慢性鼻窦炎鼻内镜手术治疗的临床效果评价

目的评价鼻内镜手术治疗慢性鼻窦炎的临床效果。方法对我院收治127例慢性鼻窦炎患者予以鼻内镜手术进行治疗,同时在术中对合并症进行处理。并予以6个月以上的随访。结果全部患者中,92例治愈,约占72．4％,31例好转,约占24．5％,4例无效,约占3．1％,总有效率为96．9％。2例患者出现鼻腔少量出血,予以微波烧灼后出血情况消失。2例鼻腔粘连,予以局麻下粘连松解术,并采用明胶海绵对创面进行分隔,1周后痊愈。结论鼻内镜手术治疗慢性鼻窦炎创伤小、恢复快,且效果满意,同时在术中还需注意其他病变的处理,可使其远期疗效进一步提高。     

尖吻蝮蛇血凝酶用于鼻内镜手术患者止血的效果

目的评价尖吻蝮蛇血凝酶（HCA）用于鼻内镜手术患者的止血效果。方法将择期行鼻内镜下手术患者60例随机分为观察组（R组）和对照组（F组）,每组各30例。R组于术前15min给予尖吻蝮蛇血凝酶2U,F组未用任何止血药物。记录两组术中出血量,评价HCA的止血效果。结果 R组总有效28例,占93.3%;F组总有效21例,占70.0%。R组止血效果优于F组（P〈0.05）。结论尖吻蝮蛇血凝酶在鼻内镜下手术应用中有较好的止血效果。     

Semantic integration of differently asynchronous audio-visual information in videos of real-world events in cognitive processing: an ERP study

In the real world, some of the auditory and visual information received by the human brain are temporally asynchronous. How is such information integrated in cognitive processing in the brain? In this paper, we aimed to study the semantic integration of differently asynchronous audio–visual information in cognitive processing using ERP (event-related potential) method. Subjects were presented with videos of real world events, in which the auditory and visual information are temporally asynchronous. When the critical action was prior to the sound, sounds incongruous with the preceding critical actions elicited a N400 effect when compared to congruous condition. This result demonstrates that semantic contextual integration indexed by N400 also applies to cognitive processing of multisensory information. In addition, the N400 effect is early in latency when contrasted with other visually induced N400 studies. It is shown that cross modal information is facilitated in time when contrasted with visual information in isolation. When the sound was prior to the critical action, a larger late positive wave was observed under the incongruous condition compared to congruous condition. P600 might represent a reanalysis process, in which the mismatch between the critical action and the preceding sound was evaluated. It is shown that environmental sound may affect the cognitive processing of a visual event.     

Cystic tumors of the liver: on the problems of diagnostic criteria

We report on three cases of cystic neoplasms of the liver with mucinous epithelium. Case 1 showed a low-grade cystic neoplasm with ovarian-like stroma (OS). Case 2 showed a low-grade cystic neoplasm without OS, and case 3 showed a high-grade cystic neoplasm without OS. In all three cases, bile duct communication (BDC) was absent. Currently, pancreatic mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm of the pancreas (IPMN) are clearly distinguishable. However, MCN of the liver and intraductal papillary neoplasm of the bile duct (IPN-B) are not as easily distinguished. According to the latest WHO classification (2010), these conditions are classed as typical MCN of the liver, MCNs of the liver without OS, or IPN-Bs without BDC. The clinicopathological differences between MCN without OS and IPN-B without BDC are controversial. We present three cases describing these presentations and discuss the difficulties related to the diagnostic criteria used to distinguish between MCN of the liver and IPN-B.     

Increasing Independence in Autism Spectrum Disorders: A Review of Three Focused Interventions

The features of autism that inhibit the independent demonstration of skills, as well as three effective interventions for increasing independence, are explored in this review article. Independent performance may prove difficult for individuals with autism spectrum disorders (ASD) due to the core deficits of the disability, as well as executive function deficits that impact initiation and generalization. These difficulties, coupled with intervention strategies that encourage over-reliance on adult support, contribute to poor long term outcomes for adults with ASD in employment, housing, and relationship development. Self-monitoring, video modeling, and individual work systems each emphasize a shift in stimulus control from continuous adult management to an alternative stimulus and have proven successful in addressing executive function deficits and increasing independence.     

Totally Transumbilical Laparoscopic Cholecystectomy

A recently convened Consortium at the Cleveland Clinic agreed on the term Laparo-Endoscopic Single-Site (LESS) surgery to describe minimally invasive techniques that use a single incision to accomplish laparoscopic procedures. These procedures are done by using either a single port through one fascial incision or multiple ports placed through separate fascial incisions. Because of cost containment issues and the lack of widespread availability of a single port, we currently use multiple reusable ports placed through three separate fascial incisions via a transumbilical incision. As opposed to standard laparoscopic cholecystectomy, a deflecting laparoscope and one articulating instrument are utilized to improve the safety and ease of this procedure. Presented in this video are the steps necessary to perform a LESS cholecystectomy via a transumbilical incision with commercially available instruments. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

腹腔镜胆总管探查术中十二指肠镜下乳头切开术53例报告

目的探讨腹腔镜胆总管探查术中十二指肠镜下乳头切开术治疗十二指肠乳头狭窄的手术方法和适应证。方法腹腔镜下行胆囊切除、胆总管切开和胆管镜探查取石术,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下对乳头施行切开术。结果施行术中十二指肠镜下乳头切开术53例,51例乳头狭窄切开成功,2例中转为其他术式。术后轻症胰腺炎1例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论只要选择合适的病例,腹腔镜胆总管探查术中十二指肠镜下乳头切开术是可行、有效和安全的。