,以及创面愈合情况进行观察和比较。结果与对照组比较,观察组住院时间、肉芽组织覆盖创面时间均显著缩短（P〈0.05）。两组创面愈合,死腔完全消除,没有出现明显并发症,创面细菌培养阴性。结论对于软组织缺损患者,手术治疗基础上,给予封闭式负压吸引、氧气、臭氧联合治疗,能够提高治疗的临床疗效。     

人工气道吸痰方法的研究进展

<正>人工气道是将导管直接置入气管或经鼻(口腔)插入气管所建立的呼吸通道,主要用以清除呼吸道分泌物,改善通气功能,从而纠正患者的缺氧症状。但在建立人工气道的同时,也破坏了患者的上呼吸道非特异性防御屏障,失去对吸入空气的加热和加湿,以及对灰尘和微生物的过滤功能,从而导致气道分泌物粘稠,呼吸道纤毛运动能力下降,分泌物排出减慢等,造成细菌的繁殖引起肺部感染[1]。而感染又会加重分泌物的产生,增加痰液的粘稠度,导致气