病灶清除加双贯通管灌洗术治疗股骨术后感染76例

目的 探索一种更为有效的灌洗术式,以提高对股骨术后感染的治疗效果. 方法 统计唐山市第二医院骨病科2001年3月-2008年5月收治并采用双贯通管灌洗术治疗的股骨术后感染患者76例,做同顾总结,从而探讨这种灌洗术的优缺点. 结果 76例患者术后伤口均Ⅰ期愈合,随访半年以上未见复发. 结论 双贯通管灌洗术在保证灌洗效果的同时,降低了灌洗管的脱落率和阻塞率,是对常规灌洗术的有效改良.     

前路病灶清除植骨内固定结合局部灌洗化疗治疗下颈椎结核伴巨大脓肿

目的:评价前路病灶清除植骨内固定结合术后异烟肼生理盐水持续灌洗局部化疗治疗下颈椎结核伴巨大脓肿的临床疗效.方法:2001年6月～2010年6月收治下颈椎结核伴巨大脓肿患者13例,男8例,女5例;年龄28～62岁,平均44岁.病变累及部位:C3～C4 2例,C4～C5 3例,C5～C6 4例,C5 2例,C6 2例;脓肿累及节段:C3～C6 5例,C3～C7 3例,C4～C7 4例,C4～T1 1例.患者均存在颈部疼痛和不同程度的吞咽及呼吸困难,术前颈部疼痛VAS评分7～10分(8.1±1.3分).10例出现神经功能障碍,JOA评分5～12分(8.3±1.7分).术前血沉78±12mm/h,C反应蛋白65±17mg/L.均在全身抗结核药物治疗下采用颈前路结核病灶清除、钛网填充自体髂骨植骨内固定,术后异烟肼生理盐水持续局部灌洗化疗,并继续全身抗结核治疗12～18个月.随访观察患者临床症状改善、脓肿清除和植骨融合情况.结果:手术均顺利完成,所有患者无术中及术后并发症,术后异烟肼生理盐水持续灌洗14～26d,平均18d.未出现窦道、瘘管和脑脊膜感染.随访24～72个月,平均42个月,血沉和C反应蛋白在术后3个月内均恢复正常,手术节段在3～7个月(平均5.8个月)均得到骨性融合.颈部疼痛VAS评分末次随访时为0～3分(1.5±0.7分),与术前比较有显著性差异(P＜0.05).末次随访时JOA评分为12～17分(14.6±1.5分),与术前比较有显著性差异(P＜0.05).末次随访复查MRI均未见结核复发.结论:在全身规范抗结核药物治疗的前提下,采用前路病灶清除植骨内固定结合术后持续局部灌洗化疗治疗下颈椎结核伴巨大脓肿安全有效,临床效果满意.     

环孢素A对积水肾脏急性压力灌注损伤的保护

目的 在不同程度肾脏积水的前提下,观察线粒体渗透性转换孔(MPTP)抑制剂环孢素A(CsA)对于急性压力灌注所致损伤的保护作用.方法 健康新西兰大白兔20只,随机分为轻度积水组(M组,n=10)和重度积水组(S组,n=10),肾脏轻度积水及重度积水模型采用输尿管套扎法构建.M组及S组分为M1、M2、S1、S24个亚组,分别予以60、100、20、60 mmHg(1mmHg=0.133 kPa)压力灌注.灌注前M组及S组均给予CsA灌胃1周.灌注后48 h取标本,检测标本中超氧化物歧化酶(SOD)及丙二醛(MDA)的含量,JC-1染色检测线粒体膜电位(MMP)的变化.结果 M1、M2、S1、S2各组SOD活力分别为(30.11±2.23)、(28.41 ±2.26)、(44.82±6.61)、(40.31±5.21) U/mg,M1与M2之间SOD活力差异无统计学意义(P＞0.05),S1与S2之间SOD活力差异无统计学意义(P＞0.05);MDA的含量分别为(0.61 ±0.17)、(0.60±0.15)、(0.95 ±0.26)、(0.80±0.32) nmol/mg,M1与M2之间MDA含量差异无统计学意义(P＞0.05),S1与S2之间MDA含量差异无统计学意义(P＞0.05).JC-1染色橙红色阳性细胞百分比分别为(67.16±9.47)％、(60.75±11.89)％、(41.08 ±4.50)％、(42.36 ±3.44)％.M1与M2比较,S1与S2比较,阳性细胞百分比差异均无统计学意义(P＞0.05).结论 CsA对于积水肾脏因急性压力灌注所致的损伤有一定的保护作用.在经皮肾镜及输尿管镜治疗结石前给予MPTP抑制剂可有效减轻压力灌注所致损伤.     

