激光周边虹膜成形术治疗急性发作的PACG

目的：探讨倍频532激光周边虹膜成形术在患者不适合用抗青光眼药物的情况下,治疗急性发作期原发性闭角型青光眼(primary angle-closure glaucoma,PACG)的安全性及有效性。

方法：患者13例13眼应用4g/L盐酸奥布卡因滴眼液表面麻醉后立即行倍频532nm激光周边虹膜成形术。术前及术后15,30,60min测量眼压。

结果：患者眼压：虹膜成形术前平均60.6±8.8mmHg(1kPa=7.5mmHg),术后15min下降至平均37.4±7.3mmHg,术后30min平均26.2±6.6mmHg,术后60min平均17.1±5.3mmHg。所有患眼角膜水肿全部消退,无严重并发症出现。

结论：倍频532激光周边虹膜成形术治疗急性发作期PACG安全、有效,可作为治疗首选。     

双重血浆分子吸附系统对急性肝衰竭临床疗效研究

目的：研究双重血浆分子吸附系统对严重肝衰竭患者的治疗效果。方法：回顾性分析急性肝功能衰竭行双重血浆分子吸附系统（DPMAS）治疗患者 45例的临床资料,观察临床疗效,治疗前后患者临床症状、胆红素水平、凝血功能、凝血酶原活动度（PTA）、血常规、乳酸、其他肝功能及电解质指标。结果：45例患者行DPMAS治疗共73次,显效12例,有效22例,无效11例,总有效率75.56%。DPMAS治疗后总胆红素193.29±109.26 μmol/L,直接胆红素148.19±83.49 μmol/L,分别低于治疗前的271.95±147.92 μmol/L（P=0.0004）和201.24±98.66 μmol/L（P=0.0006）,差异均有统计学意义。治疗前12小时PT及APTT分别为18.24±9.59 s,65.49±57.64 s,治疗后12小时PT及APTT分别为21.63±11.63 s,79.68±34.83 s,较治疗前有所延长,但差异均无统计学意义（P＞0.05）。治疗前12小时PTA（51.46±22.12）%,治疗后12小时为（46.25±22.46）%,较治疗前有所下降,但差异无统计学意义（P＞0.05）。第一次DPMAS治疗前PTA（49.11±20.22）%,完成最后一次DPMAS治疗后PTA为（57.69±19.57）%,较治疗前升高,差异有统计学意义（P＜0.05）。DPMAS治疗后患者AST、ALT较前下降,但差异均无统计学意义（P＞0.05）。治疗后TBA、ALB及球蛋白（GLB）较前明显下降,差异均有统计学意义（P＜0.05）。发生不良反应13例次（17.8%）,包括轻度皮肤瘙痒、皮疹、发热、呕吐、胸闷,经对症处理后缓解。结论：DPMAS对急性肝功能衰竭治疗效果良好,对内环境影响较小,不良反应轻,值得临床推广。     

A double bifurcated graft for abdominal aorta and bilateral iliac artery reconstruction

Revascularization of the hypogastric artery often tends to be neglected in aortoiliac reconstructive surgery; however, its incomplete revascularization can result in unfavorable complications such as buttock claudication or necrosis, vascular impotence, and colonic ischemia. Multiple vascular lesions in the abdominal aorta and bilateral iliac arteries were reconstructed using a newly designed double bifurcated graft in five male patients. All five patients demonstrated excellent graft limb patency and postoperative improvement of the ankle-brachial pressure index without any clinical signs of ischemia in regions of the hypogastric artery. Thus, we conclude that an aggressive approach toward hypogastric circulation maintenance is essential in aortoiliac reconstructive surgery. By using this double bifurcated graft, rapid and safe revascularization of the bilateral hypogastric arteries concomitant with the external iliac or femoral arteries can be performed.     

Factors predicting atracurium reversal time

BACKGROUND: To identify individual factors and combination of factors predictive of reversal time (defined as time from neostigmine administration to train-of-four (TOF) ratio 0.70) from atracurium-induced neuromuscular block, the present study tested the following variables as possible predictors of reversal time: 1) degree of block at the time of antagonism as quantified by first response to TOF or double-burst stimulation (DBS); 2) time from last supplemental dose of atracurium to administration of neostigmine (pre-reversal time); and 3) time from administration of initial atracurium dose to T1 (the magnitude of the first twitch in TOF) recovered to 10% (duration of action of the initial dose of atracurium). METHODS: The study population comprised 83 female patients, ASA physical status 1 or 2, anaesthetized with fentanyl, thiopental, halothane and nitrous oxide. Initial and supplemental doses of atracurium were 0.5 mg x kg(-1) and 0.15 mg x kg(-1), respectively. Evoked responses to TOF or DBS were recorded mechanomyographically. Neuromuscular block was antagonized with neostigmine, 0.07 mg x kg(-1), at varying time intervals (6-50 min) after the final atracurium dose. RESULTS: Multiple linear regression analyses testing T1, D1 (the magnitude of the first twitch in DBS), pre-reversal time and duration of action of the initial dose of atracurium, demonstrated that with superficial block, T1 >15%, T1 is the only significant predictor for reversal time. With moderate block, 0< T1 < or =15%, both T1 and duration of action of the initial atracurium dose are significant predictors for reversal time. With profound block, T1=0, duration of action of the initial dose and pre-reversal time are significant predictors for reversal time. CONCLUSION: 1) T1 is a more important predictor for reversal time from atracurium-induced neuromuscular block than D1; 2) predictors differ with the degree of block: with T1 > 15%, T1 is the only significant predictor; with 0< T1 < or =15%, the duration of action of the initial dose and T1 are predictors for reversal time; with T1=0, the duration of action of the initial dose and pre-reversal time predict reversal time.     

