重型颅脑损伤患者硬脑膜网状和放射状切开疗效比较

目的 观察重型颅脑损伤患者硬脑膜网状切开和放射状切开的治疗效果.方法 将64例重型颅脑损伤患者采用随机数字表法分为网状组和放射状组,每组32例.两组患者均采用标准外伤去骨瓣减压术治疗,网状组患者硬脑膜采用网状切开,放射状组患者硬脑膜采用放射状切开,观察两组治疗前后颅内压(ICP)及格拉斯哥评分(GCS)变化、并发症发生率、神经功能恢复及格拉斯哥预后评分(GOS)情况.结果 治疗后两组ICP较治疗前显著降低,GCS较治疗前明显好转,治疗后网状组ICP[(16.21±2.17) mmHg比(23.94±2.43) mmHg]、GCS评分[(10.28±2.94)分比(8.71±3.23)分]、预后及神经功能保留均优于放射状组;网状组并发症发生率和治愈率分别为37.5％、40.6％,放射状组并发症发生率和治愈率分别为53.1％、28.1％,两组比较差异有统计学意义.结论 重型颅脑损伤患者硬脑膜网状切开在缓解脑水肿、减少并发症、保留认知及运动功能等方面明显优于硬脑膜放射状切开,值得临床引起足够的重视.     

Two Nonlinear Positivity-Preserving Finite Volume Schemes for Three-Dimensional Heat Conduction Equations on General Polyhedral Meshes

In this article we present two types of nonlinear positivity-preserving finite volume (PPFV) schemes for a class of three-dimensional heat conduction equations on general polyhedral meshes. First, we present a new parameter selection strategy on the one-sided flux and establish a nonlinear PPFV scheme based on a two-point flux with higher efficiency. By comparing with the scheme proposed in [H. Xie, X. Xu, C. Zhai, H. Yong, Commun. Comput. Phys. 24 (2018) 1375–1408], our scheme avoids the assumption that the values of auxiliary unknowns are nonnegative, which makes our interpolation formulae suitable to be constructed by existing approaches with high accuracy and well robustness (e.g., the finite element method), thus enhancing the adaptability to distorted meshes with large deformations. Then we derive a linear multi-point flux involving combination coefficients and, via the Patankar trick, obtain another nonlinear PPFV scheme that is concise and easy to implement. The selection strategy of combination coefficients is also provided to improve the convergence behavior of the Picard procedure. Furthermore, the existence and positivity-preserving properties of these two nonlinear PPFV solutions are proved. Numerical experiments with the discontinuous diffusion scalar as well as discontinuous and anisotropic diffusion tensors are given to confirm our theoretical findings and demonstrate that our schemes both can achieve ideal-order accuracy even on severely distorted meshes.     

High success rate and considerable adverse events of pelvic prolapse surgery with Prolift: A single center experience

ObjectivesThe aim of this study was to analyze short-term outcomes of pelvic prolapse surgery using Prolift transvaginal mesh in a teaching hospital.Materials and MethodsThirty-four patients who received prolapse surgery with Prolift were followed up for 7–26 months. Assessment included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage, and Urogenital Distress Inventory (UDI)-6, and Incontinence Impact Questionnaire (IIQ)-7 scores. Surgical characteristics and adverse events during follow-up were also recorded.ResultsObjective and subjective data were available for 29 patients. The overall anatomical success rate was 96.5 % (28/29) after a mean of 18 ± 6.3 months follow-up. The POP-Q, UDI, and IIQ all improved significantly after surgery. Uterine sparing prolapsed surgery with Prolift unexpectedly yielded a cure rate of 100%. Ten adverse events occurred during and after prolapse surgery with dyspareunia (3/34) as the most common, followed by bladder injury (2/34).ConclusionsProlapse surgery with Prolift yielded a good anatomical outcome and satisfactory symptom improvement at different periods of follow-up, especially in uterus-sparing prolapse surgery. However, adverse events were not uncommon, and patients should be fully informed of all possible adverse events prior to surgery.     

