上肢康复操在维持性血液透析患者中的应用研究

目的 评价上肢康复操在维持性血液透析患者中的应用效果。 方法 选取2021年10月—12月于山东省某三级甲等医院血液净化中心行维持性血液透析治疗的患者77例,按随机数字表分为试验组38例和对照组39例,试验组在常规护理的基础上进行上肢康复操训练,对照组只接受常规护理。分别比较干预前和干预3个月后两组的双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径。 结果 试验组36例、对照组38例完成研究。干预前两组双手握力、肩关节活动度、动静脉内瘘血流量及非内瘘侧头静脉直径比较,差异无统计学意义（P>0.05）;干预后试验组与对照组比较,内瘘侧握力（t=-2.350,P=0.022）、非内瘘侧握力（t=-3.693,P<0.001）,内瘘侧肩关节外展（t=-2.468,P=0.016）、外旋（t=-5.167,P<0.001）、内旋（t=-2.059,P=0.043）,动静脉内瘘血流量（t=-2.020,P=0.047）、非内瘘侧头静脉直径（t=-5.229,P<0.001）均增加,差异具有统计学意义。 结论 上肢康复操训练有助于改善维持性血液透析患者的上肢功能及维护动静脉内瘘。     

Significant association of strictures and internal fistula formation in Crohn’s disease

Intestinal inflammation in Crohn’s disease (CD) may be complicated by the occurrence of strictures and fistulae. The pathogenesis of fistula formation is unknown. We therefore wanted to determine whether mechanical factors might contribute to the development of fistulae. Furthermore, we tried to define the path of internal fistulae through the muscular layer. For this purpose, surgical resection specimens from 42 consecutive patients with CD were prospectively studied. In gross examination the whole bowel was cut into circumferential cross sections 0.3 cm thick. Abnormal areas were histologically examined. Strictures were found in 38 patients (90.5%), and fistulae were observed in 27 (64.3%) patients. In 11 (40.7%) specimens fistulae were found within a stricture, in 15 (55.6%) at the proximal end, and in 1 (3.7%) no stricture was found. In 7 (25.9%) cases with fistulae, herniated mucosa was found within the muscularis propria or the subserosa. In 7 (25.9%) cases a blood vessel was identified near a fistula traversing the muscularis propria. From these findings we conclude that that mechanical factors may contribute to fistula formation. This is further supported by the fact that fistulae appear to traverse the muscular layer along piercing vessels. Received: 21 January 2000 / Accepted: 7 March 2000     

Delayed High Output Heart Failure due to Arteriovenous Fistula Complicated with Herniated Disc Surgery

A 36-year-old male presented with progressive exertional dyspnea over months. Physical examination showed jugular venous distension, lung crecipitations, femoral bruit and pitting pedal edema. Echocardiogram showed a dilated right ventricle with severe pulmonary hypertension and a non collapsing inferior vena cava (IVC). On right heart catheterization, IVC oxygen saturation was noted at 92% suggesting arterial mixing; a computed tomography of the abdomen showed a fistula between the right common iliac artery to the right common iliac vein at L4 level and a massive IVC; this was linked to trauma from a disectomy done 16 years ago at L4–L5 level. Endovascular sealing with a 16 × 60 mm bifurcated stent graft (S & G Biotech, Seoul, Korea) was performed which led to complete resolution of the patient’s dyspnea. Iatrogenic vascular injury during lumbar disc surgery, although rare, can lead to high output cardiac failure developing over months to years.     

乳管瘘的诊断和治疗

目的 探讨乳管瘘的诊断和治疗方法。方法 分析总结乳管瘘46例，诊断主要依据病史、体征和病理检查，治疗是用美兰注入瘘管作标记，彻底切除瘘管，术后给予对需氧菌和厌氧菌有效的抗生素。结果 46例均经手术治愈，术后随访6个月-5年无复发。结论 结合病史，体征易于诊断。对疑为恶性病变或结核病人行细胞学检查或病理切片检查。为了防止乳瘘管复发，应彻底切除瘘管。     

Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

BackgroundTo present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS).CaseA 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision.ConclusionHWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.     

Treatment of a malignant esophageal fistula with a Gore-Tex-covered flexible nitinol stent

In order to treat fistulated esophageal cancer using a flexible stent, a covered flexible stent was constructed by wrapping a nitinol stent with a thin sheet of Gore-Tex, preserving the stents original advantages of flexibility and a low-profile introducer system. This stent was used to perform standard radiotherapy in a case of fistulated esophageal cancer.     

Supralevator abscess: Diagnosis and Treatment

Anorectal suppurations are quite common. Supralevator abscesses, previously regarded as a rare subgroup, were seen in 9.1 per cent of 506 patients admitted to Cook County Hospital in a two-year period. Aggressive supportive management was followed by early, adequate drainage through single or multiple radial perianal incisions or through the rectum whenever indicated. When fistulas were identified, either a primary fistulotomy or a two-stage fistulotomy using a seton was performed in the majority of cases. Important factors in the prevention of morbidity and mortality included debridement of all necrotic tissue, careful bacteriologic studies and judicious use of antibiotics, close postoperative observation, and long-term follow-up of the patients. Read at the meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 11 to 16, 1980.     

Extramedullary plasmacytoma of the small intestine: First case report of ileocolic fistula and review of the literature

Extramedullary plasmacytoma (EMP) of the small bowel is a rare entity previously reported as a cause of intestinal obstruction or bleeding. A case report of this disease entity presenting as an ileocolic fistula is reported. EMP is diagnosed by the following critiera: 1) absence of paraproteinemia; 2) absence of Bence Jones proteinuiria; 3) normal skeletal survey; and 4) normal bone marrow biopsy specimen. Gastrointestinal plasmacytoma often occurs as a manifestation of multiple myeloma. EMP of the gastrointestinal tract is a rare cases manifestation of the disease, accounting for 13 per cent of all cases of EMP. It is a slow-spreading, radiosensitive tumor with a high tendency toward local recurrence. Surgical excision combined with radiotherapy is the treatment of choice for EMP of the gastrointestinal tract.     

显微外科技术治疗复杂膀胱尿道阴道瘘(附五例报告)

目的 总结显微外科技术修补复杂性膀胱尿道阴道瘘的经验。方法 膀胱尿道瘘患者4例，膀胱阴道多发瘘1例，均在手术放大镜下用细线行瘘修补，膀胱颈缺损多层缝合或利用阴道壁修补尿道缺损。结果 5例均一次修补成功，随访6～12个月，排尿均通畅。1例膀胱颈全尿道缺损者咳嗽时有轻微尿失禁，余4例无尿失禁、无漏尿，性生活满意。结论 多层缝合膀胱颈缺损可恢复膀胱颈括约肌功能，显微外科技术组织对合好、反应小，有利于尿瘘愈合。