Prospective Study Comparing Two Brands of Cohesive Gel Breast Implants with Anatomic Shape: 5-Year Follow-Up Evaluation

BACKGROUND : The new generation of breast implants has an anatomic shape. These implants are made with a textured shell and filled with a cohesive silicone gel. Available since 1993 except in the United States, these implants are gaining in popularity for breast enlargement and reconstruction. This prospective, randomized, controlled, and blinded study was designed to compare mid- and long-term results with the use of cohesive gel-filled implants from two different manufacturers: Style 410 of the McGhan brand (MG) made by Allergan and Vertex made by Eurosilicone (ES). METHODS: From May 1997 to May 1999, 80 women underwent breast augmentation: 40 with Style 410 implants (MG) and 40 with Vertex implants (ES). All surgeries were performed by the same surgeon (I.N.). Another physician (G.J.) interviewed and examined 64 of these women (80%) 4 to 6 years (median, 5 years) after implantation. In addition, 10 patients responded to the same questionnaire and were interviewed by phone, bringing the follow-up rate to 92.5%. RESULTS: Overall, satisfaction was high, with 98.6% of the patients evaluated after 4 to 6 years "very satisfied" or "satisfied" with the result in general. Approximately 20% of the patients who responded judged their breasts to be firmer than desirable. Breast augmentation classification (BAC) was used to grade the breast firmness of the 64 patients examined by G. J. At examination, 24% of patients had soft breasts, 53% had slightly firm breasts, and 23% had moderately firm breasts. That last category also was classified as capsular contracture. No patient was graded as having very hard breasts (BAC 4). Skin sensitivity of the breast adjacent to the incision was altered for 25% of the patients. The implant rotated in four patients (5%). Breast firmness, implant palpability, nipple sensitivity, and skin sensitivity were further analyzed by implant location (submuscular vs subglandular) and implant size (volume). Frequency of the breast asymmetries and the impact of augmentation on asymmetric breasts also was studied. All these analyses were performed with the entire pool of examined patients who answered the follow-up questionnaire. Data also were analyzed by distinguishing between results of the two each implant manufacturers. The results showed no difference between the Eurosilicone and McGhan implants except for the self-evaluation of "breast consistency" by the patient. A higher percentage of patients with the Vertex implants than with the McGhan implants reported that their breast was "firmer than desired." CONCLUSIONS: Breast augmentation with anatomic, textured, cohesive silicone gel-filled implants is a reliable procedure with consistently good results. The results also show that candidates for breast enlargement should be informed that their implanted breast may feel firmer than their natural breasts. They also may experience reduced sensation of their nipple or breast skin.     

当归苦参丸联合阿达帕林凝胶治疗寻常性痤疮45例疗效观察

目的:观察当归苦参丸联合阿达帕林凝胶治疗寻常性痤疮的临床疗效与安全性。方法:选择2009年3月~2013年3月在门诊就诊的130例Ⅰ~Ⅲ级寻常性痤疮患者,将其按照随机数字表法分成三组。治疗组:口服当归苦参丸,同时睡前外用1%阿达帕林凝胶;对照Ⅰ组:口服当归苦参丸;对照Ⅱ组:睡前外搽1%阿达帕林凝胶。三组疗程均为8周,所有患者治疗12周后判定疗效。结果:治疗12周后,治疗组有效率为88.89%,对照Ⅰ组为64.28%,对照Ⅱ组为67.45%,治疗组有效率均高于与其他两组,差异有统计学意义(P0.05)。结论:当归苦参丸联合阿达帕林凝胶治疗寻常性痤疮疗效高,安全性好,值得临床推广应用。     

异维A酸红霉素凝胶联合胶原蛋白敷料治疗中度寻常性痤疮疗效观察

目的:观察异维A酸红霉素凝胶联合胶原蛋白敷料治疗中度寻常性痤疮的临床疗效及安全性。方法:96例中度寻常性痤疮患者,随机分为治疗组和对照组各48例。对照组外用异维A酸红霉素凝胶,1次/天,治疗6周;治疗组在对照组基础上联合使用胶原蛋白敷料,1次/天,每次30min,连续使用4周,第5~6周隔日使用1次。疗程均为6周。结果:治疗组愈显率和有效率分别为89.58%和100.00%,对照组为66.67%和91.67%,两组疗效比较差异均有统计学意义(P0.05)。治疗组发生轻度局部刺激反应率为12.50%,对照组为10.42%,均未发现任何全身不良反应,两组用药不良反应比较差异无统计学意义(P0.05)。结论:异维A酸红霉素凝胶联合胶原蛋白敷料贴敷治疗痤疮安全、有效,可临床推广应用。     

