100例2型糖尿病患者交感神经皮肤反应研究

目的探讨交感神经皮肤反应(SSR)检测在评价2型糖尿病(T2DM)自主神经损害中的价值.方法对100例T2DM患者进行SSR检测,30例健康志愿者作为对照.结果2组SSR的起始潜伏期、N波潜伏期、波幅、面积比较差异有显著性意义(P＜0.05),P波潜伏期差异无显著性意义(P＞0.05).T2DM组72例(72%)患者至少有一肢SSR异常.血糖控制满意组和血糖控制不良组比较,起始和N波潜伏期差异有统计学意义(P＜0.05),波幅和面积无显著性意义(P＞0.05).T2DM组病程＜5年与病程≥5年比较,潜伏期、波幅、面积差异均无统计学意义(P＞0.05).结论SSR可作为评价T2DM自主神经损害的客观电生理指标;T2DM患者SSR与血糖控制水平相关,与病程无关.     

选择性脱细胞猪皮研制及早期临床应用

目的介绍选择性脱细胞猪皮覆盖大面积烧伤早期创面的研制方法及临床应用效果. 方法 2001年1月～2002年5月,对1例深Ⅱ度15%、Ⅲ度25%烧伤患者的右前臂和右小腿,行选择性脱细胞中厚猪皮早期覆盖.戊二醛交联后表皮面黏贴于容器,边缘包埋.在含0.25%胰酶的PBS液中37℃消化2小时,去污剂处理24小时后,漂洗备用.将处理后猪皮应用于1例切削痂自体微粒植皮创面覆盖约2%,大体和光镜观察其功能和外观恢复情况. 结果组织学观察见表皮层基本完整,真皮内无细胞.初步临床观察显示,选择性脱细胞猪皮的真皮可在创基成活,失活表皮可被宿主自体表皮替代. 结论选择性脱细胞猪皮有望替代现有材料用于大面积烧伤切削痂创面的早期覆盖.     

Do ethnicity and gender have an impact on pain thresholds in minor dermatologic procedures?

Background and Objectives: The perception of pain is a personal experience influenced by many factors, including genetic, ethnic and cultural issues. Understanding these perceptions is especially important in dermatologic patients undergoing minor surgical operations and who often differ in their pain response to surgical treatments. Little is known about how these differences affect the perception of experimental pain. The purpose of this study was to determine experimental pain perception differences in three distinct East Asian ethnic populations.
Methods: Pain thresholds were examined with a psychophysical computerized quantitative thermal sensory testing device (TSA 2001) in healthy volunteers recruited from three different Asian ethnic groups. Using the methods of limits, experimental pain perception threshold was measured on the forehead and volar aspect of the forearm in 49 healthy subjects. The measurements were then repeated after skin barrier perturbation with adhesive tape stripping of the stratum corneum. All three ethnic groups were analyzed separately with respect to age, gender educational level and skin type.
Results: A total of 20 Chinese, 14 Malay and 15 Indian subjects completed the study. Thermal pain thresholds were similar in all three ethnic groups before and after tape strippings. No significant differences were noted between genders.
Conclusions: Using quantitative sensory thermal testing, we demonstrated that no significant differences in pain occur between different races and genders.     

Differential Stripping: Determination of the Amount of Topically Applied Substances Penetrated into the Hair Follicles

The determination of penetration pathways of topically applied substances into the skin is the subject of several investigations. Recently, follicular penetration has become a major focus of interest. To date, a direct, non-invasive quantification of the amount of topically applied substance penetrated into the follicles had not been possible. The development of such a method was the aim of this study. Therefore, the advantages of both stripping techniques, tape stripping and cyanoacrylate skin surface biopsy, were combined and evaluated. Tape stripping was used to remove the part of the stratum corneum that contained the topically applied dye. Subsequently, the follicular contents were ripped off by cyanoacrylate skin surface biopsy. The combined method termed "differential stripping" was evaluated in vitro and in vivo , and the amount of topically applied fluorescent dye penetrated into the hair follicles was quantified after different penetration times. After 30 min, 5% of the recovered concentration of sodium fluorescein was found in the follicular infundibula, where it was still detectable after 48 h. Altogether, the results of this investigation revealed that differential stripping is a new method that can be used to study the penetration of topically applied substances into the follicular infundibula non-invasively and selectively.     

皮(肌)瓣治疗小腿长段骨坏死实验研究与临床应用

[目的] 探讨皮（肌）瓣治疗骨坏死的可行性。[方法]应用新西兰大白兔48只，随机分为对照组、实验组。按实验方法将胫骨制成骨坏死模型。对照组用游离皮片覆盖坏死骨；实验组用腓肠肌皮瓣覆盖坏死骨。术后2、4、8、12周行ECT、X线片、骨钙素（BGT）、组织切片检查。临床应用436例。[结果]ECT显示实验组动脉相放射摄入值及延迟相放射摄入值明显高于对照组（P〈0．02）；血清BGP水平实验组各时段均比对照组高（P〈0．001）；组织学检查4周实验组髓腔中可见增生的血管，大量骨细胞；X线片12周实验组的胫前皮质骨接近正常骨，而对照组皮质骨仍为坏死、骨质硬化。临床应用小腿外观好，足部肿胀消退，创面感染治愈，坏死骨成活，骨髓腔再通。[结论]用血运丰富的皮（肌）瓣覆盖坏死胫骨段后，血运改善，坏死骨可以成活。     

