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目的　探讨一种更精确而行之有效的测量甲状腺残留量的方法。方法　自 1996～ 2 0 0 1年对 15例原发性甲状腺功能亢进症病人于术前经CT对甲状腺进行体积测量 ,于双侧甲状腺次全切除术后 ,再用增强CT对上述病人残留甲状腺进行体积测量 ,并与术中测得残留量比较。结果　术中测得残留量 2 8～ 13 0 g ,术后CT测量为 3 4～ 16 6g ,二者之间有一定误差 (P =0 0 6 7) ,产生原因主要为术者对残留甲状腺背面气管旁沟处的不规则腺体测量不准确。体积切除率 83 1%～ 97 9% ,体积残留率 2 1%～ 17 9% ,活体组织相对体积质量 (1 0 5 4 8± 0 0 2 0 5 ) g/cm3 ,离体组织相对体积质量 (1 0 6 4 8± 0 0 188) g/cm3 。结论　CT测量更接近实际残留量 ,可重复性强 ,可比性强。体积残留率比腺体残留重量、手术切除率更具有个性化参考意义。     

Adaptive changes of juxtamedullary glomerular filtration in the remnant kidney

The participation of surviving juxtamedullary nephrons in the adaptive changes of glomerular filtration that occur in response to loss of functioning nephron mass was examined by direct micropuncture of the rat renal papilla. The solitary remnant kidney (RK) in rats with an 85% reduction of renal mass demonstrated strikingly elevated values for single nephron glomerular filtration rate (SNGFR) in both superficial (46.1±3.2 nl/min) and juxtamedullary (73.5±6.1 nl/min) nephrons in comparison to respective values observed in normal hydrophenic rats (superficial SNGFR=15.0±1.9nl/min,P<0.001, and juxtamedullary SNGFR=30.2±3.2 nl/min,P<0.001). In RK rats, the proximal portions of both superficial and juxtamedullary nephrons exhibited a marked increase in absolute fluid reabsorption as well as a markedly enhanced delivery of fluid to more distal portions of the nephron. These observations indicate that similar, not preferential, functional adaptations in glomerular filtration occur concommitantly in both superficial and juxtamedullary nephrons consequent to reduction of renal mass.     

胃大部分切除术后残胃癌26例临床诊治分析

目的:探讨残胃癌的早期诊断方法和外科治疗,观察不同手术方式对预后的影响.方法:对26例残胃癌的临床病理资料进行回顾性分析,比较胃镜和钡餐对残胃癌的诊断价值.结果:胃镜对残胃癌的诊断率为80.8%,钡餐为50.0%.手术切除的20例中根治性残胃切除13例均生存≥3年;姑息性切除7例,术后生存2年5例,1.5年2例.行胃空肠吻合4例中3例于6个月内死亡,1例生存10个月.2例腹腔内广泛转移者仅行肿块活检术.结论:胃镜对残胃癌的诊断价值优于钡餐.早期诊断并行根治性残胃切除患者预后较好.     

膝关节交叉韧带断裂后保留交叉韧带残端的韧带重建术应用进展

膝关节交叉韧带断裂后很难自愈,通常需要进行交叉韧带重建术,从而恢复膝关节的稳定性.近年来通过保留交叉韧带残端进行韧带重建术,被认为有利于移植物的血管长入、加快移植物与骨隧道的愈合、有利于恢复韧带的本体感觉等.笔者通过对有关文献的回顾,对交叉韧带残端的组织学分析、动物实验以及临床应用等方面进行总结.     

关节镜下同时保留股骨及胫骨残端重建前交叉韧带的临床疗效评估

目的 探讨关节镜下采取同时保留股骨及胫骨残端方式重建前交叉韧带的技术应用并观察其效果。方法 选取安徽医科大学第一附属医院2014年1月至2016年1月收住的前交叉韧带（ACL）损伤患者52例,术前依据随机数字表法分为同时保留胫骨及股骨韧带残端重建ACL组（保残组）与不保留任何韧带残端重建ACL组（对照组）并按照单束重建ACL方法完成手术,每组26例。采用Lysholm膝关节功能评分评估客观功能及行为能力,采用国际膝关节文献委员会（IKDC）主观评分评估主观运动能力及生活质量,比较两组患者术前、术后18个月上述评分标准评估的患者膝关节功能。所有患者于术后6个月复查磁共振,观察移植肌腱与骨隧道的愈合情况及有无其他关节异常信号。结果 保残组患者膝关节术前Lysholm评分和IKDC评分均低于术后[（57.21±5.05）分vs（89.43±4.12）分;（52.18±7.61）分vs（91.43±4.52）分],差异有统计学意义（P<0.05）。对照组患者术前Lysholm评分和IKDC评分均低于术后[（54.72±4.06）分vs（86.21±3.89）分;（56.24±6.59）分vs（83.56±5.02）分],差异有统计学意义（P<0.05）。术后IKDC主观评分保残组优于对照组[（91.43±4.52）分vs（83.56±5.02）分],且差异有统计学意义（P<0.05）。所有患者术后未发生严重并发症。结论 关节镜下同时保留胫骨及股骨侧残端重建前交叉韧带术术后效果良好,无不良并发症,有利于前交叉韧带重建术后膝关节功能的恢复。     

Recurrent deep neck abscess and piriform sinus tract: A 15-year review on the diagnosis and management

Background

Piriform sinus tract (PST) is a rare congenital condition. A delay in diagnosis is common leading to recurrent inflammation.

