空心钉经皮微创内固定技术治疗骨盆环损伤的疗效评价

目的：评价经皮微创空心钉固定骨盆环损伤的安全性及可靠性。方法：对48例不稳定骨盆环损伤患者，分别行闭合复位、经皮微创空心钉内固定术。按Tile分型：B1型4例，B2．1型8例，B2．2型10例，B3型4例，C1型11例，C2型7例，C3型4例。39例前后环损伤均固定，4例仅固定前环损伤，5例仅固定后环损伤。以术前骨盆的三位x线片（前后位、入口位及出口位）及CT片判断骨盆的稳定性及移位情况，术后以x线片及CT片评估复位情况及螺钉位置准确性。结果：手术时间15～95min，平均55min。术中出血量15～150ml，平均60ml，术中及术后无输血。48例患者共植入空心钉157枚，每人2～8枚，平均3．3枚。术后行骨盆CT检查42例（共植入135枚空心钉），发现123枚空心钉位置准确，占91．11％；7枚空心钉因偏向或超长而侵入盆腔或髋臼（但均〈0．5em）；5枚位置偏差干扰骶管或骶孔，但均未引起任何症状。随访8～49个月，平均13个月，45例患者骨盆环移位复位满意，所有骨折均Ⅰ期愈合。40例恢复原工作，4例末次随访时尚处康复期，其余4例因坐骨神经损伤或下肢截肢而不再工作。参照Lindahl改良的骨盆损伤后功能评定标准，优35例，良10例，可3例，平均得分78.7分。结论：在对骨盆环及其毗邻血管神经的解剖结构熟练掌握的基础上，结合良好的透视引导，闭合复位经皮微创空心钉内固定治疗不稳定骨盆环损伤安全可行，疗效满意。     

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。     

Role of laparoscopy in identifying the clinical significance and cause of adhesions and chronic pelvic pain: a retrospective review at the Kiel School of Gynecological Endoscopy.

OBJECTIVES: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. METHODS: A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. RESULTS: Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin-filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). CONCLUSIONS: Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain.     

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。     

Silastic ring vertical gastric bypass: cohort study with 83% rate of 5-year follow-up

BackgroundSilastic ring vertical gastric bypass (SRVGB) with jejunal interposition is our standard operation for morbidly obese patients. We present the results of 5 years of follow-up in a cohort of patients who underwent SRVGB in 2001.MethodsThe records of all 160 consecutive patients who underwent SRVGB from January to December 2001 were reviewed. Of the 160 procedures, 143 were primary open cases, 14 were revisions from restrictive procedures, and 3 were laparoscopic cases. At 5 years, the body mass index and percentage of excess weight loss was available for 133 patients (83%) at office visits (n = 91, 68.4%), by telephone (n = 40, 30.1%), or by e-mail (n = 2, 1.5%).ResultsOf the 160 patients, 121 were women and 39 were men, with a mean age of 33.15 ± 10.0 years, percentage of ideal body weight of 195.7% ± 40.8%, and body mass index of 44.6 ± 9.3 kg/m². The mean hospital stay was 3 ± 1 days. One patient (.6%) died of a pulmonary embolus. Early complications included 3 cases (1.87%) of upper gastrointestinal bleeding and 4 gastric leaks (2.5%): 2 (1.36%) from primary cases and 2 (14.29%) from revisional cases. Late complications included 32 patients (20%) with incisional hernias, 20 (12.5%) with anemia, 14 (8.8%) with dumping, 4 (2.5%) with gastrojejunal stricture, 2 (1.25%) with intestinal obstruction, and 2 (1.25%) requiring silastic ring surgical removal. The 5-year follow-up data were available for 133 patients (83%). The mean body mass index in this group was 27 ± 5 kg/m², with a percentage of excess weight loss of 83% ± 18.3% at 5 years postoperatively.ConclusionThe results of our study have shown that SRVGB is an effective operation for promoting lasting weight loss, with acceptable mortality and complication rates.     

