Islanded facial artery osteomyomucosal/osseous flap in head and neck reconstruction

A local pedicled vascularized bone flap can prevent the morbidity and cost of free bone flap surgery in small segmental bone defects or long cartilaginous defects of the head and neck. Such flaps can also be useful in patients who are high risk for surgery. The periosteal vascularity of the mandible can be used to design islanded facial artery-based bone flaps, which can be utilized to that extent. Two patients with a small segmental mandibulectomy defect and one patient with a long cricotracheal resection defect underwent reconstruction using three different designs of islanded facial artery osteomyomucosal/osseous flap (iFOMM). The patients had a minimum follow-up period of 18 months. All flaps were successful, with satisfactory healing and without any functional deficit or disease at last follow-up.     

凝血栓蛋白1基因异常甲基化与大肠腺癌关联

目的 探讨凝血栓蛋白l（THBS1）基因启动子CpG岛异常甲基化与大肠腺癌及其临床病理特征的关联。方法 THBS1基因甲基化状态用甲基化特异性PCR检测。结果 大肠腺癌、癌旁组织中，THBSI基因启动子cpG岛甲基化率的差异有显著性（X^2=5．93，P=0．025）；老年患者肿瘤组织中THBS1基因甲基化率明显商于非老年患者（X^2=5.68，P=0．017），直径≥3cm的肿瘤组织中THBSl基因甲基化率显著高于直径〈3cm的肿瘤（X^2=4．16，P=0．041），C期和D期肿瘤组织中THBS1基因甲基化率显著高于A期或B期肿瘤（X^2=8．04，u=2，P=0．018）。结论 THBS1基因甲基化与大肠腺癌的发生有关，肿瘤以老年、晚期和直径较大的肿瘤多见。     

人原发性肝癌中p16基因表达及CpG岛甲基化状态的研究

目的　进一步探讨人原发性肝癌中 p16基因 m RNA转录水平变化与其基因启动子区 Cp G岛甲基化的关系 ,及其在肝癌发生中的意义。方法　采用狭缝印迹杂交检测 2 0例人原发性肝癌及相应的癌旁、远癌组织及 2例正常人肝组织中 p16基因 m RNA表达水平 ,以甲基化特异性 PCR分析各组织中 p16基因启动子区 Cp G岛的甲基化状况 ,并进行统计分析。结果　 2 0例人原发性肝癌中 14例 (70 % ) p16 m RNA水平比远癌组织显著降低 ;13例 (6 5 % )显示 p16基因启动子区 Cp G岛甲基化 ,其中 84 .6 % (11例 )伴 p16 m RNA转录水平降低。结论　人原发性肝癌中存在高频率的 p16基因表达失活 ,其主要机制可能是启动子区 Cp G岛甲基化抑制了基因的转录 ,在人原发性肝癌的发生发展中有重要作用。其临床诊断和治疗意义有待进一步深入研究。     

足底深支或(和)第一跖背动脉逆行足背岛状皮瓣的临床应用

目的探索足部远端软组织缺损修复的较佳方法。方法采用足底深支或(和)第1跖背动脉逆行足背岛状皮瓣对6例足部远端软组织缺损创面进行修复。结果6例患者均一次性修复,软组织缺损最大面积8cm×6cm,术后随访1~4年,足部功能与外观均较满意。结论足底深支或(和)第1跖背动脉逆行足背岛状皮瓣血管解剖比较恒定,操作简单,是修复足远端软组织缺损的较好方法。     

掌背动脉逆行岛状筋膜瓣修复手部皮肤缺损

目的:介绍掌背动脉逆行筋膜瓣修复手部皮肤缺损的临床应用。方法:采用第二、第三掌背动脉逆行岛状筋膜瓣分别修复手部皮肤缺损10例。皮肤缺损面积2.0cm×3.0cm-3.0cm×5.0cm。结果:10例筋膜瓣移位均成活,效果满意。结论:应用第二、三掌背动脉逆行岛状筋膜瓣移植是治疗手部皮肤缺损一种简单有效的手术方法。     

Histological Changes and Differential Diagnosis of Mesenchymal Chondrosarcoma

Eight cases of mesenchymal chondrosarcoma either of skeletal(5 cases) or extrasketetalorigin (3 cases) are reported. According to histopathological and diagnostic criteria,mesenchymal chondrosarcoma were classified into two types cartilage isiand cell type andundifierentiated small cell type It is believed that the application of this classification in the study ofmesenchymal chondrosarcoma is helptul the estimation of its malignancy and choice of treatmentas well al in the prediction of its prognosis. Mesenchymal chondrosarcoma is a highly malignant neoplasm with poor prognosis. None ofthe patients in this series survived more than five years after they were diagnosed. The diffentialdiagnosis of malignant lymphoma, chondrosarcoma, hemangiopericytosarcoma, etc. was discussed.My data support the assumption that mesenchymal chondrosarcoma originates from the secondarymesenchyme rather than the primary mesenchyme.     

