Successful laparoscopic cholecystectomy for acute cholecystitis with kyphoscoliosis by the devised placement of trocar ports: A case report

IntroductionKyphoscoliosis, which is a deformity of the spine caused by aging and osteoporosis, results in various surgical difficulties for laparoscopic cholecystectomy (LC) due to low-lying costal arches, such as a small abdominal working space, disturbance of the surgical view and decreased controllability of the surgical instrument.Presentation of caseWe herein report the case of a 92-year old woman with severe kyphoscoliosis who was diagnosed with Grade II acute cholecystitis. Taking her general status into consideration, emergency percutaneous transhepatic gallbladder drainage (PTGBD) was initially performed. After PTGBD, the patient’s physical status and systemic inflammation markedly improved. She then underwent interval LC. The surgical view of the upper abdomen including the gallbladder was entirely interrupted by bilateral low-lying costal arches with adhesion to the greater omentum. To access the gallbladder without interruption by the low-lying costal arch, the first umbilical port was changed to a multi-port with surgical glove and an additional port was added in the left abdomen. Consequently, LC was safely accomplished with the creation of the critical view.DiscussionA low-lying costal arch due to kyphoscoliosis can prevent surgeons from accessing the gallbladder. LC with the standard 4-port method could not be accomplished because of insufficient lifting of the low-lying costal arch. Devised placement of the ports is needed to access the gallbladder between bilateral low-lying costal arches.ConclusionA transumbilical multi-port and left abdominal port may be effective for successful LC of acute cholecystitis with kyphoscoliosis.     

Characterization of costal cartilage and its suitability as a cell source for articular cartilage tissue engineering

Costal cartilage is a promising donor source of chondrocytes to alleviate cell scarcity in articular cartilage tissue engineering. Limited knowledge exists, however, on costal cartilage characteristics. This study describes the characterization of costal cartilage and articular cartilage properties and compares neocartilage engineered with costal chondrocytes to native articular cartilage, all within a sheep model. Specifically, we (a) quantitatively characterized the properties of costal cartilage in comparison to patellofemoral articular cartilage, and (b) evaluated the quality of neocartilage derived from costal chondrocytes for potential use in articular cartilage regeneration. Ovine costal and articular cartilages from various topographical locations were characterized mechanically, biochemically, and histologically. Costal cartilage was stiffer in compression but softer and weaker in tension than articular cartilage. These differences were attributed to high amounts of glycosaminoglycans and mineralization and a low amount of collagen in costal cartilage. Compared to articular cartilage, costal cartilage was more densely populated with chondrocytes, rendering it an excellent chondrocyte source. In terms of tissue engineering, using the self‐assembling process, costal chondrocytes formed articular cartilage‐like neocartilage. Quantitatively compared via a functionality index, neocartilage achieved 55% of the medial condyle cartilage mechanical and biochemical properties. This characterization study highlighted the differences between costal and articular cartilages in native forms and demonstrated that costal cartilage is a valuable source of chondrocytes suitable for articular cartilage regeneration strategies.     

自体肋软骨联合硅胶假体鼻整形效果探讨

目的:探讨自体肋软骨联合硅胶假体在鼻整形中的应用效果。方法:回顾性分析2015年5月-2017年5月笔者医院接受鼻整形的105例就医者临床资料,通过治疗方式不同分为观察组55例和对照组50例,对照组使用硅胶假体隆鼻,观察组使用自体肋软骨联合硅胶假体隆鼻,比较两组手术情况、鼻部塑形效果、二次手术率及并发症发生情况。结果:两组手术成功率、愈合时间比较,差异无统计学意义(P>0.05);观察组手术时间明显长于对照组,差异有统计学意义(P<0.05)。和术后3个月时比较,观察组术后12个月时鼻根高、鼻面角、鼻尖角、鼻额角差异无统计学意义(P>0.05);对照组术后12个月时鼻根高、鼻面角、鼻尖角均明显降低(P<0.05),且术后12个月时,观察组鼻根高、鼻面角、鼻尖角均明显高于对照组(P<0.05)。观察组二次手术率为3.64%(2/55)明显低于对照组的16.00%(8/50),差异有统计学意义(χ^2=4.646,P=0.031)。观察组术后并发症总发生率为14.55%明显低于对照组的32.00%,差异有统计学意义(P<0.05)。结论:和单用硅胶假体相比,自体肋软骨联合硅胶假体用于鼻整形中效果更加显著,具有鼻部塑形效果满意、二次手术率低、并发症少等特点,临床应用价值高。     

