Left Ventricular Transvenous Electrode Dislodgement After Mustard Repair for Transposition of the Great Arteries

An 11-year-old girl who underwent Mustard's operation for complete transposition of the great arteries in infancy, developed Mobitz type II second-degree AV block 81/2 years later. A transvenous, active fixation left ventricular lead was inserted and connected to a rate responsive pacemaker. Two years later the lead dislodged due to the child's growth. A new active fixation electrode was positioned in the left ventricle below the pulmonary valve, leaving an electrode loop in the ventricle. Such an approach may prevent lead dislodgement due to growth after intraatrial repair for transposition of the great arteries, but regular radiological or echocardiographic follow-up of lead position is recommended in these patients.     

Epiploic appendagitis and omental infarction: pitfalls and look-alikes

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders frequently mimic symptoms of an abdominal surgical emergency, often leading to clinical misdiagnosis of appendicitis or diverticulitis. Because a misdiagnosis can result in an unnecessary laparotomy, a correct diagnosis is of great importance. Ultrasound and computed tomography can be used to make a reliable diagnosis. This pictorial essay illustrates the various ultrasonographic and computed tomographic appearances of epiploic appendagitis and omental infarction and focuses on their radiologic differential diagnoses and pitfalls. Received: 22 February 2001/Accepted: 18 April 2001     

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap

Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques. Received: 19 January 1996/Accepted: 26 August 1996     

桡神经移位术在肱骨中下段骨折内固定中的解剖与临床应用

目的:通过对肱骨中下段和桡神经的解剖观测,设计桡神经移位术,为肱骨中下段骨折内固定术中或术后取内固定物避免损伤提供解剖学依据。方法:采用解剖学技术,对15具10%甲醛固定的成人男性尸体30侧上肢桡神经的走行、分支与肱深血管的关系进行了解剖观察与测量,同时对100侧干燥肱骨的长度、桡神经沟长度及桡神经走行的角度(桡神经沟与肱骨纵轴夹角)进行观测,并将其结果进行统计学处理后应用于桡神经移位术的方案设计及实施。结果:①骨标本测量:肱骨平均长度左侧为(30.60±1.46)cm(27.80～33.00cm),右侧为(31.38±1.23)cm(29.20～33.70cm);桡神经沟平均长度左侧为(56.52±10.13)mm(43.82～75.68mm),右侧为(65.74±5.80)mm(55.42～78.82mm);桡神经走行的平均角度左侧为(13.00±1.08)°(10.00°～13.50°),右侧为(13.86±0.97)°(10.50°～14.50°)。②尸体标本观察:桡神经走行中的角度:桡神经在桡神经沟内由内上斜向外下方,穿过外侧肌间隔后行向内下方,形成向内开放的钝角。角度明显29侧(占96.67%);不明显1侧(占3.33%)。③桡神经分为浅深支的位置:在肱骨内外上髁连线(髁间线)以上17侧(占56.67%),在髁间线以下10侧(占33.33%),平髁间线3侧(占10.00%)。④从桡神经出口到桡神经分叉的平均距离(弧距)为(14.26±1.01)cm(12.80～19.20cm)。⑤桡神经和相邻肱深血管的关系:桡神经在肱深血管内侧12侧,在肱深血管外侧10侧,和肱深血管相交叉8侧。⑥临床56例肱骨中下段骨折患者,行桡神经移位术后肱骨中下段骨折内固定,骨折全部愈合,无桡神经损伤等并发症。结论:桡神经移位术设计合理,符合桡神经的解剖生理,为肱骨中下段骨折进行各种内固定提供了更大的操作空间,减少了术中或术后(取内固定时)桡神经再损伤的发生,且不增加手术难度和损伤,是一种理想的术式。     

完全型大动脉错位伴室间隔缺损、肺动脉狭窄的外科治疗

治疗完全型大动脉错位伴室间隔缺损、肺动脉狭窄(TGA/VSD,PS)的手术方式有Rastelli手术、Lecompte手术、Nikaidoh手术、Yamagishi手术以及动脉转位 左心室流出道扩大术等多种术式,Rastelli手术和Lecompte手术损伤小,但远期并发症多;Nikaidoh手术和Yamagishi手术解剖纠治完全,但手术损伤大;动脉转位术 左心室流出道扩大术适应证相对较狭窄。因此,在TGA/VSD,PS的外科治疗上,应根据患者的自身情况和手术指征采取不同的手术方法。现对上述手术术式的优缺点、适应证、禁忌证、疗效和展望进行综述。     

直肠癌根治会阴部造口术后二期股薄肌移植肛门成形

目的　回顾性总结32例直肠癌根治会阴部造口术后二期股薄肌移植肛门成形术的治疗效果。方法　采用Williams 5级评分法对重建前后肛门功能进行评价。结果　二期股薄肌移植肛门成形术前,32例患者肛门功能均在4级以上[4级28.4%(9/32),5级71.6%(23/32)],二期股薄肌移植肛门成形术后肛门功能明显好转。结论　二期股薄肌移植肛门成形术是直肠癌根治会阴部造口术后有效的肛门重建手段。     

Accessory Scrotum with Penoscrotal Transposition and Retrocerebellar Arachnoid Cyst: A Case Report

A 2-year-old boy presented with an accessory scrotum associated with penoscrotal transposition and a perineal lipoma. He also had a retrocerebellar arachnoid cyst. The accessory scrotum was resected with concurrent scrotoplasty. The retrocerebellar arachnoid cyst was seen on a subsequent brain computed tomography scan and was left untreated because there was no evidence that the volume was increasing.     

Demonstration of the Feasibility of Implantation of a Skeletal Muscle Pulse Generator for Fecal Incontinence in a Patient with an Implanted Unipolar DDD Pacemaker

Electromagnetic fields and myopotentials from skeletal muscle may interfere with the function of a cardiac pacemaker. A 65-year-old woman with a unipolar DDD cardiac pacemaker underwent dynamic graciloplasty (transposition of the gracilis muscle around the anal canal and subsequent implantation of a bipolar pulse generator to stimulate the gracilis muscle), for the treatment of fecal incontinence. This gracilis pulse generator is turned "off" with an external magnet to allow defecation. Appropriate functioning of these two pulse generators (the cardiac pacemaker and the gracilis pulse generator) was tested during implantation of the gracilis pulse generator and afterwards. It was demonstrated that the combination could be used safely in this patient.     

骨间前血管腕背支骨膜瓣移位修复骨不连的临床应用

报道用骨间前血管腕背支骨膜瓣移位修复骨不连、骨坏死的手术方法及疗效。方法：根据应用解剖学研究，设计以骨间前动脉腕背支为蒂的骨膜瓣，顺行移位修复尺、桡骨骨不连，逆行移位修复手舟骨、月骨不连与骨坏死。结果：临床应用19例，随访1年，在术后3～6月均达到骨愈合和骨坏死修复，关节活动功能明显改善。结论：骨间前血管腕背支为蒂的骨膜瓣移位术适合邻近骨不连、骨坏死修复。