腓动脉皮支逆行岛状皮瓣的解剖与应用改进

目的探讨腓动脉皮支逆行岛状皮瓣的解剖学基础及临床应用效果。方法采用新鲜及防腐尸体下肢共25肢,对腓动脉皮支进行解剖学观测。于2003年9月~2005年6月收治足跖趾关节处软组织缺损患者10例,男8例,女2例。年龄21~55岁。其中背侧6例,跖侧4例,缺损范围10cm×6cm~15cm×10cm。应用带有外踝上11.0±1.7cm腓动脉固定皮支的腓动脉皮支逆行岛状皮瓣修复,皮瓣范围11.0cm×6.5cm~16.0cm×11.0cm。供区6例直接减张缝合,4例行自体游离皮片覆盖。结果解剖学观测外踝上11.0±1.7cm自腓动脉发出一固定皮支,起始点直径1.45±0.12mm,入深筋膜点距腓肠神经营养血管皮瓣轴线15.70±1.20mm。10例患者术后皮瓣均成活,血运良好,无静脉回流障碍;供区愈合良好。术后获随访6~12个月,皮瓣外形良好,质地、色泽与周边相似,足功能恢复良好,两点辨别觉11~18mm。结论腓动脉皮支逆行岛状皮瓣经改进后血运好,逆转距离长,修复范围大,操作简便,为临床修复足中远端软组织缺损提供了一种新方法。     

岛状皮瓣转移修复小腿及足部骨外露创面

自1986年1月以来,我们使用5种岛状皮瓣为5例小腿及足部骨外露病人修复了创面,效果满意。笔者认为:岛状皮瓣转移术具有手术操作简单,安全可靠,血供丰富,抗感染能力强,术后处理容易等优点。本文还详细介绍了全部病例及手术注意事项。     

FASCIOCUTANEOUS ISLAND FLAPS FOR ORTHOPAEDIC MANAGEMENT IN LOWER LIMB RECONSTRUCTION USING DERMATOMAL PRECINCTS

This paper describes a technique of fasciocutaneous island flaps used in reconstruction of the lower limb. It is very versatile and some 26 individual flaps in 22 patients have been used to reconstruct skeletal and soft tissue problems from the popliteal fossa to the ankle joint. These longitudinally designed flaps made up of a trilaminate of skin, subcutaneous fat and fascia are aligned within the dermatomal precincts. The most important location for such flap design is along the peroneal compartment sitting within the L5 dermatome and incorporating the superficial peroneal nerve. It can be lengthened as far as the lateral malleolus and is an excellent reconstructive method to close defects over the lower third of the tibia. The medial compartment of the leg employing the saphenous nerve (L4 dermatome) is another area for fasciocutaneous island flap reconstruction, but use is restricted to the upper two-thirds of the tibial area. Posteriorly the island flap design sits along the S2 dermatome, this time incorporating the sural nerve to reconstruct defects of the calf and can be extended to include problems of the popliteal fossa. In the overall flap technique, the age of the patient is not a contraindication and cases with peripheral vascular disease have been treated successfully. The flaps may extend up to a 5:1 ratio in dimension. The operating time can be considerably shortened.     

高温高湿环境下守岛官兵训练时脑血流和脑电生理的变化研究

目的 探讨高温高湿环境下守岛官兵训练前后脑血流和脑电生理的变化,为临床防治热致疾病提供依据.方法 从守岛官兵中随机抽取在常温常湿环境下温度(27.40±1.37)℃,湿度(50.25±6.76)%]新兵100名为常温新兵组,高温高湿环境下(温度≥35℃,湿度≥80%)新兵100名为高温新兵组;高温高湿环境下服役2～3 年的官兵100名为高温老兵组.受试者负重15 kg,分次在3000 m/15 min,5000 m/30 min和10 000 m/45 min内完成跑步训练.10 000 m训练后,根据受试者脑血流高低又分为脑血流增高组(24名)、脑血流降低组(46名)和脑血流正常组(230名).训练前后行经颅多普勒血流诊断仪和脑电图仪检测.结果 (1)3000 m训练后3组受试官兵脑平均血流速度(Vm)较训练前均显著增高(P＜0.01),但5000 m和10 000 m训练后,常温新兵组降低6%和16%,高温老兵组降低5%和15%,高温新兵组降低14%和31%,比常温新兵组和高温老兵组低(P＜0.01);(2)10 000 m训练前后3组脑电图均在正常范围,3组比较差异无统计学意义(P＞0.05);(3)10 000 m训练后脑血流增高组和降低组脑电图比正常血流组活跃(P＜0.01).结论 高温高湿环境下10 000 m训练对官兵的脑血流有较大的影响,但对脑电生理无影响,老兵在此环境下则表现出较好的热耐受力和适应性.