线栓法制备大鼠大脑中动脉闭塞模型手术操作探讨

探讨了大鼠大脑中动脉闭塞模型中栓线的制备、动物体重、切口位置、线的插入深度及结扎翼腭动脉等问题，并对模型是否成功的标志及缺血时间再灌注和术后处理问题提出了标准。     

Lack of sexual knowledge blamed for HIV/AIDS among Latin American youths

Lack of sexual knowledge is the main culprit for HIV/AIDS among Latin American youths, said Chilean expert Raquel Child, who also blamed the authorities for not doing enough to help youngsters deal with the deadly disease.     

女性压力性尿失禁手术治疗失败的处理

目的探讨女性压力性尿失禁(SUI)各类手术治疗失败的临床处理方法。方法2003年7月~2006年5月,收治女性SUI各类手术治疗失败患者23例,平均年龄(65±9.8)岁。根据病情和处理方法分为三组:A组2例,术后因排尿困难留置导尿管,予以留置导尿、定期尿扩、体育锻炼和α受体阻滞剂治疗;B组13例,其中3例轻度SUI者予以盆底肌群电刺激结合提肛锻炼,10例中、重度患者保守治疗3个月后再施行TVT吊带术;C组8例,为急迫性尿失禁(UUI)患者,予以电刺激盆底肌群结合M胆碱能受体阻滞剂治疗。结果A组患者治疗4~6周后可自行排尿;B组轻度尿失禁者经3个月治疗后症状消失,中、重度者再次TVT吊带术术后症状消失;C组患者治疗3月后症状明显好转,其中4例症状完全消失。结论对于女性SUI各类手术治疗后失败的患者,应根据具体病情选择治疗方法。部分患者综合性保守治疗有效,待保守治疗无效后再选择手术;严重UUI患者因再次手术可能加重症状,故为再次手术的相对禁忌证。     

三种不同膀胱扩大术治疗神经源性膀胱分析

目的运用三种不同术式的膀胱扩大术治疗神经源性膀胱并观察疗效。方法10例神经源性膀胱患者接受膀胱扩大手术。其中7例(10侧)行乙状结肠膀胱扩大术,2例行自体膀胱扩大术,1例行输尿管膀胱扩大术。术后随访1~42月,经B超或磁共振尿路造影(MRU)、肾功能及影像尿动力学检查评估疗效。结果与术前比较,乙状结肠膀胱扩大术患者肾积水明显缓解或消失;4例血清肌酐明显下降;10侧膀胱输尿管返流均消失,膀胱容量和顺应性明显改善。自体膀胱扩大中的1例脊膜膨出患者,术后1月膀胱容量增加了13 mL,但顺应性改善不明显;另1例脊髓损伤患者的自主神经过反射症状得到部分缓解。接受输尿管膀胱扩大术的1例隐性骶裂患者,术后膀胱容量增加显著,肾积水状况改善,血清肌酐下降。本组9例患者术后均能掌握并坚持自行间歇导尿术。结论乙状结肠膀胱扩大术仍然是目前神经源性小容量低顺应性膀胱治疗的金标准。有返流性巨输尿管的患者(尤其小儿)可选择输尿管膀胱扩大术。自体膀胱扩大术的选择要慎重,相对乙状结肠膀胱扩大术来说其容量扩大有限,疗效尚待大样本长期的随访验证。     

剖宫产术中大出血的病因分析及紧急处理措施

目的探讨影响剖宫产术中出血的原因，提出其预防和紧急处理的有效措施。方法对2005～2006年株洲地区部分医疗机构发生的110例剖宫产术中大出血的临床资料进行回顾性分析。结果成功救治107例，死亡3例，切除子宫7例。宫缩乏力是首要病因（80％），其次是胎盘因素（15％）。宫腔纱条填塞和子宫B-Lynch缝合术等都是行之有效的止血方法，而综合规范的抢救措施是成功的关键。结论严格手术指征，重视高危患者的手术，一旦剖宫产术中大出血应立即采取综合规范的紧急处理，即启动术中大出血急救程序是挽救产妇生命的有效措施和抢救成功的保证。     

额眶筛入路切除前中颅底颅鼻眶沟通瘤

目的探讨切除前中颅底、额、筛窦、眶沟通性肿瘤的最佳手术方式,以满足临床需要。方法对13例前中颅底颅鼻眶沟通瘤患者采用额眶筛入路、T型切口,将外鼻下翻,切除部分筛窦、纸板、额骨眶部及额窦后壁,充分暴露肿瘤组织,在手术显微镜下分块或完全切除肿瘤,分离、保护相应解剖部位,如视神经、内动脉、蝶鞍和脑膜等重要解剖结构。将外鼻回复,用钛板钛钉与额骨固定,恢复良好颌面外形。结果13例颅鼻眶沟通瘤手术均获得成功,随访24个月,11例肿瘤无复发,均无脑脊液鼻漏、脑膜脑膨出等并发症。面部外形良好。结论经额眶筛进入、侧下翻鼻骨入路是耳鼻咽喉科切除前中颅底颅鼻眶沟通瘤的一种良好方法。     

