经皮腰椎间盘切除术治疗复发性腰椎间盘突出症

目的：总结经皮腰椎间盘切除术治疗传统后路术后复发性腰椎间盘突出症的经验。方法：分析１９９５年１月至１９９８年１２月采用经皮腰间盘切除术治疗１９例复发性腰椎间盘突出症的临床资料。结果：穿刺成功率１００％,术后随访１０～３２月,平,平均２１月,优１１例、良５例,可２例,差１例,优良率８４．２％。结论：在具有再次开放手术适应症的复发性腰椎间盘突出症中,初次手术行单节段半椎板、全椎板切除和开窗术者中一侧单     

Gastric Bypass Distal Roux-en-Y Jejunal Interposition with Selective Proximal Vagotomy and Posterior Truncal Vagotomy

Selective proximal vagotomy and posterior truncal vagotomy have been performed in 71 consecutive gastric bypass (GBP) patients from June 1991 to December 1992. Vagotomy was used to prevent or diminish the incidence of marginal ulcer in GBP patients. Anterior and posterior highly selective proximal vagotomy with circular-instrument stapled gastrojejunostomy in patients undergoing GBP distal Roux-en-Y with jejunal interposition had no marginal ulcer complications (minimal follow-up 18 months).     

Effect of Liposome—Encapsulated Total Alkaloid of Harmaline on Rabbit Lens Epithelial Cells：Experimental Study on the Prevention of Posterior Capsule Opacification

Purpose: To investigate whether liposome encapsulated total alkaloid of Harmaline (TAH) as a therapeutic agent is beneficial to prevention of posterior capsular opacifi-cation (PCO).Methods: Liposome-encapsulated TAH was prepared by modified freeze-thawing method. 0. 1ml of liposome-encapsulated TAH (0. 2mg/ml) was injected into the capsular bag during extracapsular lens extraction (ECLE) of each eye in total 10 rabbit eyes. Blank liposome or balance salt solution (BSS) was used as control. Slit-lamp examination and histopathological examination was used to evaluated capsule opacifica-tion. Intraocular pressure (IOP) , density and morphology of corneal endothelia cells, the amplitude and latency of b wave of ERG were measured.Results: The inflammatory response was mild both in TAH treated and the control group. PCO formation occurred in the control group 2 weeks postoperatively, but the posterior capsule was clear in TAH treated eyes. 4 weeks and 8 weeks after operation, PCO occurred both in TAH treated     

后巩膜加固术对视网膜振荡电位的影响

目的　为了更进一步地了解后巩膜加固术治疗高度进行性近视的疗效和机理。方法　采用日本产Ｎｅｕｒｏｐａｃｋ Ｆｏｕｒ ４１０４ Ｋ 电生理仪,对２６ 例５２ 眼高度进行性近视行后巩膜加固术前、术后视网膜振荡电位进行定量分析。结果　术前、术后振荡电位总振幅经统计学处理有非常显著性差异,波的潜伏期无显著性差异。结论　本文认为后巩膜加固术可改善视网膜血液循环,并对机理进行了探讨     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

Dermoid and epidermoid cysts of the midline in the posterior cranial fossa

Clinical features and surgical outcome of 16 patients with dermoid or epidermoid cysts on the midline of the posterior cranial fossa are compared. Salient points in the comparison are the younger age, presence of associated malformations and better prognosis of dermoid cyst.     

Retropublic colpourethropexy with transabdominal anterior and/or posterior repair for the treatment of genuine stress urinary incontinence and genital prolapse

A new operative technique combining retropublic colpourethropexy with transabdominal internal anterior and/or internal posterior repair for the treatment of genuine stress incontinence (GSI) and genital prolapse is described in 75 cases. The overall success rate in correcting GSI was 92.0%, with a 94.8% success rate in the primary surgical group (n=58) and an 82.4% in the secondary group (n=17). Average follow-up has been 1.31 years (range 6 weeks–6 years). There was a 3.4% incidence of residual prolapse. Nine patients also underwent concomitant colpourethropexy. Overall surgical complications include febrile morbidity 4/75 (5.3%), wound infection 1/75 (1.3%), deep vein thrombosis 1/75 (1.3%) and partial ureteric obstruction 1/75 (1.3%). There were no statistically significant changes in multichannel urodynamic studies preoperatively and at 1 year following surgery. Onethird (2/6) of the GSI failures had low MUCP (<20 cm H₂O) prior to surgery and continued so at 1 year follow-up.EDITORIAL COMMENT: Genital prolapse is often present in patients who have GSI. If an operation is performed to correct the GSI, and those areas of weakness in the pelvic support system that are contributing to the genital prolapse are not treated, the genital prolapse will become more severe. In the operation which has been described, the colpopexy sutures will correct any cystourethrocele, and the removal of the wedge of tissue from the anterior superior vaginal wall will correct the cystocele. The removal of the wedge of tissue from the posterior superior vaginal wall will reduce the redundancy of the posterior vaginal fornix, but a culdeplasty of the Moschcowitz or Halban type is recommended to treat or prevent an enterocele and to place the vaginal apex in the hollow of the sacrum. Any coexistent rectocele must always be treated vaginally. If it is not treated, it will appear to be more advanced following elevation of the anterior vaginal wall by retropubic urethropexy and the anterior repair which has been recommended.Genital prolapse is best treated by a vaginal approach. When one must une an abdominal approach, ancillary procedures such as the authors have described should be considered. A bulbous upper vagina is ideal for childbearing but if the apical support system and vaginal wall is weakened it is predisposed to prolapse. If the surgeon, in operating for genital prolapse, which involves the upper vagina, will taper the vaginal apex and support it by obliteration of the cul-desac and shortening and reattachment of the uterosacralcardinal complex, postoperative prolapse will be less likely to recur.     

针刺加斜扳法治疗脊神经后支源性下腰痛的临床观察

目的:比较邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗脊神经后支源性下腰痛的疗效.方法:将70例脊神经后支源性下腰痛患者随机分为2组,分别使用邵氏点针刺加斜扳法、华佗夹脊针刺加斜扳法治疗,每组35例.结果:治疗后邵氏点针刺加斜扳法组疗效较优,且短病程较长病程疗效优.结论:运用神经定位取穴的邵氏点针刺加斜扳法治疗病程较短的脊神经后支源性下腰痛有较好的疗效.     

Permanent Postoperative Anosmia: A Serious Complication of Neurovascular Decompression in the Sitting Position

Summary  In posterior fossa surgery, the sitting position offers a number of advantages believed to outweigh complications such as air embolism and pneumatocephalus. For this reason, the sitting position is frequently used in neurovascular decompression for trigeminal neuralgia. Two years ago we reported on a previously undescribed complication: permanent postoperative anosmia. Following the recent occurrence of a second case, we conducted a nationwide survey to determine the frequency of this complication. Permanent postoperative anosmia following surgical procedures in the sitting position has been observed in 3 other institutions. In addition, the survey revealed that only 40% of German neurosurgeons still favor the sitting position for surgery of the posterior cranial fossa.  Considering that permanent anosmia severely reduces quality of life, and that it can be avoided by using another position, the sitting position for surgical procedures in the posterior fossa should be restricted to special cases (e.g., brain stem tumors).