Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.     

Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy

Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration. Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach proved impossible or unsuccessful. Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited biliary leak. Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital stay. Received: 29 March 1996/Accepted: 12 June 1996     

改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床观察

目的 :探讨改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床效果。方法 :用 7～ 9号腰脊穿刺针针头去尖 ,磨光后制成改良空管式泪道探针。为慢性泪囊炎 98例、10 2眼探通泪道后沿空管注入素高捷疗眼膏 ,使之布满泪道内壁 ,尽快修复探通的泪道内皮 ,达到扩张疏通的目的。以同一疾病 84例、85眼为对照组 ,以 1～ 3号银质泪道扩张针扩通泪道 ,留针 15min ,隔日 1次 ,共扩张 2～ 3次 ,扩张后用 0 .2 5 %氯氟液冲洗。结果 :术后随访 3个月 ,观察组治愈率为 97.0 5 %,对照组治愈率为 9.4 1%,差异有高度显著性 (P<0 .0 1)。 结论 :用改良的泪道探针探通泪道后注入素高捷疗眼膏 ,促使泪道修复 ,是治疗泪道阻塞或狭窄的有效方法。     

ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.     

超声心动图测定未闭动脉导管内径及临床意义

目的　探讨超声心动图测定未闭动脉导管内径的可靠性及其在导管法封堵动脉导管未闭症 (PDA)中的临床意义。　方法　 4 4例 PDA患者 ,男 18例 ,女 2 6例 ,平均 10 .8± 10 .5岁。应用二维超声心动图 (2 DE)及彩色多普勒血流显像 (CDFI)测定 PDA近端及最小内径 ,并与 X线造影测值及最终所选择的封堵器直径比较。　结果　 2 DE及 CDFI显示 PDA解剖全程及测量 PDA内径的成功率分别为 5 7%和 10 0 % ;2 DE对 PDA直径测量的均值显著低于 X线测值及封堵器实际尺寸 ,其回归方程斜率更偏离 1,截距较大 ,估计标准误高 ;CDFI对 PDA直径测量的平均值与 X线测值差异无显著性 ,但平均小于封堵器尺寸 2 .9mm,其回归方程斜率更接近 1,截距小及估计标准误小。　结论　与 2 DE相比 ,CDFI能更准确地测量 PDA直径 ;在导管封堵术中选择封堵器时 ,CDFI的 PDA直径测值可与 X线测量互相补充甚至可替代 X线造影 ,避免穿刺股动脉的技术困难及大量注射造影剂的副作用     

先天性心脏病动脉导管未闭介入治疗及血流动力学变化

目的观察动脉导管未闭经皮心导管封堵术前后右心血流动力学的变化,评价其临床意义。方法对50例动脉导管未闭儿童患者,在进行介入性经皮心导管封堵术治疗前应用X线降主动脉造影测量前,术后经导管检测右心血流动力学指标变化。结果未闭动脉导管最窄处直径(5．6±1．3)mm;术前肺动脉平均压(19．1±2．3)mmHg,左向右分流量平均为(0．41±0．13)l／min,血流分流量占肺循环血流量的比例平均为(0．17±0．03);术后肺动脉平均压(14．4±1．7)mmHg,左向右分流量平均为(0．03±0．01)l／min,血流分流量占肺循环血流量的比例平均为(0．02±0．01),相应数据比较,差异有统计学意义(P＜0．05)。结论动脉导管未闭经皮心导管封堵术前后血流动力学会发生改变,肺动脉平均压,左向右分流量以及分流量占肺循环血流量的比例均会不同程度下降,这种改变可以作为评价介入治疗效果的重要指标。     

CASE OF FASCIOLIASIS: EXTRACTION WITH ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY

Fascioliasis is a worldwide zoonotic infection with fasciola hepatica and fasciola gigantica. The zoonoses are particularly endemic in sheep‐raising countries and are also endemic in Turkey. Clinical features of fascioliasis relate to the stage and intensity of infection. Fasciola hepatica infection comprises two stages: hepatic and biliary, with different signs and symptoms. Cholestatic symptoms may be sudden, but, in some cases, they may be preceded by a long period of fever, eosinophilia and vague gastrointestinal symptoms. We reported a case with fever and upper‐quadrant abdominal pain since 3 months that comes from an area endemic for fasciola hepatica, with suspected imaging about fasciola hepatica in common bile duct on ultrasonography. After that, fasciola hepatica was extracted with endoscopic retrograde cholangiography.     

Bilateral Hematogenous Pseudomonas aeruginosa Endophthalmitis After Lung Transplantation

Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.     

Laparoscopic choledochotomy with primary closure

Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described. Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations, and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures. Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range 4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8–10 mm). Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known. Received: 20 October 1995/Accepted: 28 February 1996     

胸导管引流对慢性哮喘病人外周血淋巴细胞内环核苷酸代谢的影响

观察7例慢性哮喘病人胸导管引流治疗前后外周血淋巴细胞内 cAMp/cGMP 值的变化。结果发现,慢性哮喘病人外周血淋巴细胞内 cAMP/cGMP 的值较正常人低(P<0.001);胸导管引流治疗后,哮喘病人外周血淋巴细胞内 cAMP/cGMP 值较治疗前升高(P<0.01)。提示,慢性哮喘病人外周血淋巴细胞功能异常、活性增强,这可能是哮喘发病的重要原因之一。胸导管引流引起的免疫抑制作用,一个重要的机理就是影响淋巴细胞内环核苷酸的代谢,而使淋巴细胞的活性降低,这可能也是胸导管引流治疗慢性哮喘的机理之一。