Method

A retrospective review was performed on all cases of PST treated at a tertiary referral centre between May 1997 and May 2012.

Results

Eighteen patients were reviewed with a mean age of 5.4 years at presentation (ranged from 0 day to 14 years). Most patients presented as acute inflammation (88.9%) and 16 had a left sided lesion. 72.2% of the PST are identified by contrast swallow study. The diagnostic yield was significantly higher if the study was done after the initial acute inflammation settled. Ultrasonography and computer tomography are less sensitive. The median duration from presentation to diagnosis was 17.6 months (ranged 0–120 months). Ten patients (55.6%) experienced recurrent inflammation before confirming the diagnosis. Fistulectomy alone was performed in 15 patients while an additional en-bloc hemithyroidectomy was done in 2 patients.

Conclusion

PST should be suspected in children presenting with a left deep neck abscess. Contrast swallow study is very effective in making diagnosis but has to be postponed after the acute inflammation settles. The condition can be effectively treated by fistulectomy without hemithyroidectomy in majority of our cases.     

Post-surgical vestibular schwannoma remnant tumors: What to do?

BackgroundVestibular schwannomas (VS) are benign tumors of the vestibular nerve's myelin sheath. The current trend in VS surgery is to preserve at the facial function, even if it means leaving a small vestibular schwannoma tumor remnant (VSTR) after the surgery. There is no defined therapeutic management VSTR. The aim of this study was to assess the evolution of the VSTR to define the best therapeutic management and identify predictive factors of VSTR progression.MethodsAmong the 256 patients treated surgically for VS in the Department of Neurosurgery at Angers University Hospital, 33 patients with a post-surgical VSTR were included in this retrospective study. For all surgical patients, the data collected were age at diagnosis, the Koos classification, the surgical access, the existence of a type 2 neurofibromatosis (NF2), the TR location and size on control MRI-scans. Patients had a bi-annual follow-up with clinical status and VSTR size assessment with MRI-scan. Survival analyzes were performed to determine the time and rate of VSTR progression, and identify factors of progression.ResultsThe mean follow-up of the population was 51 months. All VS remnant progression occurred between 38 and 58 months after surgery. In non-NF2 patients with first follow-up MRI-scan three months after surgery, 43% presented a spontaneous regression, 50% a stability and 7% a progression of the VSTR. In the same population with the 1-year MR-scan after surgery as baseline, 25% presented a spontaneous regression, 62.5% a stability and 12.5% a VSTR progression. These data are consistent with the data reported in the literature. The post-operative facial function impairment and an initial remnant ≥ 1.5 cm³ were found to be significant risk factors of VS remnant progression in non-NF2 population in univariate analysis (P = 0.048 and 0.031) but not in multivariate analysis.ConclusionIn our experience, the best therapeutic management of the post-surgical VSTP in non-NF2 patients with no risk factor of progression is a simple clinical radiological follow-up otherwise complementary radiosurgery should be considered.     

Early and late gastric cancer arising in the remnant stomach after distal gastrectomy

AIM: Following distal gastrectomy, carcinogenesis has been suggested to result from gastroduodenal reflux. In this study, surgical cases of gastric cancer arising after distal gastrectomy were analyzed clinico-pathologically and the possible link to reflux examined. PATIENTS: Thirty-two patients (24 males, 8 females; mean age, 68.7 years; age range, 33-84 years) with gastric cancer arising in the remnant stomach after gastrectomy (also known as gastric stump cancer) were included in this study. Patients were divided into two groups on the basis of the initial diagnosis (benign or malignant) prompting surgery, and distal gastrectomy reconstruction method (Billroth I or II). RESULTS: The interval between distal gastrectomy and detection of cancer in the remnant stomach of patients treated initially for a benign gastric condition vs. malignancy was 360+/-33.04 and 63+/-19.16 months (median+/-SE), respectively (p<0.0001). However, the benign and malignant groups did not differ significantly in the clinicopathological analysis of their stump cancers. All 10 patients in whom gastric cancer was diagnosed within five years of initial surgery had initially been surgically treated for malignancy. The interval between surgery and detection of gastric cancer in the Billroth I and Billroth II groups was 84+/-26.67 and 276+/-44.26 months (median+/-SE), respectively (p<0.01). In the remnant stomach, cancer tended to occur near the site of gastrojejunostomy in the Billroth II group (p=0.05). Helicobacter pylori infection was only detected histologically in four patients who had undergone Billroth I reconstructions after distal gastrectomy for malignancy. CONCLUSION: After distal gastrectomy, careful periodic endoscopic examination for microcarcinoma is required in patients, particularly in those who undergo surgery for malignancy, to maximize detection of gastric cancer.