应用商环行合并系带过短包皮环切术51 例体会

目的：总结应用商环行合并系带过短包皮环切术手术方法及临床效果。方法：对51例合并系带过短的包皮过长或包茎患者行系带成形后再应用商环行包皮环切术,术后7～10d取环,观察术后外观及手术并发症。结果：伤口愈合良好,外观满意,系带无断裂发生,无明显感染发生,1例出现脱环（2.0％）,2例出现伤口轻微裂开（3.9％）,35～40d愈合。结论：对于合并系带过短的包皮或包茎在行系带成形后也能行商环包皮环切术。     

不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响

目的评价不同植骨融合方式治疗胸腰椎爆裂性骨折的临床疗效,探讨最佳的植骨融合方式。方法 2000年6月-2009年6月,采用一期后路短节段内固定植骨融合治疗126例胸腰椎爆裂性骨折患者。均为急性脊柱脊髓损伤,损伤节段T11～L2;均合并不同程度脊髓神经功能损伤,Frankel分级在D级以下。将患者随机分成A、B、C 3组,分别辅以椎体加椎间植骨(A组)、后外侧植骨(B组)及360°环形植骨(C组)3种植骨融合方式进行治疗,观察各组患者术后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率、Oswestry功能障碍指数(ODI)及Frankel分级情况等的变化,评价不同植骨融合方式的疗效。结果 126例患者均获随访,随访时间24～32个月,平均28个月。C组手术时间和术中出血量均多于A、B组(P<0.05),A、B组间差异无统计学意义(P>0.05)。术后2年及末次随访时B组Cobb角及矫正丢失度均显著大于A、C组,比较差异有统计学意义(P<0.05),A、C组间差异无统计学意义(P>0.05)。末次随访时A组骨性融合率及内固定失效率分别为100%、0,B组分别为78.6%、21.4%,C组分别为97.5%、0,B组与A、C组比较差异均有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。术后各组ODI及Frankel分级均较术前有明显改善(P<0.05),末次随访时B组与A、C组比较差异有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。结论椎体加椎间植骨融合符合人体生物力学特点,能获得最佳的节段性骨性融合,是一种较优的骨性融合方式;后外侧植骨不符合人体生物力学特点,内固定失效率高,不是一种适宜的植骨融合方式;360°环形植骨并未表现出最佳的骨性融合率,而且性价比低,可能并不是一种必需的植骨融合方式。     

正中神经环指桡侧指神经支移植修复尺神经深支缺损的应用解剖

目的 为研究环指桡侧指神经支移植修复尺神经深支缺损提供解剖学基础. 方法 对16例32侧新鲜成人上肢进行观测.在10倍手术显微镜下对腕部尺神经深支、正中神经旋前方肌支和环指桡侧指神经支进行显微解剖及测量. 结果 正中神经旋前方肌支直径为(1.13±0.02)mm,正中神经环指桡侧指神经支直径为(1.17±0.05)mm,对掌肌管出口处尺神经深支直径为(1.75±0.07)mm.显微镜下分离环指桡侧指神经支,对掌肌管出口处尺神经深支至旋前方肌支入肌长度即移植段神经长度为(104.59±20.25)mm. 结论 环指桡侧指神经支移植为带血运的神经移植,属肌支对肌支的吻合,是修复尺神经深支缺损的有效方法.     

一种新的商环内环内置手术路径在成人包皮环切中的临床应用研究

目的:观察商环内环内置手术路径行成人包皮环切的手术特点及术后并发症。方法:因包皮过长或包茎就诊的528例成年患者采用商环内置手术路径实施商环包皮环切手术,其中包皮过长465例(88.1%),包茎63例(11.9%)。对手术时间、术中出血;术后感染、水肿、伤口裂开、出血进行观察。结果:528例患者手术时间为(3.8±0.3)min;术中出血量为(0.6±0.1)ml;术后2 h疼痛评分为(7.3±0.3)分。67例(12.7%)患者选择不拆环,让环切器自行脱落,脱落时间为(21.6±2.1)d,461例(87.3%)患者术后第7天复诊时选择拆环,给予拆外环处理,拆环时没有出现疼痛。术后感染3例(0.56%),轻度水肿9例(1.70%)。未发生术后出血及切口裂开,患者对外观满意度为98.1%。结论:商环内置式手术方式安全,不需要拆内环,操作更简便,需要的手术器械少,与标准的商环技术相比,缩短了手术时间,术后并发症发生率低,满意度高。不过,仍需要进行随机对照研究来证实这些优势。     

