脉络膜脱离型视网膜脱离的手术治疗

1999年2月至2002年4月,我们共收治脉络膜脱离型视网膜脱离患者23例,均行手术治疗,效果满意。现报告如下。1 资料与方法1.1 临床资料 本组男16例,女7例;年龄9～67岁,平均43岁;右眼10例,左眼13例;病程半天至3个月。发病原因为人工晶体置入术后5眼,眼外伤2眼,先天性脉络膜缺损及糖尿病视网膜病变玻璃体积血玻切术后各1眼。14眼伴有不同程度的近视。以马蹄形裂孔为主10眼,巨大裂孔2眼。

Treatment of extremely-lateral lumbar disc herniation with METRx through intertransversal route

Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conclusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory results are obtained.

Effects of cardiopulmonary bypass on endothelial cell injury

Objective: To observe the changes of plasma concentrations of endotoxin, soluble intercellular adhesion molecule 1, tumor necrosis factor α, and urinary microalbumin in children undergoing cardiac procedure and to study the effects of cardiopulmonary bypass (CPB) on the injury or activation of endothelial cells and vascular permeability. Methods: Twenty children undergoing cardiac operation with CPB were selected in the study. Plasma concentrations of endotoxin, soluble intercellular adhesion molecule 1, tumor necrosis factor α, and urinary microalbumin were measured after anesthetic induction (baseline), bypass for 20 minutes, at the end of CPB, and at 2, 4, and 18 h after the end of CPB. Results: The plasma concentrations of endotoxin, soluble intercellular adhesion molecule 1, and urinary microalbumin began to increase at 2 h after the end of CPB, and remained higher than that of the baseline, while the concentration of tumor necrosis factor α increased only at the end CPB and at 2 h after the end of CPB. Conclusion: Cardiopulmonary bypass can induce inflammatory response, resulting in the activation or injury of vascular endothelial cells, and can increase the vascular permeability.

下方孔源性视网膜脱离手术治疗的进展

孔源性视网膜脱离(RRD)是常见的急性致盲性眼部疾病,若不及时治疗,将严重影响患者的生活及工作。与上方裂孔引起的孔源性视网膜脱离相比,下方孔源性视网膜脱离术后复发率较高。因此,选择适当的手术方式对患者至关重要。本文中笔者对下方孔源性视网膜脱离手术治疗的进展进行综述。

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar, sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

Effects of preoperatively selected gut decontamination on cardiopulmonary bypass-induced endotoxemia

Objective ： To evaluate the influence of preoperatively selected gut decontamination （SGD） on intestinally derived endotoxemia （ETM） in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulinonary bypass （ CPB ） . Methods ： Thirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i. e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 ing garlicin and 20 % Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levds of endotoxin, D-lactate, TNF-α and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded. Resnits - Aerobic gram-negative bacilli （AGNB） ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group （ P 〈 0.05 ）. The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB （P 〈 0. 05 ）. Endotoxin levels of patients in both groups elevated significantly after CPB （P 〈0.05 ）, and endotoxin levels of the patients in SGD group decreased significantly at points ofCPBend （P〈0.01） and 24 h after CPB （P〈0.05） compared with those in control group. The levels of TNF-α and complement 3 were similar in both groups as well as clinical and biochemical markers. Conclusions： CPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.

The role of visceral adipose tissue on improvement in insulin sensitivity following Roux-en-Y gastric bypass:a study in Chinese diabetic patients with mild and central obesity

Background:Most Chinese patients with type 2 diabetes mellitus(T2DM)have mild obesity and central obesity.Central obesity is combined with insulin resistance.The aim of this study was to assess the effect of abdominal adipose tissue on insulin-sensitivity improvement after Roux-en-Y gastric bypass(RYGB)in Chinese diabetic patients with mild and central obesity.Methods:Seventeen T2DM patients with a mean body mass index of 30.3 kg/m^(2) were scheduled for laparoscopic RYGB.A hyperinsulinemic-euglycemic clamp and dual-energy X-ray absorptiometry were performed prior to surgery and 3 months after RYGB.The primary end points were the correlations between insulin sensitivity and abdominal adipose tissue,including visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT),before and 3 months after RYGB.Results:Indices of peripheral insulin sensitivity,including glucose-disposal rate(M value)and glucose infusion rate,were significantly increased after RYGB.Body-fat mass,VAT and SAT were significantly reduced after RYGB.The pre-operative M value was significantly correlated with VAT mass(r=–0.57,P=0.02),but not correlated with SAT mass.M value changes after RYGB were highly correlated with changes in VAT mass(r=–0.59,P=0.01),percentage of VAT mass(r=–0.66,P<0.01),VAT area(r=–0.56,P=0.02)and percentage of VAT area(r=–0.57,P=0.02).Conclusions:A significant correlation was observed between increased peripheral insulin sensitivity and decreased VAT following RYGB in Chinese patients with mild and central obesity.VAT and SAT were significantly decreased with improved insulin sensitivity after RYGB.VAT mass may be considered as an indication for gastric bypass during patient selection.