颅内血肿清除术并发脑梗死治疗经验总结

目的总结分享颅内血肿清除术并发脑梗死的治疗经验。 方法回顾性分析济宁医学院附属金乡医院神经外科自2010年6月至2017年12月收治的22例行颅内血肿开颅手术并发脑梗死患者的临床资料,对其治疗和结果进行总结。 结果22例患者中,术后即刻或24 h内复查颅脑CT,术后患者死亡7例,重残3例,轻残5例,基本正常7例。术后3~7 d复查颅脑CT,显示低密度区局部可见脑回密度,其中大脑中动脉供血区梗死1例,大脑后动脉供血区梗死基本均恢复,大脑半球梗死患者未见脑供血恢复情况。 结论提早发现颅内血肿清除术并发脑梗死的高风险因素,可大幅提高抢救的成功率,降低患者致死致残率。     

腹腔镜下精索静脉高位结扎术治疗精索静脉曲张30例

目的:评价腹腔镜下精索静脉高位结扎术的有效性、安全性及其价值。方法:对30例精索静脉曲张患者的临床资料进行回顾性总结分析。结果:手术均获成功,平均手术时间32min,平均住院3d,症状均改善或消失。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,对双侧精索静脉曲张及预防术后复发更具价值。     

双手持重物双侧对比诊断肩锁关节脱位的价值

目的:研究双手持重物双侧对比摄片对肩锁关节脱位的诊断价值。材料与方法:对100例肩锁关节脱位病人均采取拍摄患侧肩关节正位片、双肩关节正位对比片和双手持重物双肩关节对比片,对比、分析其影像特征。结果:双手持重物双侧对比对肩锁关节脱位诊断准确率高,特异性强,明显优于其它两种方法,能为临床提供有价值的诊断治疗依据。     

颅骨钻孔尿激酶溶解引流术与小骨窗开颅血肿清除术治疗高血压脑出血的比较

目的比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。方法 2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组,n=34）和小骨窗开颅术（B组,n=30）的高血压脑出血患者共64例（出血量30～50mL,无脑疝）,两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。结果 A组手术时间短于B组,两组比较,有统计学意义（P〈0.05）。术后1、6个月,A组疗效优于B组,两组比较,有统计学意义（P〈0.05）。A、B组术后近期和远期死亡率比较,无统计学意义（P〉0.05）。结论对出血部位在基底节区、出血量在30～50mL,无脑疝的高血压脑出血患者,钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。     

双侧植入人工耳蜗对儿童选择性听取能力影响的个案研究

目的探讨双侧人工耳蜗植入儿童在噪音环境下的选择性听取能力。方法采用实验法,研究个案在不同信噪比条件（SNR=0,10,20）下,单,双侧耳识别双音节词和短句的能力。测试使用计算机导航系统给声。结果在双音节词识别方面,当SNR=20和SNR=10时,单、双耳的识别率都为100％;但当SNR=0时,单、双耳识别率同时下降,结果较为接近。在短句识别方面,SNR=20和SNR=10时的结果相似,但单。双耳之间的差异较为明显;当SNR=0时,单、双耳识别率同时下降,结果较为接近。结论双侧人工耳蜗提高了该儿童在背景噪声中的选择性听取技能。SNR=20和SNR=10时,单耳和双耳的选择性听取能力都没有显著差异,但双耳明显好于单耳。在SNR=0时,单耳和双耳的选择性听取能力明显下降,且双耳和单耳差异缩小。     

Occult contralateral nodal metastases in supraglottic laryngeal cancer crossing the midline

We evaluated the risk of occult contralateral neck involvement according to T stage and ipsilateral neck stage in centrally located supraglottic laryngeal cancer. The side largely involved by the tumor was defined as ipsilateral and the other side was defined as contralateral in terms of the neck dissection side. We retrospectively analyzed clinical and pathologic data from a group of 189 centrally located supraglottic cancer patients in which bilateral neck dissection was part of the primary treatment. Among 378 neck dissection specimens, the rate of bilateral metastasis was 33/189 (17.5%). The rate of occult metastases in the contralateral side were 33/75 (44%) and 6/114 (5.3%), when ipsilateral neck was pN+ and pN−, respectively. Clinically or pathologically positive ipsilateral nodes and the extracapsular spread in the ipsilateral positive nodes displayed significantly higher risk of contralateral metastases. The incidence of occult contralateral metastases did not seem to be affected significantly by T stage of the tumor. Our retrospective study confirmed that the probabilistic criteria of the incidence of contralateral occult metastases in supraglottic laryngeal cancer with tumor largely involving one side and crossing the midline. On the basis of our data, there is a high prevalence of contralateral metastases in tumors with clinically or pathologically positive ipsilateral lymph nodes. The extracapsular spread of the nodes is also an important determinant of the contralateral involvement. The work related to this article was done in Department of Otorhinolaryngology and Head and Neck Surgery, İzmir Atatürk Research and Training Hospital, Ministry of Health, Izmir, Turkey.     

