Radical Resection of Giant Congenital Melanocytic Nevus and Reconstruction With Meek-Graft Covered Integra Dermal Template

BACKGROUND: Giant congenital melanocytic nevi represent a surgical challenge, particularly in cases in which the size of the nevus exceeds certain extend and malignant transformations have to be considered. OBJECTIVE: To discuss through case report considerable surgical options when extensive giant congenital melanocytic nevi with malignant transformation are encountered. METHODS: We present an unusual case of a giant congenital melanocytic nevi of the entire back of a 44-year-old patient. To achieve radical resection with direct appropriate wound closure and acceptable outcome, the integument of the entire back was excised and covered with Integra, followed by split-thickness skin grafting after stable integration of the matrix. RESULTS: The approach resulted in a complete excision of the tumor and acceptable cosmetic and excellent biomechanical outcome. CONCLUSION: The introduced practice demonstrates a useful alternative to established methods, particularly if tumor excision in large areas and subsequent wound closure might be achieved in one procedure.     

Cold Air Analgesia in Photodynamic Therapy of Basal Cell Carcinomas and Bowen''s Disease: An Effective Addition to Treatment: A Pilot Study

BACKGROUND: There is considerable interpatient variability in pain tolerance during and after treatment of skin cancer with photodynamic therapy (PDT). Additionally, erythema and edema are common, with mild crusting and healing over 1 to 2 weeks. OBJECTIVE: To determine whether concurrent cold air analgesia improves the tolerability of PDT. METHOD: Twenty-six patients with two similar superficial skin cancers were treated with PDT. One lesion was treated with cold air analgesia and the other without. Patients rated their pain during treatment using the Wong Baker Faces Pain Scale and detailed duration of posttreatment pain. At week 2, the inflammatory response was assessed. RESULT: A statistically significant difference in the analgesia group was shown with respect to the mean duration of pain and the level of erythema after the first treatment as well as pain scores during the second treatment. CONCLUSION: Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field.     

色素痣426例组织病理及手术疗效分析

分析色素痣组织病理结果及观察色素痣美容手术治疗效果。方法：对就诊于西京医院皮肤科接受美容手术治疗的色素痣患者进行组织病理分析，门诊及电话随访疗效。结果：色素痣患者共426例，男性175例，占41.08％，女性251例，占58.92％。组织病理结果：皮内痣87.79％，交界痣0.93％；混合痣6.82％；蓝痣4.46％；术后3月、6月、1年、3年门诊及电话随访，患者对于治疗的满意率分别为91.8％、94.3％、97.3％、97.7％，无1例复发。结论：色素痣手术治疗效果最佳，建议常规送组织病理检查。     

996例纤维乳管镜诊治分析

目的探讨乳管镜诊治乳管内早期病变的价值。方法2009年1月-2011年12月,采用日本FiberTeehr-FT-201型乳管镜对996例非乳汁性乳头溢液及部分无乳头溢液进行诊断、灌洗治疗、定位、活检。其中镜下植入定位针532例,灌洗治疗197例,取活检114例。结果996例乳管镜诊断乳头状瘤和乳头状瘤病697例,似乳管癌99例,乳管积液扩张123例,平坦型红斑病变4例,毛细血管扩张2例,闭塞性乳管炎50例,余21例乳管镜除乳管扩张外未见明显异常。镜下植入定位针准确扎入瘤体460例,准确率86．5％（460／532）。镜下灌洗治愈乳管炎196例,治愈率99．5％（196／197）。镜下活检成功取出瘤体组织98例,成功率86．0％（98／114）。结论乳管镜可作为诊治乳管内早期病变的首选措施,其所起到的作用是B超、钼靶所不及的。     

胆总管、胰管汇合部的应用解剖及临床意义

给“内镜肝胰壶腹括约肌切开术”、“内镜逆行胆胰管造影”和临床诊断、治疗提供解剖学基础。方法:对70例人尸体的胆总管和胰管汇合部进行了解剖、测量并统计。结果:胆总管肠壁内段长度:成人1.04±0.42cm,儿童0.89±0.35cm。胆总管人十二指肠角成人41.1±1.75°,儿童40.1±1.72°。十二指肠大乳头至胃幽门间距成人为9.84±1.58cm,儿童为8.26±1.64cm。十二指肠大乳头至上颌中切牙间距成人为74.58±1.77cm,儿童为8.26±1.64cm。胆总管和胰管汇合后共同开口有41例,占分型数50例(82％),其余为分别开口。开口处位于十二指肠降部中1/3为44例,占总例数70例(67％),其余开口于降部的上1/3或下1/3。结论:胆总管人角越小,其壁内段长度越长。胆总管和胰管汇合共同开口者占多数,十二指肠大乳头位于其降部中1/3后内侧壁者为多数,并对其临床意义展开了讨论。     

Time- and Dose-Dependent Effects of Chronic Wound Fluid on Human Adult Dermal Fibroblasts

