Open surgery of giant paraclinoid aneurysms improved by intraoperative angiography and endovascular retrograde suction decompression

Summary In three consecutive cases of giant left sided paraclinoid aneurysms we employed an endovascular retrograde suction decompression technique in combination with intra-operative angiography. A double-lumen balloon catheter was placed in the left internal carotid artery by the transfemoral route. After balloon inflation and placement of a temporary clip distal to the aneurysm blood was aspirated and the aneurysm collapsed. Thus further dissection of the aneurysm could easily be achieved and clips could be placed. Afterwards real-time digital subtraction angiography was performed. Intra-operative angiography led to clip repositioning in all cases either due to a clip induced stenosis of the parent vessel, or because of incomplete aneurysm obliteration. Afterwards successful clipping could be confirmed in all cases. Outcome was excellent in one case, good in the other. The third case, extremely complicated by an accompanying craniopharyngioma, showed a satisfactory outcome, but presented new neurological deficits.     

皮肤发疱仪的研制与临床应用

目的：研制皮肤发疱仪，并临床应用于自体表皮移植治疗白癜风，分析治疗效果。方法：根据局部皮肤双控发疱理论，应用负反馈原理，研制出皮肤双控发疱仪；该仪器应用于自体表皮移植治疗白癜风，通过控制局部发疱部位的压力和温度，实现发疱时需要的恒压和恒温。结果：皮肤发疱仪能恒定控制局部皮肤发疱时的压力和温度，使自体表皮移植治疗白癜风的总成活率达到98．01％。结论：皮肤发疱仪性能稳定，操作方便，临床应用效果好，值得推广。     

Endotracheal suctioning causes right upper lobe collapse in intubated children

Objective: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors. Methods : The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period ( n = 102). Graduated suction catheters and suction vacuums of < 165 cm H₂O were then introduced. Another prospective audit was carried out 3 months later ( n = 60). Results : We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures, a significant reduction in the incidence of RUL collapse, to 7%, was observed ( p < 0.05). Conclusions : We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.     

A randomized, double blind, placebo-controlled study to investigate the use of conscious sedation in conjunction with paracervical block for reducing pain in termination of first trimester pregnancy by suction evacuation

BACKGROUND: This study evaluated the role of conscious sedation in pain relief during termination of first trimester pregnancy by suction evacuation (SE) under local anaesthesia. METHODS: A hundred women undergoing SE before 12 weeks gestation were randomized by computer using the sealed envelope method to receive placebo (saline) or conscious sedation (2 mg midazolam and 25 microg fentanyl) i.v. 5 min before cervical dilatation. Paracervical block was given to all patients, 2 min later. Pain scores during and after SE, post-operative side-effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores were found between the two groups. Post-operative side-effects such as dizziness (P = 0.015) and drowsiness (P < 0.001) were significantly more severe in the conscious sedation group. However, patients in the conscious sedation group reported better satisfaction levels than the control group (P = 0.003). CONCLUSION: The use of conscious sedation significantly improved patient satisfaction during termination of first trimester pregnancy by SE under local anaesthesia, despite a lack of improvement in pain relief and the presence of increased severe dizziness/drowsiness in the post-operative period.     

Low resting potentials in single isolated heart cells due to membrane damage by the recording microelectrode

Single myocytes from adult rat hearts were prepared following the method of Powell and co-workers (9, 10, 11). Low resting potentials (E_m) could be improved by three techniques. (i) Elevation of Ca_o to 7.2 mM which, however, mostly resulted in spontaneity and irreversible contracture. (ii) Pre-incubation in a KB medium (6). (iii) Use of suction pipettes instead of tapered microelectrodes for intracellular recordings (2). It is concluded that low E_m measured previously (11) were due to membrane damage upon microelectrode impalement accopanied by insfufficient healing of the membrane around the electrode insertion.     

口服米索前列醇联合宫腔吸引管在剖宫产术后无痛人流的应用

分析口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流的临床效果及机制。120例患者随机分为对照组(n=60)和观察组(n=60)。对照组患者接受宫腔吸引管处理,观察组患者口服米索前列醇(0.6 mg)后接受宫腔吸引管。结果显示观察组患者的手术时间和苏醒时间明显缩短(P<0.05),术中出血量和异丙酚用量明显减少(P<0.05);观察组患者的宫颈扩张效果总有效率明显升高(P<0.05)而不良反应发生率明显降低(P<0.05);两组患者治疗后血清中白细胞介素1β(IL-1β)和IL-2水平明显升高,且对照组患者的上述白细胞介素水平升高更显著(P<0.05)而雌激素促黄体生成素(Luteotropic hormone,LH)、促卵泡激素(Follicle stimulating horman,FSH)和雌二醇(Estradiol,E2)水平无明显变化(P>0.05)。实验表明口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流临床效果明显,且不引起白细胞介素和雌激素水平的剧烈变化。     

