A new operational approach for the piriform sinus fistula

It has been well documented that piriform sinus fistulae often cause suppurative thyroditis; however, when a piriform sinus fistula does not present this symptom, making a correct diagnosis is very difficult. We have experienced 11 cases of a piriform sinus fistula. The conventional operational approach was performed in the initial eight patients, among which there were four recurrences in two patients. Therefore, a new operational approach was introduced for the three most recent cases and one recurrent case. First, the existence of the internal orifice of the fistula is confirmed with a laryngoscope, after which a transverse incision on the neck is made and the abscess dissected. The side wall of the piriform sinus is then opened with the help of a laryngoscope and the bottom part of the mucosa of the sinus transected with the internal orifice of the fistula, after which the fistula is removed en bloc with the bottom part of the sinus and abscess cavity. Using this operation, we experienced no complications and there has been no recurrence so far.This paper was presented at the 23rd Annual Meeting of Pacific Association of Pediatric Surgeons, June 1990 in Kona, Hawaii.     

白血病抑制因子反义寡核苷酸对髓母细胞体外生长的抑制作用

为进一步认识白血病抑制因子（LIF）对人髓母细胞瘤生长的生物学作用，我们使用LIF反义寡核苷酸，在髓母细胞内特异性阻断LIF基因表达并观察它对靶细胞的生物学效应。结果发现，被处理细胞的LIF表达降低至RT／PCR检出的阈值之下，抗LIF的免疫组织化学染色亦呈阴性，同时，这些细胞的生长速度明显减缓。相反，用与反义寡核苷酸互补的正义序列处理的细胞无论在基因表达／产生，还是在生长速度方面，均和正常培养细胞的细胞相似，本研究从而提示了一条以LIF为对象的髓母细胞瘤以及其它LIF生长依赖性肿瘤的基因和免疫治疗途径。     

老年人脑皮质下斑点状病灶的MRI病理基础研究

本文对29例脑标本行 MRI-病理对照研究,其中18例脑标本 MRI 检查阳性,发现脑皮质下斑点状病灶(Subcortical Patchy Lesions,SPLs)95个。该病灶分两大类:第一类(64个)位于脑皮层下白质、基底核、小脑和脑干,其病理基础主要为血管周围间隙扩大(83%),小梗塞灶(11%),其他还有小动、静脉畸形(AVM),脱髓鞘灶和胶质增生灶;第二类(31个)位于侧脑室周围白质内,其病理基础为局部组织结构疏松呈空泡状,病灶相应部位的室管膜大片脱落。     

Vesicocutaneous fistula: An unusual complication of inguinoscrotal hernia

Involvement of the urinary bladder in an inguinal hernia is common, but massive bladder hernia is rare. Most urinary bladder herniations are discovered and repaired during surgery. We report a case of large incarcerated inguino-scrotal hernia, which was reduced only to present as a scrotal abscess and vesicocutaneous fistula; an unusual complication. The patient was managed conservatively due to underlying comorbidities.     

NO在体外循环中脑损伤作用机制的研究进展

一氧化氮及一氧化氮合酶在体外循环导致的脑损伤中具有重要作用,它可以通过扩张血管/抑制血小板聚集与黏附/减少细胞凋亡等对脑组织产生保护作用。一氧化氮的临床应用仍需对其作用机制作进一步深入研究。     

Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Preoperative diagnosis of fallopian tube carcinoma is difficult, with fewer than 5% being diagnosed preoperatively. We describe tubal carcinoma, presenting as a tubo-ovarian abscess in two 47-year-old women. Both patients presented with abdominal pain, pelvic mass, and fever. Both patients were treated as having a tubo-ovarian abscess but failed to respond to therapy. During surgery a metastatic right tubal carcinoma was found. A definite operation was performed in both patients. Three additional cases of fallopian tube carcinoma, presenting as acute pelvic inflammatory disease, were found while reviewing the English literature. Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. Carcinoma of the fallopian tube should be considered in the differential diagnosis of tubo-ovarian abscess in those who failed to respond to a previously unreported clinical presentation.     