脊柱畸形后路内固定矫形术后深部感染的治疗

目的:探讨脊柱畸形后路内固定矫形术后深部感染的治疗效果。方法:2012年6月~2014年12月167例脊柱畸形患者行后路内固定矫形术,11例术后并发切口深部感染,男3例,女8例,年龄14.6±4.7岁(11~27岁);其中早发性感染(术后90d内)9例,迟发性(术后90d后)感染2例。9例早发性感染患者中,伤口渗出液或在B超引导下深层穿刺取脓液细菌培养阳性6例,其中2例为耐甲氧西林金黄色葡萄球菌(MRSA)、3例为甲氧西林敏感金黄色葡萄球菌(MSSA),1例为大肠杆菌;另3例培养阴性者,依据伤口脓性渗液、持续胀痛及术中大量脓性积液而诊断为早发性切口深部感染。2例迟发性感染患者分别于矫形术后7个月和10个月时因腰背部持续性疼痛不适,经MRI检查提示切口深部积液形成,以及血沉、C反应蛋白等炎性指标显著高于正常值而确诊,清创术时取内固定旁组织细菌培养均为表皮葡萄球菌感染。均行彻底清创、置管持续冲洗引流,同时联合敏感抗生素治疗。结果:9例早发性感染经一期切口清创、置管持续冲洗引流及联合敏感抗生素治疗后,伤口均愈合,感染获得控制,内置物得以保留;随访13.5±5.8个月(6~36个月),无内置物松动及感染复发迹象。2例迟发性感染经多次清创、置管持续冲洗引流及联合敏感抗生素治疗仍无法控制感染,于矫形术后1年时取出内置物后治愈,取出内置物后分别随访6个月和14个月,无感染复发迹象,但分别有25°和17°的矫形丢失。结论:对脊柱畸形后路内固定矫形术后早发性深部感染,积极采取彻底清创、置管持续冲洗引流联合敏感抗生素治疗,可有效控制感染,避免取出内置物;而迟发性感染则可能需取出内置物才能控制感染,但有矫形丢失风险。     

腹腔镜手术中腹腔冲洗引流的原则和方法

目的:探讨腹腔镜手术中腹腔冲洗引流的原则和方法。方法:总结腹腔镜胆囊切除术(LC)1 200例,腹腔镜阑尾切除术(LA)356例(肝脏功能异常和急性化脓性炎症病例除外),术中冲洗422例,引流101例的临床资料。结果:术后除2例延期拔管外,余均于术后1~2d拔管。未发生与腹腔冲洗引流有关的并发症。结论:准确掌握腹腔镜术中腹腔冲洗引流的原则和方法,可以缩短手术时间,术后加快患者恢复,减少手术并发症的发生。     

B超引导下经皮穿刺肝肾卵巢囊肿的硬化治疗

目的观察超声导向下无水酒精的不同注射方法治疗肝肾卵巢囊肿的疗效和并发症。方法108例囊肿患者,被随机分成两组,常规组46例,在超声引导下经皮穿刺肝肾卵巢囊肿抽液后向肝肾卵巢囊肿内注射无水酒精,灌洗组62例,在超声引导下经皮穿刺肝肾卵巢囊肿抽液加无水酒精灌洗。术后3个月、6个月、12个月随访,观察并发症及疗效、疗程。结果108例肝肾卵巢囊肿经无水酒精治疗后3个月、6个月、1a复查常规组治愈率分别为56.5%、78.3%、80.4%;灌注组治愈率为79.0%、82.3%、83.8%。术后3个月的治愈率,两组差异有显著性(χ2=6.306,P=0.012<0.05)。并发症常规组发生14例,其中8例患者腹痛,6例头晕;灌洗组发生13例,其中疼痛9例,头晕6例。无出血、感染、剧痛等严重并发症。两组发生率P>0.05,差异无显著性。结论超声导向下经皮穿刺肝肾卵巢囊肿抽液加无水酒精灌洗法是一种高疗效、短疗程、并发症少的方法。     

Microcystin production in benthic mats of cyanobacteria in the Nile River and irrigation canals, Egypt.

