示指固有伸肌腱移位重建伸拇功能的疗效及解剖学研究

目的：探讨示指固有伸肌腱移位重建伸拇功能术后对拇指和示指功能的影响及其解剖学机制。方法对12例进行回顾性研究,男7例,女5例,年龄18～78岁,平均42.3岁,拇长伸肌腱损伤的平面为III区4例,IV区5例,V区3例。采用示指固有伸肌腱移位重建伸拇功能,术后8～83（33.5＆#177;29.9）个月进行电话随访。评价指标包括拇指和示指的功能。拇指功能评价指标：（1）患手手掌向下平置于桌面,能否主动将拇指指尖抬离桌面;（2）能否完成“挑大拇指”的动作;（3）在保持拇指掌指关节和指间关节伸直的情况下,能否完成以第一腕掌关节为支点的拇指划圈运动;（4）在拇指处于中立位时,能否较好地完成拇指指间关节屈曲动作。示指功能评价指标：（1）患手手掌向下平置于桌面时,能否主动将示指指尖单独抬离桌面;（2）在第3～5指呈握拳位时,能否将示指伸直至与手背同一平面,完成指示的动作;（3）能否完成“兰花指”的动作;（4）示指能否自如地使用鼠标,并完成连续双击左键的动作。另外,对5具成年男性尸体的前臂标本进行解剖学研究,重点测量了指总伸肌腱中示指和中指伸肌腱腱性起点的位置。结果术后所有患者都能使用患手较为顺利地完成日常生活和工作中的常用动作,年轻患者中除1例外,均恢复了原工作。12例中有11例主观评价手术疗效满意,1例表示对疗效不满意。其中有8例能完成全部4项拇指功能评价的动作,有3例可以完成拇指功能评价动作的3项,1例仅能完成拇指功能评价动作中的2项。12例均能使用示指自如地使用鼠标,有9例能够在患手手掌向下平置于桌面时主动将示指指尖单独抬离桌面。12例均能单独伸示指,完成指示动作,但仅有7例能在第3～5指呈握拳位时将示指伸直至与手背同一平面,另5例单独伸示指时为-20＆#176;和-30＆#176;。解剖学研究发现在指总伸肌腱中,示指的肌腹比较独立,示、中指的肌腱起点位置较高。结论示指固有伸肌腱移位重建伸拇功能在适应证恰当的情况下能够获得较好的伸拇功能,对示指的功能影响非常小。指总伸肌腱中的示指伸肌肌腹独立分化较好,去除示指固有伸肌腱后仍能完成独立伸示指的功能。     

肩关节疼痛弧的研究

各国学者对于肩关节疾病诊断方法的探索从未停止,随着对肩关节软组织结构和运动的不断深入研究,渐渐明确了肩关节疾病的损伤机制。此类疾病的发生与肩峰的形态变异以及长时期的肩袖组织的慢性磨损密切相关。与肱盂关节的特殊运动方式有关的肩关节疼痛弧综合征（Shoulder Painful Arc Syndrome）是指：肩关节在人体肩胛骨平面上做外展动作时,正常者无疼痛。     

High resolution autoradiographic study of normal lactating mammary gland and mammary tumors of the mouse: preliminary report

Protein metabolism of normal lactating gland and mammary tumor cells was studied with high resolution autoradiography. Special attention was devoted to the Golgi zone in both cell types because of the involvement of this structure in milk protein secretion in the normal gland cell and the topographical relation of this apparatus with viral "inclusion bodies" in the tumor. In the normal gland, the cycle of protein secretion was completed in about 50 minutes, the main part of the cycle being represented by a heavy and extensive labeling of the Golgi zone. In the tumorous gland, marking was relatively stationary and remained within the cell, the label predominating in the ergastoplasm with only a faint labeling of the Golgi apparatus. Percent markins of the nucleus was notably greater in the tumor cell as opposed to the normal gland cell. In the calculation of the specific activities of the tissues, the size of the nucleus of both cell types was very similar, while the cytoplasm of the normal gland was five times that of the tumor cell. Comparison of the specific activities showed that the over-all activity of the two cell types was not significantly different. This phenomenon supports a theory proposed by Schultze whereby the ratio of protein incorporation into the nucleus and the cytoplasm is constant and the value of this ratio decreases as the metabolic activity of the cell increases.     