Women's experiences with vaginal pessary use

Title.  Women's experiences with vaginal pessary use.
Aim.  This paper is a report of a study of the lived experiences of women using vaginal pessaries for the treatment of urinary incontinence (UI) and/or pelvic organ prolapse.
Background.  The use of a vaginal pessary offers a non-surgical treatment option to provide physical support to the bladder and internal organs. As the literature asserts, a woman's choice to use a pessary is very individual and involves not only physical, but also psychological and emotional considerations.
Method.  Narrative inquiry was used to conduct face-to-face semi-structured interviews in 2007 with 11 postmenopausal women who accessed services from a Urogynecology Clinic in Eastern Canada.
Findings.  The women's stories revealed that living with a pessary is a life-changing experience and an ongoing learning process. The women's comfort level and confidence in caring for the device figured prominently in their experiences. Psychosocial support provided by the clinic nurses also played a primary role in the women's experiences.
Conclusion.  Women and healthcare professionals need to be aware of the personal isolation and embarrassment, and social and cultural implications that urinary incontinence may cause as well as the subjective experiences of using a pessary. With appropriate support, vaginal pessaries can provide women with the freedom to lead active, engaged and social lives.     

Pitfalls in using the ring finger test alone for the diagnosis of carpal tunnel syndrome

Latency differences (>0.5 ms) of median and ulnar sensory action potentials (mSAP and uSAP) at the wrist evoked by ring finger stimulation are considered a sensitive and specific test for diagnosis of carpal tunnel syndrome (CTS). In this study, we aimed to assess the practical usefulness of the ring finger test (RFT) in routine electromyography (EMG) examinations. We investigated 2 series of patients: in the first prospective series we considered 300 hands affected by only mild CTS; in the second series we examined retrospectively the EMG charts of 961 hands affected only by CTS but not selected for severity or duration of symptoms. In the first series we found pathological RFT scores in 87% of cases, and pathological RFT or mSAP latency results in 92%. In the second series, pathological RFT scores were found only in 55% of cases, while in 20% where mSAP failed, a volume conducted uSAP had been erroneously interpreted as arising from the median nerve. RFT sensitivity tested in routine EMG examinations of unselected hands affected by CTS drops considerably. Fingers innervated by one only nerve, such as the index and the little fingers, must also be investigated to increase the diagnostic value of RFT.

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Sommario La differenza (>0.5 ms) tra le latenze distali dei potenziali sensitivi di mediano e ulnare (mSAP e uSAP) registrati al polso ed evocati per stimolazione al quarto dito (ring finger test, RTF) viene considerato un test sensibile e specifico per la diagnosi di sindrome del tunnel carpale (CTS). Sono state studiate 2 serie di pazienti: nella prima serie prospettica abbiamo esaminato 300 mani affette da CTS lieve, in cui mSAP e uSAP dopo stimolazione al quarto dito potevano essere chiaramente differenziati. Il RFT era patologico nell'87%. Considerando insieme il risultato del RFT e il valore assoluto della latenza distale del mSAP dal quarto dito, almeno uno dei test era patologico nel 92% dei casi. Nella seconda serie sono stati esaminati retrospettivamente i referti EMG di 961 mani non selezionate affette esclusivamente da CTS. Attraverso il solo RFT solo il 55% delle diagnosi sarebbero state classificate correttamente, perchè in 20% un uSAP volume condotto era stato erroneamente interpretato come proveniente dal mediano. Dita innervate da un solo nervo come il secondo dito ed it quinto dito devono essere esaminate per aumentare il valore diagnostico del RFT in esami di routine.