The present study describes for the first time the species composition and toxicity of benthic cyanobacteria forming mats on the Nile River and irrigation canal sediments in Egypt. A total of 19 species of cyanobacteria were isolated from these mats during this study. The toxicity of the extracts of these species was investigated using Artemia salina assay, mouse bioassay and enzyme linked immunosorbent assay (ELISA). The results showed that all the 19 benthic species isolated from cyanobacterial mats, were toxic to A. salina. Two of these species, namely Calothrix parietina and Phormidium tenue, caused toxicity to mice with neurotoxic signs appeared within 12 h after injection. Whereas, five species showed hepatotoxic effects to mice within 6 h after injection. The results of ELISA showed that all the extracts which had hepatotoxic effects to mice, contained high levels of microcystins with concentrations ranging from 1.6 to 4.1 mg g(-1) dry weight. HPLC analysis for heptotoxic extracts revealed that these extracts contained two peaks corresponding to microcystin-YR and -LR with different proportions. This study suggests that benthic species should be considered along with planktonic species during monitoring of toxic cyanobacteria in water sources, particularly the Nile river which is the main source of drinking water in Egypt.     

The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy

Objective: to determine fluid-electrolyte andhemodynamics changes and complicationsassociated with irrigation fluid volume andtime in percutaneous nephrolithotripsy in that0.9% NaCI was used as irrigant.Methods: Standard anaesthetic procedureswere performed to 6 women and 16 men. Meanarterial pressure, heart rate, central venouspressure, Na⁺, K⁺, osmolality,haemoglobin, haematocrit were recorded before,during and after irrigation every 10 minutes.Creatinine and blood urea nitrogen weredetermined before and after irrigation.Moreover, the operation and irrigation times,irrigation fluid volume, total fluid outputversus input, blood transfusions andcomplications were recorded.Results: Mean arterial pressure, heartrate, central venous pressure, Na⁺,K⁺, osmolality did not changesignificantly during and after irrigation andno relationship was observed between those withirrigation volume and time. Creatinine andblood urea nitrogen values during and afterirrigation did not change significantly versusthose before irrigation. Although no bloodtransfusion was needed for any case during theprocedure, it was necessary for two cases afterthe procedure. One case with pneumothorax thatdeveloped during procedure was treated byinserting a thoracic tube.Conclusion: There were no significantchanges in fluid-electrolyte balance andhemodynamics related to both irrigation fluidvolume and irrigation time when 0.9% NaCI wasused in PNL.     

超声龈下刮治联合同步1%聚维酮碘液龈下冲洗治疗牙周炎的效果分析

目的探讨超声龈下刮治联合同步1%聚维酮碘液龈下冲洗治疗牙周炎的临床疗效。方法回顾性分析本院2011—2013年口腔科收治的164例牙周炎患者的资料,将患者随机分为观察组和对照组,各82例。两组患者均进行全口洁治、龈下超声刮治及根面平整,观察组患者同步1%聚维酮碘液龈下冲洗治疗,对照组患者用0.9%氯化钠溶液冲洗,比较两组患者治疗后3、6个月牙周袋探诊深度（PD）、龈沟出血指数（SBI）、菌斑指数（PLI）,黑色素类杆菌量和厌氧菌总数。结果两组患者治疗前、后PD、PLI、SBI比较,差异均有统计学意义（P〈0.05）;治疗后观察组PD、PLI、SBI、黑色素类杆菌量和厌氧菌总数与对照组比较,差异有统计学意义（P〈0.05）。结论超声龈下刮治联合同步1%聚维酮碘液龈下冲洗治疗牙周炎,能较长时间控制龈下菌斑,改善牙周炎症情况,疗效满意,值得在临床推广。