Infrared laser puncture in the treatment of facial neuritis

Overall eighty-seven patients with facial neuritis [correction of paralysis] received multimodality treatment involving infrared laser acupuncture procedures. The unit "Biomed-001" operating at wavelength 890 nm with intensity 20 mW served as a source of laser light. The acupuncture points (with 10 to 15 points in each treatment session, duration of exposure being 1 to 3 min) were selected according to principles of traditional Chinese medicine. One course of the infrared laser therapy acupuncture treatments is 12 to 16 sessions. The described treatment option applied in the above patients population was associated with a good clinical effect confirmed by results of studies made with the aid of electrophysiological modalities.     

Complications of surgery for discogenic disease of the spine

Disc disease is benign and not life threatening. Its long-term prognosis is uncertain, and spontaneous recoveries are common. The decision to perform surgery thus carries with it a heavy responsibility to provide safe treatment. "Good safe surgical technique" is essential, but it is much more than a well-rehearsed routine procedure. From preoperative evaluation to surgery to postoperative care, the surgeon must look ahead to problems that might arise. Where anticipated risks cannot be avoided, they should be minimized, and when adverse events occur, active recognition will lead to early and accurate management.     

Clinical application of the erbium:YAG laser for apicoectomy

Recently, an Er:YAG laser has attracted attention because of the possibility of cutting hard tissues with extremely small thermal effects. In this article, we report 8 cases (13 teeth) of apicoectomy using Er:YAG laser. All procedures were performed without using an air turbine or an electric drill. Although the cutting speed of this laser was slightly slower than ordinary methods, its clinical application for apicoectomy has many advantages including absence of discomfort and vibration, less chance for contamination of the surgical site, and reduced risk of trauma to adjacent tissue.     

The CO2 laser otoscope. A new application device for paracentesis

The CO2 laser myringotomy is a current low-pain procedure for middle-ear ventilation for secretory otitis media (SOM) that can be performed under topical anesthesia, even in children. The duration of middle-ear ventilation is essentially determined by the size of the perforation created. Perforations with a diameter greater than 2 mm ventilate the tympanic cavity for approximately 3 weeks, thus avoiding tympanic ventilation tubes. To date, the CO2 laser beam can only be reliably applied to the tymapanic membrane via a micromanipulator system coupled to an ear microscope. The CO2 laser otoscope is a new application system that markedly reduces the technical complexity of surgery and improves the mobility and availability of the system. The incorporation of a small inexpensive CO2 laser in the otoscope represents a significant development in SOM therapy.     

The treatment of patients with chronic cerebral circulatory failure by using laser puncture and the microclimate of the biotron

A mode is proposed of treatment of chronic cerebrovascular disorders, such as initial manifestations of cerebral blood supply insufficiency (IMBSI) and dyscirculatory encephalopathy (DE) stage I-II in hypertensive disease, involving the use of laser puncture and microclimate of biotron. All patients (n = 162) were exposed to laser puncture (10-12 procedures). Laser puncture treatments were devised according to classical approaches of reflexotherapy, using determinants of electropuncture diagnostic method by Riodoraku. The treatments were carried out with the aid of infrared portable laser "Biomed-001". IMBSI patients presenting with vegetovascular dystonia and about 70% of IMBSI patients presenting with hypertensive disease derived benefit from a course of laser puncture, as evidenced by REG, EEG, acupuncture diagnosis, iridodiagnosis according. In DE stage I-II patients and about 30% IMBSI patients presenting with hypertensive disease good therapeutic effect occurred after treatment in a ward with a stable microclimate of biotron. The proposed method can be used for treating chronic cerebrovascular disorders and administering stroke prophylaxis.     

多功能穿刺模拟人在诊断学实验教学中的应用

多功能模拟人在诊断学穿刺实验教学中应用.其优势为克服教师教学的单调、呆板和过于抽象缺点;克服学生学习主动性不强、接受知识困难的缺点;能解决典型病例不足、病人配合困难等问题,其不足为在多功能穿刺模拟人所实施的穿刺术有失真现象.     

CT-guided interventional procedures for pain management in the lumbosacral spine

The lumbosacral spine is the source of pain, suffering, and disability more frequently than any other part of the body. Pain in the lower back can be managed with computed tomography-guided analgesic interventional procedures, such as periradicular infiltration, percutaneous laser disk decompression, facet joint block, and percutaneous vertebroplasty. Periradicular injection of steroids provides short-term and sometimes even long-term relief of low back pain. Percutaneous laser disk decompression is used to treat radiculalgia caused by disk herniation. Facet joint block is useful in diagnosis and treatment of facet syndrome. Percutaneous vertebroplasty provides short- and long-term pain relief in patients with vertebral body disease. However, precise patient selection is essential to the success of each of these techniques. The interventional radiologist has an active role to play in minimally invasive management of lower back pain and should be part of an interdisciplinary team that determines the appropriate therapy.     

