套扎联合粘膜切除术治疗贲门息肉的应用及护理

目的:探讨单环套扎联合粘膜切除贲门部息肉术中配合和护理要点。方法 :收治的15例贲门部息肉患者,在护理配合下,内镜下应用单环套扎器套扎后联合粘膜切除术切除贲门部息肉。结果:所有患者均顺利完成手术,未发生出血、穿孔等并发症。结论:提高内镜下单环套扎器套扎联合粘膜切除术切除贲门息肉成功率,减少并发症的发生,必须注重手术各环节配合护理。关键是术中正确把握套扎时机和电凝电切方法,而熟练、细致和完善的护理干预配合是手术成功的前提保证。     

试管婴儿宫内孕合并异位妊娠破裂的围手术期护理

目的:对于围手术期患者给予个体化的心理干预和合理有效的护理措施,预防患者的心理危机,顺利完成手术。方法 :采取我科2014年6月收治1例试管婴儿宫内孕合并异位妊娠患者,根据心理特点,做好围手术期心理疏导干预,手术后护理,出院指导。结果 :正确的护理使患者度过由于疾病影响产生的情绪危机,顺利接受治疗,在治疗过程中积极配合,减少手术后并发症,保胎成功,康复出院。结论:对于本例患者的护理,使我们认识到对于围手术期患者及时有效地给予个体化心理疏导干预,合理有效的术后护理对患者康复是至关重要。     

1例行胎儿镜下激光凝固术后并发急性左心衰患者的护理

报告了1例双胎输血综合征行胎儿镜下胎盘交通血管激光凝固术后并发急性左心衰患者护理,认为氧疗、卧位、镇痛镇静等及时有效的对症治疗和护理十分重要,并运用合作型干预方式予以相应的心理护理。患者术后12天康复出院。     

犬腰椎间盘切除术入路探索

为了探索治疗犬腰椎间盘突出症的合理手术入路,选择2月龄～1岁龄临床健康的本地杂交犬5只,分别编为1号～5号犬,其中1号、2号、3号犬施行半侧椎板切除术,4号、5号犬施行全椎板切除术,手术2周后进行X线摄片并剖检其腰椎结构变化。结果显示,术后1号～3号犬精神状态良好,饮食欲及体温正常,术部切口正常愈合,椎间盘部分或全部髓核被顺利取出;4号、5号犬手术中大出血,经治疗4号犬痊愈,而5号犬因衰弱而死亡。结果表明,腰椎间盘切除术要求严格的无菌操作和有效控制的麻醉,术犬侧卧位保定行半侧椎板切除是良好的手术入路,能够充分显露椎间盘、打开纤维环通道和切除髓核,有利于提高手术的安全性和保持腰椎的完整性与稳定性。     

犬的喉切开喉室声带切除术实验研究

对３２头实验犬，种用犬进行喉切喉室声带切除术，完整地切声带，术后可以长久性地消除犬叫声的音调与音量，本手术消音效果好，术后无并发症，手术简单，易于推广，是消除养犬对环境噪音污染的有效措施。     

蜂胶蜜加TDP照射治愈腋臭术后严重感染

腋臭 ,俗称狐臭。以往外科治疗采用腋部菱形切除法 ,术后常见并发症为伤口裂开 ,易并发感染 ,采用常规换药愈合较慢 ,如行手术植皮病人常难接受 ,至今尚无满意的治疗方法。笔者观察１例 ,腋部菱形切除法治疗腋臭 ,拆线后皮肤全层裂开 ,并继发严重感染的病人 ,采用局部涂蜂胶蜜液加ＴＤＰ照射 (电磁波治疗器简称ＴＤＰ) ,治疗效果满意 ,现报道如下 :患者 ,女 ,２０岁 ,学生。于２０００年２月７日在某医院做腋部菱形切除术治疗腋臭 ,术后１周拆线时伤口全层裂开。在当地医院曾用呋喃西林湿敷 ,口服抗菌素及药粉外涂 ,治疗月余效果不显 ,病人…     

