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1.
Ludwig Labler Marius Keel Otmar Trentz Michael Heinzelmann 《European spine journal》2006,15(9):1388-1396
The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection. 相似文献
2.
目的通过是否进行腭咽肌肉重建的两组腭裂修复术后患者鼻咽内窥镜的比较观察,了解腭咽部肌肉重建术后腭咽闭合状况的改变。方法将41例腭裂术后患者,按照在腭裂修复时是否进行腭咽肌肉重建分为重建组(22例)和非重建组(19例),以鼻咽纤维内窥镜记录静态和发音时腭咽闭合运动状况,对两组患者腭咽闭合运动类型和状况进行比较。结果重建组静态腭咽腔形态较非重建组明显缩小,各壁光滑丰满,未见软腭鼻腔面V型缺损畸形;动态时以环状闭合为主。非重建组静态腭咽腔形态较大,可见软腭鼻腔面V型缺损畸形;动态时以冠状闭合为主。经比较重建组腭咽闭合良好率(90.91%)明显优于非重建组(37.31%)。结论鼻咽内窥镜观察证实腭咽肌肉重建腭裂修复术后腭咽闭合功能恢复明显优于非重建组。腭裂修复术时重建腭咽肌肉有助于缩小腭咽腔和更易于达到良好的腭咽闭合状态。 相似文献
3.
Cleft closure for the treatment of unhealed perineal sinus 总被引:2,自引:0,他引:2
OBJECTIVE: Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem. METHODS: From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease. RESULTS: Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date. CONCLUSION: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit. 相似文献
4.
Purpose : To compare the clinical application value of Ultrasound biomicrsocpic dark room provocative test with the traditional dark room test in screening primary angle closure glaucoma (PACG).Methods: 22 eyes with PACG in prodromal stage and 30 eyes with deep anterior chamber and wide angle of 15 normal persons were observed in this trail. All 52 eyes were performed traditional dark room provocative test and ultrasound biomicorosopic darkroom test respectively. With different positive diagnostic criteria, the sensitivity of the two methods were compared using chi-squared analysis.Results : After staying in the dark room for 2 hours, In case group, IOP in 10 of 22 eyes rose more than 1. 07kPa(1kPa = 7.5mmHg), in 12 eyes less than 1.07kPa or had no changes; appositional angle closure were found by Goldmann gonioscopy in 8 eyes : 3 eyes in two quadrants, 5 eyes in more than two quadrants; the appositional angle closure was found by UBM in 15 eyes; 3 eyes in one quadrants, 5 eyes in two quadrants, 7 eyes 相似文献
5.
Roopa Thukaram William A Suarez Sreekanthan Sundararaghavan 《Catheterization and cardiovascular interventions》2005,66(1):18-20
A symptomatic 1,400 g premature triplet underwent successful transcatheter coil embolization of patent arterial duct using the umbilical artery. One 3 mm x 3 cm Flipper coil was used with no angiographic residual shunt. To the best of our knowledge, this is one of the smallest preterm infants to undergo this transcatheter procedure. 相似文献
6.
Dr. S. Søresen H. J. Kirkeby H. Stødkilde-Jørgensen J. C. Djurhuus 《Neurourology and urodynamics》1986,5(1):5-16
The pressure variations at the maximal urethral closure pressure (MUCP) were continuously recorded in healthy female volunteers by means of a two-point microtip transducer catheter for one hour. Before the investigation a normal voiding was assured objectively and bladder instability was excluded. All women showed pressure variations both at the MUCP and more distally. The pressure variations, from 3 to 66 cm H2O, showed rhythmicity and three frequency ranges could be identified. Slow pressure waves with a frequency of one in eight to 19 minutes were observed. Relatively fast-pressure waves were observed (one every one to four minutes) and relatively fast-frequency pressure waves were observed (rate: one to eight per minute). The pressure variations of the urethra seem to be an aspect of normal urethral physiology possibly contributing to continence and urinary tract infection prevention. 相似文献
7.
目的观察动脉导管未闭经皮心导管封堵术前后右心血流动力学的变化,评价其临床意义。方法对50例动脉导管未闭儿童患者,在进行介入性经皮心导管封堵术治疗前应用X线降主动脉造影测量前,术后经导管检测右心血流动力学指标变化。结果未闭动脉导管最窄处直径(5.6±1.3)mm;术前肺动脉平均压(19.1±2.3)mmHg,左向右分流量平均为(0.41±0.13)l/min,血流分流量占肺循环血流量的比例平均为(0.17±0.03);术后肺动脉平均压(14.4±1.7)mmHg,左向右分流量平均为(0.03±0.01)l/min,血流分流量占肺循环血流量的比例平均为(0.02±0.01),相应数据比较,差异有统计学意义(P<0.05)。结论动脉导管未闭经皮心导管封堵术前后血流动力学会发生改变,肺动脉平均压,左向右分流量以及分流量占肺循环血流量的比例均会不同程度下降,这种改变可以作为评价介入治疗效果的重要指标。 相似文献
8.
Yutaka Saito Takahisa Matsuda Tsuyoshi Kikuchi Hisatomo Ikehara Toshio Uraoka 《Digestive endoscopy》2007,19(Z1):S34-S39
Endoscopic submucosal dissection (ESD) for colorectal cancer is not widely accepted because of its technical difficulty and the risk of perforation. In addition, the risk of peritonitis cannot be completely eliminated even if a perforation is closed successfully. Reported here are two cases of early colon cancer in which the patients sustained iatrogenic perforations of the ascending colon during conventional endoscopic mucosal resection and of the sigmoid colon during ESD, respectively, requiring abdominal decompression with an 18 G Medicut needle. Both of these perforations were successfully treated by endoscopic clipping. In conclusion, conservative medical management may be possible in patients who have undergone successful closure of colonic perforations using endoscopic clipping. In order to perform immediate endoscopic closure, abdominal decompression has been useful to decrease patient discomfort and colonic lumen collapse. Now, CO2 insufflation is being used effectively for the prevention of pneumoperitoneum. 相似文献
9.
The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in
females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM),
the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were
made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with
surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by
a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA.
During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to
support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure. 相似文献
10.
Temporary closure of the abdominal wall (laparostomy) 总被引:2,自引:0,他引:2
A. Schachtrupp V. Fackeldey U. Klinge J. Hoer A. Tittel C. Toens V. Schumpelick 《Hernia》2002,6(4):155-162
The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment
of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is
temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome.
Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials
are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate
access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of
the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and
to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent
infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use
of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh
after a period of 6–12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of
absorbable mesh material is common and represents the state of the art.
Electronic Publication 相似文献