Purpose: The ubiquitous use of synthetic materials in hernia surgery has brought about a new clinical syndrome: Surreptitious Irreversible Neuralgia (SIN). It is surreptitious because it is of slow onset, unsuspected ...Purpose: The ubiquitous use of synthetic materials in hernia surgery has brought about a new clinical syndrome: Surreptitious Irreversible Neuralgia (SIN). It is surreptitious because it is of slow onset, unsuspected and enigmatic to clinicians;irreversible because the pain is progressive, unrelenting and unresponsive to treatment. Removal of the mesh does not guarantee pain relief. Neuralgia following mesh insertion, when it occurs, remains a poorly understood phenomenon. Methods: Ten specimens in each group: virgin tissue, scar tissue and explanted mesh from the posterior inguinal wall were examined histologically to assess nerve density, nerve size and nerve and vessel ingrowth into the deformed mesh and within its pores. Results: There was no significant difference in nerve density between virgin, scar and mesh samples. All of the explanted meshes had nerves within the scar tissue encasing the mesh (interstitial infiltration). Nerve ingrowth through the pores of the mesh (micro-entrapment) was detected in 90% of the explanted mesh specimens. Additionally, nerves were detected entrapped within the folds and deformations of mesh explants. Ingrown vessels showed congestion and focal fibrin thrombi. Conclusion: The presence of mesh does not significantly affect nerve density, while the nerves and their terminal ends are in a vulnerable position about the mesh and within its pores. These pores need to be viewed as “mini-compartments” of biological tissue where the vasculature, nerves and their receptors are exposed to potential mechanical and chemical factors: scarring, entrapment, compression, tugging, deformation, contraction, hypoxia/acidosis, inflammation and edema.展开更多
BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety ...BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.展开更多
类固醇激素反应性慢性淋巴细胞性炎症伴脑桥血管周围强化症(chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids)是一种十分罕见的对皮质类固醇激素治疗有效的中枢神经系统炎症性疾病,病...类固醇激素反应性慢性淋巴细胞性炎症伴脑桥血管周围强化症(chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids)是一种十分罕见的对皮质类固醇激素治疗有效的中枢神经系统炎症性疾病,病变主要累及脑桥、小脑及脊髓,病理上以CD3+T淋巴细胞浸润为主,MRI上增强病灶呈“曲线样”、“胡椒盐”样特殊强化,病灶波及幕上很少见,大部分情况病灶位于小脑、脑干,我们报道1例病灶累及丘脑的Clippers综合征患者,结合近年的文献总结Clippers综合征的临床特点、影像学特点、鉴别诊断,提高临床医师对Clippers综合征的认识,做到及早诊断,及早治疗。展开更多
目的探讨两种躯干控制训练方法对脑卒中后遗症期运动功能的康复作用。方法共42例脑卒中患者随机分为对照组和观察组,对照组采用传统躯干控制训练,观察组采用悬吊下躯干控制训练,两组患者均接受其他常规康复训练。分别于治疗前和治疗后2...目的探讨两种躯干控制训练方法对脑卒中后遗症期运动功能的康复作用。方法共42例脑卒中患者随机分为对照组和观察组,对照组采用传统躯干控制训练,观察组采用悬吊下躯干控制训练,两组患者均接受其他常规康复训练。分别于治疗前和治疗后20 d采用躯干控制能力测验(TCT)、功能性步行分级量表(FAC)、Berg平衡量表(BBS)和10 m最大步行速度(10 m MWS)评价运动功能。结果治疗后两组TCT评分(P=0.000)、FAC评分(P=0.000)、BBS评分(P=0.000)和10 m MWS评分(P=0.000)均高于治疗前,观察组TCT评分(P=0.000)、FAC评分(P=0.002)、BBS评分(P=0.000)和10 m MWS评分(P=0.000)亦高于对照组。结论悬吊下躯干控制训练可以有效提高脑卒中后遗症期运动功能。展开更多
This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation(CCSWORFD),retrospectively analyze the cases of CCSWORFD,and evaluat...This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation(CCSWORFD),retrospectively analyze the cases of CCSWORFD,and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD.Twenty four cases of CCSWORFD(19 males and 5 females),all suffering from cervical hyperextension injury,between 45–68(average 59)years old,were operated on by anterior cervical surgery methods.Among these,18 cases had been followed up for 6–24(average 15)months;18 cases,who had anterior decompression and platefixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association(JOA)evaluation(improved scores of cases with titanium mesh bone grafting,t=2.800,P<0.05;improved scores of cases with iliac bone grafting,t=3.270,P<0.05)and reliable reconstruction of cervical spine.The two groups obtained the same curative effect(t=0.470,P>0.05).Most of these cases had degeneration of cervical vertebra.The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord,and earlyfixation for stability of cervical vertebra is better for the recovery of spinal cord injury.Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD,and titanium mesh bone grafting can avoid the trauma of the supplying graft.Mesh bone grafting can also shorten hospital stay.展开更多