成人髁突骨折三种切口术式在切口选择、止血、面神经损伤的观察研究

目的 :讨论归纳比较成人髁突骨折三种切口术式:耳屏前切口、腮腺入路切口、下颌下切口及其在切口、止血、面神经损伤中的不同,达到最大程度管控手术风险及获得后期包括功能恢复等满意疗效。方法:对于耳屏前切口术式,采用本科室手术患者手术全程观察,作为实验组对象;对于腮腺入路切口术式及下颌下切口术式,在其他条件与耳屏前切口术式基本相同的条件下(髁突骨折部位均为单侧高位)采用相关文献资料查阅,作为观察组对象。进而通过观察演绎,以比较三种切口术式在切口、止血、面神经损伤中的不同。结果:1)实验组在术中损伤面横动脉导致大出血,紧急采取纱布块填塞、结扎止血后顺利完成手术;2)实验组、对照组显示不同切口术式由于切口选择位置、开放式手术入路的不同,对于术中止血难度、面神经保护,以及术后功能恢复、瘢痕愈合存在不同影响,文中将展开具体论述。结论:1)三种切口术式对于不同的病例选择各有优缺点,耳屏前切口术式(本科室按照四类手术进行)由于该区域存在上颌动脉等重要知名动脉对手术者要求较高,存在较高的手术风险。而其由于切口术野暴露充分,术者可以通过患者口内配合口外暴露的开放式术野利用手感将断开的髁突固定,对于辅助切口的要求不高甚至不需要辅助切口,该入路切口比较隐蔽故患者术后伤口遗留瘢痕较少适合于亚洲等瘢痕体质者。腮腺入路切口术式切口面积较小,可以避开知名动脉减少术中大出血(注意保护面横动脉),同时手术视野暴露充分,大大降低了手术风险,但术中易损伤面神经(在进入面神经颊支和下颌缘支之间较宽的间隙之前)以及术后可遗留较明显瘢痕,故适合欧美非瘢痕体质者。下颌下切口术式由于切口位置可以事先寻找面神经下颌缘支,将其分离出来并牵开保护,同时结扎面动脉和面静脉,但术中视野对术者提出了较高的要求,有时需要将切口向下颌支后延伸或辅助切口的添加对于术后美观要求也较高。2)三种切口术式只要术中髁突固定完成,对于术后的功能恢复没有明显差异,其差异主要体现在术中不同切口手术入路对于止血、面神经的保护,以及术后出现瘢痕的不同。     

经桡动脉行冠脉造影术后血肿的护理体会

总结我科23例经桡动脉行血管造影术后血肿的护理经验,降低造影术后并发症的发生,减轻患者痛苦,提高手术患者术后的护理质量。     

经尿道前列腺电气化术后护理体会

目的 :探讨经尿道前列腺电气化术后的有效护理措施。方法 :对356例平均年龄为66.3岁前列腺增生患者经尿道前列腺电气化术后,采取有效护理措施。加强心肺功能监测,保证膀胱引流管道通畅,查找膀胱痉挛原因并及时处理,发现尿外渗协助处理并充分引流。结果:全组356例TUVP术后患者,采取了有效护理措施,近期并发症少,恢复良好,排尿通畅。术后住院时间4~10d,平均6d,无远期并发症。结论:TUVP以其损伤小,效果好,是适用于高龄、高危及有并发症的BPH患者比较满意的手术方式,但术后有效的护理措施,对减少或者防止继发性大出血、水中毒、附睾炎等并发症,对促使TUVP术后患者早日痊愈起着重要作用。     

大黄、芒硝外敷治疗剖宫产切口脂肪液化临床观察及护理

目的:比较中药大黄、芒硝外敷治疗与术后常规护理在治疗剖宫手术后切口脂肪液的临床疗效。方法 :将100例剖宫手术后发生切口脂肪液化患者,随机分组,试验组50例,采用术后常规护理基础+大黄、芒硝外敷。对照组65例,采用术后常规护理方法治疗。观察两组的治疗效果。结果:大黄、芒硝外敷治疗在剖宫产手术后切口脂肪液化中疗效明显优于术后常规护理治疗(P0.01)。结论:大黄、芒硝外敷能促进手术切口脂肪液化的愈合。     

Dynamic computed tomography of the pituitary gland in dogs with pituitary-dependent hyperadrenocorticism