BACKGROUND Wound healing is a biologic process that is altered in patients affected by chronic venous ulcers. The wound microenvironment is reflected in the chronic wound fluid (CWF), an exudate containing serum components and tissue-derived proteins.
OBJECTIVES We investigated the effects of increasing doses of CWF collected from patients suffering from chronic venous ulcers on human adult dermal fibroblasts cultured in vitro and the relationship among CWF effects and treatment length.
METHODS Fibroblasts were treated with 60, 240, and 720 μg/mL CWF for 3 and 7 days. We evaluated cell proliferation and viability by MTT and Trypan blue assay, cell morphology by light microscopy, F-actin microfilaments organization by tetramethylrhodamine B isothiocyanate-conjugated phalloidin, α-smooth muscle actin expression by immunofluorescence, and senescence-associated β-galactosidase activity.
RESULTS CWF induced an increase in cell proliferation in the first 3 days of treatment. In contrast, at 7 days, a strong decrease in cell viability was observed. These changes were related to a cytoskeletal F-actin reorganization and not to fibroblast–myofibroblast differentiation nor to changes in cellular senescence.
CONCLUSIONS This study shows a dose-dependent and biphasic effect of CWF on dermal fibroblasts, suggesting that a continuous exposure to chronic wounds microenvironment may induce late cellular dysfunctions possibly involved in the delayed wound healing.     

体外构建携带PDGF-BB和IGF-1缓释微粒的脱细胞人工真皮

目的探讨体外构建携带并持续释放血小板源生长因子(PDGF-BB)和胰岛素样生长因子(IGF-1)的脱细胞人工真皮的可行性。方法体外合成含PDGF-BB和IGF-1生长因子的可降解微球,并与脱细胞人工真皮联结,Elisa方法检测人工真皮中生长因子释放情况;通过携带生长因子的人工真皮与真皮成纤维细胞的共培养,采用细胞计数及WST-8比色法,观察成纤维细胞的增殖速率与细胞活力。结果携带生长因子的人工真皮与真皮成纤维细胞共培养组与对照组细胞倍增时间分别为(2.01±0.38)d和(7.27±1.16)d,共培养组细胞倍增时间明显缩短(P<0.05,n=5);体外培养7d、14d、21d时,共培养组及对照组细胞活力无统计学差异(P>0.05,n=5)。结论本实验成功制备了能持续释放PDGF-BB和IGF-1生长因子并加速体外培养的成纤维细胞增殖的人工真皮,为加速创面修复的研究提供实验依据。     

胆总管探查术后一期缝合的临床经验及适应证探讨

目的总结胆总管探查术后一期缝合的经验,探讨其适应证以及评价其临床效果。方法回顾性分析2006年2月至2010年6月期间137例行胆总管一期缝合手术患者的临床资料。结果所有患者手术均成功,手术时间65~213 min(平均129 min),出血量50~350 ml(平均148 ml)。124例(90.5%)患者术后均未发生并发症,术后1周内顺利出院;其余13例(9.5%)患者术后出现漏胆,其中10例(18.5%,10/54)为技术早期(2007年10月以前)开展病例,3例(3.6%,3/83)为开展后期病例,均未作特殊处理,于术后3周内好转出院。113例(82.5%)患者获得随访,经过2~54个月随访(中位随访时间14个月),无一例患者出现胆管残石、胆总管结石复发和胆管狭窄。结论在严格掌握手术适应证和具备熟练的手术技巧前提下,胆总管探查术后一期缝合是安全、有效的。     

胆囊结石继发胆总管结石不同手术方式的临床疗效分析

目的 探讨腹腔镜联合胆道镜治疗胆囊及胆总管结石的临床疗效。方法 回顾性分析2010年1月至2013年1月期间收治于笔者所在科室的96例胆囊及胆总管结石患者的临床资料,根据手术方式分为开腹组、腹腔镜联合胆道镜＋T管引流术组和腹腔镜联合胆道镜＋放置鼻胆管一期缝合组3组。对3组患者的手术时间、术中出血量、肛门排气时间、住院时间、残石率、复发率、并发症发生率、手术有效率及术后淀粉酶和肝功能指标水平进行对比分析。结果 微创手术组与开腹组比较,患者的出血量、肛门排气时间、住院时间、残石率、复发率及并发症发生率均减少、缩短或降低,同时手术的有效率提高（P＜0.05）;腹腔镜联合胆道镜＋放置鼻胆管一期缝合组术后淀粉酶和肝功能指标的水平较其他2组明显降低（P＜0.05）。结论 微创手术创伤小,残石率及复发率低,并发症少,患者术后恢复快,是一种安全有效的治疗方式,值得临床推广应用。     