胃食管反流病致重度牙齿侵蚀的固定-活动联合修复

目的:探讨用固定-活动义齿联合修复,对胃食管反流病致重度牙齿侵蚀症患者进行咬合重建的临床效果。方法:对从2010年1月~2013年10月来我院就诊的10例胃食管反流病致重度牙侵蚀症患者采用诊断义齿过渡3~6个月,患者适应后再以诊断义齿为依据,采用固定-活动联合修复行咬合重建。分别于修复后3个月、6个月、1年、2年、3年复查。复查内容:修复体完整性、咬合稳定性、美观度、患者使用满意度。结果:整个随访期间,10例咬合重建患者面部外形改善,咀嚼功能恢复良好,患者对义齿的美观及舒适性均较为满意,配合用药后食管反流症状基本消失。结论:用固定-活动义齿联合修复,进行牙合重建能恢复患者美观,提高咀嚼功能同时后期维护简便。     

Ultrapure alginate anti-adhesion gel does not impair colon anastomotic strength

Background

Ultrapure alginate gel is promising in terms of adhesion prevention. Because anti-adhesive barriers have been shown to disturb healing of bowel anastomoses, the effect of ultrapure alginate gel on the repair of colon anastomoses was studied.

Materials and methods

In 102 male Wistar rats, a 0.5-cm segment was resected from the descending colon and continuity was restored by an inverted single-layer end-to-end anastomosis. Animals were randomized into a control, an alginate gel, and a sodium hyaluronate carboxymethyl cellulose film group, each n = 34. Half of each group was sacrificed at day 3 and 7 postoperatively. Anastomotic strength was assessed by measuring both bursting pressure and breaking strength. Hydroxyproline content was measured and histologic analysis was performed. The incidence of adhesion and abscess formation was scored at sacrifice.

Results

No difference in either anastomotic-bursting pressure or breaking strength was found between experimental groups and the controls at any time point. Both the incidence of adhesion formation (35% versus 71%, P = 0.007) and the adhesion score (0.38 versus 0.79, P = 0.009) were significantly lower in the alginate gel group than in the controls. The abscess rate was higher (46% versus 18%, P = 0.030) in the hyaluronate carboxymethyl cellulose group than in the controls and unchanged in the alginate gel group.

Conclusions

While reducing adhesion formation, ultrapure alginate gel does not interfere with the development of colonic anastomotic strength during the crucial early healing period.     

局部利多卡因凝胶与静脉注射利多卡因在喉罩应用中的比较研究

目的探讨在喉罩使用过程中局部利多卡因凝胶与静脉注射利多卡因对维持血流动力学的稳定性是否有相同效应。方法选择2011年6月～2012年10月择期全麻下腹腔镜胆囊切除术48例,随机分为3组,每组16例。T组（局部给药组）,2％利多卡因凝胶涂抹于喉罩罩杯的双面,同时静脉注射生理盐水10ml;1组（静脉给药组）,普通水溶性润滑剂涂抹于喉罩罩杯的双面,同时2％利多卡因1．5mg／kg生理盐水稀释至10ml静脉注射;C组（对照组）,普通水溶性润滑剂涂抹于喉罩罩杯的双面,同时生理盐水10ml静脉注射。记录喉罩置入前,置入即刻,置入后1、3、5min,以及拔除喉罩前1min,拔除即刻,拔除后1、3、5min的平均动脉压（MAP）、心率（HR）,记录拔除喉罩前后并发症。结果3组置入和拔出喉罩时MAP、HR无明显变化（P〉0．05）。T组和I组MAP在喉罩置入后1min和拔出即刻、1min、3min、5min明显低于C组（P〈0．05）。拔除喉罩后3组均无喉痉挛和吞咽困难发生,咽痛、干呕并发症发生率3组差异无显著性（P〉0．05）。结论局部应用利多卡因凝胶与静脉注射利多卡因在喉罩使用过程中对维持血流动力学的稳定性具有相同效应。     