Deformation of the corona radiata and internal capsule in normal pressure hydrocephalus

Background and purposeThe pathophysiology of the clinical manifestations in normal pressure hydrocephalus (NPH) remains obscure. Ventricular dilatation could generate forces on the paracentral fibers of the corona radiata (CR), hence interfering with their function and producing the classical clinical triad. The analysis of the regional displacement and deformation of the white matter bundles, forming the corona radiata and internal capsule, may clarify the relationship between ventricular dilatation and clinical manifestations in NPH.MethodAn experimental finite element (FE) analysis was used to simulate ventricular dilatation in 3 dimensions (3D) and to calculate the strain and deformation on the surrounding parenchyma. Magnetic resonance diffusion tensor imaging-based white matter tractography was then applied to retrieve the displacement and deformation exerted along various fiber bundles of the corona radiata and internal capsule. Anterior and posterior limb displacements and elongations were compared using a paired samples t-test.ResultsThe internal capsule, hence the corona radiata, of each cerebral hemisphere was segmented into anterior and posterior limbs. Mean displacements and elongations were calculated for each limb. Mean displacement was significantly larger in the anterior limb whereas mean deformation was larger in the posterior limb (P < 0.01).ConclusionThe present simulation demonstrates that ventricular dilatation does not have a homogeneous effect on the periventricular fibre tracts, with a particular load on the corticospinal tract. The affection of this tract remains thereby a potential factor in the generation of the NPH gait disorders.     

Incisional hernia after extreme lateral interbody fusion on the lumbar spine: A case report

IntroductionExtreme lateral interbody fusion is a minimally invasive lateral transpsoas approach for spine surgery. We herein report a case of an incisional hernia after an extreme lateral interbody fusion on the lumbar spine that was successfully treated by laparoscopic surgery with intraperitoneal onlay mesh repair.Presentation of caseA 78-year-old woman was referred to our hospital with a complaint of left abdominal bulge and pain. She had undergone an extreme lateral interbody fusion for a lumbar spinal canal stenosis from L1 to L4 a year prior. Abdominal computerized tomography showed a left lumbar incisional hernia, and laparoscopic surgery was performed. The hernia orifice was sutured closed and covered with mesh. The patient was discharged five days after the operation with no complications.DiscussionWhen performing XLIF for a spinal disorder, the muscles should be separated bluntly along their fibers to prevent muscle atrophy, and the incised fascia should be securely sutured closed. Abdominal wall incisional hernias can occur after spinal surgeries such as extreme lateral interbody fusion.ConclusionLaparoscopic repair for abdominal wall incisional hernia after spine surgery is safe and feasible.     

Influence of a New Monofilament Polyester Mesh on Inflammation and Matrix Remodeling

ABSTRACT

Synthetic mesh is widely used for hernia repairs, but mesh-induced chronic inflammatory responses may lead to postoperative complications. We previously showed an elevated response to multifilament polyester (PE) versus monofilament polypropylene (PP) and polytetrafluoroethylene (PTFE) meshes, but it is unclear whether this discrepancy is due to the differences in chemical composition or filament structure. This study compares the influence of a newly available monofilament PE mesh to that of multifilament PE, monofilament PP, and monofilament PTFE on the expression of genes important in inflammation and extracellular matrix remodeling in a rat model. Full thickness abdominal wall defects were corrected with onlay repair or suture repair with no mesh. Explants were harvested 7 or 90 days after repair and divided for histology and mRNA analyses using real-time quantitative polymerase chain reaction arrays to profile expression at the tissue-mesh interface. Monofilament PE elicited a reduced foreign body reaction compared to multifilament PE, corresponding with reduced mRNA expression of important inflammatory cytokines and matrix metalloproteinases (MMPs). Unexpectedly, monofilament PE also resulted in markedly reduced mRNA expression of tumor necrosis factor and MMPs 3 and 9 compared to the widely-used monofilament PP mesh. Findings from this study revealed that both chemical composition and filament structure are important mesh characteristics that may affect a patient's wound healing response and clinical outcome, and should be considered by the surgeon when choosing a particular mesh. Although clinical studies are warranted, results in a rodent model suggest that monofilament PE may be more beneficial than the multifilament form for certain hernia repairs.     

Early Necrectomy in Deep Burns of Aesthetically and Functionally Important Areas

Deep burns of aesthetically and functionally important body areas in children may in their later growth and development have a decisive role. Of the total number (2743) of hospitalized children at the Burns Department of the Pediatric Surgery in Zagreb in the last ten years. deep burns of some aesthetically and functionally important body areas were separated and the results of the application of the early necrectomy and immediate grafting method, as recommended by Jan?ekovi?, are analysed. It is concluded that the results, due to the strict and minute application of the method (considered are individual technically important details and solutions) are good in aesthetic and even more so in the functional sense. Very fast recovery of the functions as well as the fact that up till now no surgical corrections for functional disorders were necessary in analyzed areas, along with already known advantages of the early surgical treatment, undoubtfully speak for its application.