喉内窥镜下吸引旋切加射频治疗复发性喉乳头状瘤

目的：探讨喉内窥镜下吸引旋切加射频消融治疗复发性喉乳头状瘤的疗效。方法：对21例复发性喉部乳头状瘤患者行在喉内窥镜下吸引旋切后再用射频消融。结果：术后随访6个月～3年。2例扩展至声门下气管内的4、6岁儿童分别在术后5、7个月复发再次手术。1例局部涂鸦胆子油，另1例术后使用干扰素，已观察6个月，未见复发。1例38岁患者术后1年复发并癌变，行大部喉切除术。结论：在支撑喉镜加喉内窥镜成像系统监视下，用吸引旋切刀切除肿瘤后再用射频消融为一种有效治疗喉乳头状瘤的方法。     

Conventional versus endoscopic powered adenoidectomy: A comparative study

Background: Adenoidectomy is a commonly performed ENT surgery. It is conventionally performed using the curettage method. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative.     

Hip orthosis powered by pneumatic artificial muscle: voluntary activation in absence of myoelectrical signal

Abstract:  Powered orthosis is a special class of gait assist device that employs a mechanical or electromechanical actuator to enhance movement of hip, knee, or ankle articulations. Pneumatic artificial muscle (PAM) has been suggested as a pneumatic actuator because its performance is similar to biological muscle. The electromyography (EMG) signal interpretation is the most popular and simplest method to establish the patient voluntary control of the orthosis. However, this technique is not suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. For those cases, an alternative control strategy should be provided. The aim of the present study is to develop a gait assistance orthosis for lower limb powered by PAMs controlled by a voluntary activation method based on the angular behavior of hip joint. In the present study, an orthosis that has been molded in a patient was employed and, by taking her anthropometric parameters and movement constraints, the adaptation of the existing orthosis to the powered orthosis was planned. A control system was devised allowing voluntary control of a powered orthosis suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. A pilot clinical study was reported where a patient, victim of poliovirus, successfully tested a hip orthosis especially modified for the gait test evaluation in the parallel bar system. The hip orthosis design and the control circuitry parameters were able to be set to provide satisfactory and comfortable use of the orthosis during the gait cycle.     

Electric-powered indoor/outdoor wheelchairs (EPIOCs): users' views of influence on family,friends and carers

Purpose.?This study explored the effects of electric-powered indoor/outdoor wheelchair (EPIOC) provision to users on their family and carers.

Method.?EPIOC users receiving their chairs between February and November 2002 (N?=?74) were invited to participate in a telephone questionnaire/interview, and 64 agreed. This study examined the responses to the question ‘Has the use of your EPIOC affected your family or friends in any way?’ and related comments. Interviews were analysed using a qualitative framework approach to identify emergent themes. In addition, the proportion of individuals raising issues related to each theme was determined. Participants were interviewed 10–19 (mean?=?14.3) months after chair delivery.

Results.?The following themes emerged: reduced physical burden on family/friends and increased independence and freedom. However, an EPIOC does not eliminate other practical problems particularly during transportation and negotiating kerbs and slopes. Users also reported anxiety/worry in relationship to EPIOC use, e.g., weather conditions, personal safety (muggings), use of ramps and kerbs.

Conclusion.?There are considerable benefits to families and carers associated with powered wheelchair use. A reduction in the physical demand for pushing and increased freedom were identified. These benefits appear to outweigh the residual practical difficulties and worries.     

Is the endovascular embolization of tributaries of the internal iliac veins essential in the treatment of isolated pelvic-perineal reflux?

Aim: The aim of study was to investigate the opportunities of local phlebectomy in the elimination of isolated pelvic-perineal reflux (PPR), as well as to determine the feasibility of endovascular embolization of the tributaries of internal iliac veins in PPR. Clinical trial no. NCT01598051.

Materials and methods: The work is based on the results of examination and treatment of 43 female patients with varicose veins of the pelvis, perineum, and lower extremities. Patients had no signs of pelvic congestion syndrome (PCS). All patients underwent duplex ultrasound scanning (DUS) and ovariography with pelvic phlebography (OPP). For the elimination of PPR, local phlebectomy was performed in the major labia and perineal area, with maximal possible mobilization of the vessel within the operative wound (33 patients). In 10 patients with isolated varicose transformation of the superficial veins on the posterior thigh, mini-phlebectomy was performed using the Varady phlebectomy extractors.

Results and discussion: The varicose syndrome of the external genitalia, perineum, and posterior thigh was successfully treated in 100% of patients. Findings suggest that thorough mobilization and excision of the veins of the pudendal labia, perineum, and subcutaneous veins of the thigh is a reliable method for eliminating the pathological reflux from the intrapelvic veins to the superficial veins of the perineum and lower extremities. No recurrences of vulvar, perineal varices or dilation of the veins of the lower extremities were observed in 100% of patients over the 3-year follow-up period.

Conclusion: Local phlebectomy is an effective technique for eliminating the isolated PPR in patients with varicose transformation of intrapelvic, vulvar, or perineal veins. Endovascular embolization of the tributaries of the internal iliac veins is not an essential component in the treatment of PPR. The present study has a limitation due to the absence of patients with PCS. The effectiveness of phlebectomy in the treatment of isolated PPR was studied.     

Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: A systematic review

BackgroundRobotic exoskeletons have been developed to assist locomotion and address gait abnormalities in children with cerebral palsy (CP). These wearable assistive devices provide powered assistance to the lower-extremity joints, as well as support and stability.Research QuestionDoes exoskeleton-assisted walking improve gait in children with CP?MethodsThe PRISMA guidelines were used to conduct this systematic review. Articles were obtained in a search of the following electronic databases: Embase, CINAHL Complete, PubMed, Web of Science and MEDLINE. Studies investigating spatiotemporal, kinematic, kinetic, muscle activity and/or physiological parameters during exoskeleton-assisted walking in children with CP were included. All articles were assessed for methodological quality using an adapted version of the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group, provided by the National Institutes of Health (NIH).ResultsThirteen studies were included. They involved the use of the following exoskeletons: tethered knee exoskeleton, pediatric knee exoskeleton (P.REX), untethered ankle exoskeleton, WAKE-Up ankle module, WAKE-Up ankle & knee module and unilateral ankle exosuit. Methodological quality varied, with key limitations in sample size and allocated time to adapt to the exoskeleton. There was a consensus that robotic exoskeletons improve gait given careful optimisation of exoskeleton torque and sufficient exoskeleton practice time for each participant. Improvements in gait included reduced metabolic cost of walking, increased walking speed, and increased knee and hip extension during stance. Furthermore, exoskeletons with an actuated ankle module were shown to promote normal ankle rocker function.SignificanceRobotic exoskeletons have the potential to improve the mobility of CP children and may therefore increase community participation and improve quality of life. Future work should involve larger controlled intervention studies utilising robotic exoskeletons to improve gait in children with CP. These studies should ensure sufficient exoskeleton practice time for each participant.     

Powered off-road wheelchair for the transportation of tetraplegics along mountain trails

Purpose: For off-road mobility, some manual or power assisted devices were conceived to be self-driven by paraplegics while for tetraplegics non power-assisted devices were conceived. These devices require one or more conductors who are subjected to a high physical demand thus potentially creating: precarious safety condition for the user an elevated physical demand of conductors could reduce the care and the attention to give to the user; the time of the outdoor adventure experience of the user could be limited.

Methods: To address these issues, an innovative user-centered power assisted off-road wheelchair for the transportation of tetraplegics along mountain trails was developed. The device, structured like a trike, is driven by two healthy conductors; the user is placed in the middle of the frame. A movable seat provides for the transfer from the standard to the off-road wheelchair. An electrical motor, powered by a battery pack, provides for the actuation. All the design and prototype aspects, the control system and experimental tests are detailed.

Results: The prototype satisfies mechanical, safety and duration requirements. No physical demand while using the device and for the transfer of the user to the device was identified. Fun and engaging tests were carried out and all the participants were involved.

• Implications for Rehabilitation

• The device has the potential to enhance the quality of life of tetraplegics in terms of new life experiences.

• The device revealed the real possibility of a full recreational experience, an enhanced participation and a better social integration of tetraplegics.

     

透光旋切术与传统手术治疗大隐静脉曲张临床效果对比研究

目的:回顾性分析传统方法与透光旋切术治疗大隐静脉曲张的近期及远期临床效果。方法:将329例患者按采取的手术方式的不同分为传统组与透光旋切术(transilluminated powered phlebectomy,TIPP)组,传统组采用大隐静脉高位结扎+抽剥的方法手术,TIPP组采用大隐静脉高位结扎+曲张静脉透光旋切的方法手术。比较两组平均术中出血量、平均手术时间、平均术后住院时间,术后早期并发症(皮肤麻木、皮下血肿、静脉炎、深静脉血栓形成)的发生率,术后皮肤溃疡愈合情况以及术后复发率(长期随访)等指标。结果:平均术中出血量、平均手术时间及术后早期并发症(皮肤麻木、皮下血肿、静脉炎、深静脉血栓形成)发生率两组无显著差异,TIPP组术后住院时间短、术后皮肤溃疡愈合快、术后复发率低。结论:透光旋切治疗大隐静脉曲张明显优于传统手术方法,具有微创、术后恢复快、术后复发率低等优点,远期临床效果显著,特别适合于静脉曲张严重及合并下肢皮肤溃疡的大隐静脉曲张患者。     

支撑喉内镜下吸引旋切法治疗小儿喉乳头状瘤

目的探讨支撑喉内镜下吸引旋切法治疗小儿喉乳头状瘤的手术效果。方法对39例小儿喉乳头状瘤在支撑喉内镜下采用喉旋切技术治疗,并对其中27例肿瘤范围较广泛,创面容易出血或易形成喉粘连的患儿结合射频治疗。结果手术时间(11.2±2.6)min,出血量<30ml。术后3个月28例发音质量良好。37例随访2~5年,3年复发率51%(19/37),其中初发患儿复发率30%(3/10),复发患儿再次复发率59%(16/27)。结论采用喉内镜下喉旋切术,可以精确切除肿瘤,最大可能保留正常的喉黏膜,手术出血少,时间短,术后住院时间短,疗效确切。