原发性腹膜后肿瘤术后复发的再手术治疗

目的提高复发性腹膜后肿瘤的手术切除率和生存率。方法回顾性分析了我院１９８７年至１９９５年原发性腹膜后肿瘤术后复发而再手术治疗的患者３４例，其中恶性肿瘤３３例，良性肿瘤１例。共行手术５３次，完整切除肿瘤４２次（７９．２％），姑息切除８次（１５．１％），探查活检３次（５．７％）。结果复发性腹膜后肿瘤患者肿瘤完全切除者，１、２年生存率分别为７１．２％和６５．３％，而姑息切除和探查活检者均在１年内死亡。结论重视复发性腹膜后肿瘤的术前诊断、准备及术中处理是确保手术安全和提高生存率的关键，强调对复发性腹膜后肿瘤应积极争取完整手术切除。  

Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus

We applied a nerve transfer, using the ipsilateral C7 nerve root to treat the C5 and C6 root avulsion of the brachial plexus. Four patients with C5 and C6 preganglionic injury were operated on with this new technique from 1998-2000. Transfer of the spinal accessory nerve to the suprascapular nerve was simultaneously done in 2 these patients. After a follow-up of 1-2.5 years, the muscle strength of elbow flexors recovered to M4 (Lovett) in all cases, shoulder abduction of >90 degrees with external rotation of 30-40 degrees was gained in two cases, and that of 15-45 degrees with no external rotation in the other two cases. No remarkable impairment was found in all C7-innervated muscles except for decrease of muscle power of 1 grade (Lovett) in the short run. This new technique shows promise as an efficacious and safe treatment for C5 and C6 root avulsion of the brachial plexus. However, it should be applied prudently when incomplete injuries of the lower trunk are involved.  

Treatment of painful heel syndrome with shock waves

In a prospective clinical study, the effectiveness of shock waves on painful heel syndrome in 80 patients (20 men and 60 women) with an average age of 48 years was investigated. Six patients had bilateral treatments. Each treatment consisted of 1,000 impulses of shock waves at 14 kV. A 100-point scoring system (70 points for pain and 30 points for function) was used for evaluation. The intensity of pain was measured with a visual analog scale from 0 to 10. The overall results were no complaints in 20.6%, significantly better in 52.9%, slightly better in 17.6%, and unchanged in 8.8% of 64 patients (68 heels) with 12 weeks followup; no complaints in 59.3%, significantly better in 27.7 %, slightly better in 13% of 52 patients (54 heels) with 6 months followup. None of patients' symptoms became worse. Seventeen patients (18 heels) who did not respond favorably to the first treatment had significantly better results after a second treatment. There were no device-related problems, and no systemic or local complications. Shock wave treatment is a new modality of therapy that is safe and effective in the treatment of patients with painful hell syndrome.  

Treatment of lateral epicondylitis of the elbow with shock waves

In a prospective clinical study, the effectiveness of shock wave treatment for lateral epicondylitis in 56 elbows in 53 patients (27 men and 26 women) with an average age of 46 years was investigated. Three patients received treatment for both elbows. Each elbow was treated with 1,000 impulses of shock waves at 14 kV. A 100-point scoring system was used for evaluation including 40 points for pain, 30 points for function, 20 points for strength, and 10 points for elbow motion. The intensity of pain was measured using a visual analogue scale from 0 to 10. The overall results were 13.2% excellent, 44.7% good, 36.8% acceptable, and 5.3 unchanged in 35 patients with 12 weeks followup; 30.8% excellent, 42.3% good, and 26.9% acceptable in 25 patients with 24 weeks followup. Considerable improvement was observed from 6 weeks to 6 months after the treatment. None of the patients' symptoms became worse. The results of nine patients who also received a second treatment were good in three patients, acceptable in five patients, and unchanged in one patient. There was no device-related problems, systemic, or local complications. Shock wave therapy may offer a new and safer nonoperative treatment for patients with lateral epidoncylitis of the elbow.  

Construction and functional evaluation of an autologous thymokidney model in the rat

BACKGROUND: We constructed a rat model of stable autologous thymokidney to observe the time required for revascularization and to examine functional recovery of the transplanted tissue and the reconstruction of T-cell reservoirs in peripheral blood mononuclear cells. MATERIALS AND METHODS: Male adult Sprague-Dawley rats were divided into groups. Group I (n=12, 150 to 250 g) underwent thymectomy, group II (n=15, 150 to 250 g) received an autologous thymokidney in which thymic tissue was transplanted under the renal capsule, group III (n=5, 50 to 100 g) received sham surgery, and group IV (n=5) consisted of rats selected from group 1 to undergo splenectomy 8 weeks after thymectomy. Revascularization and functional recovery of the transplanted thymuses were evaluated with flow cytometry and histomorphologic examination. RESULTS: Two weeks after surgery, blood vessels grew into the renal capsules in group II, the transplanted thymic tissue thickened at 8 weeks, and thymic structure was normal. At 6 weeks, numbers of CD4-CD8- T lymphocytes increased in group I and especially in group IV. A gradual decrease was noted in group II. Numbers of CD4+ and CD8+ T lymphocytes fluctuated at low levels in group I but stayed constant in group II. The transplanted thymuses began to gradually degenerate 12 to 16 weeks after surgery. CONCLUSIONS: Thymuses transplanted under the renal capsules adequately revascularized 2 weeks after surgery, and the autografts began functional recovery at 6 weeks. Proliferation of peripheral mature T lymphocytes is important in maintaining the number of mature T lymphocytes in peripheral blood mononuclear cells.  