The safety of brachial artery puncture for arterial blood sampling

OBJECTIVE: This study was designed to determine the incidence of complications in a sample of 6,185 brachial artery punctures for arterial blood gas analysis. METHODS: The study sample was comprised of adult patients who had arterial blood gas analysis ordered in the course of their clinical evaluations in a multispecialty clinic and hospital affiliated with a university school of medicine. Subjects were entered prospectively at the time the procedure was done. RESULTS: The overall incidence of all complications was 2.0%. Immediate limb pain or parenthesias occurred in 1.1%, while the onset of symptoms was delayed up to 24 h in 0.9%. Hematoma formation occurred in only 0.06%. None of the complications was considered to be of major impact, in that none was associated with limb ischemia or other objective abnormalities. Only one subject required analgesic medication to control pain that ultimately subsided spontaneously without deficit. CONCLUSION: We believe that brachial artery puncture, when properly performed, is a safe and reliable alternative route for obtaining arterial blood for gas analysis.     

The contribution of peridurography to the anatomy of the lumbosacral spinal canal

Phonocardiography and echocardiography were used to examine 20 patients with a normally functioning Beall disc mitral valve prosthesis. Phonocardiographic intervals were: Q-S1 interval 67 +/- 3 msec; A2-OC interval 118 +/- 8 msec. Maximal variation of the Q-S1 interval within one examination was 21 +/- 2 msec, for A2-OC interval it was 31 +/- 5 msec. Echocardiographic disc velocities were: opening velocity 296 +/- 30 mm/sec, closing velocity 414 +/- 44 mm/sec. Maximal variation of the opening velocity was 126 +/- 25 msec; maximal variation of the closing velocity was 334 +/- 57 msec. Abnormal poppet function was suspected in one patient with unusual prolongation and variability of A2-OC interval.     

The puncture and catheterization of the peripheral vessels using ultrasonic scanning

1% acetylcholine (5.5 10 M--acetylcholine chloride) applied directly to the cortex of conscious non-immobilized rabbits was established to produce neuroglial reaction in motor area. Following 30 min long application the number of astrocytes was significantly increased. Application lasting for 2 hrs resulted in a reverse effect. The above-mentioned changes were observed in surface and deep cortical layers. They were functional and could be attributed to the cell tinctorial properties.     

The quantitative anatomy of the iliac vessels and their relation to anterior lumbosacral approach

Forty embalmed cadavers (24 men and 16 women) were obtained to evaluate the anatomic features of iliac vessels with respect to the anterior approach to the lumbosacral junction. Through a midline longitudinal incision over the linea aspera and retraction of the intraperitoneal contents, exposure of the abdominal aorta, inferior vena cava, and common iliac vessels was done. Direct measurements regarding the relations of these greater vessels to the sacral promontory were then performed. The results showed the average width of the trigone, measured between the medial edges of the left common iliac vein and the right common iliac artery, was 55.9 mm for male and 55.3 mm for female subjects, respectively. The average height of the trigone, measured from its apex to the sacral promontory, was 36.9 mm for male and 35.2 mm for female subjects separately. The width of the uncovered left common iliac vein averaged 7.2 mm for male and 6.3 mm for female subjects, respectively, with a range of 3-11 mm for both male and female specimens. One should be always aware of the medially placed left common iliac vein and an approach medial to the right common iliac artery to the L5-S1 disk is recommended if anterior surgery is desired.     

Pedicle screw fixation for arthrodesis of the lumbosacral spine in the elderly. An outcome study

STUDY DESIGN: An analysis of the outcome and effectiveness of instrumented arthrodesis of the lumbosacral spine in elderly patients conducted using a review of records, assessment of fusion via plain radiographs, and a two-part questionnaire. OBJECTIVE: To ascertain the outcome and efficacy of instrumented arthrodesis of the lumbosacral spine in patients 60 years of age and older. BACKGROUND DATA: From 1987 to 1991, 38 patients of at least 60 years of age underwent instrumented arthrodesis of the lumbosacral spine using the Wiltse or Selby pedicle screw fixation system (Advanced Spine Fixation Systems, Inc., Irvine, CA). Patients were considered for surgery only after attempts at conservative management, including physical therapy, medication, injection blocks, and home exercises, had proven unsuccessful. METHODS: Follow-up examinations were performed 3 months, 6 months, 1 year, and 2 years after surgery. Fusion was assessed using plain radiographs, including flexion-extension films. Inpatient and outpatient records were reviewed, and a two-part questionnaire was used to establish the effect of surgery on function and lifestyle. Thirty patients responded to the questionnaire. Follow-up observation of the patients ranged from 25 to 56 months. The mean age was 73.8 years (range, 60-90 years). RESULTS: The mean co-morbidity was 1.7. Based on the authors' method of evaluation of fusion, the fusion rate was 92%. Fifty-seven percent of the patients reported excellent or good results, 26% reported fair results, and 17% reported poor results. Functional gains of 50% or more were reported by 71% of the respondents. Female patients had significantly more complications than male patients, but reported comparable outcomes. CONCLUSION: Despite the increase in age, co-morbidity, and associated risk of perioperative complications inherent in this population, an outcome comparable with that of younger patients is reported.     