食管鳞状上皮癌生长方式计量研究

作者对102例食管鳞状上皮癌癌实质体积密度和癌巢表面密度进行测量,结果癌实质体积密度仅在浅表型与浸润型癌有差别,癌巢表面密度与淋巴结癌转移和患者存活时间有非常密切的关系,癌肿生长方式的计量诊断作为病理诊断内容,有助于临床了解患者的预后。     

Psycho-Endocrinological Reactions in Female Relatives of Cancer Patients: Effects of an activation programme

Psychiatric grief reactions after the loss of a close relative are associated with endocrinological reactions, in particular elevated plasma Cortisol. In the present study it was tested if a psychosocial intervention programme for relatives to cancer patients affects the reaction patterns. Thirty-six female relatives in the intervention programme were compared with 36 relatives only subjected to a routine programme. Eighteen of the relatives in the intervention programme and 17 in the routine programme experienced the death of the patient during the study period. Systematic psychiatric observations and analyses of the plasma levels of Cortisol and prolactin were made approximately once a month. During the treatment period the psychiatric scores did not differ between the groups, but the prolactin levels tended to be lower in the intervention group (p=0.06). During the terminal phase preceding the patient's death the plasma Cortisol levels were significantly elevated in the intervention group but not in the routine group. At examination one and two months after the death of the patient the mental exhaustion scores were significantly lower in the intervention group. The findings are consistent with the hypothesis that grief is activated by the intervention and that the active mourning may have prophylactic value to the relatives after the death of the patient.     

Minimizing and measuring lens dose when giving cranial irradiation

Three different techniques of administering cranial irradiation were used to determine the dose to the lens as measured in the Rando phantom. The techniques employed were as follows: (1) the central axis of the radiation beam was placed at the thickest portion of the cranium; (2) the central axis of the radiation beam was placed at the lateral orbital rim (bony canthus); (3) the central axis of the radiation beam was placed at the thickest portion of the cranium but with the beam angled 5 degrees posteriorly away from the eye. Thermal luminescent dosimeters (TLD) were placed in a phantom, at a point determined from a life-sized anatomical section of the plane through the midsection of the eye, to be at the location of the posterior capsule of the lens. In addition, TLDs were placed on the outer surface of the phantom head, directly lateral to the location determined to be where the lens would lie. With equally weighted lateral opposed beams, delivering a midplane dose of 200 cGy, the TLDs at the point of the lens measured 21, 9.9 and 10.6% of the midplane doses from the three techniques respectively. TLDs placed directly lateral to the lens on the surface of the phantom head gave an approximation of the lens dose, particularly when techniques 2 and 3 were used. Isodose curve generated by a General Electric treatment planning computer gave lens doses similar to those of the phantom data for each of the three different radiotherapy techniques. Cranial irradiation should be carried out by either technique 2 or technique 3 to minimize radiation dose to the lens.     

Transmission of Trichosporon asahii oesophagitis by a contaminated endoscope

Two cases of oesophageal trichosporonosis due to a suspected nosocomial infection are reported. Both the patients were immunocompetent and had undergone an endoscopic examination on the same day. Six strains of Trichosporon were isolated: three strains from the oesophageal biopsy of the first patient, one strain from the endoscopic forceps, one from the air in the endoscopy room, and one from the oesophageal biopsy of the second patient. The nosocomial nature of the infection and the role of the endoscopic forceps in transporting the micro-organism was suspected, but the morphology and physiology of the isolated strains did not confirm such hypothesis. To elucidate the nature of the infection and the genetic similarities of the strains isolated, all strains were typed with RFLPs of the rDNA fragment and with RAPD. The results of RAPD using primer (GTG)5 (GACA)4, M13 core sequence, and the 15-mer oligonucleotide GAGGGTGGXGGXTCT indicated the molecular identity of three strains supporting the hypothesis concerning a transport of the aetiological agent from the first patient to the second and that the carrier was the forceps of the endoscopic device.     

