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11.
Cleft closure for the treatment of unhealed perineal sinus 总被引:2,自引:0,他引:2
OBJECTIVE: Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem. METHODS: From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease. RESULTS: Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date. CONCLUSION: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit. 相似文献
12.
目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法. 方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁, 鼻内镜与显微镜联合切除病变. 结果 10例孤立性蝶窦炎术后症状消失.6例蝶窦囊肿、脑膜瘤均一次手术切除.32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗.48例术后随访6个月~3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症. 结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好. 相似文献
13.
14.
经结膜下穹隆至上颌窦插管术治疗泪道阻塞的临床研究 总被引:1,自引:0,他引:1
采用经结膜囊下穹隆至上颌窦插管的术式引流泪液,治疗泪道阻塞引起的溢泪症,获得较为满意的效果。手术的主要步骤是:局麻后于结膜囊下穹隆内1/3区作一4mm长的结膜切口,自筋膜下分离至眶线下5mm。从切口伸入上颌窦骨钻钻通上颌窦顶壁,插入长短适度的义管,并向管内注入生理盐水,证实有液体流入鼻咽部后,固定义管。术后定期冲洗,无需拆线,应用这种术式治疗泪道阻塞引起的溢泪症218眼,其中溢泪完全消失151眼占82.1%,溢泪减轻的27眼占14.6%,总效率96.7%。 相似文献
15.
KOHICHI ASAMI HIDENOBU ASHIKAWA TOMOKO TERAI NAOKO ISHIHARA HIROKO NAWATA KENZO HIRAO NOBUYUKI MIYASAKA TOKUHIRO KAWARA KAZUMASA HIEJIMA TOMOO HARADA FUMIO SUZUKI 《Pacing and clinical electrophysiology : PACE》1998,21(2):352-366
The typical fourth criterion for transient entrainment is defined when both a sudden shortening in conduction interval to and a distinct change in electrogram morphology at a bipolar recording site are demonstrated while performing overdrive pacing of a reentrant tachycardia from a single pacing site at two different constant rates. The purpose of this article was to test the hypothesis that if an intracardiac recording site showing both orthodromic and antidromic capture with entrainment pacing is located suitably distant from the circuit, sudden shortening in conduction interval to that site may occur without any significant change in the bipolar electrogram morphology (i.e., atypical form of the fourth criterion). Atrial overdrive pacing of orthodromic tachycardia was performed in 20 patients with either left anterior (12 patients) or left posterior (8 patients) accessory pathways. We investigated the effects of overdrive pacing from the proximal or distal coronary sinus, specifically effects on the electrogram interval and the electrogram morphology at the right atrial appendage. Overdrive pacing of orthodromic tachycardia from the proximal coronary sinus was performed in 10 of the 12 patients with left anterior accessory pathways; those 10 patients demonstrated the first entrainment criterion at the right atrial appendage site. Overdrive pacing of orthodromic tachycardia at still shorter cycle lengths demonstrated a sudden shortening in conduction interval to the right atrial appendage site. Despite shortening in conduction interval the morphology of the right atrial appendage electrogram was completely or almost identical to that during orthodromic tachycardia, indicating an atypical form of the fourth criterion. This criterion was not demonstrated in patients with left posterior accessory pathways. Thus, atypical fourth entrainment criterion was demonstrated during overdrive pacing of orthodromic tachycardia from the proximal coronary sinus only in patients with left anterior accessory path ways. Demonstration of atypical fourth criterion seems largely dependent on the location of the accessory pathway, the pacing, and the recording sites. 相似文献
16.
Hideki SATO Kazuyuki KANEMASA Masamichi TANINO Tsugihiro KIMURA Kenji MAENOU Shouji MITSUFUJI Kyouhei MARUYAMA Tadashi KODAMA Kei KASHIMA Naoki TERAMAE Susumu FUKUI Keizo KAGAWA 《Digestive endoscopy》1996,8(1):41-45
Abstract: Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T-tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary disease. 相似文献
17.
