鼓膜贴补术治疗外伤性鼓膜穿孔30例

目的探讨鼓膜贴补术治疗外伤性鼓膜穿孔的疗效。方法对外伤性鼓膜穿孔患者48例(48耳)随机分为两组,进行治疗。治疗组30例,鼓膜穿孔后,一周内使用百多邦药膏浸渍片贴补;对照组保守治疗。统计学处理采用x2检验。结果治疗组平均愈合时间12 d,愈合率100%;对照组16.5 d,愈合率为92%,有显著性差异(P<0.05)。治疗组均未发生感染,对照组有两耳继发感染,有显著性差异(P<0.05)。结论鼓膜贴补术治疗外伤性鼓膜穿孔可提高听力,促进鼓膜早期愈合,避免继发性感染,操作简便、安全有效。

外伤性急性硬膜下血肿126例

目的探讨外伤性急性硬膜下血肿的临床疗效。方法回顾性分析经标准大骨瓣开颅血肿清除术治疗因外伤性急性硬膜下血肿患者126例临床资料。结果 126例患者,恢复良好97例,中残12例,植物状态或重残11例,。死亡6例,死亡率5%,结论根据患者病情及时选择不同治疗方法,一旦发现有手术适应证立即在患者瞳孔散大或昏迷前采取手术治疗。

外伤性黄斑裂孔

外伤性黄斑裂孔主要是由眼球钝挫伤所致的黄斑中心凹区的视网膜裂孔，在组织学上是从内界膜到感光细胞层的部分或全部组织缺损。外伤性黄斑裂孔的病因明确，但目前对其发病机制及治疗方法一直存在争议。国内相关的研究较少，本文对本病的发病机制、临床特征、自然病程和治疗方法进行综述。

Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery

atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.

A case of malignant fibrous histiocytoma of the head after trauma and radiation therapy

Malignant fibrous histiocytoma(MFH) firstly described as"malignant fibrous xanthoma"by O' Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life.Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity.MFH only rare arises from structures of the head and neck.When it does, it most often originates in facial structures, particularly the maxilla.This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes.Radical excision was a surgical challenge because of the extensiveness of the lesion.

AN EXPERIMENTAL STUDY OF THE TUMOUR NECROSIS FACTOR LEVELSIN AQUEOUS HUMOR AFTER TRAUMATIC CATARACT AND INTRAOCULAR LENS IMPLANTATION

Purpose. This paper studies the tumour necrosis factor (TNF) levels in aqueous humor after traumatic cataract extraction and posterior chamber (PC) intraocular lens (IOL) implantation in rabbits,and discusses the effect of TNF on postoperative anterior ocular inflammation. Methods. Twenty seven pigmented rabbits were divided into three groups: for the first group, the IOL were placed in the capsular bag after traumatic cataract extraction; for the second, the Extracapsular cataract extraction without IOL implantation; and for the third, the control group without surgical intervention. On the 1st, 3rd, 7th and 14th day postoperatively, aqueous humor samples were obtained. A modified double antibodies indirect sandwich ELISA was used to detected for the presence of TNF. The data were studied by means of analysis of variance in SAS software. Result. The TNF level was increased in aqueous humor and reached its maximum on the 1st postoperative days after traumatic cataract extraction and PC IOLs implantation, and the TNF levels are significantly higher (P<0 05) on the 1st, 3rd, 7th and 14th day postoperatively in traumatic cataract extraction and PC IOL implanted group than that in the non surgical intervention group and extracapsular cataract extraction group. Conclusions. The increase of TNF levels had a close relationship with presence of the IOL itself which induces the secretion of TNF. This suggested that TNF as the principal mediators of immunological and inflammatory responses, so that may play critical role in anterior ocular inflammative response after traumatic cataract extraction and IOL implantation.

Circulating endothelial progenitor cells in traumatic brain injury： an emerging therapeutic target？

Traumatic brain injury （TBI） is a major cause of mortality and morbidity in the world. Recent clinical investigations and basic researches suggest that strategies to improve angiogenesis following TBI may provide promising opportunities to improve clinical outcomes and brain functional recovery. More and more evidences show that circulating endothelial progenitor cells （EPCs）, which have been identified in the peripheral blood, may play an important role in the pathologic and physiological anglo-genesis in adults. Moreover, impressive data demonstrate that EPCs are mobilized from bone marrow to blood circula- tion in response to traumatic or inflammatory stimulations. In this review, we discussed the role of EPCs in the repair of brain injury and the possible therapeutic implication for func- tional recovery of TBI in the future.