Superior gluteal vessel as recipient for free flap reconstruction of lumbosacral defect

When the lumbosacral soft-tissue defect cannot be closed with a local flap, the option of a free flap should be considered. However, very few cases of free flaps have been reported, the reason being mainly difficulties in finding a suitable recipient vessel. Several vessels, such as inferior gluteal vessel, extension of thoracodorsal vessel with vein graft were reported as recipient vessels, but each one had its own drawbacks. The superior gluteal vessel has been used as a donor vessel in breast reconstruction after mastectomy but is thought to be undesirable as a recipient for microvascular anastomosis, mainly because of technical difficulty. From May of 1993 to March of 1997, five patients (one man and four women) received microvascular transfer of latissimus dorsi myocutaneous flaps using the superior gluteal vessel as a recipient. Their ages ranged from 11 to 64 years (mean 44 years of age). The causes of lumbosacral defects were tumor (1), trauma (1), radiation (2), and pressure sore (1). Before free flap transfer, the patients received an average of 2.8 operations for sacral lesions. Mean follow-up period was 12.4 months (2 to 40 months). A lateral approach was used to the superior gluteal vessel after elevation and retraction of gluteus maximus muscle. A thoracodorsal artery and vein were anastomosed to superior gluteal artery and vein in three cases, whereas in two cases, one artery and two veins could be anastomosed. All the flaps survived with complete recovery from sacral lesions. During the follow-up period, one case of partial skin graft necrosis and one case of a small superficial pressure sore developed, but there was neither dehiscence nor recurrence. The superior gluteal vessel is large in caliber, constant, with numerous branches, lying in proximity to the lesion, and relatively unaffected despite previous radiation. The technical difficulties with the deep location and short pedicle length can be overcome with some modifications in approach to the vascular pedicle. The superior gluteal artery and vein can be used as a recipient for the free tissue transfer when the lumbosacral defects cannot be covered with a conventional method.     

企业应用统计方法探讨

分析了统计方法的作用和企业对统计方法的应用需求 ,阐述了提高企业实施统计技术有效性的基本思路     

A physiological approach to the evaluation of lumbosacral spinal stenosis

It has been demonstrated that MR imaging of the lumbosacral spine may frequently show stenosis in an asymptomatic individual. This article discusses the value of a physiologic test--dermatomal somatosensory evoked potentials--to assist in the diagnosis of true neurogenic spinal stenosis in patients with back and leg complaints and to aid in the separation of these patients from those whose symptoms are caused by degenerative spine disease with referred pain.     

Dynamic interstitial laser application for therapy of secondary liver tumors. An animal experiment study

Laser-induced interstitial thermotherapy (LITT) is a promising method of treating different types of tumors. To increase the effectiveness of LITT, a new thermo-controlled application system for minimal invasive intervention was designed. This laser system consists of a laser applicator 3 mm in diameter, insertion equipment and an Nd:YAG laser source. The power of the laser source is controlled dynamically by thermosensors in a water-cooling system of the laser applicator. In in vivo experiments in five pigs, within 10 min we found homogeneous coagulation regions in the liver that were of 3 cm and 5 cm in diameter. Via ultrasound we observed in real time the increasing coagulation zone that appeared as a hyperechogenic halo. However, due to perifocal edema, the real coagulation area was smaller than detected by ultrasound. Macroscopically and microscopically, the coagulation zones showed well-demarcated borders of the coagulation lesions, and the surrounding tissue appeared vital. The reparative reaction after irradiation was early fibrosis. In the course of 4 weeks, the surrounding scar capsule, containing fibrocytes, biliary ductules and collagen fibers enlarged. As a result, the coagulation necrosis became more and more fragmented between collagen fibers and was largely resorbed. The absence of complications in our animal experiments suggest that the technique of thermo-controlled laser light application is safe and useful in therapy for metastases that are not resectable.     

Pulsed Doppler sonography for the guidance of vein puncture: a prospective study

Blind deep venous puncture is an invasive procedure with risks of serious complications compromising the availability of veins for future punctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurement volume. We used this technique prospectively in two independent centers (the nephrology department and the intensive care unit) involving senior as well as junior staff members. Either the non-Doppler or the Doppler method were randomly selected for subclavian vein catheterization in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members was 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler method and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous punctures especially when used by seniors or by juniors after a training period.