Evaluation of the reconstruction of brachytherapy implants in three-dimensions from stereo radiographs

The precision and the accuracy of the stereo-shift method for reconstruction of brachytherapy implants were evaluated. Analysis of shift films was performed by measuring the coordinates of the seeds in an experimental set-up in the laboratory, by manually calculating the coordinates of the seeds from the projection distances on the stereo-shift radiographs, and by using a computer-aided treatment planning system. The resultant reconstructed coordinates agreed well with each other. The uncertainties in precision for the coordinates were expressed as the standard deviation of the measurements. The standard deviation of the computer and manual measurements agreed well with predicted values by an analysis of the random uncertainties in the reconstruction parameters. The uncertainties were within 0.2 mm for the coordinates parallel to the plan of the film and were within 0.4 mm for the coordinate perpendicular to the plane of the shift film. The uncertainties in the accuracy of the reconstruction were compared with the values obtained in clinical practice as well as with the values reported in the literature. Suggestions are made to improve the accuracy.     

头颈部多原发癌——附28例病例分析

目的:探讨头颈部肿瘤患者多原发癌(MPCs)的流行病学和临床特点。方法:回顾分析本科近11年收治的头颈部多原发癌患者28例,分析患者的性别、有无吸烟史、先证癌及治疗、第二原发癌及治疗和两者发病的间隔时间及转归。用完全随机化设计资料的方差分析第一、二原发癌均发生于上呼吸消化道的病例(A组)和第一、二原发癌非均位于上呼吸消化道的病例(B组),比较其发生间隔时间有无差异,采用Kaplan-Meier法评估累积生存率。结果:在28例头颈部多原发癌患者中男性多于女性,平均年龄56岁。除1例同时性MPCs外,先证癌与第二原发癌出现的间隔年限为0.5年～20年。28例病例中有12例患者的先证癌和第二原发癌先后发生于上呼吸消化道器官,占42.9%。资料中有6例鼻咽癌患者在放疗数年后,于放射野发生第二原发癌。A组患者MPCs发生的平均间隔时间长于B组患者,但两组差异没有统计学意义。两组患者的累积生存率无显著性差异。结论:头颈部多原发癌好发于上呼吸消化道。第二原发癌的发生可能与放疗有关;放疗可能降低第二原发癌的颈淋巴结转移率。头颈部多原发癌的治疗根据患者全身情况、肿瘤部位及病理性质等选择。第二原发癌常于先证癌治疗后数年发生,需长期密切随访。     

妇科恶性肿瘤腹股沟区转移淋巴结解剖分布和CTV边界

目的 明确妇科恶性肿瘤腹股沟区转移淋巴结的解剖分布,探讨CTV的勾画边界。方法 回顾分析34例妇科恶性肿瘤并腹股沟淋巴结转移患者。基于腹股沟淋巴结的解剖分布,应用CT和MRI的血管增强扫描影像和Eclipse计划系统的三维重建图像,分析腹股沟区淋巴结与股静脉、大隐静脉及其分支、股部浅筋膜和深筋膜的关系,以及包含95%以上腹股沟淋巴结的CTV边界。结果 34例患者共145个腹股沟转移淋巴结。浅组淋巴结131个,在腹股沟韧带下方,129个位于股部浅筋膜和深筋膜之间。浅组增大淋巴结上群25个在耻骨联合上1 cm以上,沿旋髂浅静脉分布;中群85个在耻骨联合水平,邻近隐静脉汇入股静脉处,11例单个浅组淋巴结转移均在该组;下群21个在耻骨联合下缘以下,沿大隐静脉和股内、外侧浅静脉分布。14个深组转移淋巴结,在股静脉内侧,缝匠肌内侧缘与股静脉后外侧缘连线的后外侧未发现肿大淋巴结。上界:142个淋巴结在耻骨上支上缘以下,3个达股骨头上缘;下界:143个在小转子下缘以上,2个下界达小转子下缘下2 cm。结论 包含98%腹股沟区转移淋巴结CTV边界:前界为浅筋膜,内侧界为腹股沟韧带和股血管后内侧肌肉边缘,后外侧界为股静脉后外侧缘与缝匠肌内侧缘连线,上界为股骨头上缘,下界为小转子下缘。     

