中西医结合治疗感染性骨缺损

采用一期完成彻底病灶清除和骨组织修复的手术方法,治疗慢性创伤性骨髓炎所致骨缺损50例,成功46例,失败4例,成功率为92％。经6个月～7年随访,功能恢复满意,无1例骨髓炎复发。认为应用显微外科技术提供的复合组织体积大、血运丰富、抗感染能力强,能满足骨缺损修复的需要,是治疗感染性骨缺损的新途径;中西药联合应用控制感染可提高疗效。     

催乳素垂体腺瘤经蝶显微外科治疗

目的 探讨催乳素垂体腺瘤经蝶显微手术的治疗效果。方法 总结１１９例催乳素垂体腺瘤采取经蝶显微手术的治疗安全性与远期疗效。本组女１０７例,男１２例。年龄１３～５６（平均３６．７）岁。术前均经ＣＴ扫描中ＭＲＩ确诊,其中大腺瘤１５例（１２．６１％）,微腺瘤１０４例（８７．４％）。手术采取经唇下－鼻中隔－蝶窦入路行肿瘤切除术。结果 术后并发症少,无死亡。１０３例（８６．６％）行随访观察,随访期６月～７．５     

以颅脊管型肿瘤为表现的成人第四脑室巨大室管膜瘤的手术治疗

目的 探讨第四脑室巨大室管膜瘤的影像学特征、手术切除情况及预后。方法 回顾性分析了22例疝入颈椎管的巨大四脑室室管膜瘤病人的临床资料。所有病人术前均进行了磁共振成像(MRI)检查,16例还进行了CT检查,所有肿瘤除占据四脑室外,还经四脑室正中孔疝入颈椎管,深达C2或C3平面。结果 所有病人接受枕下和C13后正中入路肿瘤切除术,全切除20例,近全切除2例,术后6例病人接受放疗。平均随访5．5年,1例复发又行手术切除,其他病人无复发,5年存活率100％,所有病人均恢复正常工作和生活。结论 颅脊管型四脑室巨大室管膜瘤是一种预后较好的肿瘤,手术全切除率高,复发率低,术后结合放疗可以获得理想的预后。     

Rate of vasospasm following the transsylvian versus transcortical approach for selective amygdalohippocampectomy

Abstract

Affection of the cerebral circulation following the extraaxial transsylvian approach has been reported. This study aims at the comparison of the risk for the development of vasospasm in the transparenchymal transcortical versus the transsylvian approach for selective amygdalohippocampectomy in patients with Ammon's horn sclerosis. n = 80 consecutive patients (13–58 years) were randomized and allotted to either the transsylvian (TS) or transcortical (TC) group. Bilateral middle cerebral arteries (MCA) and internal carotid arteries (ICA) were examined with transcranial Doppler pre-operatively, and from post-operative day 1 to 7. Blood flow velocities (BFV) were compared via ANOVA. Post-operatively, ipsilateral (= side of operative approach) mean BFV increased significantly in both groups with a mean ipsilateral increase of 79.2% in the TS group, and 48.8% in the TC group. This intergroup difference was also statistically significant. In addition, contralateral BFV increased significantly to a maximum mean of 26.3% in the TS group with no significant increase in the TC group. The results in the TS group are interpreted as vasospasm and not hyperemia – due to dissection of the sylvian vessels and the breakdown of blood within the basal cisterns. Factors such as the extent of visual field cuts and results from neuropsychological testing must be taken into account before drawing a conclusion leading to a fundamental change in surgical strategy.     

Latent prolactinoma on MRI-selective venous sampling and trans-sphenoidal microsurgical treatment

Abstract

Bilateral and simultaneous selective venous sampling from the cavernous sinus, inferior petrosal sinus, jugular vein and peripheral vein was performed in 13 patients with hyperprolactinemia in whom dynamic magnetic resonance imaging failed to reveal pituitary adenoma. The prolactin level in peripheral veins of the patients on admission ranged from 35 to 141 ng ml^-1, with a mean value of 69 ng ml^-1. All patients showed disturbance of menstruation or galactorrhea. The indication for surgery in the present study was extremely rare; the patients each wanted to become pregnant and had an intolerance of dopamine agonists. Trans-sphenoidal surgery was performed based on the results of selective venous sampling. The postoperative levels of prolactin were normalized in nine of the patients and normal pituitary function was preserved after surgery. The present study revealed a correspondence of laterality of the peak prolactin level with the main tumor location in patients with latent prolactinoma. However, the tumor/nontumor ratio did not necessarily coincide with the pattern of tumor location, and tumor location was accurately predicted in only 70% of the cases. Selective venous sampling directly from central veins is useful for diagnosis of microprolactinoma. [Neurol Res 2001; 23: 691-696]     

Medial thigh lift free flap for autologous breast augmentation after bariatric surgery

Background: Massive weight loss following bariatric surgery frequently results in body contour deformities like ptotic and hypoplastic breasts, redundant abdominal tissue and loose skin especially in the medial thigh area.This redundant tissue can be used for breast augmentation in the case of hypertrophic ptotic breasts. Method: In 3 patients who underwent a vertical banded gastroplasty and consecutively lost more than 60% of their body weight, a breast augmentation with a transverse gracilis myocutaneous free flap was performed. Results: Bilateral myocutaneous gracilis free flap breast augmentation resulted in an esthetic, pleasing result, with additional correction of the redundant skin from the medial thigh region. Conclusion: Autologous breast augmentation with a simultaneous medial thigh lift can be performed safely, after successful weight loss following bariatric surgery.