Retrospective study on the endovascular embolization for traumatic carotid cavernous fistula

Objective： To retrospectively analyze 95 cases of traumatic carotid cavernous fistula treated by endovascular embolization. Methods： From January 1994 to December 2008, 95 patients with traumatic carotid cavernous fistula were treated in our hospital. All patients received selective cerebral angiography through femoral artery catheterization. Accordingly, 89 cases were treated by detachable balloon embolization, 5 by platinum microcoils and 1 by coveredstem, respectively. Results： In the study, 61 cases achieved successful balloon embolization at the first time. Fifty-six cases had multiple balloons due to the big fistula. Nine cases received balloon embolization twice. But among the 5 patients treated with platinum microcoils, one developed slight brainstem ischemia. After operation the patient had herniparesis and swallow difficulty, but gradually recovered 3 months later. No neurological deficits were observed in other cases. All the cases recovered. Eighty-five cases were followed up for 1-15 years and no recurrence was found. Conclusions： The endovascular embolization for traumatic carotid cavernous fistula is minimally invasive, safe, effective and reliable. The detachable balloon embolization is the first choice in the treatment of TCCF.

Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma

Objective：We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.Methods：Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen （15 mg/kg） intravenously after cervical spine immobilization.Then,all the patients underwent plain radiography and computerized tomography of the cervical spine.The outcome measure was the presence of traumatic cervical spine injury.Sixty minutes after acetaminophen infusion,posterior midline cervical tendemess was reassessed.Results：Of 1 309 patients,41 had traumatic cervical spine injuries based on imaging.Sixty minutes after infusion,posterior midline cervical tenderness was eliminated in 1 041 patients,none of whom had abnormal imaging.Conclusion：Patients with cervical spine trauma do not need imaging if posterior midline cervical tendemess is eliminated after acetaminophen infusion.This analgesia could be considered as a diagnostic and therapeutic intervention.

Outcome of 2 284 cases with acute traumatic brain injury

Objective: To analyze the prognosis of 2 284 cases with acute traumatic brain injury and discuss possible methods to improve the outcome of head injuries. Methods: The relationship between trauma cause, trauma severity and management and patients outcome was retrospectively analyzed. Results: Good recovery was achieved in 60.20% , moderate disability was 13.22 %, severe disability 15.24 %, vegetative status 0.31 % and mortality 11.03 %. The mortality was 1.07 % in cases with GCS 15 13, 2.47 % in cases with GCS 12 9, 13.29 % in cases with GCS 8 6, and 57.4 % in cases with GCS 5 3. Conclusions: To prevent hypoxia, remove intracranial hematoma as soon as possible, use standard large traumatic craniotomy and apply mild hypothermia may be useful means for improving the outcome of severely head injured patients.

Endoscopic decompression of the optic canal for traumatic optic neuropathy

Purpose： Traumatic optic neuropathy （TON） is a serious complication of head trauma with the incidence rate of 0.5%-5%. The aim of this study was to investigate the therapeutic efficacy of endoscopic decompression of the optic canal for optic nerve injuries. Methods： In this study, 11 patients treated in our hospital from January 2009 to January 2015 with the visual loss resulting from TON were retrospectively reviewed for preoperative vision, visual evoked potential （VEP） scan, surgical approach, postoperative visual acuity, complications, and follow-up results. Results： All these patients received endoscopic decompression of the optic canal. At the 3-month follow- up, the visual acuity improvement rate of the 11 patients was 45.5%. The vision acuity of 2 cases improved from hand movement to 0.08 and 0.3 after operation. Another patient＇s vision acuity returned to 0.05 compared to light sensation preoperatively. Two cases had finger counting before surgery but they had a vision acuity of 0.4 and light sensation respectively after surgery. However, the other 6 cases＇ vision did not improve after surgery. Conclusion： Endoscopic decompression of the optic canal is an effective way to cure TON. VEP could be used as an important reference for preoperative and prognosis evaluation. Operative time after trauma is only a relative condition that may affect the therapeutic effect of optic canal decompression. Poor results of this procedure may be related to the severity of the optic nerve injury.

A comparative study on therapeutic method of traumatic epidural hematoma

Objective:To explore the therapeutic methods, surgical indications and clinical practice of minimally invasive surgery on traumatic epidural hematoma(EDH). Methods:Retrospective study was made on 135 patients with traumatic EDH admitted into our hospital from June 2002 to August 2005.Sixty-five patients were treated with mini-invasive negative pressure drainage (treatment group),70 patients with comparable condition used traditional craniotomy(control group).The mean time of operation,average days in hospital,expenditure and prognosis of two groups were recorded and analyzed. Results:There was no significant difference in therapeutic efficacy between two groups.Patients in treatment group had a shorter hospital stay and less expenditure than those in control group. Conclusion:Mini-invasive negative pressure drainage is simple,effective,economical and applicable to some traumatic EDH patients.