Dynamic computed tomography (CT) of the pituitary gland was performed in 55 dogs with pituitary-dependent hyperadrenocorticism (PDH) that underwent transsphenoidal hypophysectomy. On routine contrast-enhanced CT images, microadenomas of the pituitary gland often are indistinguishable from nontumorous pituitary tissue because of isoattenuation. Dynamic CT may allow visualization of these adenomas. The changes in the contrast-enhancement pattern of the pituitary during dynamic CT in 55 dogs with PDH were correlated with surgical and histopathologic findings. In 36 dogs, dynamic CT identified distinct contrast enhancement of the neurohypophysis (pituitary flush). In 24 dogs, this pituitary flush was displaced, which indicated the presence of an adenoma. This observation was confirmed surgically and histopathologically in 18 of the 24 dogs. In 19 dogs, there was a diffusely abnormal contrast-enhancement pattern. CT findings agreed with surgical findings in 13 of these dogs and with histopathologic findings in all 19 dogs. It is concluded that a dynamic series of scans should be included in the CT protocol of the pituitary gland in dogs with PDH because it allows for identification of an adenoma or a diffusely abnormal pituitary gland.     

Histologic and immunohistochemical characterization of spontaneous pituitary adenomas in fourteen cynomolgus macaques (Macaca fascicularis)

Pituitary adenomas were identified in 14 of 491 (2.9%) cynomolgus macaques evaluated from 1994 to 2004. Cases included male (8) and female (6) cynomolgus macaques ranging from 18 to 32 years of age. Seven of the pituitary adenomas caused gross enlargement of the pituitary gland that was visible on postmortem examination, whereas the remaining 7 were multifocal microadenomas identified on histologic examination. A total of 35 adenomas were identified in the 14 macaques, 6 of which were being treated for diabetes mellitus. Mean (+/- SD) pituitary weight was 0.31 +/- 0.42 g, compared with 0.07 +/- 0.02 g for 430 historical control animals (P < 0.0001). Immunohistochemical staining for follicle-stimulating hormone, luteinizing hormone, prolactin, human growth hormone, thyroid-stimulating hormone, and adrenocorticotropic hormone was applied to pituitary tissue from all cases. Immunostaining revealed 22 of 35 (62.9%) lactotroph adenomas, 5 of 35 (14.3%) plurihormonal cell adenomas, 3 of 35 (8.6%) corticotroph adenomas, 2 of 35 (5.7%) null cell adenomas, 1 of 35 (2.9%) somatotroph adenomas, 1 of 35 (2.9%) mixed corticotroph-somatotroph adenomas, 1 of 35 (2.9%) mixed lactotroph-corticotroph adenomas, 0 of 35 gonadotroph adenomas, and 0 of 35 thyrotroph adenomas. This study represents the first extensive retrospective case series performed to evaluate the histologic and immunohistochemical characteristics of pituitary adenomas in cynomolgus macaques. Our findings indicated that macaque pituitary adenomas frequently had mixed histologic appearance and hormone expression, and that, similar to human pituitary adenomas, prolactin-secreting neoplasms were the most prevalent type.     

Cross-Sectional Imaging Characteristics of Pituitary Adenomas, Invasive Adenomas and Adenocarcinomas in Dogs: 33 Cases (1988–2006)

Background: Pituitary tumors in dogs can be adenomas, invasive adenomas, or adenocarcinomas. In people, invasive adenomas and pituitary adenocarcinomas carry a worse prognosis than adenomas.
Hypothesis/Objective: To identify differentiating features on cross-sectional imaging in dogs with pituitary adenomas, invasive adenomas, and adenocarcinomas.
Animals: Thirty-three dogs that had computed tomography (CT) or magnetic resonance imaging (MRI) performed and a necropsy diagnosis of pituitary adenoma ( n = 20), invasive adenoma ( n = 11), or adenocarcinoma ( n = 2).
Methods: Medical records were retrospectively reviewed for signalment, history, and diagnosis. CT and MR images were reviewed for characteristics of pituitary tumors.
Results: Mean (± standard deviation) age for dogs with pituitary adenomas (10.6 ± 2.9 years) was greater than that of those with invasive adenomas (8.3 ± 2.7 years, P = .04). Eighteen out of 20 (90%) dogs with adenomas had contrast-enhancing masses. Thirteen out of 20 (65%) had homogeneous enhancement. Mean adenoma height was 1.2 ± 0.7 cm. Eight out of 20 (40%) adenomas were round and 8/20 (40%) compressed surrounding brain. Eleven out of 11 dogs (100%) with invasive adenomas had contrast-enhancing masses. Seven out of 11 (64%) masses were homogeneous. Mean invasive adenoma height was 1.8 ± 0.7 cm, which was significantly greater than adenomas ( P = .03). Mass shape varied from round to oval to irregular. Six out of 11 (55%) masses compressed surrounding brain. Clinical and imaging features were variable for 2 dogs with adenocarcinomas.
Conclusions and Clinical Relevance: Invasive adenoma should be suspected if a dog with a pituitary tumor is <7.7 years of age and has a mass >1.9 cm in vertical height. Adenocarcinomas are uncommon and metastatic lesions were not seen with imaging.     

