中西医结合治疗眼眶骨折致眼眶瘀肿及眶下神经知觉障碍临床观察

目的 :观察早期运用中西医结合疗法治疗眼眶骨折致眼眶瘀肿及眶下神经知觉障碍的临床疗效。方法 :将76例(82眼)眶骨骨折患者按随机数字表法分为对照组和治疗组各38例(41眼)。对照组予抗生素、地塞米松静脉滴注,B族维生素及甲钴胺片口服,并对症治疗;治疗组在对照组的基础上辨证运用自拟经验方眼眶骨折1号方、眼眶骨折2号方。观察两组治疗后眼眶瘀肿及眶下神经知觉障碍改善情况,综合评价疗效。结果:治疗组软组织肿胀、眼睑瘀血、结膜下瘀血平均消退时间均短于对照组,差异有统计学意义(P<0.05)。眶下神经知觉障碍改善情况,治疗组显效6例,有效12例,无效0例,总有效率100%;对照组显效2例,有效12例,无效6例,总有效率70%;治疗组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论:早期运用中西医结合疗法治疗眶骨骨折安全、有效,能加快眶周软组织损伤修复,缩短眼眶瘀肿消退时间,改善眶下神经知觉障碍。与单纯西医治疗比较,中西医结合疗法能缩短疗程、提高临床疗效。     

Cryoconservation du tissu ovarien : indications et devenir des patientes

ObjectivesOvarian Tissue Cryopreservation (OTC) is a very promising approach of fertility preservation for women and young patients who have to follow gonadotoxic treatments (chemotherapy, radiotherapy…). The aim of this study was to analyse the indications and the outcomes of the patients who had OTC in our center during the last 17 years.Patients and methodsThe study is retrospective. Forty-six patients, who underwent OTC in the Laboratory of Reproductive Biology of the University Hospital of Clermont-Ferrand, between January 1997 and December 2009, were included.ResultsThe average age on the day of ovarian tissue harvesting was 19.5 years. Fifty-two percent of the patients were minor. In order of decreasing frequency, the diseases for which OTC has been proposed were hematologic, ovarian tumors, sarcoma ou PNET and breast neoplasia. In 93.5 %, the harvesting of ovarian cortex was performed by laparoscopy. After OTC, 82.6 % of the patients were treated by chemotherapy. A bone marrow transplant was performed for 48 % of the study patients. At the time of data collection, 57 % of the patients who had evaluation of their ovarian function presented premature ovarian failure. Eight patients had one or more pregnancies after treatment. It was a natural pregnancy for five of them. The three others were obtained by medically assisted procreation (in vitro fertilization and oocyte donation).Discussion and conclusionWe report a long-term follow-up of patients treated in our center for OTC. The originality of our study is to evaluate all aspects of OTC from the decision to propose the patients an OTC to their outcomes several years after the ovarian tissue harvesting. It is therefore a multidisciplinary approach both oncology, gynecological and pediatric whereas OTC is often considered restrictively in the literature. Finally, it seems to be essential to establish a specific medical care for these patients. This monitoring will allow an adequate assessment of pubertal development and ovarian function, management of estrogen deficiency and secondary infertility, supporting patients in their desire for motherhood.     

Laparoscopic grasper for intramedullary biopsy: a technique to improve tissue sampling

Reaming samples are usually sent for histological testing to establish or confirm the primary source of malignancy while intramedullary nailing is performed for impending or established pathological fracture of the long bones. However, this conventional technique of sampling does not always yield accurate results. Herein, we introduce a technique for intramedullary biopsy using a laparoscopic grasper under image intensifier guidance. This novel technique was applied in three cases, and the tissue samples obtained successfully established or confirmed the primary source of malignancy. In comparison, reaming samples obtained via the conventional method showed negative findings in one case and tumour cells that were of poor sample quality in another case. We opine that this new technique is an effective and reproducible method that could improve tissue sampling and achieve a more reliable histological diagnosis.     

Tissue-engineered dermo-epidermal skin grafts prevascularized with adipose-derived cells

The major problem in skin grafting is that tissue-engineered skin grafts after their transplantation are initially entirely dependent on diffusion. Since this process is slow and inefficient, nutrients, growth factors, and oxygen will insufficiently be supplied and the regenerating graft will undergo a physiological crisis, resulting in scar-like dermal structures and shrinkage. The tissue-engineering of a vascular network in human dermo-epidermal skin substitutes (DESS) is a promising approach to overcome this limitation. Here we report, for the first time, on the use of the adipose stromal vascular fraction (SVF)-derived endothelial cell population to tissue-engineer DESS containing a highly efficient capillary plexus. To develop vascular networks in vitro, we employed optimized 3D fibrin or collagen type I hydrogel systems. Upon transplantation onto immune-deficient rats, these pre-formed vascular networks anastomosed to the recipient's vasculature within only four days. As a consequence, the neo-epidermis efficiently established tissue homeostasis, the dermis underwent almost no contraction, and showed sustained epidermal coverage in vivo. Overall, the here described rapid and efficient perfusion of SVF-based skin grafts opens new perspectives for the treatment of hitherto unmet clinical needs in burn/plastic surgery and dermatology.     

Pharmacokinetics of cysteamine bitartrate following intraduodenal delivery

Cysteamine is approved for the treatment of cystinosis and is being evaluated for Huntington's disease and non‐alcoholic fatty liver disease. Little is known about the bioavailability and biodistribution of the drug. The aim was to determine plasma, cerebrospinal fluid (CSF), and tissue (liver, kidney, muscle) cysteamine levels following intraduodenal delivery of the drug in rats pretreated and naïve to cysteamine and to estimate the hepatic first‐pass effect on cysteamine. Healthy male rats (n = 66) underwent intraduodenal and portal (PV) or jugular (JVC) venous catheterization. Half were pretreated with cysteamine, and half were naïve. Following intraduodenal cysteamine (20 mg/kg), serial blood samples were collected from the PV or the JVC. Animals were sacrificed at specific time points, and CSF and tissue were collected. Cysteamine levels were determined in plasma, CSF, and tissue. The C_max was achieved in 5–10 min from PV and 5–22.5 min from JVC. The PV‐C_max (P = 0.08), PV‐AUC_0–t (P = 0.16), JVC‐C_max (P = 0.02) and JVC‐AUC_0–t (P = 0.03) were higher in naive than in pretreated animals. Plasma cysteamine levels returned to baseline in ≤120 min. The hepatic first‐pass effect was estimated at 40%. Peak tissue and CSF cysteamine levels occurred ≤22.5 min, but returned to baseline levels ≤180 min. There was no difference in CSF and tissue cysteamine levels between naïve and pretreated groups, although cysteamine was more rapidly cleared in the pretreated group. Cysteamine is rapidly absorbed from the small intestine, undergoes significant hepatic first‐pass metabolism, crosses the blood brain barrier, and is almost undetectable in plasma, CSF, and body tissues 2 h after ingestion. Sustained‐release cysteamine may provide prolonged tissue exposure.