穿刺技术的改进和创新是穴位埋线疗法的第三次飞跃

穴位埋线是长效针灸,是在传统针具和针法基础上建立和发展起来的,是针灸技术的发展和延伸,穴位埋线的核心技术是穿刺技术,穴位埋线的三大要素中,针具、埋藏物、穿刺技巧之间是互相影响、互相促进的。针具的改进成功实现了穴位埋线疗法的第一次飞跃,埋藏物的改进成功实现了穴位埋线疗法的第二次飞跃,穿刺技术的改进和创新是穴位埋线疗法的第三次飞跃。     

Endocrine evaluation after endoscopic third ventriculostomy (ETV) in children

Objective Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment of obstructive hydrocephalus in children. Main part of the procedure is the perforation of the third ventricle floor (tuber cinereum). This structure is part of the hypothalamic–pituitary neuronal network of cerebral endocrine regulation. There are no systematic data available about the endocrine status after ETV in children. Materials and methods We examined 20 children who had undergone ETV. Examination included laboratory tests (adrenocorticotropic hormone, prolactin, insulin-like growth factor 1 [IGF-1], IGF-binding protein 3 [IGFBP-3], fT3, fT4, thyroid-stimulating hormone [TSH], serum osmolarity, electrolytes, glucose, urea, follicle-stimulating hormone [FSH] and luteinizing hormone [LH], and testosterone in selected patients), measurement of weight, height, and head circumference, and physical examination. The study was approved by the Ethics Committee of the Medical Faculty of Kiel University. Results In seven patients, prolactin was moderately elevated. One patient demonstrated a significantly increased prolactin (56.3 ng/ml). In all eight patients, this was the only laboratory value that was out of the normal range; all other parameters were normal. Three other patients showed one abnormal parameter (decrease in FSH and LH, increase in TSH, decrease in IGF-1 and IGFBP-3). In nine patients, weight or height was not within the 3rd to 97th centiles for age. Discussion and conclusion More patients than expected demonstrated endocrine laboratory abnormalities. However, there was no clinical relevance in any of the studied patients. It remains inconclusive whether ETV contributes to the abnormalities of prolactin levels or to other endocrine parameters in pediatric patients. Longitudinal studies are necessary to delineate the effect of ETV on endocrine regulation. Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18 June 2005.     

Early results of immediate repair of obstetric third-degree tears: 65% are completely asymptomatic despite persistent sphincter defects in 61%

OBJECTIVE: The outcome of immediate repair of obstetric third-degree tears is poorly documented. Immediate repair may give better functional results than delayed repair because scarring is reduced. This aim of this prospective study was to examine the early outcome of immediate repair of third-degree tears. METHOD: A total of 121 women who had immediate repair of obstetric third-degree tears underwent interview, anal ultrasonography and anorectal physiology. RESULTS: At review, 79 (65%) were completely asymptomatic (score = 0), 23 (19%), had minor flatus incontinence or mild urgency causing no compromise to their quality of life (score 1-4), and 19 (16%) had clinically embarrassing faecal incontinence (score 5-24). Thirty-nine (32%) had an intact internal anal sphincter (IAS) and external anal sphincter (EAS) (i.e. a successful repair), eight (7%) had a defect in the IAS alone but the EAS was intact (i.e. a successful repair but a residual IAS defect), 43 (35%) had a residual defect in the EAS alone (IAS intact) and 31 (26%) had a persistent defect in the IAS and EAS. Residual defects in either or both of the sphincters were associated with a significantly higher incidence of abnormal resting and squeeze anal pressures. Anal manometry had no correlation with symptoms. The highest proportion of severe incontinence was in those with an IAS defect alone (37%) and when there was a residual IAS and EAS defect (24%). Only 2 of 39 (5%) with an intact IAS and EAS had severe incontinence and only 8 of 43 (18%) with a residual EAS defect alone had severe faecal incontinence. CONCLUSION: These results indicate a good outcome following immediate repair of third-degree obstetric tears and emphasize the role of the IAS in providing continence.     