文摘Purpose: The ubiquitous use of synthetic materials in hernia surgery has brought about a new clinical syndrome: Surreptitious Irreversible Neuralgia (SIN). It is surreptitious because it is of slow onset, unsuspected and enigmatic to clinicians;irreversible because the pain is progressive, unrelenting and unresponsive to treatment. Removal of the mesh does not guarantee pain relief. Neuralgia following mesh insertion, when it occurs, remains a poorly understood phenomenon. Methods: Ten specimens in each group: virgin tissue, scar tissue and explanted mesh from the posterior inguinal wall were examined histologically to assess nerve density, nerve size and nerve and vessel ingrowth into the deformed mesh and within its pores. Results: There was no significant difference in nerve density between virgin, scar and mesh samples. All of the explanted meshes had nerves within the scar tissue encasing the mesh (interstitial infiltration). Nerve ingrowth through the pores of the mesh (micro-entrapment) was detected in 90% of the explanted mesh specimens. Additionally, nerves were detected entrapped within the folds and deformations of mesh explants. Ingrown vessels showed congestion and focal fibrin thrombi. Conclusion: The presence of mesh does not significantly affect nerve density, while the nerves and their terminal ends are in a vulnerable position about the mesh and within its pores. These pores need to be viewed as “mini-compartments” of biological tissue where the vasculature, nerves and their receptors are exposed to potential mechanical and chemical factors: scarring, entrapment, compression, tugging, deformation, contraction, hypoxia/acidosis, inflammation and edema.
基金Supported by National Natural Science Foundation of China,No.81570483 and 81770541Technology Innovation Project of Chongqing,No.cstc2019jscxmsxmX0227 and cstc2015shmszx120109.
文摘BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.
文摘类固醇激素反应性慢性淋巴细胞性炎症伴脑桥血管周围强化症(chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids)是一种十分罕见的对皮质类固醇激素治疗有效的中枢神经系统炎症性疾病,病变主要累及脑桥、小脑及脊髓,病理上以CD3+T淋巴细胞浸润为主,MRI上增强病灶呈“曲线样”、“胡椒盐”样特殊强化,病灶波及幕上很少见,大部分情况病灶位于小脑、脑干,我们报道1例病灶累及丘脑的Clippers综合征患者,结合近年的文献总结Clippers综合征的临床特点、影像学特点、鉴别诊断,提高临床医师对Clippers综合征的认识,做到及早诊断,及早治疗。
文摘目的探讨两种躯干控制训练方法对脑卒中后遗症期运动功能的康复作用。方法共42例脑卒中患者随机分为对照组和观察组,对照组采用传统躯干控制训练,观察组采用悬吊下躯干控制训练,两组患者均接受其他常规康复训练。分别于治疗前和治疗后20 d采用躯干控制能力测验(TCT)、功能性步行分级量表(FAC)、Berg平衡量表(BBS)和10 m最大步行速度(10 m MWS)评价运动功能。结果治疗后两组TCT评分(P=0.000)、FAC评分(P=0.000)、BBS评分(P=0.000)和10 m MWS评分(P=0.000)均高于治疗前,观察组TCT评分(P=0.000)、FAC评分(P=0.002)、BBS评分(P=0.000)和10 m MWS评分(P=0.000)亦高于对照组。结论悬吊下躯干控制训练可以有效提高脑卒中后遗症期运动功能。
文摘This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation(CCSWORFD),retrospectively analyze the cases of CCSWORFD,and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD.Twenty four cases of CCSWORFD(19 males and 5 females),all suffering from cervical hyperextension injury,between 45–68(average 59)years old,were operated on by anterior cervical surgery methods.Among these,18 cases had been followed up for 6–24(average 15)months;18 cases,who had anterior decompression and platefixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association(JOA)evaluation(improved scores of cases with titanium mesh bone grafting,t=2.800,P<0.05;improved scores of cases with iliac bone grafting,t=3.270,P<0.05)and reliable reconstruction of cervical spine.The two groups obtained the same curative effect(t=0.470,P>0.05).Most of these cases had degeneration of cervical vertebra.The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord,and earlyfixation for stability of cervical vertebra is better for the recovery of spinal cord injury.Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD,and titanium mesh bone grafting can avoid the trauma of the supplying graft.Mesh bone grafting can also shorten hospital stay.
