Flexible tantalum stents: Effects in the stenotic canine urethra

Purpose Evaluate the effects of flexible tantalum stents (Strecker) implanted into stenotic canine urethras.Methods Eight conditioned, adult, German shepherd dogs, weighing 30–40 kg, were used. Strictures were created surgically in the bulbar urethra just proximal to the os penis. Two months postsurgery, strictures were documented radiographically and then balloon dilated. Following dilatation, a single Strecker stent was placed across the stricture. Stents were 7 mm in expanded diameter and either 2 or 4 cm in length. Retrograde urethrography was performed immediately after stent placement and then biweekly for up to 12 months. Two dogs were sacrificed at 2, 4, 6, and 12 months post-stenting, and necropsy was performed. The urethra was excised, fixed, and examined by scanning electron and light microscopy.Results Clinical success was achieved without complications in all animals. Hyperplasia of the urothelium was noted 4–6 weeks after stent placement and was most pronounced at 4–6 months. Mucosal folds were found between the stent struts. Restenosis occurred at the distal end of the stent in one dog. Histological alterations were noted in the deeper layers of the urethral wall.Conclusion Strecker stents were well tolerated in all animals and seem useful for the treatment of urethral strictures.Presented at CIRSE Annual Meeting and Postgraduate Course, Budapest, June 20–24, 1993     

Effects of computer-assisted documentation in orthopedic surgery on budget and reimbursement

Summary Since 1995 German health maintenance laws require hospitals to document and code all referals, admissions and discharges using the 4-digit ICD. Operative procedures are documented and coded using the ICPM. Beginning in January 1996, reimbursement for health services requires a diagnosis-related billing and payment for special procedures. The decision for billing is based on documented diagnosis and therapy. This extended request for documentation makes an online access to diagnosis and therapy with a computer-assisted coding system advisable. In 1996 in our hospital each diagnosis and operation was manually documented and coded on a form. Since the beginning of 1997, documentation and coding has been exclusively computer-assisted. On the basis of documented diagnosis and therapy the computer provides the route of reimbursement. Retrospectively we evaluated the number of charged diagnosis-related billings and payments for special procedures from January to April of 1996 and 1997. It became evident that with computer-assisted documentation and coding the number of detected and charged diagnosis-related billings and payments for special procedures was significantly increased in comparison with the previous year.      

Invasive diagnosis and therapy—are they still reasonable in the age of sildenafil?

Diagnosis of erectile dysfunction is important because sildenafil may not be the proper therapy for patients with underlying major diseases such as coronary sclerosis, arteriosclerosis of the stroke vessels, depression, etc., where erectile dysfunction is just a symptom of the disease.     

The Patient Factor

Long-term results of bariatric surgery are reviewed. The weight criteria for patient acceptance for bariatric surgery and their variation are presented graphically and discussed. Factors affecting patient selection in an attempt to improve outcome results in the small group of patients who currently achieve less weight loss than anticipated are defined. An attempt is made to define pre-operative criteria for selection of pure restrictive versus combined restrictive and malabsorptive procedures. Aspects of motivation, co-morbidity, age and pre-operative weight are discussed and the position statement of the ASBS in regard to laparoscopic bariatric surgery is defined.     

Ultrasound-guided percutaneous laser ablation of liver tissue in a rabbit model

The present report evaluates the efficacy and safety of percutaneous interstitial laser tissue ablation of the liver in nine New Zealand rabbits. A Nd: YAG laser was coupled to a quartz fibreoptic guide (600 m) with a flat tip. The fibre and a thermocouple were placed in the lumen of two Chiba needles (18G) and these were inserted into the liver 10 mm apart under ultrasound guidance. The laser was fired for 5 min at 1, 3 and 5 W power, respectively, in three groups of rabbits. There were no acute complications and all the rabbits except one survived until the established time of sacrifice. The procedure induced a cavity surrounded by a zone (about 10 mm) of coagulative necrosis. After 2 weeks a strong peripheral inflammatory response was evident and after 4 weeks a capsule of connective tissue enclosed the lesions. Our study seems to offer a safe and rapid technique producing a guaranteed kill radius for the treatment of small hepatic neoplasms. Correspondence to: C. M. Pacella     