Expression of TRAIL, DR4, and DR5 in kidney and serum from patients receiving renal transplantation

Renal transplantation is the best treatment of some end-stage renal diseases. Unfortunately, not every transplant is successful due to the rejection or dysfunction of the transplanted kidney. Many cytokines participate in rejection by inducing inflammation or apoptosis. In this study, the expressions of TRAIL, DR4, and DR5 in rejected renal tissue and of serum soluble TRAIL (sTRAIL) in patients with kidney rejection were investigated by immunohistochemical staining and sandwich enzyme-linked immunosorbent assay, respectively. The results showed that the expression of TRAIL, DR4 and DR5, and serum sTRAIL levels were markedly upregulated among renal transplant patients. Since both membrane and soluble forms of TRAIL can induce apoptosis of DR4/DR5-expressing cells via recruiting FADD and caspase 8, elevated TRAIL and its receptors may participate in renal graft rejection.  

Classification of impairment of shoulder abduction in obstetric brachial plexus palsy and its clinical significance

Shoulder abduction was studied in 25 cases of obstetric brachial plexus palsy (OBPP). According to muscle function, electromyographic features and X-ray examination, impairment of shoulder abduction could be classified into dynamic, resistant or combined types. Five cases were the dynamic type, which was characterized by paralysis of the shoulder abductors. Fifteen cases were categorized as the resistant type, with contracture of the subscapularis muscle, co-contraction of latissimus dorsi and teres major muscles and secondary disorders of the shoulder joint. Five cases were classified as the combined type in which there were both dynamic and resistant factors. Appropriate management and surgical procedures in the shoulder affected by OBPP depend on the pathological classification.  

颅内原发性黑色素瘤的诊断及治疗

目的 探讨颅内原发性黑色素瘤的诊治方法。方法 分析１９６８年以来收治的６例颅内原发性黑色素瘤的临床表现、诊治方法和疗效。结果 临床表现无特异性，ＣＴ及ＭＲＩ均难以明确诊断。肿瘤全切除１例。在碚切除３酌，部分切除１例，活检１例。诊断颅内原发性恶性黑色素瘤３例，脑膜黑色素瘤３例。随访５例，３例恶性黑色瘤患者死亡，２例脑膜黑色素瘤３例，随访５例，３例恶性黑色素瘤鹗２死亡，２例脑膜黑色素瘤１例长期卧床，１  

磁共振血管造影在评价门静脉高压症患者断流手术效果中的价值

目的　探讨磁共振血管造影在评价对于门静脉高压症患者行脾切除加贲门周围血管离断术手术效果中的价值。　方法　 15例门静脉高压症患者行脾切除加贲门周围血管离断术 ,分别在术前 1周、术后 2周采用Siemens 1 5T磁共振仪测定门静脉直径、侧支循环、曲张静脉和门静脉主干流速及流量的改变。　结果　门静脉高压症患者术后 2周门静脉主干直径明显变小 ,胃底曲张静脉、食管曲张静脉和食管支、高位食管支术后复查均消失或明显改善 ;术后门静脉血流速度、血流量比术前降低 ;15例患者中 9例患者术后胃体显影强度增加。　结论　磁共振血管造影对于门静脉高压症患者的门静脉系统显影良好 ,并可进行血流动力学的客观评价 ,在无创性评价手术效果和预测患者预后中有重要的价值 ;术后胃体静脉性充血增加可能是断流术后门静脉高压性胃病增加的重要原因。  

The addition of morphine prolongs fentanyl-bupivacaine spinal analgesia for the relief of labor pain

The combination intrathecal fentanyl (25 microg) and bupivacaine (2.5 mg) provides effective labor analgesia for approximately 90 minutes. The purpose of this prospective, randomized, double-blinded investigation was to determine if the addition of morphine (150 microg) to the intrathecal combination of fentanyl (25 microg) and bupivacaine (2.5 mg) would prolong labor analgesia. By using the combined spinal epidural technique, 95 healthy primiparous laboring women in early labor received 2 mL of one of the two intrathecal study solutions, either FB (n = 48): fentanyl (25 microg) and bupivacaine (2.5 mg); or FBM (n = 47): fentanyl (25 microg) and bupivacaine (2.5 mg) plus morphine (150 microg). The mean duration of labor analgesia was significantly longer in the FBM group than in the FB group (252 +/- 63 min vs 148 +/- 44 min, P < 0.01). There were no significant differences between the two groups regarding the sensory levels, the incidence of nausea, vomiting, pruritus, hypotension, or operative delivery. In conclusion, the addition of 150 microg of morphine to the intrathecal combination of fentanyl plus bupivacaine prolonged the duration of labor analgesia duration without increasing adverse effects. IMPLICATIONS: The addition of morphine (150 microg) to intrathecal fentanyl (25 microg) and bupivacaine (2.5 mg) prolongs the duration of labor analgesia duration without increasing adverse effects.