Correlations between presence of spontaneous lesions of the pituitary (adenohypophysis) and plasma prolactin concentration in aged Wistar rats.

The predictive value of elevated plasma prolactin concentrations for the presence of spontaneous pituitary lesions was studied in 40 male and 38 female Wistar (Cpb:WU) rats, all 30 months old. The pituitaries were examined light microscopically and stained for prolactin using immunohistochemical methods. Plasma prolactin concentrations were measured by radioimmunoassay. Pituitary lesions were classified on the basis of their morphology in hematoxylin and eosin-stained sections as foci of hypertrophic or hyperplastic cells and hemorrhagic, pleomorphic, or spongiocytic adenomas; no carcinomas were found. There were significantly (P = 0.001) more female than male rats with pituitary adenomas (58% females, 33% males) or without any pituitary lesions (21% females, 5% males); however, there were less female (21%) than male rats (63%) with foci of hyperplastic and/or hypertrophic cells but no adenomas in the pituitary (P = 0.001). Elevation of plasma prolactin concentration above the upper 99th percentile value in age-matched rats without lesions was predictive, but not conclusively, of the presence of pituitary hemorrhagic adenomas in both sexes. It was, however, not predictive of the presence of foci of hypertrophic or hyperplastic cells. Elevation of plasma prolactin concentration above 10 ng/ml in male and 60 ng/ml in female rats was conclusive for the presence of hemorrhagic adenomas. Using multivariate analysis, significant positive correlations (P less than 0.01) were found between plasma prolactin concentration and presence and size of hemorrhagic adenomas and their prolactin staining intensity (correlation coefficients between 0.392 and 0.652). Foci of hyperplastic cells stained positively for prolactin, whereas hypertrophic cell foci and pleomorphic and spongiocytic adenomas did not stain for prolactin. There were no correlations (coefficients of less than +/- 0.189) between plasma prolactin concentration and the presence of hypertrophic or hyperplastic cell foci and pleomorphic or spongiocytic adenomas in the pituitary. The morphologic criteria developed to distinguish spontaneous hypertrophic, hyperplastic, and neoplastic lesions of the rat pituitary corresponded well with their prolactin immunoreactivity and/or ability to elevate plasma prolactin concentration. These criteria constitute a biologically meaningful classification system for these rat pituitary lesions.     

Ki-67 and minichromosome maintenance-7 (MCM7) expression in canine pituitary corticotroph adenomas

Pituitary-dependent hyperadrenocorticism (PDH) caused by pituitary corticotroph adenoma is a common endocrine disorder in dogs. The ratio between pituitary height and the area of the brain (P/B) has been used to evaluate the pituitary size. A P/B ratio > 0.31 indicates an enlarged pituitary, whereas a P/B ratio ≤ 0.31 indicates a nonenlarged pituitary. The aim of this study was to investigate the expression of proliferation markers Ki-67 and minichromosome maintenance-7 (MCM7) in canine corticotroph adenomas in enlarged and in nonenlarged pituitaries and to evaluate their relation with the size of canine pituitary corticotroph adenomas. Ki-67 and MCM7 expression in ACTH-positive tumor cells was determined by dual-labeling immunohistochemistry in resected corticotroph adenomas from 15 dogs with PDH. The mean ± SD Ki-67 labeling index (LI) was 0.55% ± 0.59% in corticotroph adenomas with nonenlarged pituitaries and 1.6% ± 0.6% in adenomas with enlarged pituitaries. The MCM7 LI in corticotroph adenomas with nonenlarged pituitaries and in adenomas with enlarged pituitaries was 2.9% ± 2.2% and 10.9% ± 3.7%, respectively. The Ki-67 LI and MCM7 LI were significantly greater in the adenomas with enlarged pituitaries than in the adenomas with nonenlarged pituitaries (P < 0.01 and P < 0.01, respectively). The MCM7 LI was significantly greater than the Ki-67 LI in adenomas (P < 0.01). The Ki-67 LI was positively correlated with the MCM7 LI (r = 0.820, P < 0.01), and the P/B ratio was positively correlated with the Ki-67 LI (r = 0.560, P = 0.03) and the MCM7 LI (r = 0.854, P < 0.01). In conclusion, canine corticotroph adenomas in enlarged pituitaries show greater proliferation potential than do adenomas in nonenlarged pituitaries. MCM7 expression was significantly greater than Ki-67 expression in canine pituitary corticotroph adenomas. Thus, MCM7 may be superior to Ki-67 as a proliferation marker in pituitary tumors.     

