封闭式负压吸引、氧气、臭氧联合治疗软组织缺损的疗效观察

目的探讨封闭式负压吸引、氧气、臭氧联合治疗软组织缺损的临床疗效。方法 40例软组织缺损患者随机分为对照组（根据病情分别给予游离植皮覆盖、二期缝合、局部皮瓣移位修复等手术治疗）和观察组（对照组手术治疗基础上,给予封闭式负压吸引、氧气、臭氧联合治疗）,每组各20例,对两组住院时间、肉芽组织覆盖创面时间,以及创面愈合情况进行观察和比较。结果与对照组比较,观察组住院时间、肉芽组织覆盖创面时间均显著缩短（P〈0.05）。两组创面愈合,死腔完全消除,没有出现明显并发症,创面细菌培养阴性。结论对于软组织缺损患者,手术治疗基础上,给予封闭式负压吸引、氧气、臭氧联合治疗,能够提高治疗的临床疗效。     

Laparoscopic greater curvature plication: Surgical techniques and early outcomes of a Chinese experience

BackgroundLaparoscopic greater curvature plication (LGCP) is a novel restrictive bariatric procedure that can reduce the gastric volume by infolding the gastric greater curvature without gastrectomy. The objective of this study was to describe the surgical technique of LGCP and validate the efficacy and safety of LGCP for the treatment of obesity in obese Chinese patients with a relatively low body mass index (BMI).MethodsTwenty-two obese patients (mean age 33.8±6.0 years; mean BMI 37.0±7.0 kg/m²) underwent LGCP between September 2011 and September 2012. After dissecting the greater omentum and short gastric vessels, the gastric greater curvature plication with 2 rows of nonabsorbable suture was performed under the guidance of a 32-F bougie. The data were collected during follow-up examinations performed at 1, 3, 6, and 12 months postoperatively.ResultsAll procedures were performed laparoscopically. The mean operative time was 84.1 minutes (50–120 min), and the mean length of hospital stay was 3.8 days (2–10 d). There were no deaths or postoperative major complications that needed reoperation. The mean percentage of excess weight loss (%EWL) was 22.9%±6.9%, 38.6%±9.8%, 51.5%±13.5%, and 61.1%±15.9% at 1, 3, 6, and 12 months postoperatively. At 6 months, type 2 diabetes was in remission in 2 (50%) patients, hypertension in 1 (33.3%) patient, and dyslipidemia in 11 (78.6%) patients. Decreases in the index for homeostasis model assessment of insulin resistance (HOMA-IR) and in insulin and glucose concentrations were observed.ConclusionsThe early outcomes of LGCP as a novel treatment for obese Chinese with a relatively low BMI are satisfactory with respect to the effectiveness and low incidence of major complications. Additional long-term follow-up and prospective, comparative trials are still needed.     

False positive retroaortic left circumflex coronary artery in a patient with atrial septal defect

Retroaortic course of coronary artery is a relative contraindication for device closure of an atrial septal defect. In this brief report, we demonstrate, for the first time, inferior aortic recess mimicking retroaortic left circumflex coronary artery in a patient with atrial septal defect. This distinction is important to avoid spurious diagnosis of anomalous coronary artery denying patient a chance of nonsurgical closure of atrial septal defect.     

“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

We undertook a review of the anatomical changes of “choke” vessels between the internal thoracic artery (ITA) and deep inferior epigastric artery (DIEA), as highlighted by a case of aortoiliac occlusive disease (Leriche's syndrome), and discuss the physiological concepts observed with regard to surgical delay procedures within the abdominal wall performed prior to abdominal cutaneous free flaps and coronary artery bypass grafting. Computed tomographic angiography (CTA) was undertaken on a patient with a rare case of Leriche's syndrome and a literature review of over 200 references on the anatomy, physiology and clinical uses of choke vessels in the abdominal wall was undertaken. The CTA demonstrated that in patients with Leriche's syndrome, there is a marked dilatation of all ITA‐DIEA pathways and increased flow through choke vessels. If these changes can be surgically replicated in the form of a delay procedure for patients seeking to undergo autologous breast construction, this could improve the outcomes of abdominal cutaneous free flaps and coronary artery bypass grafting. We accordingly propose three surgical methods for augmenting blood flow to the abdominal wall: a) ligation of the DIEA; b) ligation of the distal ITA; and c) creation of an arterio‐venous fistulae in the DIEA. Our review of the literature confirmed the viability of these propositions. The dilatation of choke vessels in response to increased haemodynamic stress may thus be utilised to enhance blood supply to tissues prior to transfer and can be achieved through simple and minimally invasive methods. Clin. Anat. 25:998–1004, 2012. © 2012 Wiley Periodicals, Inc.     

