抗青光眼术在无晶体眼和人工晶体眼的疗效

探讨发生于无晶体眼和人工晶体眼的青光眼的有效的手术治疗方法。方法：回顾分析１９９２年１１月～１９９７年６月我院４５例４５眼发生于无晶体眼和人工晶体眼的青光眼的住院病例的临床资料。手术方法包括小梁切除术、睫状体冷冻术、青光眼减压阀植入引流术以及其他手术。结果：青光眼减压阀植入引流术控制眼内压优于睫状体冷冻术和小梁切除术,术后合并使用降眼压药物少于睫状体冷冻术后。结论：发生于无晶体眼和人工晶体眼的青光眼的治疗需根据临床情况考虑,青光眼减压阀植入引流术有较好的疗效     

LASIK前后非接触眼压计测量结果的研究

目的：研究激光原位角膜磨镶术（LASIK）手术前后非接触眼压计（NCT）测量值的改变,及其与屈光度矫正值和术中角膜切削厚度之间的关系,方法：随机选择112眼接受LASIK治疗的高度近视患者,排除青光眼或高眼压症,于术前、术后3、6、12个月作非接触眼压测量,对术前、术后的非接触眼压测量值作u检验,并对眼压改变值与预期屈光度矫正值和术中角膜切削厚度作相关性分析,结果：①手术前后非接触眼压测量值的改变差异有显著性意义（P＜0.001）,术后一年平均眼压测量值下降0.931±0.293kPa;③术后一年眼压下降值与预期屈光度矫正值存在统计学上的相关性(r=0.1942,P＜0．05);术后一年眼压下降值与术中角膜切削厚度亦存在统计学上的相关性(r=0.2577,P＜0.001）,结论：LASIK术后不能按传统正常值衡量非接触眼压计测量结果,否则可能延误类固醇性青光眼的早期诊断,激光切削石角膜厚度变薄是导致手术后非接触眼压计测量结果下降的直接原因。     

对外科手术中意外低体温影响因素的观察研究

对３０例神经外科择期手术体温正常患者术中影响体温变化的因素进行观察。在国麻醉期持续监测体温、室温及相对湿度,记录液体输注量及尿量。结果显示,当室温≤２４℃、手术时间＞ ５小时、输注室温下人液量≥（６５１±１２１）ｍｌ／ｈ时,可导致意外低体温。所以,麻醉中体温监测是必不可少的。     

Timing of surgery for common pediatric surgical conditions

Depending upon various factors the surgical procedures in childhood are divided into three groups—immediate, intermediate and elective. The timing of surgery is probably the most important factor governing the outcome of surgical correction in pediatric surgery. With continuing research and clinical experience our understanding of the various conditions have improved and with that has come a change in the optimum timing of many surgical procedures. This paper highlights the best timing of surgery for some of the commoner pediatric surgical procedures and the reasons behind these so that the children may be referred to pediatric surgeons in time.     

Laparoscopic transgastric suturing for bleeding peptic ulcers

Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing. Methods: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a lift and cut technique. Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots. Results: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm³/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement. Conclusions: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Laparoscopic rectopexy for complete rectal prolapse

Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations. Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography. Results: No recurrences of rectal prolapse were seen (median follow-up 19 months). Continence improved in eight of nine preoperatively incontinent patients. Two patients had mild constipation after surgery. Median maximum basal pressure measured by anorectal manometry increased from 20 to 25 mmHg (p=0.005) and the rectoanal inhibitory reflex improved in seven patients (p=0.03). Rectal sensitivity did not change significantly. Endosonography showed asymmetry and thickening of the internal anal sphincter and submucosa preoperatively. After surgery the maximum internal anal sphincter thickness decreased from 3.0 mm to 2.6 mm (p=0.02). Conclusions: Laparoscopic rectopexy improved continence in our patients. Anorectal function tests show a partial recovery of the internal anal sphincter. Laparoscopic rectopexy combines the low morbidity of minimal invasive surgery with the good outcome of abdominal rectopexy.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures

Background: The objective of this preliminary study was to describe the particles contained in cautery smoke produced during five laparoscopic procedures and verify the collection method during three laboratory experiments on ex vivo animal tissue. Methods: A cascade impactor collected the smoke according to particle size, and particle weights were calculated on an electronic microbalance. Electron microscopic analysis and energy dispersive X-ray evaluation were used to determine particle morphology and elemental composition. Results: The particles, distributed according to size on the seven rotating trays of the impactor, had diameters ranging from 0.05 to >25 m, with most being 0.1–1 m. In vitro experiments yielded more particles, especially larger (>5 m) ones, than the surgical procedures, because the cauterized specimens could be placed much closer to the cascade impactor in the laboratory environment, eliminating most obstacles to particle recovery. In the laparoscopic surgery patients, larger particles, because of their physical properties, were more likely to remain trapped in the abdomen or to drop off in the collection apparatus. Uniformly, two populations of particles were demonstrated—either large, irregular fragments (2–25 m) rich in carbon and oxygen, suggesting structural cellular components, or small homogeneous spheres (0.1–0.5 m) composed of sodium, magnesium, calcium, and potassium salts. Conclusions: This study demonstrates the presence of breathable areosols and cell-size fragments in the cautery smoke produced during laparoscopic procedures. Their exact chemical composition and potential adverse effects for patients and personnel are not known.     

Increased incidence of retching and vomiting during periovulatory phase after middle ear surgery

Purpose  

To assess the effect of the menstrual cycle on post-operative retching and vomiting (R& V) after middle ear surgery, and the efficacy of prophylaxis against R& V in female patients with transdermal scopolamine during either general or local anaesthesia and with intravenous ondansetron during general anaesthesia.     

Therapeutic Megalipoextraction or Megaliposculpture

Background: For a long time, surgeons hesitated to extract more than 2.5 liters of adipose tissue from a patient. Through the years, liposuction has advanced, now allowing megaliposculptures to be performed so that more than 10 liters can be extracted without posing any greater risk to the patient than a conventional esthetic liposculpture. Methods: This article traces the progressive evolution of the technique, discussing complications and the concept of megaliposculpturing. Results: The syringe-assisted extraction of large quantities of adipose tissue without transfusion, hypovolemic shock, or any major complication opens new horizons in the symptomatic treatment of certain types of osteoarthritis of the lower extremities and the potential complications of obesity. Conclusions: Large quantities of adipose tissue may safely, quickly and efficiently be extracted. Numerous investigations in various pathological domains can now begin after this first step (megalipotherapy). Therapeutic megalipoextraction can be done either as a preliminary indication or as a treatment of the residual adiposities that occur after bariatric operations.     

Obesity: The Last Bastion of Prejudice

Background: Most people do not realize how pre-judicially damaging they behave, particularly towards the obese. Their discrimination has been deemed, unconsciously perhaps, as acceptable by society. Methods: This paper describes a high school senior's exploration of prejudice and discrimination towards the obese. Results: Through interviews with bariatric surgeons, bariatric patients, an obese victim of prejudice in her high school, attendance at support group meetings, statements from others experiencing similar bias in their workplace as well as a review of the relevant literature, the author developed a new understanding of the extent and depth of prejudice against the obese in North American society. She realized how this prejudice limits social opportunities and access of all sorts, interferes with employment opportunities, and even how deeply it penetrates the medical community. Conclusion: The intent of this paper is to educate those in society who continue to discriminate against the obese, and to open our eyes to our own behavior, as the author's have been opened.