掌背动脉逆行岛状筋膜瓣修复手部皮肤缺损

目的:介绍掌背动脉逆行筋膜瓣修复手部皮肤缺损的临床应用。方法:采用第二、第三掌背动脉逆行岛状筋膜瓣分别修复手部皮肤缺损10例。皮肤缺损面积2.0cm×3.0cm-3.0cm×5.0cm。结果:10例筋膜瓣移位均成活,效果满意。结论:应用第二、三掌背动脉逆行岛状筋膜瓣移植是治疗手部皮肤缺损一种简单有效的手术方法。     

神经内镜治疗脑室内病变

目的探讨脑室内病变的神经内镜治疗。方法应用神经内镜对68例脑室内病变进行治疗,其中松果体区肿瘤16例,囊性颅咽管瘤15例,丘脑肿瘤14例,脑室内囊肿16例,侵及室管膜下的胼胝体肿瘤3例,侧脑室脉络丛乳头状瘤2例,侧脑室猪囊尾蚴病1例,侧脑室内分流管脱落1例。结果随访17～69个月,56例有效,12例死于肿瘤扩散。无严重并发症。结论对脑室内病变选择性应用神经内镜治疗安全、有效。     

Endoscopic observation of pathophysiology of ventricular diverticulum

Background Although there have been reports dealing with ventricular diverticulum (VD) analyzed by cisternography and computed tomography (CT), those focusing on magnetic resonance imaging (MRI) or neuroendoscopic findings are rare. Case report We present a case of noncommunicating hydrocephalus caused by aqueductal stenosis with cystic lesion located in supracerebellar region. Third ventriculostomy was performed on this case. The conventional CT and MRI were compatible with usual VD, but neuroendoscopic examination suggested otherwise. The endoscopic view inside of the cystic lesion demonstrated passing veins and no membrane. We diagnosed this cystic lesion as a unique subtype of advanced VD mimicking spontaneous ventriculostomy. Endoscopic observation of the cyst was very useful for accurate diagnosis and safe treatment.     

大型颅咽管瘤的显微手术治疗

目的:结合颅底手术入路提高鞍上、三脑室、脚间池大型颅咽管瘤的手术全切除率,提高疗效。方法:采用不同颅底手术入路显微手术切除37例鞍上、三脑室、脚间池大型颅咽管瘤。结果:肿瘤全切除35例,次全切除2例。术中解剖保留垂体柄31例,所有患者术后伴有不同程度一过性尿崩、动眼神经麻痹10例。全部病例平均随访3年,复发1例。结论:对位于鞍上、三脑室和脚间池的大型颅咽管瘤应根据肿瘤的不同生长方向采用相应的手术入路,充分暴露鞍区各脑池、视神经、前循环及其穿通支和三脑室底部等结构,对脑组织和脑神经牵拉小,术后并发症少且易控制,可取得较好的手术治疗效果。     

Recurrent sleep attacks associated with a craniopharyngioma

Symptomatic narcolepsy, once regarded as common, is now believed to be very rare. A 32-year-old man had a history of recurrent sleep attacks. A magnetic resonance imaging scan revealed a third ventricle tumor. The tumor was totally removed, and the histology was a craniopharyngioma. The symptoms ceased after the operation. The chronological correlation and the anatomical location of the tumor suggest that the patient had a symptomatic narcolepsy caused by the tumor. This is the first report that documents the cessation of narcolepsy attacks after tumor removal.     

正常足月孕妇骨矿物质含量的测定

用单光子吸收法对足月孕妇尺、桡骨骨矿物质含量（ＢＭＣ）、骨面密度（ＢＭＣ／ＢＷ）进行测定及作血清钙、磷的生化测定。结果显示：足月孕妇的尺、桡骨骨矿物质含量、骨面密度明显低于同年龄组的未孕妇女。主要因为妊娠胎儿的骨胳生长发育，需要孕妇向胎儿输送大量的钙离子，若母亲对钙摄入不足或吸收不良，则造成孕妇的骨矿物质含量降低，骨质疏松；而孕妇血清钙、磷降低不明显。