ArcCHECK系统在食管癌螺旋断层放疗计划验证中的应用

目的 探讨ArcCHECK系统在食管癌断层治疗旋转照射和固定野照射计划验证中的应用,总结相关经验。方法 对32例不同部位食管癌分别制作Helical旋转照射和Direct固定野照射验证计划,并通过ArcCHECK测量、分析,对比验证结果通过率。分析靶体积与计划验证通过率的相关性。将靶体积较小的治疗验证计划分别放在ArcCHECK模体中心和外周探测点处,分析验证通过率差异。结果 Helical计划验证通过率高于Direct计划(P<0.01),其靶体积与验证通过率的相关系数分别为-0.364和-0.042,P值分别为0.041和0.819。Helical计划采用3%/2mm标准时,高剂量区放在模体中心和外周探测点处测得的通过率不同(P=0.005),后者通过率更高;采用3%/3mm标准时与Direct计划的3%/3m、3%/2mm标准的相近(P均>0.05)。结论 Helical计划验证通过率普遍高于Direct计划,原因可能与ArcCHECK探测器的角度响应以及因更多参考点受到低剂量辐射而未参与计算有关,另外还可能跟Direct计划对断层治疗剂量控制系统要求更高有关。在Helical验证计划中,当采用3%/3mm标准时,靶体积越大,验证时出现较低通过率的可能性增加,但相关系数较低。验证计划的高剂量区位于模体中心或者探测点处都可以实现计划验证,综合考量建议放在模体等中心处。     

In-beam PET measurements of biological half-lives of 12C irradiation induced beta+-activity

One of the long-standing problems in carbon-ion therapy is the monitoring of the treatment, i.e. of the delivered dose to a given tissue volume within the patient. Over the last 8 years, in-beam positron emission tomography (PET) has been used at the experimental carbon ion treatment facility at the Gesellschaft fur Schwerionenforschung (GSI) Darmstadt and has become a valuable quality assurance tool. In order to determine and evaluate the correct delivery of the patient dose, a simulation of the positron emitter distribution has been compared to the measurement. One particular effect is the blurring as well as the reduction of the measured activity distribution via washout. The objective of this study is the investigation of tissue dependent effective half-lives from patient data. We find no significant dependence of the effective half-life on the Hounsfield unit but on the local dose. The biological half-life within the high dose region is longer than in the low dose region. Furthermore, the influence of the overall treatment time on the kinetics of the positron emitter is reported. There are indications for a metabolic response of the tissue on the irradiation. Taking into account the biological half-life in the simulation leads to an improvement of the quality of the PET-images in some cases.     

Dielectric-loaded coaxial-slot antenna for interstitial microwave hyperthermia: longitudinal control of heating patterns.

In this paper, the microwave interstitial antenna with the dielectric load in part near the tip is introduced to realize the tip-heating and to improve the dependence of the heating patterns on the insertion depth. Numerical simulations using the Finite Difference Time Domain (FDTD) method have been conducted at the frequency of 915 MHz for four different configurations of the coaxial-slot antenna inserted into a catheter: the media between the antenna and the catheter are (a) no, (b) a thin air layer, (c) a thin dielectric layer, and (d) a thin air layer and a dielectric load in part near the tip. The diameter of the antenna including the catheter is sufficiently small for minimally invasive therapy. Comparison of the SARs for the four configurations makes it clear that the dielectric-loaded antenna can realize the best tip-heating and suppress the hot spot near the surface of the human body. Dependence of the SAR distributions on the insertion depth of the antenna has also been examined. It is found from the investigation that the dielectric-loaded antenna has little dependence on the insertion depth.     