头面颈部毛细血管畸形的手术治疗

目的 探讨手术治疗头面部不同类型毛细血管畸形的适应证,手术方法及疗效.方法 对适合手术的23例头面颈部患者,根据病灶的面积和手术前的条件分别采用了植皮,扩张器局部皮瓣转移修复和游离皮瓣修复等方法,并进行术后评价和随访.结果 除一例特别原因造成皮片下积血,皮片部分成活不良二期再植,一例同位素治疗后扩张器病例远端发生血运障碍后改植皮以外,其余皮片,皮瓣均成活良好,但随访皮片有较明显的色差,而皮瓣色泽,质地良好.结论 皮瓣修复效果较好,其中扩张的局部皮瓣转移修复效果最佳.游离皮瓣较适合有皮下组织萎缩的大面积的病例,而其他大面积病灶可采用分期分区植皮.     

Cryoscopy: a novel enhancing method of in vivo skin imaging

BACKGROUND: It is a common observation that superficial freezing of normal skin and skin tumors may create a transient superficial whitening effect. In this respect, cryoscopy refers to the direct observation by dermoscopy, with or without digital recording, of the visual alterations of the frozen tissues. AIMS: To define the optimal method of cryoscopy and to describe the cryoscopy patterns of normal skin and selected skin lesions. MATERIALS AND METHODS: The influence of (a) different cryogenic sources [solid carbon dioxide (-78.5 degrees C), liquid nitrogen (N(2), -196 degrees C), and a mixture of dimethyl ether and propane (-57 degrees C)], (b) various application methods (spraying, cotton chill tips, copper plate), and (c) freezing time was assessed with regard to clinical feasability, visualization quality, and persistance time of the whitening effect. Cryoscopy patterns of normal skin, callosities and of histologically proven seborrheic keratoses, verrucous hamartomas, molluscum contagiosum, keratoacanthomas, viral warts, condylomas, actinic keratoses, dermatofibromas, skin tags, basal cell carcinomas, angiomas, and melanocytic naevi were assessed. RESULTS: The cryoscopy images of skin highlighted the skin lines. They appeared similar regardless of the freezing source and the application method. The aspects differed according to the nature of the lesions. The cotton chill tip method provided a longer whitening period compared with the other cold sources, both in normal and lesional skin. Hence, it represented the most convenient way for performing digital recording cryoscopy. On normal skin, cryoapplication was limited to about 1.5 s due to pain, resulting in whitening times ranging from 6 to 9 s, which was too short for easy digital recording. On all studied skin tumors, a 10-s N(2) freezing time was not experienced as painful, and blanching time persisted for 20-34 s, allowing easy digital recording. The whitening time was longer with increasing freezing time on both normal and lesional skin. Every single examined normal skin site and all the skin lesions showed a strong whitening effect, except heavily cornified structures, including some keratoses, callosities, and viral warts. Increased contrast of the skin surface texture was observed in almost every studied lesion. CONCLUSION: The N(2) cotton chill tip technique appeared to be the most convenient technique for cryoscopy and provided longer whitening periods compared with the other freezing sources. Pain prevented its use on normal skin, but a series of exophytic skin lesions was conveniently accessible to cryoscopy. The differences in whitening periods of various epidermal components resulted in increased visual contrast, creating typical cryoscopy images for the different exophytic skin tumors. Cryoscopy represents a novel in vivo skin imaging technique that is rapid, non-invasive, cost-effective, and easily performed. It shows both investigative and diagnostic potentials. It is remarkable that cryoscopy pictures closely resemble those yielded by skin capacitance imaging.     

乳房皮下切除与自体组织即刻乳房再造

目的探索乳房皮下切除与几种方法的乳房再造术，即腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣等即刻再造乳房的方法。方法选择乳腺导管内原位癌10例和巨大乳腺良性肿瘤5例，顺乳晕切口活检，病理检查确立诊断后，采用经乳腺切口行乳癌或巨大肿瘤的乳房皮下切除术，若乳癌或良性肿瘤体积较大，另于腋窝部加做顺腋下皱襞的附加切口，以便于取出切除的组织及切除乳腺的腋尾部，同时可以切取腋淋巴结行冰冻切片活检。然后，应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣即刻行再造乳房，充填乳房切除后的空间，仅以少量的肌皮瓣皮肤修复乳头、乳晕切除后的缺损，并在此转移皮瓣上再造乳头、乳晕。结果经过多专科协作共完成15例，随访结果良好，无肿瘤复发。此法再造的乳房易与健侧乳房对称，保留了原有乳房皮肤的良好感觉，外观形态自然，再造乳房瘢痕较少，且手术切口瘢痕隐蔽。结论在严格选择手术适应证防止乳腺癌复发的前提下，乳房皮下切除与即刻乳房再造法，对乳腺导管内原位癌和巨大乳腺良性肿瘤患者I期完成肿瘤切除和乳房再造术，具有积极有效的意义。