膝关节后外侧结构的解剖与MRI研究

目的 改进膝关节后外侧结构MRI定位方法，提高后外侧结构损伤的诊断准确率。方法 解剖膝关节标本，辨认后外侧各结构起止点及走行，明确它们之间的解剖关系。以注水的输液器缝合标记各结构进行MRI扫描，测量各结构在矢状面和冠状面上与腓骨颈长轴之间的夹角。按照这些角度定位扫描正常膝关节，观察各结构在MRI中完整显示的情况。结果 （1）测得矢状面上腓侧副韧带和胴肌腱关节囊内部分与腓骨颈长轴的夹角分别为（11．5±1.7）°和（39．5±6，4）°冠状面上胴肌腱关节囊外部分和胴腓韧带与腓骨颈长轴夹角为（39.5±3．9）°和（31．9±3．9）°。（2）腓侧副韧带在11°后斜冠状位1个层面上完整显示占90％，胴肌腱关节囊内部分在40°后斜冠状位1个层面上完整显示占80％，胭肌腱关节囊外部分在内斜40°矢状位1个层面上完整显示占90％，胭腓韧带在外斜30°矢状位1个层面上完整显示占90％。此外，胴腓韧带在11°后斜冠状位1个层面上完整显示的占75％，股二头肌腱和髂胫束在常规冠状面均能够很好显示.结论 选择完整显示腓骨茎突和腓骨颈的冠状面和矢状面为基准面，按照后外侧各结构与腓骨颈长轴所呈角度进行定位，层厚2mm的MR扫描能很好地显示膝关节后外侧解剖结构。     

经枕下乙状窦后锁孔入路治疗听神经瘤的临床体会

目的 总结经枕下乙状窦后锁孔入路切除听神经瘤的手术经验. 方法 采用经枕下乙状窦后锁孔入路对38例听神经瘤进行切除手术.距乙状窦后缘内侧1.5 cm做一小直切口,形成直径2.5～3.0 cm大小骨窗,术毕骨瓣复位固定. 结果本组听神经瘤全切33例,次全切5例;35例面神经解剖保留,2例听力保留;无死亡病例,脑脊液漏1例,术中无一例输血,无皮下积液.结论 经枕下乙状窦后锁孔入路可提供足够的手术空间进行听神经瘤切除,明显减少了医源性损伤,切口愈合好,具备微创性、安全性和有效性.     

显微手术治疗室管膜瘤30例分析

目的 总结室管膜瘤的显微手术治疗经验.方法 显微手术治疗室管膜瘤30例并随访.结果 肿瘤全切21例,大部分切除8例,1例多发者切除四脑室肿瘤,桥小脑角肿瘤行γ刀治疗.结论 采用显微外科技术,尽可能全切除肿瘤是治疗室管膜瘤的最有效手段及治疗原则,不主张放射治疗.     

改良点式剥脱术治疗下肢浅静脉曲张临床报告

目的：评估改良点式剥脱术治疗下肢浅静脉曲张的临床疗效。方法：摒弃输精管钳改用蚊式钳，术中采用弹拔法寻找静脉，准确快捷，副损伤小。结果：采用改进术式治疗198例共208条肢体，经近10年随访疗效良好。结论：在现阶段改良点式剥脱术是较为实用简便的治疗方式。     

枕下乙状窦后-颌下联合入路显微切除颈静脉孔区哑铃型神经鞘瘤

颈静脉孔区哑铃型神经鞘瘤较为罕见，其位置深在，解剖结构复杂，诊断和治疗均比较困难，术后并发症较多。自1999年至2007年我科共收治5例。采用显微神经外科技术，选择枕下乙状窦后一颌下联合入路切除肿瘤，取得良好的效果，报道如下。     

卵巢平滑肌瘤2例临床病理分析

卵巢平滑肌瘤是原发于卵巢的一种极罕见良性肿瘤，迄今为止，国内外仅有60余例文献报道。在病理诊断上易与卵巢其他间叶组织肿瘤相混淆。本文报告2例并讨论该肿瘤的鉴别诊断。     

下腔静脉平滑肌瘤1例

病人女，53岁。3年前B超发现多发性子宫肌瘤，右心房肿瘤；先行子宫切除术，病理证实为多发性子宫平滑肌瘤；体外循环下行右心房肿瘤切除术，术中发现肿瘤根部位于下腔静脉内，肿瘤基底部未能切除，病理诊断：血管内平滑肌瘤。     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.