The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study

Irreversible electroporation (IRE) is a novel therapy used to ablate tumors with high-field electric pulses applied in short durations. It is important to reduce the generation of heat in IRE to avoid the harmful effects of thermal damage. The objective of this simulation study was to examine the effects of saline irrigation in the reduction of heat upon electrodes used in IRE treatment of hepatocellular carcinoma. We used a two dimensional Finite Element Model of a tumor in a liver with electrodes placed at the center of the tumor. We simulated a typical electroporation protocol with varying thicknesses and conductivities of the saline layer, and we observed the maximum temperature and the distribution of the electric field and temperature in the tissue. Our results showed that the maximum temperature in the tissue decreases with the use of saline, but the surface area of the tumor that could potentially be thermally damaged may increase with the thickness and conductivity of the saline. With the use of saline, one can achieve upwards of a 17% reduction of the maximum temperature at the electrodes. Also, the distribution of temperature and the electric field becomes more homogenous between the electrodes as the conductivity of the saline layer increases for all thicknesses of saline. We conclude that irrigating electrodes with saline may be an effective measure to enhance the efficacy of irreversible electroporation by reducing the maximum temperature at the electrodes and also improving the extent and distribution of the electric field in the tissue. However, the properties of the saline should be adjusted so as to limit the increase of thermal damage propagated in the tissue.     

The extending range of the tumor is a more suitable predictive risk factor for lymph node metastases than the location of the deepest tumor invasion in distal thoracic esophageal and cardiac cancer

In the regional lymph node grouping of esophageal cancer by the Japanese Guide Line (the 9th edition), the location of the deepest tumor invasion has precedence in determination. In this study, we investigated the extending range of the tumor and the location of the deepest tumor invasion to ascertain which was the more important factor in predicting lymph node metastases. We examined 52 patients with distal thoracic esophageal and cardiac cancer who had undergone esophagectomy with three-field lymph node dis-section. Among the 52 patients, 16 were found to be positive and 36 negative, for middle-upper mediastinum and cervical lymph node metastases, and the two groups were compared in terms of detailed parameters of the tumor's location. In the result, the distance from the esophagogastric junction (EGJ) to the proximal margin of the tumor was significantly longer in the metastatic group (p=0.005). In univariate logistic regression with this parameter as the independent variable, we obtained a statistically significant result (p=0.0115, odds ratio=1.041, 95% confidence interval=1.009-1.073, R2=0.1169). On the other hand, when the distance from the EGJ to the deepest portion of the tumor was used as the independent variable, p=0.0742, odds ratio=1.045, 95% confidence interval=0.996-1.096 and R2=0.0577. Multiple logistic regression was performed with these two parameters, and the distance from the EGJ to the proximal margin of the tumor was a more important factor than the distance from the EGJ to the deepest portion of the tumor (p=0.0553 vs. 0.9161). We concluded that the extending range of the tumor was a more suitable predictive risk factor of lymph node metastases than the location of the deepest tumor invasion in distal thoracic esophageal and cardiac cancer. We should seriously consider the extending range of the tumor in the regional lymph node grouping of the Japanese Guide Line.     

Stimulated rat liver mitochondrial biogenesis after partial hepatectomy

In order to elucidate the response of mitochondria to the increase in cellular energy demand after hepatectomy, we have examined the effects of partial hepatectomy and hepatic artery ligation on the energy-transducing system of rat liver mitochondria. Specific content of DNA in the mitochondria increased on the first day after the hepatectomy and reached 150% of the original value. Oxidative phosphorylation capacity of the mitochondria started to increase on the first postoperative day. In contrast, specific enzymic activities, specific cytochrome contents, and subunit contents of the energy-transducing complexes in the isolated mitochondria were significantly increased only from the second postoperative day. The ligation of the hepatic artery did not inhibit the amplification of the mitochondrial function. The immunostain for ubiquinol-cytochrome c oxidoreductase was increased predominantly in the portal area of the hepatic lobules of the hepatectomized rats. These results suggest that enhancement of the mitochondrial oxidative phosphorylation system after hepatectomy is based on the increase of the amount of the complexes in the inner membrane, which is closely related to replication of mitochondrial DNA, and that the blood supply from the hepatic artery is not an important factor in the mitochondrial amplification in rats.     