Transsphenoidal hypophysectomy for treatment of pituitary-dependent hyperadrenocorticism in 7 cats

OBJECTIVE: Evaluation of microsurgical transsphenoidal hypophysectomy for the treatment of pituitary-dependent hyperadrenocorticism (PDH) in cats. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven cats with PDH. METHODS: Urinary cortisol/creatinine ratios, pituitary-adrenocortical function tests, and computed tomography (CT) were performed on 7 cats that presented with a provisional diagnosis of hyperadrenocorticism. All cats underwent microsurgical transsphenoidal hypophysectomy with histologic examination of the excised specimen. Follow-up consisted of clinical evaluation, repeat adrenocortical function testing, and CT. RESULTS: Four cats had concurrent diabetes mellitus. In all cats, the urinary cortisol/creatinine (C/C) ratios were elevated. The dexamethasone screening test showed that 2 cats did not meet the criterion for hyperadrenocorticism. The response of the cats' plasma concentrations of cortisol and adrenocorticotrophic hormone to a high dose of dexamethasone varied from very sensitive to completely dexamethasone resistant. Basal plasma alpha-melanocyte-stimulating hormone concentrations were elevated in 2 cats with a pars intermedia adenoma and in 3 cats with an adenoma that originated from the anterior lobe. Preoperative CT enabled accurate assessment of pituitary size (5 nonenlarged pituitaries with a height <4 mm and 2 enlarged pituitaries with a height >5 mm) and localization relative to intraoperative anatomic landmarks. Two cats died within 4 weeks after surgery of a nonrelated disease. In the remaining 5 cats, the hyperadrenocorticism went into both clinical and biochemical remission. Hyperadrenocorticism recurred in 1 cat after 19 months, but no other therapy was given and the cat died at home 28 months after surgery. CT evaluation of this cat had identified pituitary remnants 6 weeks after surgery. The main postoperative complications were oronasal fistula (1 cat), complete dehiscence of the soft palate (1 cat), and transient reduction of tear production (1 cat). One cat died at 6 months (undefined anemia), and another cat at 8 months (recurrent nose and middle ear infection secondary to soft palate dehiscence) after surgery. In the surviving 2 cats, the remission periods at the time of writing were 46 and 15 months. In the 2 cats with sufficient follow-up time, the concurrent diabetes mellitus disappeared, ie, insulin treatment could be discontinued at 4 weeks and 5 months after hypophysectomy. In all 7 cats, the histologic diagnosis was pituitary adenoma. CONCLUSIONS: Microsurgical transsphenoidal hypophysectomy is an effective method of treatment for feline PDH in specialized veterinary institutions having access to advanced pituitary imaging techniques. Concurrent diabetes mellitus is usually reversible after hypophysectomy. Thorough presurgical screening for coexisting diseases is imperative. CLINICAL RELEVANCE: PDH in cats can be effectively treated by hypophysectomy. The neurosurgeon performing hypophysectomy must master a learning curve and must be familiar with the most frequent complications of the operation to treat them immediately and effectively. Urinary C/C ratios are sensitive indicators for the assessment of remission and recurrence of hyperadrenocorticism.     