不同照射方式下核黄素-A波紫外线兔巩膜胶原交联术对兔巩膜成纤维细胞生物力学特性的影响

目的　研究不同照射方式下核黄素-A波紫外线兔巩膜胶原交联术对兔巩膜成纤维细胞生物力学特性的影响。方法　取健康新西兰大白兔24只，随机将兔平均分为A、B两组，每组选取左眼为实验眼，右眼为对照眼。麻醉后暴露左眼鼻上方巩膜。在该处巩膜滴加5-磷酸核黄素5 min后，用波长为370 nm的紫外线灯照射。A组的照射时间为30 min，能量密度为3.0 mW·cm^-2；B组的照射时间为9 min，能量密度为10.0 mW·cm^-2。照射期间，每2 min滴加1次5-磷酸核黄素溶液，以保持巩膜的湿润。术后60 d，处死实验兔，培养实验眼交联部位及对照眼相应部位的巩膜成纤维细胞，用细胞微管吸吮实验检测巩膜成纤维细胞的杨氏模量、表观黏性。结果　A、B两组实验眼巩膜细胞的杨氏模量、表观黏性均较各自对照眼显著增强，差异均有统计学意义（均为P＜0.05）；而A、B两组实验眼间、及对照眼间巩膜细胞的杨氏模量、表观黏性差异无统计学意义（均为P＞0.05）。以上结果表明，交联术后巩膜细胞的黏弹性发生了明显的变化，黏弹性显著升高。而两种照射方式之间巩膜细胞的黏弹性无显著差异。结论　两种不同的照射方式，均能使巩膜成纤维细胞的生物力学性能发生显著增强，而两种照射方式之间并未见明显的差别。     

负压治疗联合盆底肌训练对前列腺癌根治术后患者控尿功能及性功能的影响

目的探讨负压治疗联合盆底肌训练对前列腺癌根治术后患者控尿功能及主观幸福感的影响。方法将中山大学附属第三医院2016年10月至2019年4月泌尿外科确诊为前列腺癌并行腹腔镜下前列腺癌根治术治疗的70例患者,按随机数字表法分为干预组和对照组各35例,其中对照组35例采用常规护理(盆底肌功能锻炼),干预组35例在常规护理基础上,术后6周起再增加负压治疗。比较对照组和干预组术后6周、10周、18周控尿功能恢复情况,同时进行国际勃起功能评分表(IIEF-5)评分及主观幸福感调查,观察其治疗效果。结果干预组术后6周、10周、18周尿失禁评分中位值分别2分、1分与0分,低于对照组的2分、2分与2分,提示干预组术后平均控尿功能恢复时间较对照组短,差异有统计学意义(P<0.05);此外干预组相比对照组,IIEF-5评分及主观幸福感评分上升速度较快,提示干预组术后勃起功能和生活质量改善情况明显优于对照组。结论负压治疗联合盆底肌训练对前列腺癌根治术后患者的控尿功能和性功能有明显改善,且缩短其恢复时间。     

吸痰枕在吸痰护理中的应用效果观察与护理

目的探讨自制吸痰枕在吸痰护理中的应用效果。方法选取44例需要吸痰的肺部感染患者,随机分为对照组和观察组,对照组24名,观察组20名。对照组采用常规方法吸痰,观察组采用应用自制吸痰枕辅助深部吸痰,比较两组单日平均吸痰次数、单次平均吸痰时间、气道粘膜出血例数等,其中对照组包含1例气管切开,观察组无气管切开。结果对照组单日平均吸痰次数为12次,气道粘膜出血例数为12例,观察组单日平均吸痰次数为4次,气道粘膜出血例数为3例,（P〈0．05）差异具有统计学意义,观察组的单次平均吸痰时间明显小于对照组。结论应用自制吸痰枕辅助深部吸痰可以明显缩短吸痰时间,减少吸痰次数,减少气道粘膜出血,有效改善患者氧合。     

简易腹水还纳输注探讨

目的　肝硬变腹水是一常见病 ,治疗处理需要探讨。方法　根据现在对其病因的新认识 ,提出“三原则两辅助处理”规则 ,而辅助之一是腹水还纳注射 ,试探一次抽出腹水分次静脉回输。结果　观察 1115例肝硬变并发腹水患者 ,12 2例 (10 .9% )在三原则治疗下辅助腹水还纳 ,腹水均获消退。结论　简易腹水还纳对特大量和顽固性腹水有甚好辅助治疗作用 ,简便易行 ,且安全