Apical vault repair, the cornerstone or pelvic vault reconstruction

Pelvic organ prolapse remains a difficult problem for pelvic reconstructive surgery. Before new surgical procedures can be developed a good understanding of pelvic anatomy is necessary. It is widely held that the etiology of pelvic organ prolapse is secondary to stretch neuropathy following childbirth and chronic cough or constipation. Several transvaginal and transabdominal procedures have been developed over the years. With the increasing use of laparoscopy, a new variation on existing culdeplasty techniques has been developed. Following anatomical principles, the apical vault repair reestablishes the pericervical ring at the vaginal apex. The incorporation of pubocervical fascia, uterosacral-cardinal ligament and the rectovaginal fascia provides a strong anchor for the vaginal apex. In addition, the repair should help prevent future transverse cystocele, rectocele, enterocele and apical vault prolapse. Early outcome studies suggest that the apical vault repair should be used routinely with laparoscopic urethropexy, laparoscopic hysterectomy and the repair of pelvic organ prolapse. Good apical vault support is considered the cornerstone of pelvic reconstruction.     

Measurement of Perceived Disruption During Rebuilding Following Hurricane Andrew

The purpose of this study was to develop and evaluate a measure of perceived disruption during rebuilding following a disaster. Two eight-item scales, which measured intensity of disruption during the entire repair phase (Intensity-RP) and intensity of disruption during the past month (Intensity-PM) were developed and administered to 135 survivors of Hurricane Andrew. At 9 to 12 months postdisaster, Intensity-RP and Intensity-PM were both significantly associated with scores on the Global Severity Index of the SCL-90-R, and with scores on the Impact of Event-Intrusion Scale; Intensity-PM alone was significantly associated with PTSD scores. Regression analyses indicated that each scale contributed significant unique variance in predicting mental health symptoms, even after controlling for relevant demographic and initial disaster exposure variables.     

Pelvic pain and recurrent urinary incontinence after laparoscopic colposuspension with the endo-stapler

Laparoscopic colposuspension is one of many new operations for treating female urinary stress incontinence. With initially reported success rates similar to those of the traditional open procedure, it appears to combine the advantages of laparoscopy (such as minimal invasiveness and quicker return to normal activities) with the effectiveness of the standard procedure. Different methods and approaches are used, but endoscopic suture techniques remain difficult and time-consuming. The use of endostapling devices for fixation of alloplastic material has been a tempting alternative. We present a case during which laparoscopic colposuspension was performed using staples and mesh. Incontinence did not improve, and the patient suffered severe chronic pain for 18 months postoperatively. Removal of the alloplastic material and traditional abdominal resuspension led to complete cure.     

Persistent bone marrow failure with dysplastic features following pentostatin therapy for hairy cell leukaemia

Myelodysplastic syndromes (MDS) have rarely been reported after treatment with nucleoside analogues, and mainly in patients who have also received alkylating agents. We report a patient who developed MDS (refractory anaemia with ring sideroblasts) after treatment with pentostatin (deoxycoformycin) alone.     

The shell region of the nucleus ovoidalis: a subdivision of the avian auditory thalamus.

The connectivity of a region surrounding the established thalamic auditory nuclei, n. ovoidalis (Ov) and n. semilunaris parovoidalis (SPO), was explored in the ring dove by using the anterograde tracers, Phaseolus vulgaris leucoagglutinin (PHAL) and biocytin, and the retrograde tracer, fluorogold. The Ov-SPO surround received a projection from a cell group along the interface of the auditory midbrain and the n. intercollicularis, as revealed with PHAL and biocytin, and was composed of neurons exhibiting a common morphology. These features and the presence of overlapping projections from different portions of the Ov-SPO surround suggest that this region comprises a functionally discrete area, which we term the Ov shell. Single unit recording within the shell established the existence of acoustically responsive units. Both PHAL and fluorogold labeling revealed a robust projection from the Ov shell to the caudomedial hypothalamus. Major telencephalic projections of the shell terminated within the ventral paleostriatal complex, "end-zones" of the field L, the caudomedial hyperstriatum ventrale, and regions immediately dorsal and lateral to the auditory neostriatum. Except for a portion of the shell bordering medial ovoidalis, PHAL injections into the shell also labeled fibers within the caudolateral neostriatum and along the lateral neostriatal rim. The connectivity of the Ov shell suggests that this region may integrate auditory pathways with brain regions associated with endocrine mediated behavior. In addition, the shell may constitute a source of converging input to several levels of central auditory pathways.