亚低温对大鼠脑损伤后脑组织炎性反应的影响

目的探讨颅脑外伤后早期应用亚低温治疗对脑组织炎性反应的影响。方法采用Feeney自由落体改良模型,设定对照组、颅脑外伤模型组及亚低温组,每组再根据伤后不同生存时间随分为3个亚组。取伤灶脑组织检测髓过氧化酶(MPO)活性,做细胞间黏附子-1(ICAM-1)免疫组化染色,光镜下计数ICAM-1阳性血管数。结果亚低温组各时间点伤灶区ICAM-1阳性血管数明显低于颅脑外伤模型相应时间点(P<0.01)。亚低温组各时间点MPO活性均明显低于颅脑外伤模型组相应时间点(P<0.01)。结论亚低温治疗能明显减少伤灶区白细胞浸润及ICAM-1的表达,有助于改善颅脑外伤后脑组织炎性反应引起的继发性脑损伤。     

磁共振弥散加权成像在脑脓肿与坏死囊变性脑肿瘤鉴别诊断中的价值

目的　评价磁共振弥散加权成像 (diffusiionwieghtedimaging ,DWI) ,在脑脓肿与坏死囊变性脑肿瘤鉴别诊断中的价值。方法　 12例经手术病理 ( 10例 )或临床随访 ( 2例 )证实的脑脓肿和 5 0例经手术病理证实的坏死囊变性脑脓肿 (其中星形细胞瘤 2 8例、脑转移瘤 10例、血管母细胞瘤 6例、听神经瘤 6例 ) ,在术前或治疗前接受了常规MRI检查及DWI。结果　脑脓肿 (脓腔 )在DWI上表现为明显的高信号 ,而脑肿瘤坏死囊变区表现为低信号。结论　DWI对脑脓肿与坏死囊变性脑肿瘤的鉴别诊断具有重价值 ,应与常规MRI序列一起列为基本序列。     

缺血性脑血管病患者血清基质金属蛋白酶水平及影响因素分析

目的 比较急性脑梗死、短暂脑缺血发作(TIA)和陈旧脑梗死患者血清基质金属蛋白酶-9(MMP-9)水平并分析其影响因素.方法 缺血性脑血管病患者136例,分为急性脑梗死组57例,TIA组22例,陈旧脑梗死组57例,进行神经功能评分及血压、血常规、血脂、血糖检查.依据ELISA法进行血MMP-9测定.结果 MMP-9水平分别为急性脑梗死患者(444.13±418.46)ng/ml,TIA患者(374.36±278.31)ng/ml,陈旧脑梗死患者(231.11±367.43)ng/ml.急性脑梗死和TIA患者血MMP-9水平明显高于陈旧脑梗死患者(P＜0.05).MMP-9水平与血白细胞水平(r=0.192,P=0.025)、低密度脂蛋白(r=0.261,P=0.002)、收缩压(r=0.232,P=0.006)呈正相关;与高密度脂蛋白(r=-0.219,P=0.011)和血糖(r=-0.254,P=0.003)呈负相关.MMP-9与收缩压(β=0.259,P=0.001)、血白细胞(β=0.209,P=0.008)、低密度脂蛋白(β=0.586,P=0.000)、胆固醇(β=-0.458,P=0.007)和血糖(β=-0.200,P=0.014)具有线性关系.结论 MMP-9水平在急性脑梗死及TIA时升高,收缩压、血白细胞和低密度脂蛋白均可能为其影响因素.     

急性缺血性脑血管疾病的药物序贯治疗

目的:探讨药物的序贯治疗对急性缺血性脑血管病的治疗效果。方法:随机分成去纤酶、奥扎格雷钠、盐酸丁格地尔序贯治疗组和使用肠溶阿斯匹林、复方丹参针对照组,治疗组和对照组在治疗前后作神经功能评估,患者的生活能力状态评价及脑循环血流变化的测定。结果:治疗组显效率76.1%,有效率8.7%,总有效率84.8%,对照组显效率23.5%,有效率14.7%,总有效率38.2%(P<0.05)。结论:药物序贯治疗急性缺血性脑血管病比常规治疗疗效显著。