     

Experiences with total Hip Replacement Arthroplasty Ad Modum Ring

The results of total replacement of the hip joint ad modum King are presented. The review includes 63 hips (from among the total number of cases operated by the various methods) followed up for periods ranging from 6 months to 5 years. The assessment has shown excellent results in 33.3 per cent, good results in 50.8 per cent, fair in 9.5 per cent and poor results in 6.4 per cent. Advantages and disadvantages of the method are discussed.     

Gonadal dysgenesis and somatic stigmata in patients with 45,X/46,Xr(X) ring chromosome

Two cases of gonadal dysgenesis and stigmata of Turner's syndrome with ring chromosome X are described. Their features support the idea that ring chromosome X should be considered as a deletion in the genetic sense, affecting both the gonadal and statural determinants. Without knowing the cytogenetic findings, these patients are usually labeled as having Turner's syndrome. Furthermore, endocrine data and histologic examination of the gonads are indistinguishable from those of individuals with 45,X or 46XX gonadal dysgenesis.     

Short-term brain atrophy changes in relapsing-remitting multiple sclerosis

The objective of this study was to establish whether the time interval of 3 months is sufficient to detect whole-brain atrophy changes in patients with relapsing-remitting (RR) multiple sclerosis (MS). Another aim was to assess the value of monthly gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) and of different Gd-enhancement patterns as predictors of brain atrophy. Thirty patients with RRMS (mean disease duration 4.9 years, mean age 34.4 years and mean Expanded Disability Status Scale [EDSS] 1.4) were assessed at baseline and monthly for a period of 3 months with clinical and MRI examinations. Calculations of baseline and monthly absolute and percent changes of MRI measures have been obtained using two semiautomated (Buffalo and Trieste) and one automated (SPM99) segmentation method. Changes of brain parenchymal fraction (BPF) were investigated according to Gd-enhancement patterns. Mean absolute and percent changes of BPF did not significantly differ at any time point in the study for any of the three methods. There was slight but not significant decrease of BPF from baseline to month 3: -0.0004 (0.05%), p=0.093 for Trieste; -0.0006 (0.07%), p=0.078 for Buffalo; and -0.0006 (0.08%), p=0.081 for SPM99 method. In ring-enhancement positive patients, there was a significant difference between baseline and month 3 changes of BPF, EDSS, and number of relapses. Over the study period, we did not demonstrate differences between changes of BPF according to the presence of Gd enhancement. Longitudinally, multiple regression analysis demonstrated that the only clinical or MRI parameter that predicted BPF decrease was the mean absolute change of ring-enhancing lesion load (R=0.62, p=0.003). The noteworthy findings of this study are (1) the observation that a significant brain atrophy progression cannot be detected over a 3-month period in RRMS; (2) the demonstration that the ring-enhancement pattern may contribute to more severe brain tissue loss in the short term; and (3) the lack of relationship between the presence and duration of Gd-enhancement activity and brain volume changes in the short term.     

2017年度参加全国生物剂量估算能力考核结果分析

目的 通过对2017年参加全国生物剂量估算能力考核总结分析,提高该项工作的专业技术能力。方法 根据《2017年度生物剂量估算能力考核方案》,进行受照后的培养、制片、分析染色体的非稳定性畸变,统计染色体非稳定性畸变数量（dic+r）,应用国家标准上的曲线Y=7.3512×10^-3+3.4037×10^-2D+8.0398×10^-2 D²估算剂量。结果 样本05-1平均值是3.62Gy,95%的可信区间是（3.32~3.90）Gy,相对偏差为0.56%;样本05-2平均值是2.37 Gy,95%的可信区间是（2.19~2.54）Gy,相对偏差为7.73%,两样品相对偏差均<20%,综合判定本实验室生物剂量能力估算结果为合格。结论 本实验室能满足生物剂量工作需要,但仍然需要加强质量控制,规范操作,不断总结分析,建立本实验室生物剂量曲线,减少系统误差,使结果更加准确可靠,为核与辐射事故的临床救治及监督管理提供科学依据。