Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz goose-neck snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential. Correspondence to: R. D. Edwards     

闭角型青光眼凝血指标的变化

目的:探讨闭角型青光眼患者凝血指标变化与临床的关系。方法:对50例闭角型青光眼患者及43例正常对照组进行了凝血指标(PT、TT、Fbg、APTT)检测。结果:闭角型青光眼患者与对照组比较PT、TT无显著变化(P<0.05),Fbg含量升高有极显著性差异(P<0.01),APTT时间缩短有极显著性差异(P<0.01)。结论:闭角型青年眼患者体内血液是高凝状态,而这种高凝状态在闭角青光眼病的发生、发展中起着重要的作用。     

An effective device to keep the sternum open

(Received for publication on Oct. 6, 1997; accepted on July 7, 1998)     

介入化疗栓塞治疗32例宫颈癌合并出血的临床疗效分析

目的探讨介入化疗栓塞治疗宫颈癌合并出血的临床意义。方法对３２例宫颈癌合并出血的患者采用子宫动脉灌注５－氟尿嘧啶（５－Ｆｕ）、顺铂（ＰＤＤ）、丝裂霉素（ＭＭＣ）加碘油行子宫动脉化疗栓塞,再用明胶海绵栓塞止血。结果①盆腔动脉造影能清楚显示肿瘤血管及范围,明确出血部位,经化疗栓塞后全部病例得以止血。②介入治疗能够短时间内控制巨大肿瘤,但难以使肿瘤完全坏死。结论介入化疗栓塞能够取得满意的止血效果,是其他治疗手段不可比拟的。介入治疗能够提高宫颈癌的近期疗效,但单纯用介入治疗难以根治,必须配合手术治疗或放射治疗。     

心血管疾病介入诊治术患者心理状态调查分析

对８６２例心血管疾病介入诊治术患者术前分别采用心理护理（ｎ＝４３１）和非心理护理（ｎ＝４３１）前后比较心理状态差别观察。结果显示：手术前所有患者均有严重焦虑心理,经采用心理宣教、心理护理后,患者焦虑程度大大降低（Ｐ＜０．００１）,处于接受手术的最佳心理状态,保证手术顺利进行,并减少了术前、中、后并发症的发生。而未行心理宣教及心理护理的患者的焦虑程度几乎没有变化（Ｐ＞０．０５）,有的甚至提高。通过对照观察、心理宣教及心理护理的有效实施,对消除患者的焦虑、恐惧心理有较满意的效果,并能达到仅靠操作技术难以获得的效果,起到良好的助手作用。     

Ultrasound-guided percutaneous laser ablation of liver tissue in a rabbit model

The present report evaluates the efficacy and safety of percutaneous interstitial laser tissue ablation of the liver in nine New Zealand rabbits. A Nd: YAG laser was coupled to a quartz fibreoptic guide (600 m) with a flat tip. The fibre and a thermocouple were placed in the lumen of two Chiba needles (18G) and these were inserted into the liver 10 mm apart under ultrasound guidance. The laser was fired for 5 min at 1, 3 and 5 W power, respectively, in three groups of rabbits. There were no acute complications and all the rabbits except one survived until the established time of sacrifice. The procedure induced a cavity surrounded by a zone (about 10 mm) of coagulative necrosis. After 2 weeks a strong peripheral inflammatory response was evident and after 4 weeks a capsule of connective tissue enclosed the lesions. Our study seems to offer a safe and rapid technique producing a guaranteed kill radius for the treatment of small hepatic neoplasms. Correspondence to: C. M. Pacella     

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.     

The immobilization response in rhesus monkey: a behavioral and electroencephalographic study.

Rhesus monkeys maintained in individual cages are rarely inactive when observed by humans unfamiliar to them. It has been observed that these animals display a greatly reduced behavioral repertoire after they are transferred to primate chairs. The present study used systemic behavioral observations to document those changes and to examine additional changes produced by arm restraint. Chair restraint was associated with a reduction in activity which was intensified when animals were further immobilized by arm restraint. This immobilization produced a reduction of tone in all limbs, a reduction of spontaneous behavior, and the appearance of eye closure. Electroencephalographic (EEG) correlates of the behavioral changes were examined also, using quantitative data generated through power spectral analysis of sensorimotor cortical EEG signals. Immobilization was accompanied by a significant increase in spectral density at 12 to 15 Hz which was most marked at mid and far lateral rholandic recording sites. No other significant changes were seen in the frequency bands studied. When the immobilized animal was alerted with novel stimuli, lower frequencies were attenuated but 12- to 15-Hz activity remained enhanced. These findings indicate that a unique immobilization response is elicited by restraint in the rhesus monkey which is associated with discrete changes in both behavior and accompanying EEG patterns.     

小儿先天性左向右分流型心脏病的介入治疗

目的　评价应用Amplatzer封堵器进行介入治疗小儿先天性心脏病的效果、安全性。方法　超声心动图确诊的动脉导管未闭 (PDA)、房间隔缺损 (ASD)及膜部室间隔缺损 (膜部VSD)患者 4 9例 ,在透视或 /和经胸超声心动图 (TTE)指引下置入Amplatzer封堵器 ,术后 2 4小时 ,1、3、6、12个月及以后每年分别TTE、ECG和X线胸片检查评价治疗效果。结果　 16例ASD球囊测量缺损伸展径为 13～ 2 8(平均 19 3± 4 9)mm ,选择封堵器直径 13～ 30 (平均 2 0 6± 5 1)mm ;2 5例PDA造影测量PDA最窄处直径为 2～ 7 7(平均 3 9± 1 5 )mm ,选择封堵器直径 4～ 12 (平均 6 6± 1 9)mm ;8例膜部VSD造影测量VSD直径 3 4～ 8(平均 4 7± 2 3)mm ,选择封堵器直径 6～ 10 (平均 7 8±1 7)mm。技术成功率为 10 0 % ,术中未发生任何并发症 ,无急诊手术病例。术后即刻造影或TTE显示 10例存在残余分流 ,3个月TTE示所有病例无残余分流和再通 ,心室内径均有不同程度的缩小 ,肺动脉压下降。结论　应用Amplatzer封堵器介入治疗小儿先天性心脏病 ,具有操作简单、安全、损伤小、成功率高等优点 ,适合于儿童继发孔型ASD、各种类型的PDA及膜部VSD的介入治疗     

局部动脉内灌注化疗治疗晚期恶性骨肿瘤的近期疗效观察

目的　评价晚期恶性骨肿瘤局部动脉内灌注化疗 (TAI)的临床价值。方法　 43例均采用Seldinger技术经皮穿刺股动脉 ,插入4～ 5F导管至肿瘤局部供血动脉内行化疗药物的灌注术 ,并对术前、术后 2周内病人疼痛的VAS评分 (视觉模拟量表或视觉模拟评分法 ) ,入院、出院病人生活质量的Karnofsky评分 (卡莫夫斯基机能评分 )和ECOG(东方肿瘤协作组 )评分 ,以及WHO对骨原发及骨转移瘤近期治疗效果的评价标准等进行综合比较。结果　TAI术后病人疼痛的VAS评分明显少于术前 ;病人出院的Karnofsky评分、ECOG评分明显优于入院 ,CR PR近期有效率为 48 8%。结论　TAI为治疗晚期恶性骨肿瘤的一种有效方法 ,它能明显缓解病人疼痛 ,改善生存质量。