自体肋软骨移植外耳再造术中超声引导胸椎旁神经阻滞麻醉的应用

 目的 探讨超声引导胸椎旁神经阻滞在自体肋软骨移植外耳再造术中的应用。方法 选取2018-05至2019-11武警山东总队医院择期行肋软骨移植外耳再造Ⅱ期手术的患儿60例,随机分为单纯全身麻醉组(A组)30例,全身麻醉复合椎旁神经阻滞组(B组)30 例。观察两种麻醉方式在外耳再造术中的麻醉效果、术后镇痛、术中全麻药物用量及术后不良反应等方面的差异。结果 B组术中使用1%异丙酚(725.69±145.50)mg,瑞芬太尼(2129.90±536.72)μg, 明显少于A组异丙酚(914.58±242.41)mg,瑞芬太尼(3266.79±770.64)μg,差异有统计学意义(P<0.05);B组在切皮时(H₂)、取软骨时(H₃)及拔除气管导管时(H₄)的心率和血压、术后6 h内VAS评分均明显低于A组,差异有统计学意义(P<0.05);B组术后苏醒时间(T₀)为(11.53±1.43)min,明显短于A组的(15.00±1.46)min,差异有统计学意义(P<0.05);B组发生心血管、恶心呕吐、便秘等不良反应明显少于A组,差异有统计学意义(P<0.05)。结论 超声引导胸椎旁神经阻滞复合全身麻醉应用于自体肋软骨移植外耳再造术,术中麻醉效果显著,血流动力学更加稳定,全麻药物用量少,术后镇痛效果明显,适合临床应用。     

16排螺旋CT及三维成像在肋软骨骨折诊断中的应用

目的 探讨16排螺旋CT及三维成像在肋软骨骨折诊断中的应用价值。方法 对31例共42处肋软骨骨折采用胸部16排螺旋CT及三维成像技术检查,并对其三维成像资料进行对比分析。结果 三维成像发现31例42处肋软骨骨折,平扫仅发现19例28处肋软骨骨折。CT平扫和三维成像表现特征为肋软骨钙化中断伴明显错位、肋软骨条状高密度影不连续伴明显错位或错位不明显。结论 三维成像对肋软骨骨折诊断有重要价值。     

兔肋软骨膜和肋软骨来源的间充质干细胞的比较

目的 探讨从兔肋软骨膜和肋软骨中分别提取间充质干细胞的方法以及两者间的比较. 方法 取3～4周新西兰大白兔,共20只.酶消化及贴壁培养法分别获取软骨膜细胞和软骨细胞,体外培养观察其生长、形态、表型特征及其诱导成骨、成脂的分化潜能. 结果 从肋软骨膜中分离的原代细胞聚集成团,多为圆形和多边形;从第2代开始细胞以梭形为主,呈漩涡状排列,已传至第15代.从肋软骨中分离的原代细胞连接成片,以铺路石形态为主,第2代和第3代细胞逐渐转变成梭形;但第5代出现细胞老化,只传至第6代.免疫细胞化学染色发现,两种原代细胞均不表达CD29、CD90和CD34,从第2代开始均表达CD29、CD90,仍不表达CD34.原代软骨细胞表达Ⅱ型胶原,第2代细胞弱表达,第3代细胞开始不表达Ⅱ型胶原;而软骨膜细胞不表达Ⅱ型胶原.两种来源的第3代细胞经诱导均可分化为成骨细胞或者脂肪细胞. 结论 从兔肋软骨膜和软骨中均可获得干细胞.软骨细胞在体外可去分化成为干细胞.但软骨膜来源的干细胞的生长明显优于软骨来源的干细胞.     

Reimplantation of an Amputated Hand: Long-term Follow-up Report

A case of nearly total amputation of the right hand is described. The hand was reimplanted with initially good result. A final evaluation of the hand was attempted 6 years following the accident. It is concluded that the unsatisfactory nerve regeneration renders the final result a function failure. However, the psychological and cosmetic effect of a real hand may justify the reimplantation.     

Les fractures du cartilage costal : un diagnostic souvent méconnu

Costal cartilage fracture is a rare misdiagnosed traumatic injury. Its clinical diagnosis is also underestimated. Clinically, it is difficult to differentiate costal cartilage fracture from osseous injuries or injuries of the soft tissues. Radiographs are insensitive for detecting cartilage injury. Sonography, CT, and MRI have been shown to be useful in distinguishing causes of chest wall pain. We report a case of costal cartilage fracture in a 25-year-old man practicing judoka.     

Biomechanical strength of human nasal septal lining: comparison of the constituent layers

OBJECTIVE/HYPOTHESIS: Nasal septal perforation is a common complication following surgery involving the nasal septum. Septoplasty, septorhinoplasty, and submucosal resection may result in the inadvertent resection of perichondrium, which may predispose the patient to septal perforations. STUDY DESIGN: Controlled human cadaver study testing the biomechanical strength of the constituent layers of nasal septal lining. METHODS: Uniform samples of nasal septal mucosa, perichondrium, and a composite of both layers were obtained from five fresh human cadavers. The mechanical tensile strength of these layers was evaluated and compared with the Instron 4301 Mechanical Testing System (Canton, MA). RESULTS: Mixed-effects regression analysis demonstrated a significant difference in the tensile strength of the three groups (mean values +/- SD: mucosa, 662 +/- 308 g; perichondrium, 1370 +/- 798 g; composite, 2340 +/- 1252 g). All three pairwise comparisons among the three groups showed a significant difference in tensile strength. CONCLUSION: The perichondrial layer imparts the majority of the biomechanical strength to septal lining. Lining flaps containing both perichondrium and mucosa are stronger than flaps with either perichondrium or mucosa alone. Dissection in the subperichondrial plane during septal surgery provides a stronger septal flap and may prevent the development of nasal septal perforation during nasal surgery.