A double or bilobar gallbladder as a cause of severe complications after (laparoscopic) cholecystectomy

A double or bilobar gallbladder is a rare congenital anomaly. If not recognized during preoperative evaluation or operation, it can cause severe complications. We describe two cases in which a second operation had to be performed because of the presence of a second or bilobar gallbladder that was not recognized in the preoperative evaluation and during (laparoscopic) cholecystectomy. The types of anomalies, the concomitant pathology, and treatment are discussed.     

3-D echocardiographic imaging of double aortic arch.

Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.     

Cross talk in surface electromyograms of human hamstring muscles.

Signals generated from muscles other than the muscle(s) of interest (cross talk) can confound the interpretation of surface electromyograms (EMGs). In this study, the amount of cross talk in surface EMGs of human hamstring muscles was estimated using a protocol in which the quadriceps femoris was electrically stimulated via the femoral nerve. EMGs were recorded from the vastus lateralis and the medial and lateral hamstring muscle groups. The amplitude of the EMG response of the vastus lateralis to electrical stimulation was adjusted to match that of its maximum voluntary effort (MVE) under isometric conditions. Subsequent power density spectrum analysis showed that the median frequencies of the signals generated by electrical stimulation and MVE were not significantly different. In conventional bipolar recordings, cross talk in lateral hamstring EMGs averaged 17.1% MVE and in medial hamstring EMGs 11.3% MVE (average-rectified values). The double differential technique significantly reduced cross talk to 7.6% MVE for the lateral hamstrings, and to 4.2% MVE for the medial hamstrings. The double differential technique appears to be more selective than the bipolar technique when recording EMGs from muscles with highly active neighbors and thus should be used in such situations. Software simulations of the double differential technique also appear to be more selective than the bipolar technique and may be used when the number of amplifiers available is limited.     

重睑成形术结合眉埋线固定法治疗上睑皮肤松弛

目的介绍一种埋线法固定眉,结合重睑成形术治疗中青年上睑皮肤松弛的手术方案。方法应用3-0无损伤线皮内缝合,固定眉于眉骨骨膜上,再结合重睑成形术,去除上睑多余的皮肤,共治疗29例上睑皮肤松弛的患者。结果本组29例患者,术后Ⅰ期愈合。21例患者术后随访6个月至2年,均获得满意效果,上睑明显年轻化,无并发症。结论重睑成形术结合眉埋线固定法治疗上睑皮肤松弛,是一种简单有效的上睑年轻化治疗方案。     

双环法旋转圆锥状腺体蒂乳房缩吊术

目的改进传统的双环法在乳房缩小术、乳房悬吊术术后外形扁平，凸度不足，上极瘪陷，提升不够等缺点。方法采用双环切口。“扇”形分离、切除皮下部分脂肪，“楔”形切除适量的外上象限腺体，螺旋状旋转剩余腺体成圆锥状，将其固定在第2肋软骨膜上，矫正轻中度乳房肥大和下垂。结果术后随访20例患者1～3个月，乳房上极较丰满，形态好，乳头乳晕功能正常，切口瘢痕轻，乳房肥大和下垂的矫正获得了满意的效果。结论双环切口，螺旋状旋转剩余腺体成圆锥状，并固定于第2肋软骨膜上，可较好地塑形并悬吊乳房，其切口相对隐蔽，术后乳房高凸，上极略饱满，乳头微上翘，乳晕形态合适，是矫正轻中度乳房肥大下垂的一种较理想的术式。     

上尿路梗阻性急性肾功能不全内、外引流的选择

目的探讨内、外引流在上尿路梗阻急性肾功能不全时的选择和效果。方法25例各种原因引起的上尿路梗阻（15例肿瘤性梗阻,10例非肿瘤性梗阻）合并急性肾功能不全,分别或先后对12例行输尿管内置双J管（doub le J,D J）内引流15次,对19例行经皮肾穿刺造瘘（percutaneous nephrectomy,PCN）外引流23次。结果引流成功23例,PCN外引流成功率86.9%（20/23）,双J管内引流成功率60.0%（9/15）,PCN术后继发出血1例。结论对于盆腹腔进展期或广泛转移肿瘤导致的梗阻,PCN解除梗阻优于输尿管支架内引流;非肿瘤性梗阻宜先尝试D J内引流。     

改进的内眦赘皮矫治术联合重睑成形术Ⅰ期成形

目的 探讨改进的内眦赘皮矫治术联合切开法重睑成形术的方法及临床效果。方法 根据内眦赘皮的轻重程度及方向，采用改良的“Z”成形术，切除或切断内眦部形成赘皮的异位眼轮匝肌及皮下筋膜组织，联合切开法重睑成形术行Ⅰ期成形。结果 本组68例患者，术后赘皮消失，泪阜显露适中，内眦间距缩短，重睑外形美观自然。其中，36例随访3个月至3年，术后皮肤切口无可见瘢痕，形态稳定，内眦赘皮无复发，效果满意。结论 该手术方法能够充分矫正内眦赘皮的异常结构，而与重睑成形术同期施术效果稳定，具有一定的临床应用价值。     

双介入并中药治疗胰腺癌35例

对３５例胰癌病人在超声引导下，局部注射纯乙醇顺铂溶液，由肿瘤远端边退针边注射，一般７－１０天注射１次，直至活栓组织中癌细胞转阴为止。并给予“胰宝康泰”辅治疗，该药具有免疫增强作用。本组３５例的半年、１年、２年活率分别为８５．７％、６８．８％、５１．４％，中位生丰了期为１０．３个月，疗效满意。     

Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.     

上睑下垂美容手术的解剖学设计和效果分析

目的探讨不对称性上睑下垂美容手术的设计要点以及术后美容效果。方法通过对33例不对称性上睑下垂患者术前双眼各自不同特点的分析,提出设计要点,同时对术后的美容效果进行评价。结果本组病例中美容效果优者占87.9%,良以上者占94.0%。结论双眼对称是眼部美容手术成功的关键,只有按照患者各自的解剖学特点设计手术,才能取得良好的美容效果。