Congenital melanocytic nevus with features of hybrid schwannoma/perineurioma

Neural differentiation by melanocytic nevi represents a well‐recognized phenomenon, and melanocytic nevi with perineurial differentiation have been reported recently. We reported a case of a congenital melanocytic nevus with histopathologic features of hybrid schwannoma/perineurioma. The patient was a 36‐year‐old male who presented with a black tumor on his arm since birth. Histopathology showed a congenital melanocytic nevus in the superficial dermis, but more strikingly, in continuity with the melanocytic nevus, there was a well‐circumscribed but unencapsulated nodule in the deep dermis. The nodule was composed of cellular and myxoid areas with storiform, laminated or whorled growth patterns. The cellular area was mainly composed of proliferation of plump spindle, oval or epithelioid cells. The myxoid area was mainly composed of proliferation of slender spindle cells with mucin deposition. Immunohistochemical stains showed that the cellular area was positive for S100 and CD34, weakly positive for EMA, negative for Glut‐1 and collagen IV, the myxoid area was positive for S100, negative for CD34, strongly positive for EMA and focally positive for Glut‐1 and collagen IV. Our results show that congenital melanocytic nevi may show neural differentiation with histopathologic features of hybrid schwannoma/perineurioma.     

The triple procedure: in the bag placement versus ciliary sulcus placement of the intraocular lens

AIMS: To evaluate the influence of intraocular lens (IOL) placement on triple procedure clinical results and to investigate whether it is appropriate to use phacoemulsification in patients with large lens nucleus. METHODS: 40 consecutive penetrating keratoplasties combined with cataract extraction performed in a single institution were studied. Whenever possible a capsulorhexis was performed and the IOL was placed into the capsular bag. Phacoemulsification was used when the nucleus was too large to pass through the capsulorhexis. RESULTS: Out of 25 patients with an intact capsulorhexis phacoemulsification was used in 13 (52.0%) whereas the entire nucleus passed through the capsulorhexis in the remaining 12 patients (48%). The average 12 month visual acuity was 0.46 (SD 0.21) in patients with in the bag IOL (n = 23) and 0.29 (0.08) in patients with ciliary sulcus IOL (n = 13) (p = 0.04). Elevated intraocular pressure occurred in 26.1% (6/23) of patients with in the bag IOL and 61.5% (8/13) of patients with ciliary sulcus IOL (p = 0.08). The average postoperative graft thickness at 18 months was 552 (27) microns in the former group and 650 (29) microns in the latter group (p = 0.04). No significant difference in graft survival, postoperative endothelial cell density, astigmatism, and videokeratoscopic measurements was found between both groups. CONCLUSION: In the bag placement of the intraocular lens during the triple procedure results in better outcome of transplantation than ciliary sulcus placement of the IOL. Phacoemulsification allows removal of large nuclei through a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.     

Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

Background Aortic root replacement with pulmonary autograft （Ross procedure） has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease. Methods From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28＋15 years （range, 5-56 years）. Congenital heart disease （CHD） with aortic valve stenosis （AS） and/or aortic valve insufficiency （AI） in 40 cases including one associated with ventricular septal defect （VSD）, degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis （SBE） with AI in 1 were studied. The diagnosis was made by ultracardiography （UCG） in all patients. The mean aortic valve annulus diameter （AVD） was （2.45±0.31） cm and pulmonary valve annulus diameter （MPVD） was （2.34±0.21） cm. All patients had normal pulmonary valves. The New York Heart Association （NYHA） function class was Ⅱ in 36 cases and Ⅲin 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass （CPB） with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft. Results There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was （6.11±0.12） mmHg. The left ventricular diastole diameter （LVDD） decreased significantly from （62±5） mm to （56±3） mm （P 〈0.001）. The mean postoperative left ventricular ejective fraction （LVEF） was 0.49±0.23. All patients were in NYHA class Ⅰ-Ⅱ. Follow-up was completed in 38 cases for a mean period of 3.2 years （range 1-10 years）. All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year af     

Testing for skin sensitization according to the notification procedure for new chemicals: the Magnusson and Kligman test

The notification procedure for new chemicals in the European Union (called the Chemicals Act in Germany) requires a skin sensitization test when the amount of a new chemical produced exceeds 100 kg/year. The preferred test is that of Magnusson and Kligman; more than 90% of the tests submitted are performed with it. Though the Magnusson and Kligman test is described in the literature, and in the test guidelines of the European Union and of the OECD, discrepancies do occur in the performance of the test between test laboratories. In this paper, recommendations are given for standardized performance of the Magnusson and Kligman test.