Trabecular bone morphometry in beagles with hyperadrenocorticism and adrenal adenomas

Trabecular bone morphometry was done on rib samples of beagles with hyperadrenocorticism and adrenal adenomas to evaluate bone loss and the remodeling changes responsible. Beagles diagnosed as having clinical hyperadrenocorticism and those with milder or subclinical hyperadrenocorticism diagnosed on the basis of adrenal and pituitary lesions at necropsy had increased adrenal and pituitary gland weights. In a group of dogs with adrenal cortical adenomas there was atrophy of remaining cortex, and the combined weight of adrenal glands or pituitary weights were not increased. In dogs with clinical hyperadrenocorticism, mean trabecular bone volume was 25% less than controls (P = 0.10). In both clinical and subclinical hyperadrenocorticism groups, the extent of trabecular surface with unmineralized osteoid matrix and osteoblasts was significantly reduced. There were no changes in resorption surfaces or number of osteoclasts present. No bone changes were seen in dogs with adrenal adenomas. In dogs with hyperadrenocorticism it appeared that decreased bone formation was primarily responsible for the relative osteopenia that developed. Although parathyroid glands were moderately enlarged in those dogs for which weights were available, the bone changes were not those of increased remodeling expected in hyperparathyroidism.     

Expression of leukemia inhibitory factor and leukemia inhibitory factor receptor in the canine pituitary gland and corticotrope adenomas

Leukemia inhibitory factor (LIF) is a pleiotropic cytokine of the IL-6 family that activates the hypothalamic-pituitary-adrenal axis and promotes corticotrope cell differentiation during development. The aim of this study was to investigate the expression of LIF and its receptor (LIFR) in the canine pituitary gland and in corticotrope adenomas, and to perform a mutation analysis of LIFR. Using immunohistochemistry, immunofluorescence, and quantitative expression analysis, LIF and LIFR expression were studied in pituitary glands of control dogs and in specimens of corticotrope adenoma tissue collected through hypophysectomy in dogs with pituitary-dependent hypercortisolism (PDH, Cushing's disease). Using sequence analysis, cDNA was screened for mutations in the LIFR. In the control pituitary tissues and corticotrope adenomas, there was a low magnitude of LIF expression. The LIFR, however, was highly expressed and co-localized with ACTH_1-24 expression. Cytoplasmatic immunoreactivity of LIFR was preserved in corticotrope adenomas and adjacent nontumorous cells of pars intermedia. No mutation was found on mutation analysis of the complete LIFR cDNA. Surprisingly, nuclear to perinuclear immunoreactivity for LIFR was present in nontumorous pituitary cells of the pars distalis in 10 of 12 tissue specimens from PDH dogs. These data show that LIFR is highly co-expressed with adrenocorticotropic hormone (ACTH) and α-melanocyte-stimulating hormone (α-MSH) in the canine pituitary gland and in corticotrope adenomas. Nuclear immunoreactivity for LIFR in nontumorous cells of the pars distalis may indicate the presence of a corticotrope adenoma.     

Hypophysectomy as a treatment for canine and feline Cushing's disease.

The microsurgical technique of transsphenoidal hypophysectomy performed with the dogs and cats positioned in sternal recumbency enables the treatment of Cushing's disease, independent of skull type, in a safe and effective manner. In dogs, the short-term survival rate after hypophysectomy is comparable to that after treatment with o,p'-DDD, whereas the recurrence rate in this period is lower. When the surgeon has gone through a learning curve, the results of the 1- to 3-year follow-up interval may be better than those after adrenocorticolysis with o,p'-DDD. CT enables assessment of localization and size of the pituitary before surgery. In general, dogs with Cushing's disease and normal-sized pituitaries or moderately enlarged pituitaries (up to 12 mm in diameter) are suitable candidates for transsphenoidal surgery. In dogs with larger pituitary tumors and tumor extension rostrally or caudally over the dorsum sellae, transsphenoidal debulking surgery may be only a palliative treatment. The main complications are postoperative hypernatremia, keratoconjunctivitis sicca, diabetes insipidus, and secondary hypothyroidism. In cats, special attention should be paid to closure of the soft palate. The neurosurgeon must be familiar with these complications so as to recognize them as early as possible and to treat them immediately and effectively. It is concluded that microsurgical transsphenoidal hypophysectomy in dogs and cats with Cushing's disease is an effective method of treatment.