A 12-year-old girl presenting with bilateral gigantic Burkitt’s lymphoma of the breast

The female breast rarely constitutes the primary localization for non-Hodgkin’s lymphoma (NHL). The incidence of primary breast lymphoma (PBL) lies between 0.04 and 1.1% for all breast tumors and 1.7–2.2% for all extranodal NHL. Mostly it occurs during the child-bearing period, during pregnancy or lactation. In general, children between the ages of 8 and 10 years are most frequently affected by Burkitt’s lymphoma. Methods for classification, detection and especially treatment of this condition continue being a subject of discussions and research. We present and evaluate the rare case of a 12-year-old girl with bilateral gigantic breast tumors treated during a surgical mission with “Doctors without borders” (MSF, “médecins sans frontiers”) in the zone of civil war in the Democratic Republic of Congo. The monstrous bilateral breast hypertrophy, symmetrical, rapidly growing, consequently ulcerating and severely bleeding had to be treated by bilateral mastectomy as a salvage procedure. Examinations through histopathology was not feasible and other facilities like ultrasound, CT, MRI and further laboratory examinations were not available.. The patient died 27 days after the surgical procedure. The histological result received by later examination in Germany showed a bilateral high malignant B cell lymphoma (Burkitt lymphoma) of the breast.     

Early Neurosurgical Procedures Enhance Survival in Blunt Head Injury: Propensity Score Analysis

Background: Studies of trauma systems have identified traumatic brain injury as a frequent cause of death or disability. Due to the heterogeneity of patient presentations, practice variations, and potential for secondary brain injury, the importance of early neurosurgical procedures upon survival remains controversial. Traditional observational outcome studies have been biased because injury severity and clinical prognosis are associated with use of such interventions. Objective: We used propensity analysis to investigate the clinical efficacy of early neurosurgical procedures in patients with traumatic brain injury. Methods: We analyzed a retrospectively identified cohort of 518 consecutive patients (ages 18–65 years) with blunt, traumatic brain injury (head Abbreviated Injury Scale score of ≥ 3) presenting to the emergency department of a Level-1 trauma center. The propensity for a neurosurgical procedure (i.e., craniotomy or ventriculostomy) in the first 24 h was determined (based upon demographic, clinical presentation, head computed tomography scan findings, intracranial pressure monitor use, and injury severity). Multivariate logistic regression models for survival were developed using both the propensity for a neurosurgical procedure and actual performance of the procedure. Results: The odds of in-hospital death were substantially less in those patients who received an early neurosurgical procedure (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.05–0.41). The mortality benefit of early neurosurgical intervention persisted after exclusion of patients who died within the first 24 h (OR 0.13; 95% CI 0.04–0.48). Conclusions: Analysis of observational data after adjustment using the propensity score for a neurosurgical procedure in the first 24 h supports the association of early neurosurgical intervention and patient survival in the setting of significant blunt, traumatic brain injury. Transfer of at-risk head-injured patients to facilities with high-level neurosurgical capabilities seems warranted.     

Bilateral liver resection for bilateral intrahepatic stones

AIM： To evaluate the short- and long-term outcomes of bilateral liver resection for bilateral intrahepatic stones. METHODS： We reviewed retrospectively 101 consecutive patients with bilateral intrahepatic stones who underwent bilateral liver resection in the past 10 years. The short- and long-term outcomes of the patients were analyzed. The Cox proportional hazards model was used to identify the risk factors related to stone recurrence. RESULTS： There was no surgical mortality in this group of patients. The surgical morbidity was 28.7%. Stone clearance rate after hepatectomy was 84.2% and final clearance rate was 95.0% following postoperative choledochoscopic lithotripsy. The stone recurrence rate was 7.9% and the occurrence of postoperative cholangitis was 6.5% in a median followup period of 54 mo. The Cox proportional hazards model indicated that liver resection range, less than the range of stone distribution （P = 0.015, OR = 2.152） was an independent risk factor linked to stone recurrence. CONCLUSION： Bilateral liver resection is safe and its short- and long-term outcomes are satisfactory for bilateral intrahepatic stones.