1997年-2008年太原地区204例出生缺陷回顾性分析

目的了解1997年-2008年间太原市出生缺陷发生情况,为进一步制定干预措施提供依据。方法将1997年-2008年12年中在我院妇产科终止妊娠的出生缺陷患儿按年限分为1997年-2002年（前六年）组和2003年-2008年（后六年）,并对其种类、发生率及城乡分布进行回顾性分析。结果 （1）12年中神经管畸形的发生率为56.11/万,居于首位,占全部出生缺陷的32.35%,虽然后六年的神经管畸形的发生率低于前6年,但无统计学差异（χ2=3.70,P〉0.05）。（2）后6年中28W前B超诊断率（1.12%）比前六年（0.41%）显著提高（χ2=7.49,P〈0.05）。（3）前6年中城市与农村出生缺陷发生率分别为133.94/万、545.45/万,后6年城市与农村出生缺陷发生率分别为129.64/万、436.50/万,（χ2=42.27,P〈0.05;χ2=44.47,P〈0.05）农村的平均发生率为城市的3.7倍,明显高于城市。结论神经管畸形的发生在我省仍较为突出,只有加强对神经管畸形的预防,加强优生优育知识的宣传,改善农村生活环境,提高产前诊断率水平,才有可能有效性地降低出生缺陷的发生。     

Successful coronary angiography with adequate image acquisition using a combination of gadolinium and a power injector in a patient with severe iodine contrast allergy

A history of severe allergic reaction to iodine contrast leading to anaphylactic shock presents a dilemma in patients requiring cardiac catheterization. As an alternative, gadolinium has been an interesting and potentially useful agent. However, gadolinium produces poor image quality and has been associated with significant arrhythmias in small case series. Furthermore, there is no consensus about the maximal allowable dose that can be administered to a patient. In the present report, a successful combination of gadolinium contrast with a power injector that produced adequate image quality in a patient with severe allergy to iodine contrast is described. The case was complicated by the occurrence of ventricular fibrillation when damping occurred during injection of contrast into the right coronary artery. This complication has been reported previously with intracoronary gadolinium injection. The report is followed by a brief literature review.     

Comparison of Fracture Toughness of All-Ceramic and Metal–Ceramic Cement Retained Implant Crowns: An In Vitro Study

To evaluate the fracture toughness of cement-retained implant-supported metal–ceramic molar crown with that of all-ceramic crowns, fabricated using IPS Empress 2 and yttria-stabilized zirconia copings. An dental implant and abutment was embedded in a clear polymethyl methacrylate model. A wax pattern reproducing the anatomy and dimension of a mandibular molar was made using inlay wax. Copings were made from the manufacturers guidelines for zirconia, metal ceramic and empress crown, in total of 21 copings, which were built for the crowns with metal layering ceramics specified by the manufacturers. The polymethylmethacrylate block-implant abutment complex was mounted on universal testing machine, and a static continuos vertical compressive load with a crosshead speed of 0.5 mm/min was applied. The breaking load and the peak load (in kilo Newtons) were recorded. The fractures for group I (zirconia–ceramic) and group II (metal–ceramic) occurred on the mesio-buccal aspect of the crowns involving the veneered ceramic layer while the catastrophic/bulk fracture was not observed. The mean value of breaking load for zirconia–ceramic, metal–ceramic and IPS-empress 2 was 3.4335, 3.071 and 1.0673 kN respectively. The mean value of peak load for zirconia–ceramic, metal–ceramic and IPS-empress 2 was 4.7365, 3.2757 and 1.566 kN respectively. It can be concluded that the zirconia–ceramic crown with the fracture toughness of 4.7365 ± 2.2676 kN has sufficient strength to allow clinical testing of these crowns as an alternative for metal–ceramic crowns (3.2757 ± 0.4681 kN).     

The influence of vertical dimension of occlusion changes on the electroencephalograms of complete denture wearers

PurposeThe present study was conducted to identify how changes in the vertical dimension of occlusion (VDO) affect the sensory perception and activity of the brain in complete denture wearers using an electroencephalogram (EEG).MethodsSubjects were 21 individuals wearing complete dentures who regularly visited the Division of Prosthodontics at Tsurumi University Dental Hospital for checkups (12 males and 9 females, average age: 76.6). Based on their original dentures, two duplicate dentures with different VDO (−3 mm and +5 mm) were fabricated. EEG activity and occlusal force were measured before and after gum chewing with each denture in all subjects. Negative indicator scores for psychological conditions and stable neuronal activity (Dα) were calculated using EEG data. Statistical analysis was performed using the Wilcoxon test to compare changes in the sensory perception, activity of the brain, and occlusal force (α = 0.05).ResultsAfter gum chewing with the +5-mm denture, a significant increase was observed in the negative indicator score (p < 0.05). No significant difference was found in the Dα values before and after gum chewing with any of the dentures (p > 0.05). A significant decrease was observed in the occlusal force between the original denture and the −3-mm denture (p < 0.05).ConclusionPsychological condition and occlusal force were influenced by immediate changes in the VDO of the complete denture.     

福建省正常牙合成人X线头影测量的Jarabak分析

目的 建立福建籍正常牙合成年人Jarabak头影测量分析法正常值标准,研究颅面发育特征,为正畸正颌诊断与治疗提供依据。 方法 选择90名福建籍大学生作为正常牙合样本,男性39例,女性51例,在自然头位下拍摄头颅侧位片,使用Viewbox正畸软件进行头影测量分析,得出正常值,并分析性别差异。 结果 得出福建地区成年人Jarabak分析法的正常值,男性颌骨大小较女性大,但其协调性基本一致。 结论 Jarabak头影测量分析法在评估患者骨骼特征、肌肉类型、畸形程度和功能改变的趋势等方面为正畸医师提供了可靠的诊断依据,有助于正畸医师预测矫治过程中面型的改变情况。