创伤后迟发性脑肿胀的临床特点与治疗

目的 探讨创伤后迟发性脑肿胀的临床特点、发病机制与治疗。方法 回顾性分析1998年1月～2005年6月年收治的17例迟发性脑肿胀患者的临床特点和救治情况。结果 所有颅脑损伤患者采用保守治疗后均有好转，但于伤后5-10d出现恶化，CT复查有脑肿胀，经加强综合脱水等治疗后16例治愈，1例死亡。结论 迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下薄层血肿及早期CT有脑肿胀者。其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。此类患者病情隐蔽性强，应加强观察、积极行CT复查，如能早期明确诊断，保守治疗多数效果良好。     

Chromogalactography preceding ductal-lobular unit excision for nipple discharge--with special reference to diagnostic galactography and histology

Between 1981-88, 223 surgical interventions were performed in cases of pathologic breast secretion after exclusion of extra-mammary aetiology. The milk duct was identified by pre-operative chromogalactography, followed by a selective excision of the ductal-lobular unit. In 36 cases (16.1%), however, neither spontaneous nor provocable secretion remained after diagnostic galactography, so that a segment resection was required. In all tissue specimens, the cause of the pathologic secretion was found histologically; most often, it was fibrocystic disease or solitary intraductal papilloma (21.5% each). In 32.3% of the specimens, findings with a prospective significance (papillomatosis, carcinoma in situ or invasive carcinoma) were discovered and further operative treatment was initiated. The colour of the discharge allowed no prediction of the histological findings. In 28.6% (8/28) of the carcinomas, secretion was bilateral. In 46.4% of the specimens containing carcinoma, papillomatosis was also detected; vice versa, papillomatosis was associated with carcinoma in 22.8%. The recurrence rate of 1.6% indicates the efficiency of this method in removing the pathology. The diagnostic value of galactography for the prediction of findings with a prospective significance was considerably reduced by a rate of 37.5% false-negatives; therefore, we have decided to omit diagnostic galactography in our patients. Now, provided extra-mammary causes of the nipple discharge have been excluded and mammography has been inconspicuous, a selective excision of the ductal-lobular unit is performed after preoperative chromogalactography.     

Retrorenal colon: implications for percutaneous diskectomy

It has been recommended that computed tomography (CT) with the patient prone be performed in every patient undergoing percutaneous diskectomy; this would enable detection of a retrorenal location of the colon, which could interfere with the percutaneous procedure. In this evaluation of 346 prone CT studies, only one patient (0.29%) was found to have retrorenal or retropsoas bowel that would have been perforated at diskectomy. Because of this extremely low prevalence, the performance of prone CT in every patient undergoing percutaneous lumbar diskectomy is not believed to be necessary.     

Laryngotracheal resection and reconstruction for subglottic stenosis.

Eighty patients with inflammatory stenoses of the subglottic larynx and upper trachea were treated by single-stage laryngotracheal resection and reconstruction. Fifty stenoses originated from postintubation lesions (endotracheal tubes, tracheostomy, cricothyroidostomy), 7 originated from trauma, 19 were idiopathic, and 4 were miscellaneous. Repair consisted of resection of the anterolateral cricoid arch in all patients, plus resection of posterior laryngeal stenosis where present, with salvage of the posterior cricoid plate, appropriate resection and tailoring of the trachea, and primary anastomosis using a posterior membranous tracheal wall flap to resurface the bared cricoid cartilage in 31 patients. One postoperative death resulted from acute myocardial infarction. Long-term results were excellent in 18 patients, good in 48, satisfactory in 8, and failure in 2. Three additional patients had good results at discharge but were followed up for less than 6 months.     

Therapy of primary fallopian tube cancer--a retrospective study of 30 cases]

Between the years 1968-1988 30 patients with primary carcinoma of the fallopian tube were treated in the Department of Obstetrics and Gynecology of the University of Kiel. In 27 cases the initial treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In 3 cases where the patients had undergone surgical treatment in another hospital a second operation for completion was performed. 2 patients received no further treatment after surgery. Postoperative radiotherapy was given to 20 patients and a combined treatment with radiation and polychemotherapy was implemented in 5 cases. Postoperative treatment in 3 patients was poly-chemotherapy alone. The 5-year-survival rate taking all tumor stages and modes of therapy employed into consideration was 36.7%. In analysing the survival rate for small numbers as directly related to postoperative treatment a 5-year-survival rate for radiotherapy of 35% (7/20) and for radiation therapy plus poly-chemotherapy of 40% (2/5) was found. After operative treatment followed by poly-chemotherapy alone one of three patients survived after 5 years.