脊柱转移瘤瘫痪状态与影像学特征相关因素分析

目的 探讨转移瘤硬膜外脊髓压迫症（MESCC）瘫痪状态与影像学特征的相关性.方法 2006年7月-2008年12月,对连续收治的56例MESCC患者按Frankel分级进行瘫痪状态评估,并对86个主要病变脊椎进行MRI及CT扫描.主要病变脊椎影像学评估因素包括：病变脊椎节段、侵犯硬膜囊、累及椎板、椎体后壁向后突出、病变脊椎连续、累及椎弓根、椎体前柱骨折、椎体后壁骨折、病变脊椎位于上胸椎和（或）颈胸交界.结果 多重回归方程表明MESCC瘫痪状态与侵犯硬膜囊、椎体后壁向后突出、椎体前柱骨折、病变脊椎位于上胸椎和（或）颈胸交界等主要病变脊椎影像学特征存在线性回归关系.回归方程决定系数R2=0.856,校正决定系数Rc2=0.841.标准化回归系数显示,侵犯椎管内硬膜外间隙对MESCC瘫痪状态影响最大.结论 采用侵犯椎管内硬膜外间隙的影像学特征预测MESCC患者瘫痪状态的发生具有明显滞后性.椎体后壁向后突出可预示MESCC患者的神经学不稳定.位于上胸椎和（或）颈胸交界的主要病变脊椎常连续发生且易发生运动功能损害.累及椎板的转移瘤易于向椎管内硬膜外间隙侵犯.椎体前柱骨折不能用以预测MESCC患者的运动功能损害.     

Review of the factors which make diabetic home medical care difficult

In the patients who were managed in the diabetes treatment department, 33 patients were chosen as the difficult cases for the home medical care, and the factors were reviewed. As for the man and woman ratio, 11 were men and 22 were women. The number of female patients was twice larger. The average age was 81.7 years old. As for the mode of the medical care, 11 patients were under the long-term hospitalization, 1 was under care of the health care facility, 12 were under care of the nursing home, 5 lived in private facilities for senior citizens, and 4 were treated under home medical care. The main reason to refuse the home medical care was the decline of the self-management ability. Of the 33 patients, dementia was observed in 21 patients, and the lack of recognition on their own disease was seen in 12 patients. So, without the support, the home medical care could not be provided. It is difficult to provide home medical care because of the complications (especially impaired visual sight, or cerebral vascular disease), the complexity of illness, the state of the family involved in home care, and the reform of the healthcare system. In order to promote the home the medical care of the elderly diabetics whose medical dependency became high, the management of the dementia patient, the support to the family involved in home care, the valid utilization of the care insurance system among other issues seems to be future challenges.     

食管癌切除颈部食管与胃吻合手术方法的改进(附99例报告)

食管癌切除,颈部食管、胃吻合过去采用直接在颈部解剖、游离食管、拉胃和食管包套的方法进行吻合。喉返神经损伤、吻合口瘘、吻合口狭窄的发生率高。作者用改进的方法对99例食管癌作了食管胃吻合。在胸锁乳突肌内缘切开皮肤、皮下组织后,颈前肌群在术者从胸内伸至颈部的手指的引导下切开,这样就避开了喉返神经。然后提拉胃粘膜下血管的缝扎线,胃可轻易提至颈部,胃的血运好。加之食管、胃前壁是单层吻合,所以术后并发症的发生率明显减少。改进的手术方法简单安全,易掌握,具有一定的实用价值。     

An on-line phase measurement system for quality assurance of the BSD 2000. Part I: technical description of the measurement system

The hyperthermia system BSD 2000 with the ring applicator Sigma 60 utilizes the principle of a phase controlled group radiation source. The accuracy of the phase relationship between the four receiving HF signals is crucial for the position of the electric field inside the applicator. Therefore, essential significance falls to the phase control of the system. An automatic phase measuring technique has been developed to register immediately the phase position of the four channels of the BSD 2000 with respect to a reference signal. The system improves the ensurance of the technical safeguarding. In the first part of this work, the technical realization of the measurement system is described and first measurements with the system are given. In the second part, results with respect to the quality assurance of the BSD 2000 system are presented.