The effects of intravesical and intradermal application of a new B.C.G. on the dog bladder

Summary Intravesical and intradermal application of B.C.G. (Bacillus Calmette Guérin) has proven to be effective in the prophylaxis of recurrence of superficial bladder carcinoma after transurethral resection and in the treatment of carcinoma in situ (C.I.S.) in man. Different strains of B.C.G. have been used for this purpose. In this article a new strain of B.C.G. (B.C.G.-R.I.V.M.) has been tested to assess its toxicity. The effects of intravesical and intradermal application of B.C.G.-R.I.V.M. were studied on normal and on coagulated canine urothelium. In this study no general side effects of B.C.G.-R.I.V.M. were seen. Only minor local changes occurred in the bladder wall. Small granulomas were found in the suburothelial tissue. No granulomas or signs of active inflammation were observed in the pelvic lymphnodes, spleen and liver. Because B.C.G.-R.I.V.M. seemed to be a safe agent in the dog we have started to use it for prophylaxis in superficial bladder cancer in man.Grant recipient of the Koningin Wilhelmina Fonds (Dutch Cancer Foundation)     

Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity

ObjectiveTo investigate whether a combination of variables from each nephrometry system improves performance. There are 3 first-generation systems that quantify tumor complexity: R.E.N.A.L. nephrometry score (RNS), preoperative aspects and dimensions used for an anatomical (PADUA) classification (PC), and centrality index (CI). Although each has been subjected to validation and comparative analysis, to our knowledge, no work has been done to combine variables from each method to optimize their performance.Patients and methodsScores were assigned to each of 276 patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Individual components of all 3 systems were evaluated in multivariable logistic regression analysis of surgery type (PN vs. RN) and combined into a “second-generation model.”ResultsIn multivariable analysis, each scoring system was a significant predictor of PN vs. RN (P<0.0001). Of the first-generation systems, CI was most highly correlated with surgery type (area under the curve [AUC] = 0.91), followed by RNS (AUC = 0.90) and PC (AUC = 0.88). Each individual component of these scoring systems was also a predictor of surgery type (P<0.0001). In a multivariable model incorporating each component individually, 4 were independent predictors of surgery type (each P<0.005): tumor size (RNS and PC), nearness to the collecting system (RNS), location along the lateral rim (PC), and centrality (CI). A novel model in which these 4 variables were rescaled outperformed each first-generation system (AUC = 0.91).ConclusionsOptimization of first-generation models of renal tumor complexity results in a novel scoring system, which strongly predicts surgery type. This second-generation model should aid comprehension, but future work is still needed to establish the most clinically useful model.     

TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响

目的:研究TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响,探讨血管生成在门静脉高压症食管、胃底静脉曲张形成中的作用。方法:取门静脉高压症Sugiura术患者的食管贲门吻合圈标本78例。(1)PHT组:术前未行TIPS治疗。食管组织118例,胃组织25例;(2)TIPS组:术前曾行TIPS治疗,食管组织5例,胃组织12例。正常食管组织10例、胃组织8例作为对照组。应用免疫组化技术分别检测食管胃底组织内的微血管密度。结果:食管胃底组织微血管高密度区主要位于粘膜固有层,其次为粘膜下层。粘膜固有层微血管密度3组差别无统计学意义(P>0.05);粘膜下层微血管密度PHT组明显高于正常组(P<0．01)和TIPS组(p<0．05),TIPS组和正常组差别无统计学意义(P >0.05)。结论:食管胃底组织内的微血管密度与门静脉压力改变有关。门静脉高压时,食管胃底组织粘膜下层血管生成活跃,可能参与了食管胃底粘膜下静脉曲张的形成;经TIPS治疗后,粘膜下层血管生成减少。     

四肢骨骼肌血管畸形的分类与治疗方法的研究

目的：探讨四肢骨骼肌血管畸形的临床分型与治疗方法。方法：资料完整的四肢骨骼肌血管畸形患者472例，分析其临床表现和影像学特征，进行临床分型，观察治疗方法与疗效。结果：根据病变的血流动力学特点分为高流速病变（即动静脉畸形，AVM）40例和低流速病变（即静脉畸形，VM）432例；依照病变的范围不同分为单发局限型92例，多发局限型162例，广泛型166例，神经干型38例，弥漫型14例。单纯手术切除360例（其中需二期以上手术者82例），手术切除加肌肉转移10例，供血动脉栓塞加手术切除34例，回流静脉栓塞加瘤内硬化剂注射58例，截肢6例，病人放弃治疗4例。386例（81.780%）随访1～20年，治愈234例（60．62％），显效78例（20．20％），好转58例（15．03％），无效16例（4.15％）。结论：合理的影像学诊断流程是病变正确分类的基础；病变的新分型能针对性地选择合适的治疗方案并可正确判断预后；采用以手术治疗为主的综合治疗方式是治疗四肢骨骼肌血管畸形的有效     

The "throbbing sign"--an indication of early venous congestion in replantation surgery.

