激光光凝联合玻璃体腔注气治疗玻璃体切割术后再发黄斑孔

目的 探讨激光光凝联合玻璃体腔注气治疗玻璃体切割术后再发与未愈黄斑孔的疗效。方法 应用COHERENT Omni多波长激光光凝黄斑裂孔底部的视网膜色素上皮层。随后眼内注入20％C3F80．5～0．8ml并置换出玻璃体腔液体。治疗后每天坚持俯卧位。结果 19只眼中16只眼黄斑孔愈合，成功率为84．2％，视力提高15只眼，占78．9％，未出现严重的并发症。结论 应用激光光凝联合眼内注气治疗玻璃体切割术后再发与未愈黄斑孔具有方法简单、费用低、疗效确定、大部分患者无须住院等优点。     

丙泊酚靶控输注用于神经外科老年患者颅骨钻孔术镇静的可行性研究

目的:探讨丙泊酚靶控输注(TCI)用于神经外科老年患者颅骨钻孔术镇静的可行性及血浆靶浓度。方法:随机选择颅骨钻孔术老年患者30例,男18例,女12例,ASAⅠ-Ⅱ级,年龄65～75岁。术前将患者性别、年龄和体重输入TCI泵,采用Marsh的药代动力学参数,以0.5μg/ml为初始靶浓度(血浆靶浓度)开始输注丙泊酚,根据OAA/S镇静评分适当调整靶浓度(靶浓度每隔5min增加0.1μg/ml),直至患者镇静深度稳定于OAA/S镇静评分为3分,记录OAA/S镇静稳定时的靶浓度。观察指标以靶控输注给药前MAP、HR、RR、SpO2、脑电双频谱指数(BIS)、ICP为各自基础值,观察基础、切皮前、切皮和钻孔时的MAP、HR、SPO2、BIS、ICP值变化和镇静满意程度及术后恢复时间(从停药至OAA/S评分为4分)。结果:OAA/S镇静稳定时的血浆靶浓度为(1.22±0.13)μg/ml,术中各时点MAP(P>0.01)和ICP较基础值有显著下降(P>0.05),但MAP下降幅度在10%￣17%,BIS值介于67￣72(平均为69.9±1.4),HR和RR无显著变化,患者镇静效果满意。结论:丙泊酚靶控输注可用于神经外科老年患者,在颅骨钻孔术中血浆靶浓度以(1.22±0.13)μg/ml为参考指标,可获得理想的临床镇静效果。     

Stability Analysis of Thin-Walled Perforated Composite Columns Using Finite Element Method

Open holes or cut-outs have been commonly used in composite structures for various engineering purposes. Those elements often demand perforation especially for weight reduction and to ease maintenance and servicing operations, for example, in aircraft wing ribs. This work presents a numerical study of the stability behavior of composite perforated columns subjected to a compressive load. Profiles were made of CFRP laminate and weakened by three types of cut-out. Four parameters, spacing ratio S/D₀, opening ratio D/D₀, hole shape and arrangement of layers, were selected to check their effect on the buckling load and postbuckling behavior of the tested channel profiles. To carry out the numerical analysis, the Abaqus software was used. The results obtained during the analysis helped to identify the best combination of tested parameters to obtain the highest critical load. The performed analysis show that the columns’ behavior is sensitive to configuration of composite, opening ratio and hole shape.     

Surviving Black Holes and Finding the Third Dimension,with Alex

This article discusses challenges in the treatment of a child, Alex, who is 11?years old when he begins treatment with the author. By the end of Alex’s first year of treatment, his sessions have become so deadening that his therapist often struggles to stay awake. Some days, she remains alert, but finds herself unable to feel or think. During a particularly grueling stretch, the author encounters Francis Tustin’s The Protective Shell, Tustin’s account of her psychoanalytic work with autistic children. Tustin’s ideas, when used by this author, have a transformative effect on Alex’s treatment. The author comes to understand that Alex employs autistic defenses, or protections—i.e., he is partially encapsulated. Tustin’s formulations regarding the etiology of autistic protections facilitate new possibilities for understanding and metabolizing Alex’s communications. In addition, the author grasps the importance of becoming a bolder and more active therapeutic presence with Alex.     

应用腹膜缝缘跳跃式戳孔法预防急腹症术后切口感染的探讨──附274例临床观察

本文观察我科１９９３年４月～１９９５年７月收治的２７４例急腹症手术病例，均应用腹膜缝缘跳跃式戳孔法关闭腹膜，切口不冲洗，不放置引流物，术后切口感染率为３．６５％，本法预防急腹症术后切口感染效果较为理想     

经脐单孔与三孔法腹腔镜胆囊切除术疗效比较

目的分析对比经脐单孔与三孔法腹腔镜胆囊切除术的疗效。方法将90例拟行腹腔镜切除术患者随机分为对照组和观察组,每组45例。对照组行三孔法腹腔镜胆囊切除术,观察组行经脐单孔腹腔镜胆囊切除术,行视觉模拟评分(VAS)和美容满意度评分,记录手术时间、术中出血量、进食时间、住院治疗时间等。结果观察组VAS评分显著低于对照组,美容满意度评分显著高于对照组,差异具有统计学意义(P0.05)。观察组手术时间高于对照组,差异具有统计学意义(P0.05)。结论在掌握手术适应证前提下,与三孔法腹腔镜胆囊切除术相比,经脐单孔手术美容效果好,术后疼痛程度低。     

三孔法腹腔镜下胆囊、阑尾联合切除36例临床体会

目的:探讨三孔法腹腔镜下胆囊、阑尾同时切除这一手术方法的可行性。方法:全麻下腹腔镜三孔法先切除胆囊,然后调换进镜孔和调整显示器位置,再切除阑尾。结果:30例病人均治愈,顺利出院,无1例发生并发症。结论:三孔法腹腔镜胆囊、阑尾同时切除,不但省时、省力,同时1次手术解决1个疾病,创伤小,术后恢复快,并发症少,患者对疗效满意。     

Nd:YAG倍频激光治疗视网膜裂孔疗效观察

目的 评价掺钕钇铝石榴石倍频激光（Nd：YAG倍频激光）治疗视网膜裂孔的临床疗效。方法 应用Nd：YAG倍频激光治疗视网膜裂孔39例47眼。追踪观察是否成功封闭视网膜裂孔、阻止视网膜脱离的发生。结果 成功封闭视网膜裂孔的37例45眼，有效率95．7％，2例2眼发展为视网膜脱离而需手术治疗。结论 Nd：YAG倍频激光治疗视网膜裂孔安全、有效。成功的光凝治疗可封闭视网膜裂孔、阻止视网膜脱离。     

A large-bore teflon endoprosthesis with side holes for nonoperative decompression of the biliary tract in malignant obstructive jaundice

A large-bore Teflon tube with side holes was used for nonsurgical palliative bile drainage in eight patients with malignant tumors. The drainage period ranged from 5 to 26 weeks. The bile drainage through the endoprosthesis was regarded as optimal in two patients, satisfactory in four, and ineffective in two. Significant complications of the method are intervening bile duct infections, risk of sepsis, spontaneous dislodgement, and occlusion of the endoprosthesis.