微创经皮钢板骨桥接术联合锁定加压钛板治疗胫骨远端骨折

目的探讨微创经皮钢板骨桥接术（minimallyi nvasive percutaneous plate osteosynthesis，MIPPO）联合锁定加压钛板（locking compression plate，LCP）治疗胫骨远端骨折的近期疗效。方法2004年6月～2006年3月采用MIPPO联合LCP治疗胫骨远端骨折16例，AO分型：43A1型7例，43A3型5例，43B1型2例，43C3型2例。采用3种方法复位胫骨骨折后插入LCP，用锁定螺钉固定。结果16例随访5～20个月，平均11，5月。16例切口一期愈合，骨折无延迟愈合、畸形愈合、断钉、断板等并发症。术后X线检查4～12周（平均7．6周）骨痂形成并开始部分负重，8～20周骨性愈合（平均16周），此时开始完全负重。3例出现胫骨远端内植物局部不适。根据美国足踝骨科学会评分系统对踝关节功能评分，优14例（87．5％），良2例（12，5％）。结论MIPPO具有创伤小、固定牢靠、可早期功能锻炼等优点，近期疗效满意，是治疗胫骨远端骨折的有效方法。     

Spontaneous migration of an inferior vena cava filter resulting in cardiac tamponade and percutaneous filter retrieval.

Thromboembolic disease accounts for thousands of hospitalizations every year in the US. Its primary management consists of anticoagulation. However, in certain instances this may be contraindicated or not sufficient. Mechanic occlusion of the inferior vena cava (IVC) becomes then a viable alternative. In this case a 35-year-old man presented with a saddle pulmonary embolus but was unable to be anticoagulated due to intestinal bleed. A removable IVC filter was then placed. The filter spontaneously migrated into the right atrium causing severe tricuspid regurgitation, perforation of the atrial wall, and cardiac tamponade. The device was successfully retrieved percutaneously and the patient discharged from the hospital in stable condition. This case illustrates the potentially lethal complications associated with the use of IVC filters, as well as the possibility to percutaneously recover them from within the right atrium.     

3种微创手术治疗复杂性输尿管上段结石的疗效比较

目的比较经尿道输尿管镜钬激光碎石(URSL)联合体外冲击波碎石(ESWL)、微创经皮肾镜取石(mini-PCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法153例复杂性输尿管上段结石患者按治疗方法分为三组:URSL联合ESWL(联合组)治疗60例,mini-PCNL治疗65例,RLU治疗28例。结果联合组有5例转开放手术取石,余50例患者平均手术时间(65.45±16.39)min,术后并发症发生率为23.64%(13/55),1个月后结石清除率为90.91%(50/55)。mini-PCNL组无中转,平均手术时间(50.38±12.91)min,术后并发症发生率为9.23%(6/65),1个月后结石清除率为100%。RLU组有2例转开放取石,平均手术时间(81.73±17.89)min,术后并发症发生率为15.38%(4/26),1个月后结石清除率为100%(26/26)。mini-PCNL组的手术时间、术后住院时间均显著短于联合组和RLU组;并发症发生率明显低于联合组;1个月后结石清除率明显高于联合组。结论mini-PCNL治疗复杂性输尿管上段结石具有手术时间短、结石清除率高、术后并发症少、恢复快的优点。     

In Vivo Skin Penetration of Acitretin in Volunteers Using Three Sampling Techniques

Etretinate and acitretin are given orally to treat psoriasis and various keratinization disorders. Acitretin, the main active metabolite of etretinate, has the pharmacokinetic advantage of being rapidly eliminated, but it shares etretinate's toxicologic profile. Thus a topical delivery of acitretin with no or reduced systemic adverse effects is desirable. To characterize the therapeutic potential of topically delivered acitretin, we quantitatively assessed its percutaneous penetration in healthy human volunteers. Additionally, three skin sampling techniques, the punch biopsy, the shave biopsy, and the suction blister technique, were validated to quantitate acitretin in the skin. The results suggest that topical delivery of acitretin renders skin concentrations which exceed those reported after oral administration of etretinate or acitretin. However, because of possible interlaminate drug contamination, drug localization within a particular skin compartment cannot be determined.     

Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy

Tracheostomy in patients requiring prolonged artificial ventilation in intensive care is increasingly being performed by a percutaneous dilatational technique, in preference to the standard surgical method. Since its introduction numerous series have reported favourably on its general safety in the short-term, but there have been few reports of longer term follow-up of patients. We present four cases of laryngotracheal stenosis, a previously unreported complication associated with the technique, and discuss the relevance of these to the future practice of percutaneous tracheostomy.     

彩色多普勒超声图指导风湿性心脏病二尖瓣狭窄球囊扩张术91例

目的：应用彩色多普勒超声心动图指导经皮二尖瓣球囊成形术(PBMV)治疗风湿性二尖瓣狭窄的价值、方法：运用彩超对行PBMV的患进行术前术后检查，观察二尖瓣钙化程度及部位、开口形状、瓣口面积、二尖瓣返流(MR)程度、瓣下病变、左房左室大小、左房有无血栓．结果：91例PBMV术后患中，术后MR72例，其中MR新出现19例，MR加重8例、与术前对比，术后二尖瓣开放幅度、二尖瓣口面积、二尖瓣跨瓣压、二尖瓣压差半降时间较术前有明显改善趋势，左房内径、肺动脉内径较术前有缩小趋势．同时，术后左房压、右室压及肺动脉压也有下降趋势。结论：彩超能明确PBMV治疗二尖瓣狭窄的效果。影响：PBMV效果的因素较多，但二尖瓣钙化的程度、部位和瓣膜形态较为重要。     

Lateral percutaneous spinothalamic tractotomy

Summary The main elements of the perrcutaneous spinothalamic tractotomy technique by the lateral approach are presented and the results obtained in 163 consecutive patients are communicated. We emphasize the importance of its early use in cases of intractable pain avoiding drug addiction. The simplicity of the method permits a less strict selection of the patients compared with the classic open cordotomy.     

Preventing percutaneous absorption of industrial chemicals: the "skin" denotation

Percutaneous absorption has received comparatively little attention in occupational health, although this route of entry has repeatedly caused occupation-related intoxications. In practice, the evaluation of skin penetration rates is far from simple. Much evidence has been obtained from studies of chemicals used for cosmetics and topical therapeutics, but the information available on compounds encountered in occupational health is limited. The data obtained from experimental studies have confirmed that the concentration, type of vehicle, skin area, skin condition, and extent of occlusion are important factors in determining the degree of percutaneous absorption, but no general model has been developed. Also, too little is known about the basic chemical properties governing the rate of penetration. Thus, prediction is difficult and bound to be rather inaccurate. Current preventive practice follows the procedure used by ACGIH and is mainly based on a "skin" denotation in official listings of chemicals to which exposure limits have been allocated. The number of substances and groups of chemicals which have received skin denotation in 17 selected countries varies between 24 and 179 and a total of 275 are listed as a skin hazard in one or more countries; ACGIH lists 143. Thus, the denotation practice varies. As an unfortunate result of these discrepancies and the dichotomy of skin denotation, the absence of skin denotation may erroneously indicate that efforts to protect the skin are unnecessary. Thus, an evaluation of skin penetration potentials should be incorporated in occupational health practice as a supplement to the official denotations.