改良微柱凝胶法检测ABO变异型血型

目的：建立用于检测ABO变异型血型的改良微柱凝胶法。方法：选取2016年11月至2018年5月温州医科大学附属第二医院育英儿童医院、温州市人民医院和瑞安市人民医院ABO血型凝集强度改变或正反定型不一致的患者12例。采用血型血清学检查和血型基因检测结合临床表现确认标本ABO血型;对已知血型标本用微柱凝胶法复核;用1% O型、A3亚型和A抗原减弱红细胞调整微柱凝胶法离心方式建立改良微柱凝胶法,并对全部标本进行检测。结果：12例标本中A3亚型1例,B（A）型3例,类孟买型3例,ABO抗原减弱5例;微柱凝胶法和盐水试管法检测敏感度相似,12例标本中只检出2例,检出比例为2/12;选定改良微柱凝胶法的离心方式为900 r/min离心2 min、4 ℃孵育30 min、1 800 r/min离心3 min;用改良微柱凝胶法检测12例标本,1例不能检出,检出比例为11/12。结论：本研究建立的改良微柱凝胶法通过改变微柱凝胶血型卡的离心方式、增加孵育时间和孵育温度,提高了检测敏感度,适合ABO变异型血型的筛检。     

抗环瓜氨酸肽抗体与超声检出的类风湿性关节炎骨侵蚀的相关性研究

目的 探讨类风湿性关节炎（rheumatoid arthritis,RA）患者抗环瓜氨酸肽（anti-cyclic citrullinated peptide,ACCP）抗体与超声检出的骨侵蚀的相关性。方法 对符合1987年RA分类标准的RA患者的双侧腕关节、第1~5掌指关节及第2~3近节指间关节进行常规灰阶超声和能量多普勒（power Doppler,PD）超声检查,观察关节骨侵蚀、滑膜增厚及PD血流信号情况,分析ACCP抗体阳性和阴性患者的骨侵蚀、滑膜增厚、PD血流信号评分之间的差异,并探讨ACCP、病程与骨侵蚀的关系。结果 RA患者101例,其中女性81例,ACCP抗体阳性患者75例,ACCP抗体阳性组与阴性组的骨侵蚀总评分在两组间差异有统计学意义（P=0.009）,而滑膜增厚及PD血流信号总评分在两组间差异无统计学意义。在病程>3年的患者中,ACCP抗体阳性组与阴性组之间的骨侵蚀总评分差异有统计学意义（P=0.01）。结论 ACCP抗体阳性、病程>3年的RA患者有较高的骨侵蚀评分。     

内上方真皮腺体蒂乳房成形术在多种乳房畸形中的应用

目的探讨内上方真皮腺体蒂乳房成形术对乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后的乳房畸形进行修复的疗效。方法对36例乳房肥大及乳房假体、聚丙烯酰胺水凝胶取出后乳房畸形的患者,行携带或不携带Wfiringer乳房水平中隔内上方真皮腺体蒂乳房成形术修复。结果36例患者,术后胸骨上凹至乳头距离为（20．10±1．94）cm,平均上提乳头7．5cm（4～13cm）,并且均未出现血肿及乳头、乳晕复合体坏死等并发症。2例发生小段切口裂开（发生率为5．56％）,其余均为I期愈合。28例获随访6～18个月,乳头、乳晕感觉良好,切口瘢痕不明显,乳房外形满意。结论应用内上方真皮腺体蒂术式可使乳房得到良好的塑形,同时又能充分保留乳头、乳晕复合体的血运及感觉功能,疗效满意。     

Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence

The suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT suburethral sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral mesh erosion. Surgical removal involved cystourethroscopic-assisted transurethral resection of the mesh, followed by vaginal dissection and periurethral withdrawal. Urethral mesh erosion should be considered in a patient who presents with atypical symptoms after being treated with a suburethral sling. It is important to obtain a detailed history and have a high clinical index of suspicion for erosion. Careful and comprehensive urethroscopy, in addition to cystoscopy, should be a mandatory part of the TVT procedure. Further study is needed to determine the optimal technique for mesh removal.Abbreviations TVT Tension-free vaginal tape