192例经乳腔镜困难甲状腺大部切除术的技巧探讨

目的探讨经乳腔镜困难性甲状腺大部切除手术方法与技巧。方法回顾性分析2010年1月-2018年1月采取腔镜下经乳晕入路完成的困难性甲状腺大部切除手术192例,结合术者的体会和经验方法进行探讨。结果 8例因术中暴露止血困难、肿物过深过大等原因而中转开放手术;手术时间(126.8±7.6)min,术中出血量(102.3±2.6)ml;术后18例出现一过性低钙血症和9例出现声音嘶哑(其中6例术后2个月恢复,3例术后半年仍未恢复)。结论困难性甲状腺手术采用腔镜下经乳晕入路术式切除是安全可靠的,但必须充分掌握甲状腺的解剖结构及腔镜操作技术。     

经皮快速气管切开在救治严重急性喉梗阻中的应用

目的:观察经皮快速气管切开术在救治严重急性喉梗阻中的应用价值.方法:对13例严重急性喉梗阻患者采用经皮快速气管切开,对解除喉梗阻的效果、手术操作时间、并发症方面进行评价.结果:13例患者均成功手术,手术操作时间在20分钟内完成,无并发症发生,完全解除喉梗阻所引起的窒息症状.结论:经皮快速气管切开术操作简单,手术时间短,适用于抢救严重急性喉梗阻的患者.     

A case of bidirectional conduction block within the superior vena cava induced by cryoballoon pulmonary vein isolation

A 53‐year‐old male underwent a pulmonary vein isolation (PVI) of atrial fibrillation (AF) with a second‐generation cryoballoon (CB). Although the patient maintained sinus rhythm after the PVI, a superior vena cava (SVC) fibrillation was recorded by a circular‐multipolar‐electrode catheter positioned inside the SVC that suggested conduction block between the right atrium (RA)‐SVC connection. An adenosine triphosphate intravenous injection induced a dormant reconnection of the SVC myocardial sleeve and converted sinus rhythm to an AF rhythm. This case demonstrated that a CB application for the isolation of a right superior pulmonary vein could induce an electrical conduction block between the RA‐SVC connection.     

Nitric oxide-mediated neurotransmission is attenuated in the anococcygeus muscle from diabetic rats

Summary The effect of STZ-induced diabetes of 8-weeks duration was examined on nitric oxide-mediated neurotransmission in the rat anococcygeus muscle. In the presence of noradrenergic blockade and raised tissue tone, relaxant responses to nerve stimulation (0.5–5 Hz, for 10 s), sodium nitroprusside (5 and 10 nmol/l) and nitric oxide (1 and 3 mol/l) were significantly reduced in anococcygeus muscles from diabetic rats compared to responses from control rats (p <0.05). In contrast, relaxations to papaverine (3 and 10 mol/l were not reduced in tissues from diabetic rats. The nitric oxide synthesis inhibitor NOLA (100 mol/l) abolished relaxant responses to nerve stimulation but had no effect on responses to any of the relaxant agents used. Exposure to NOLA at 10 mol/l reduced stimulation-induced relaxations; this reduction was significantly greater in tissues from the diabetic group than from the control group (p <0.05), probably as a consequence of the smaller relaxant responses in muscles from diabetic rats. Contractile responses to nerve stimulation (1–10 Hz, for 10 s), but not noradrenaline (0.03–30 mol/l), were significantly greater in anococcygeus muscles from diabetic rats than from control rats (p <0.05). NOLA (100 mol/l) significantly enhanced stimulation-induced contractions (p <0.05), however the enhancement was significantly less in tissues from diabetic rats (p <0.05). The results suggest that STZ-induced diabetes impairs smooth muscle reactivity to nitric oxide in the rat anococcygeus muscle.Abbreviations STZ Streptozotocin - NOLA N^G-nitro-l-arginine - NANC nonadrenergic noncholinergic - ANOVA analysis of variance     

双管喉罩在妇科腹腔镜手术中应用的临床研究

目的：探讨双管喉罩在妇科腹腔镜手术中应用的可行性和安全性。方法：选取我院收治的拟全麻下施行妇科腹腔镜手术患者60例。按随机双盲原则分为双管喉罩组（PLMA组）和气管插管组（TT组）,观察记录气道峰压（Pmax）、气道平均压（Pmean）、潮气量（VT）、分钟通气量（MV）、呼气末二氧化碳分压（PETCO2）、术后并发症。结果：两组麻醉时间、气腹时间、拔管（罩）时间、苏醒时间、Pmax、Pmean、VT、MV、PETCO2等指标组间比较,无显著性差异（P〉0.05）。PLMA组术后并发症发生率少于TT组（P〈0.05）。结论：PLMA通气效果确切、术后并发症少,应用于妇科腹腔镜手术安全可行。     

梨状窝癌的手术治疗与喉功能保留

目的：探讨梨状窝癌外科治疗与喉功能保留的可行性。方法：分析42例保留喉功能梨状窝癌切除患者的手术方法、并发症、生存率等。结果：术后拔管率为61．9％（26／42）,3、5年生存率分别为76．1％和66.6％,并发症发生率为31．0％（13／42）。结论：保留喉功能梨状窝癌手术适用于T1、T2及经过仔细选择的Ⅲ、Ⅳ期肿瘤患者,该术式不影响患者的生存率,并能提高患者的生存质量。     

Nestin expression defines both glial and neuronal progenitors in postnatal sympathetic ganglia

Sympathetic ganglia are primarily composed of noradrenergic neurons and satellite glial cells. Although both cell types originate from neural crest cells, the identities of the progenitor populations at intermediate stages of the differentiation process remain to be established. Here we report on the identification in vivo of glial and neuronal progenitor cells in postnatal sympathetic ganglia, by using mouse superior cervical ganglia as a model system. There are significant levels of cellular proliferation in mouse superior cervical ganglia during the first 18 days after birth. A majority of the proliferating cells express both nestin and brain lipid-binding protein (BLBP). Bromodeoxyuridine (BrdU) fate-tracing experiments demonstrate that these nestin and BLBP double-positive cells represent a population of glial progenitors for sympathetic satellite cells. The glial differentiation process is characterized by a marked downregulation of nestin and upregulation of S100, with no significant changes in the levels of BLBP expression. We also identify a small number of proliferating cells that express nestin and tyrosine hydroxylase, a key enzyme of catecholamine biosynthesis that defines sympathetic noradrenergic neurons. Together, these results establish nestin as a common marker for sympathetic neuronal and glial progenitor cells and delineate the cellular basis for the generation and maturation of sympathetic satellite cells.     

神经反射对脑出血急性期康复的疗效探讨

目的评价神经反射对脑出血急性期康复的临床疗效 , 探讨其早期康复的方法 . 方法将所有患者经随机化分为治疗组与对照组各 50例 , 两组均采用常规治疗作为基础治疗 , 而治疗组则增加神经反射检查的次数 , 即 3次 /d,15 min/次 , 持续 30 d. 结果治疗组与对照组相比 , 其疗效于第 14天有明显差异 (P<0.05), 于第 30天有显著差异 (P< 0.01); 随诊 2～ 5个月 , 治疗组疗效显著优于对照组 (P< 0.01). 结论反复间断地检查神经反射对脑出血急性期的康复有显著疗效 .