A successful treatment of traumatic bronchobiliary fistula by endoscopic retrograde biliary drainage

Bronchobiliary fistula（BBF）is a rare condition in which there is a nonnatural communication between the biliary tract and the bronchial trees.It is usually aroused by the complications of hepatic hydatidosis,hepatic amebic,biliary obstruction,trauma,neoplasm and hepatic abscess formation.In this paper,we described a patient suffering from BBF that is secondary to trauma or surgery.Especially,BBF was detected in the left lung.Finally,we managed this case successfully without an open surgery.

Treatment of 209 cases of liver injury

Objective: To summarize the experience of the treatment of traumatic hepatorrhexis. Methods: The clinical data of 209 cases of liver trauma treated in the three affiliated hospitals of the Third Military Medical University from 1989 to 1999 were retrospectively analyzed. Among the 209 patients, 108 ( 51.7 %) had Grade III or more severe liver injury. Operative treatment was performed in 186 cases and preservative treatment in 23. Results: In the operated group, 169 patients were cured. The complications occurred in 18 patients and 17 of them died. In the non operated group, the complications occurred in 22 patients and only 1 of them died. Conclusions: Severe injury and delayed treatment are two major factors leading to death from liver injuries. Surgical intervention is still the principal measure to treat traumatic hepatorrhexis. The indications for non operative treatment should be carefully selected.

Relation between eardrum flap area and healing outcome of traumatic eardrum perforation

Objective： To retrospectively study the clinical effects of eardrum flap area on the healing outcome following traumatic perforation.Methods： Totally 291 traumatic eardrum perforations with in-/everted edges were included in this study. They were randomly divided into three groups and received conservative treatment, epidermal growth factor （EGF） via Gelfoam patching, or edge-approximation plus Gelfoam patching respectively. Patients in each group were further divided into two subgroups according to the eardrum flap area ≤ 1/2 or 〉1/2 of the perforation size. The healing rate and mean closure time after tympanic membrane perforation were evaluated at three months.Results： Of the total 291 participants, 281 were included in the final statistical analysis. The area of curled edge did not affect the healing outcome significantly in any groups （P〉0.05）. The healing rate varied slightly： 90.7% vs 92.3% in spontaneous healing group, 98.2% vs 97.4% in EGF via Gelfoam patching group, and 96.5% vs 100% in edge-approximation plus Gelfoam patching group. In addition, in all groups the area of curled edge did not affect the mean closure time significantly （P〉0.05）. The closure time was （32.3±2.4） d vs （30.6±3.1） d in sponaneous healing group, （13.4±2.5） d vs （13.1± 1.9） d in EGF via Gelfoam patching group, and （11.9±3.1） d vs （12.2±2.1） d in edge-approximation plus Gelfoam patching group.Conclusion： The eardrum flap area of traumatic eardrum perforation does not significantly affect the clinical outcomes.

Emergent treatment of patients with traumatic aorta ruptures

Objective ： To discuss our experience on the diagnosis and treatment of thoracic aorta rupture （TAR） that is one of the main common causes of death in the victims under blunt chest trauma. Methods： Between July 2001 and March 2006, 9 patients （6 men and 3 women, aged from 20 to 54 years ） suffering from acute traumatic aorta rupture after motor vehicle accidents received emergent surgical treatments in our hospital. Based on our experience in the rescue of the first TAR patient we introduced a practical procedure on the diagnosis and treatment of TAR in our department. All the other patients generally followed this procedure. Eight patients received contrast material enhanced helical computerized tomography scan before the operation. The leakage of coustrast medium from the aorta isthmus was found, and diagnosis of TAR was confirmed. Seven patients underwent immediate operation within 14 hours after accidents. One patient was treated on the 5th day of the accident because of delayed diagnosis of aortic rupture. All patients received general anesthesia with double lumen endotracheal tube and normothermic femoro-femoral partial cardiopulmonary bypass, with beating heart and aortic clamping. One patient received simple repair, and others received partial replacement of thoracic aorta with artificial vascular graft. Results： Seven TAR patients were successfully salvaged. Three patients combined brain injury as well as extremitiy hemiplegia before operation. After treatments one was fully and two partially recovered without paraplegia. Conclusions： Proper practical protocol is emphasized for the surgical repair of TAR because it will reduce the mortality of severe blunt chest injury.

Surgical treatment of traumatic lower limb pseudoaneurysm

Objective：To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods：Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement （10 cases）,spring coil embolization （2 cases）,and surgical operation （8 cases）.Surgical operations included pseudoaneurysm repair （2 cases）,autologousvein transplantation （1 case）,and artificial-vessel bypass graft （5 cases）.Results：All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery （P＜0.05）.All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion：Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.