骨外露及皮肤软组织缺损的修复

目的　评价和探讨修复骨外露及皮肤软组织缺损的各种方法 ,使其更好地用于临床。方法　 3 5例不同部位的骨外露分别采用皮片移植、皮瓣及肌皮瓣转移、皮瓣及肌皮瓣游离移植等方法 ,覆盖外露的骨面。结果　 3 1例全部存活 ,1例皮瓣部分坏死 ,2例创口延迟愈合 ,1例游离皮瓣失败。结论　对骨外露及皮肤软组织缺损应尽量在早期修复 ,最常用的方法是皮瓣及肌皮瓣的转移或移植。     

不同低浓度罗哌卡因低位硬膜外镇痛对运动神经阻滞的临床观察

目的 观察不同低浓度罗哌卡因（ropivacaine,Rop）低位硬膜外镇痛对运动神经的阻滞作用。探讨罗哌卡因低位硬膜外镇痛的最佳药物浓度。方法 随机选择我院67例下腹部择期手术患者，术后随机分为5个治疗组（A、B、C、D、E）和一个对照组（F），3h后硬膜外腔用药。前5组使用不同浓度罗哌卡因（A：0.1%;B:0.15%;C:0.2%;D:0.25%;E:0.3%），F组使用0.9%生理盐水。注药前后20分钟分别观察、记录以下项目：1.视觉模拟评分（Visual analogue scale,VAS）；2.阻滞区运动神经反射；3. 下肢指令运动。结果 不同低浓度罗哌卡因均有程度不同的术后镇痛作用。对运动神经的阻滞作用A、B、C三组与对照组无显著性差异（P＞0.05），而D、E两组有显著性差异（P＜0.05）。结论 选择浓度为0.2%的罗哌卡因低位硬膜外镇痛既可以有效地发挥术后镇痛作用，又最大程度地减少了对运动神经的阻滞作用，有利患者术后恢复。     

异体甘油保存皮与自体微粒皮复合移植的临床应用

目的：寻找深度大面积\烧伤的早期治疗方法。方法:大面积深度烧伤于4－5天即行切痂，以异体甘油皮为支架，将有限的自体皮制作成微粒皮后均匀地复合植于创面。结果：对5例共12个肢体2个躯干进行早期切痂后异体甘油皮＋自体微粒皮的复合移植，成活后的创面平堤，外观平整，颜色淡红或近拟正常皮肤，触饮，收缩少，结论：异体甘油保存皮＋自体微粒皮复合移植是大面积深度烧伤较理想的治疗方法。     

捻转补泻手法针刺合谷穴对其局部皮肤温度的影响

目的阐明针刺捻转补法与泻法的操作是否存在效应上的差异,并探讨其效应差异是否为补泻效应的差异.方法应用红外线热像技术,采用不同的捻转补泻手法针刺健康人合谷穴后,观察其在即刻,10、20、30min,对局部皮肤温度的影响.结果不同捻转补法与泻法的操作存在着不同程度的效应差异,其中补法可以使皮温升高,泻法可以使皮温降低,以石氏捻转补泻针法较为明显.结论1)补泻手法,补法和泻法的操作可产生不同的效应.2)不同捻转补泻手法对皮肤温度产生的升降效应为补泻效应,其中以石氏捻转补泻手法最为明显.3)证明补泻手法实施的必要性.     

腹部大血管病变的3D DCE-MRA诊断

目的 阐述3D动态增强磁共振血管造影（three-dimensional　dynamic contrast-enhanced magnetic resonance angiog-raphy,3D DCE-MRA）的原理及其在腹部大血管病变诊断中的价值。方法搜集32例腹部大血管3D DCE-MRA检查的影像资料,对其影像表现进行回顾性分析。结果（1）团注试验:对比剂通过肾动脉水平腹主动脉内的高峰时间为17-23s;（2）正常表现3例,清晰显示腹主动脉及其分支;（3）腹主动脉瘤7例,均显示主动脉受累段不规则增宽及实际的动脉腔;（4）腹主动脉夹层18例,均显示内膜片、真假两腔以及分支动脉起源的位置,显示破口12处、再破口16处;（5）动脉粥样硬化3例,均显示腹主动脉迂曲,管径粗细不均;（6）髂总静脉血栓形成1例,左髂总静脉未显影。结论3DDCE-MRA是一种非损伤性血管成像技术,对腹部大血管病变的诊断有重要意义。     

The surgical management of resistant club foot by rotation skin flap and extensive soft tissue release

Summary Resistant club foot remains an unsolved problem because of the complex aetiological and pathological factors, and is still seen quite frequently, especially in developing countries. The posteromedial skin contracture is a potent deforming force which is responsible for many failures or relapses. I report the results of an operation in which a rotation skin flap was combined with an extensive soft-tissue release. The age of the children was from 9 months to 10 years. The follow-up period was from one to 9 years with an average of 43 months, and in 50 cases for more than 5 years. I consider that the outcome has been excellent or good in 94 out of 100 feet.

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Résumé Le pied bot invétéré demeure un problème mal résolu en raison de la complexité des facteurs étiologiques et anatomiques et il est encore bien souvent rencontré, notamment dans les pays en voie de développement. La rétraction cutanée postéro-interne représente un puissant élément de la déformation, qui est responsable de bon nombre d'échecs ou de récidives. Nous rapportons les résultats d'une opération qui associe un lambeau cutané de rotation à la libération des parties molles. L'âge des enfants était compris entre neuf mois et dix ans. Le recul est de un à neuf ans, avec une moyenne de 43 mois. Cinquante enfants ont été suivis plus de cinq ans. Les résultats sont excellents ou bons dans 94% des cas.

     

紫外线照射后哺乳动物细胞DNA的期外合成

本实验用~3H-TdR掺入,液体闪烁测量法测定细胞DNA期外合成的方法,测定了小鼠和大鼠的肠淋巴结细胞、人和大鼠外周血淋巴细胞、S-180V肿瘤细胞等经紫外线照射后的UDS,观察到UDS掺入量随辐照度增加而增加。在同一辐照剂量下,以小鼠肠淋巴结细胞的UDS值最高,其次是人外周血淋巴细胞和S-180V肿瘤细胞,而大鼠外周血淋巴细胞和肠淋巴结细胞最低。     

Skin test results and self-reported symptom severity in allergic rhinitis: the role of psychological factors

BACKGROUND: In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity. OBJECTIVES: To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors. METHODS: One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism. CONCLUSIONS: The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.