Venous congestion in a replanted or transplanted digit can be detected, even before any obvious color changes, by the "throbbing" elicited by pinching the digit between the thumb and finger of the examiner until the skin blanches. Releasing the pressure slowly, a sensation of throbbing will be felt synchronous with the patient's pulse rate. The sign disappears when venous congestion is relieved or when swelling persists and increases enough to lessen the arterial inflow.     

中国近21年成人先天性胆管扩张症流行学特征及诊治经验

目的：探讨成人先天性胆管扩张症的流行病学特征和诊疗经验。方法：联合检索维普数据库和中国期刊网等多家中文数据库中1990年1月～2010年11月有关成人先天性胆管扩张症的文章，总结分析成人先天性魍管扩张症的流行病学特征和诊治经验。结果：中国近2{年共报道5146例成人先天性胆管扩张症，有准确年龄及平均年龄报道4298例，平均年龄34．84岁，男女比例约为1：2．55，43．44％分布在华东地区，68．38％有不同程度腹痛表现，25．22％有发热或高热症状，32，46％有不同程度黄疸，18．31％可触及腹部包块，具有典型三联征表现患者占15．98％。Todani分型I型8041％，II型4．27％，III型123％，IV型1155％，V型占2，54％。手术治疗为主要治疗手段，胆管囊肿切除加胆管空肠Roux—en—Y吻合术占71．63％；术后并发症以胆管炎症状为主，发生率为12．24％；术后随访率83．55％，治愈率8684％。结论：成人先天性胆管扩张症女性多发，其中以华东地区较多，Todani分型I型为主，囊肿切除加胆肠Roux—en—Y吻合术为主要治疗手段。     

动力髋螺钉治疗股骨粗隆间骨折54例分析

目的 总结动力髋螺钉(Dynamic Hip Screw,DHS)治疗股骨粗隆间骨折的经验。方法 54例股骨粗隆间骨折采用DHS内固定手术治疗(A1型27例,A2型20例,A3型7例)。结果 经4～36个月平均7个月随访疗效满意。结论 术中尽可能恢复股骨粗隆后内侧皮质的完整性;标准的粗螺钉固定位置及加强术后功能锻炼是取得良好疗效的关键。     

Histological changes observed in an Arachnia propionica infection of mice

The pathological changes associated with actinomycosis in mice caused by Arachnia propionica have been described. Abscess formation in the liver was the predominant gross and microscopic alteration produced by this organism. Liver abscesses were evident 3 days post challenge and simply enlarged with time. There was no evidence of spontaneous abscess healing. Additionally, multinucleated giant cells were found in an enlarged spleen.     

超声介导腹腔神经节去除治疗胰腺癌疼痛

目的:评价超声介导腹腔神经节去除在胰腺癌疼痛中的疗效。方法:采用B超定位,实时超声动态监测经皮穿刺,于腹腔动脉干根部旁侧注入无水乙醇15ml,对97例胰腺癌痛患者实施腹腔神经节去除术。比较治疗前后疼痛的视觉模拟评分(VAS)以及血清SP水平变化。结果:97例中1例穿刺失败, 成功率98.7％,无急性胰腺炎、胰瘘及出血等穿刺并发症;VAS及SP较术前明显降低(P<0.01,P<0．05),有效率87．5％,显效率76.1％,12例无效。结论:超声介导腹腔神经节去除术安全可靠,能显著减轻胰腺癌疼痛。     

The syndrome of the fracture of the lesser trochanter in adults: a neglected aspect of the trochanteric fracture

The effects of associated fractures of the lesser trochanter were observed in 18 (47.4 per cent) out of 38 patients with trochanteric and subtrochanteric fractures when the lesser trochanter was grossly displaced. This syndrome, comprising mechanical, reflex, post-traumatic, and late features, is a reliable guide to the prognosis of these elderly patients.     

Avulsion of the gall bladder in blunt abdominal trauma

T raumatic avulsion of the gall bladder, and its subsequent dislodgement into the pelvis has not previously been reported. The case described records severe damage to the biliary system without much damage to other viscera.     

甲状腺切除术中喉返神经损伤的预防

目的:探讨甲状腺手术中喉返神经(recurrent laryngeal nerve,RLN)损伤的原因及预防措施。方法:回顾性分析手术治疗322例甲状腺疾病的临床资料。结果:暂时性RLN损伤6例。结论:熟悉RLN正常解剖和变异,根据患者具体情况选择是否显露RLN是避免RLN损伤的关键。