Maria P. Panozzo Carlo Fabris Daniela Basso Giuseppe Del Favero Aldo Infantino Attilio Cecchetto Mario Plebani Remo Naccarato 《Clinical and experimental pharmacology & physiology》1993,20(3):185-191
1. The authors investigated the effect of two extrahepatic cholestasis models (one by bile duct ligation and the other by choledocho-jugular fistula) on the hepatic clearance of horseradish peroxidase in male Sprague-Dawley rats divided into four groups. 2. In groups A (n = 5 rats) and B (n = 5), bile duct ligation was performed, while a choledocho-jugular fistula was created in groups C (n = 5) and D (n= 7). A 10 mg intravenous bolus of horseradish peroxidase was injected after 24 h (groups A and C), 48 h (groups B and D) or 1 h (Group E; five sham-operated rats). Serum and bile samples were then serially collected for 2 h. 3. In all groups, serum horseradish peroxidase levels increased soon after injection and then rapidly decreased, the curves being similar. Biliary excretion increased for 30 min and then slowly decreased. The highest horseradish peroxidase biliary concentrations and outputs were found in Group B followed by Group A; both groups had significantly higher levels than Group E. No difference was found between horseradish peroxidase biliary excretion of groups C and D and that of sham-operated rats. 4. When each group was considered separately, sampling times correlated with the corresponding ratios of bile/ plasma HRP. Significant differences were found between the relative slopes of groups A, B and E, but not between those of groups C, D and E. 5. In conclusion, bile duct obstruction greatly affects the plasma-bile transfer of fluid phase markers, such as horseradish peroxidase, while single retention, caused by choledocho-jugular fistula, has no influence. The increased biliary hyperpressure related to the duration of cholestasis may account for the degree of horseradish peroxidase transfer which, in turn, probably depends on an enhanced paracellular passage. 相似文献
18.
Kohei Hashizume Hideo Kawarasaki Tadashi Iwanaka Yutaka Kanamori Kiyoshi Tanaka Tadahito Utsuki Hiroaki Komuro Kaoru Uno 《Surgery today》1993,23(4):293-297
It has been well documented that piriform sinus fistulae often cause suppurative thyroditis; however, when a piriform sinus fistula does not present this symptom, making a correct diagnosis is very difficult. We have experienced 11 cases of a piriform sinus fistula. The conventional operational approach was performed in the initial eight patients, among which there were four recurrences in two patients. Therefore, a new operational approach was introduced for the three most recent cases and one recurrent case. First, the existence of the internal orifice of the fistula is confirmed with a laryngoscope, after which a transverse incision on the neck is made and the abscess dissected. The side wall of the piriform sinus is then opened with the help of a laryngoscope and the bottom part of the mucosa of the sinus transected with the internal orifice of the fistula, after which the fistula is removed en bloc with the bottom part of the sinus and abscess cavity. Using this operation, we experienced no complications and there has been no recurrence so far.This paper was presented at the 23rd Annual Meeting of Pacific Association of Pediatric Surgeons, June 1990 in Kona, Hawaii. 相似文献
19.
An unusual case of rectovaginal fistula is reported. An 81 year old woman presented to the geriatric team with a request to review her faecal incontinence. It was discovered that she had a predilection for placing foreign objects in her vagina. In this instance a carbonated drink top had formed a rectovaginal fistula. 相似文献
20.
RAMASWAMY MANIKANDAN YVONNE BURKE SHALOM JOSEPH SRIRANGAM GERALD NICHOLAS COLLINS 《International journal of urology》2003,10(12):667-668
Involvement of the urinary bladder in an inguinal hernia is common, but massive bladder hernia is rare. Most urinary bladder herniations are discovered and repaired during surgery. We report a case of large incarcerated inguino-scrotal hernia, which was reduced only to present as a scrotal abscess and vesicocutaneous fistula; an unusual complication. The patient was managed conservatively due to underlying comorbidities. 相似文献