经皮无水酒精注射治疗小肝癌的疗效分析（附18例报告）

目的　评估经皮注射无水酒精治疗小肝癌的疗效。方法　 1 8例原发性肝癌 2 2个病灶 (直径 <3.3cm)接受经皮注射无水酒精的治疗。在 CT引导下将细针穿入病灶中央 ,缓慢地注入无水酒精。随访采用螺旋 CT增强扫描的办法进行 ,同时观察并发症发生情况。结果　 2 1个病灶平均肿瘤直径 2 .3cm (1 .5～ 3.3cm ) ,平均注射酒精量 5 .8ml (3～ 9ml)。 1 7个病灶治疗后肿瘤组织全部坏死 ,4个病灶显示有残留肿瘤。并发症包括腹部剧痛(5 .5 5 % )、肝节段性梗塞 (5 .5 5 % )。结论　经皮注射无水酒精治疗小肝癌是安全有效的     

婴幼儿法乐四联症合并肺动脉闭锁的外科治疗

目的：探讨法乐四联症合并肺动脉闭锁（TOF－PA）的外科治疗，重点讨论根治手术的适应证。方法：1995－2001年，5例2岁以下TOF－PA患儿均施行根治手术，其中，肺动脉瓣膜性闭锁2例，肺动脉瓣闭锁＋肺动脉干发育不良3列，手术均在中度低温体外循环下进行，采用自体心包补片加宽肺动脉；Gore-Tex补片加宽右心室流出道。结果：5例患儿根治手术无住院死亡，术后1个月－1年复查，紫绀消失，体重明显增加，彩超复查未见残余分流，右心室流出道未见梗阻，肺动脉与右室流出道之间无明显压力阶差。X线检查，两肺血均有明显的增加，分布均匀对称，结论：婴幼儿TOF－PA早期施行根治术可以得到较为满意的疗效。     

先天性联体畸形的外科处理

目的 总结4例联体儿分离术的经验,对联体儿诊治提供参考。方法 回顾性分析自1982～2001年,我院小儿外科共收治的4例先天性联体儿外科分离手术的临床资料,着重在手术时机、产前诊断、合并畸形、分离技术、术后监护、随访等方面。结果 4例联体儿畸形,其中胸部-脐联合畸形3例,坐骨联体1例,男性1例,余均为女性。均不同程度合并先天性心脏缺损,坐骨联体儿合并严重大血管畸形,泄殖腔畸形及Pieer-Robin综合征。2例产前超声检查获得诊断。2例紧急分离术时间为出生后7d内,存活1名。另2例延迟分离手术时间>1个月,均存活。随访存活的5名患儿,1982年分离的剑突-脐联体儿其中1名于术后4年“肺炎”死亡。另1名已20岁,健在。另一对胸部-脐联体儿术后1年发育良好。1例坐骨联体儿1名死亡,1名失随访。结论 手术时机与分离方式必需依据每一对联体儿局部环境及器官结构而定。紧急分离术存活率低,能延迟行分离术则存活率高。     

经鼻内镜手术治疗鼻部脑膜脑膨出

目的　探讨经鼻内镜手术治疗鼻部脑膜脑膨出的可行性并确立临床处理的基本原则。方法　经鼻内镜下采用剪除、电切、切割等方式切除鼻内型脑膜脑膨出 5例 ,并根据颅底缺损的不同情况选择使用肌肉、筋膜、软骨、骨等一期修补颅底。结果　 5例均一次手术治愈 ,除 1例术后颅内感染 (脑膜炎 )外 ,无并发症发生 ,随访 1～ 5年无复发。结论　位于鼻腔内的脑膜脑膨出可以经鼻内镜手术完成 ,直径 0 5cm以下的颅底缺损可使用肌肉填塞和筋膜覆盖的方法修补 ,直径超过 0 5cm的颅底缺损应先使用软骨或骨封闭缺损 ,然后再用肌肉填塞和筋膜覆盖 ,以免复发。