Double congenital bronchoesophageal fistulae in an adult

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.     

The double contrast barium enema: a retrospective single centre audit of the detection of colorectal carcinomas.

AIM: To determine retrospectively the sensitivity and specificity of the double contrast barium enema (DCBE) as performed in one institution for the detection of colorectal carcinoma. SUBJECTS AND METHODS: Eight hundred and eighty barium enema reports were reviewed of consecutive adult patients who underwent DCBE and also had hospital case notes with a minimum follow up of two years, a later diagnostic colonoscopy, or operative and histological findings. RESULTS: Seventy-four true positive cases of colorectal carcinoma diagnosed at DCBE were confirmed at surgery and histological examination. There were four false positive diagnoses of carcinoma at DCBE. Eight false negative cases at DCBE were demonstrated within a two-year follow-up period. The sensitivity of the DCBE for detecting colorectal carcinoma was therefore 90.2% and the specificity was 99.5%. CONCLUSION: DCBE is a sensitive and highly specific investigation for the detection of colorectal carcinoma.     

Double dissociation of a latent working memory process

Background. The study explored the construct validity of a computational model of working memory (WM) by determining whether model parameters manifested double dissociations of lesion laterality with type of material studied. The data set modeled involved psychometrically matched verbal and figural WM tasks on which a double dissociation between test version and lesion laterality failed to emerge when total test scores were used as the laterality marker. Method. This re-analysis of a previously published study involved investigating the WM performance of 15 demographically matched controls with 15 adult patients with left-hemispheric (LH) lesions and 15 adult patients with right-hemispheric (RH) lesions. Each participant was given verbal and figural versions of a continuous paired associates test (CPAT). The two versions had previously been psychometrically matched in a larger sample of healthy individuals. A WM model composed of encoding, displacement, and episodic memory parameters was fit to each individual’s performance profiles for both versions of the CPAT. Results. Replicating the previous results for raw scores, rank transformed values of total score performance failed to reveal a double dissociation. Nonetheless an absolute double dissociation was observed for the model’s displacement parameter: RH patients demonstrated deficits on the figural but not verbal WM displacement parameter, whereas LH patients demonstrated deficits on the verbal but not figural WM displacement parameter. Additionally, both LH and RH patients were impaired on the figural encode parameter, perhaps explaining the absence of a double dissociation in total score performance. Conclusions. By combining different patterns of profile and level data into theoretically motivated model parameters, computational models of neurocognition can enhance the construct validity of interpretations of neuropsychological performance.     

中空双头加压螺纹钉加折断式螺钉治疗股骨颈骨折

目的:为了提高股骨颈骨折固定强度和愈合率,减少骨坏死及其它并发症.方法:应用中空双头加压螺纹钉加折断式螺钉治疗股骨颈骨折.结果:经35例临床应用及术后平均28个月随访,优良率为88.6%.结论:本手术切口小、创伤小、出血少、时间短、固定较可靠,便于功能锻炼,术后恢复良好.     

Comparison between Antegrade versus Retrograde Ureteral Stent Placement for Malignant Ureteral Obstruction

PurposeTo compare the technical success of antegrade uteral stent (AUS) and retrograde ureteral stent (RUS) placements in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS.Materials and MethodsThis study retrospectively included 61 AUS placements (44 patients) performed under fluoroscopic guidance and 76 RUS placements (55 patients) performed under cystoscopic guidance in patients with MUO from January 2019 to December 2020. Technical success rates of the 2 techniques were compared using inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures.ResultsTechnical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4%; 95% confidence interval [CI], 35.4%–63.1%). The independent predictors for technical failure of the RUS procedure were age of ≥65 years (odds ratio [OR], 5.56; 95% CI, 1.73–21.27), ureteral orifice invasion (OR, 4.21; 95% CI, 1.46–13.46), and extrinsic cancer (OR, 15.58; 95% CI, 2.92–111.81).ConclusionsThe technical success rate of AUS placement was higher than that of RUS placement in patients with MUO. RUS failure was associated with age of ≥65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.     

Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution?

Background

Multiplanar complex C3-type unstable distal femoral fractures present many challenges in terms of approach and fixation. This prospective study investigates a possible solution to these problems through double plating with autogenous bone grafting via a modified Olerud extensile approach.

Materials and methods

Twelve patients with closed C3-type injuries were included; eight of them were male, and their mean age was 33.5 years (range 22–44 years). Mechanism of injury was road traffic accident (RTA) in nine patients and fall from height in the other three cases. Eight cases were operated during the first week and four cases during the second week after injury. Mean follow-up was 13.7 months (range 11–18 months).

Results

Mean radiological healing time was 18.3 weeks (range 12-28 weeks), and all cases had good radiological healing without recorded nonunion or malunion. Clinically, two cases (16.7 %) had excellent results, five cases (41.7 %) had good results, three cases (25 %) had fair results, and two cases (16.7 %) had poor results. No cases developed skin necrosis, deep infection, bone collapse, or implant failure. However, two cases (16.7 %) had limited knee flexion to 90° and required subsequent quadricepsplasty.

Conclusions

Use of this modified highly invasive approach facilitated anatomical reconstruction of C3-type complex distal femoral fractures with lower expected complication rate and acceptable clinical outcome, especially offering good reconstruction of the suprapatellar pouch area. It can be considered as a standby solution for managing these difficult injuries.