肠道缺血再灌注损伤时淋巴干结扎及谷氨酰胺营养干预的作用

目的研究肠道缺血再灌注损伤时肠淋巴干结扎和含谷氨酰胺的肠内营养对肠道及远隔组织的影响。方法 40只SD大鼠胃造瘘后随机分为:假手术组、普通肠内营养组、普通肠内营养+肠淋巴干结扎组、谷氨酰胺组及谷氨酰胺+肠淋巴干结扎组,每组8只。除假手术组外,其余4组大鼠行7 d肠内营养干预后开腹夹闭肠系膜上动脉60 min,2个结扎组同时进行淋巴干结扎;假手术组行普通饮食7 d后开腹60 min后关腹。所有大鼠术后继续原营养3 d。于再灌注前1 d、再灌注后1 d及3 d测定肠道通透性,在再灌注后3 d观察肠壁形态学改变,检测血清中内毒素、D-乳酸、二胺氧化酶水平及肺组织细胞凋亡指数。结果再灌注后1 d时,各组肠道通透性均比再灌注前明显增加(P0.05);再灌注后3 d时与再灌注后1 d比较,2个结扎组的肠道通透性均明显降低(P0.05)。谷氨酰胺+肠淋巴干结扎组回肠和空肠的黏膜厚度及回肠的绒毛高度明显高于其余4组(P0.05),谷氨酰胺组回肠的绒毛高度明显高于普通肠内营养组(P0.05);普通肠内营养+肠淋巴干结扎组肠壁各形态学指标均高于普通肠内营养组,但差异无统计学意义(P0.05)。肠淋巴干结扎组的肺组织细胞凋亡指数明显低于未结扎组(P0.05),内毒素、D-乳酸及二胺氧化酶水平较未结扎组有下降趋势,但差异无统计学意义(P0.05)。结论大鼠肠道缺血再灌注损伤引起肠道通透性增加、细菌内毒素移位和系统炎症反应,肠淋巴管结扎和谷氨酰胺肠内营养干预可以弱化肺组织损伤,增加肠黏膜的厚度,维护肠屏障功能,减少内毒素移位,降低血中内毒素水平,减轻系统炎症反应。含谷氨酰胺的肠内营养效果优于普通肠内营养。     

腮腺咬肌筋膜联合异种脱细胞真皮基质预防味觉出汗综合征的作用研究

目的:研究应用腮腺咬肌筋膜联合异种脱细胞真皮基质预防腮腺术后味觉出汗综合征的效果。方法:将2005年6月～2008年6月邢台市眼科医院口腔外科收治的腮腺浅叶良性肿瘤患者50例,分为3组:研究组(A组)13例,行保留咬肌筋膜的腮腺肿瘤及腮腺组织浅叶切除术。研究组(B组)14例,腮腺肿瘤及腮腺组织浅叶切除术后,根据咬肌筋膜缺损大小植入异种脱细胞真皮基质。对照组(C组)23例,单纯行腮腺肿瘤及浅叶组织切除。结果:术后随访12个月,对所有病例进行客观评价,出现味觉出汗综合征的有A组1/13例(7.69%)、B组1/14例(7.14%)、C组15/23例(65.22%)。A组与C组比较,B组与C组比较,均有显著统计学差异(P<0.05),A组与B组两者之间并无明显统计学差异。结论:保留腮腺咬肌筋膜能够有效预防味觉出汗综合征,应首先使用;对于无法完整保留腮腺咬肌筋膜者,再利用异体脱细胞真皮基质修复筋膜缺损区域,同样能够预防味觉出汗综合征的发生。     

金石散对胆道梗阻性胆汁性肝纤维化的防治作用

目的：观察中药金石散对胆汁性肝纤维化的防治效应。方法：大鼠经手术结扎胆总管造成胆道完全梗阻，以血清碱性磷酸酶（s．ALP）、谷丙转氨酸（s．ALT）及肝组织羟脯氨酸（h．HYP）和脱氧核糖核酸（h．DNA）为指标，观察造模同时服用和胆道再通后经口投予金石散的防治效果。结果：胆总管梗阻后及复通后1周时s．ALP、ALT及h．HYP均明显增高，h．DNA明显降低，肝组织呈明显的淤胆及胆汁性肝纤维化病变；而用金石散防治则能显著改善上述变化。结论：金石散对胆总管梗阻引起的肝组织损伤及胆汁性肝纤维化有明显的缓解作用，尤以胆流复通后为佳。     

Effect of Glutamine and Bile Acid on Hepatocyte Apoptosis after Bile Duct Ligation in the Rat

Apoptosis is an important process in a wide variety of biologic systems. Cholestasis, or impaired bile formation, occurs in a wide variety of human liver diseases. Retention and accumulation of toxic hydrophobic bile salts in hepatocytes may cause hepatocyte toxicity by inducing apoptosis. In addition, the translocation of bacteria and endotoxin, well documented in patients with obstructive jaundice, contribute to the induction of hepatocyte apoptosis. We hypothesized that oral bile acid replacement, glutamine administration, or both can attenuate or abolish hepatocyte apoptosis. Male Sprague-Dawley rats weighing 250 to 300 g were randomized to four groups (10 in each group). Group 1 underwent a sham operation and was simultaneously treated with normal saline. Group 2 underwent common bile duct (CBD) ligation and was simultaneously treated with normal saline. Group 3 underwent CBD ligation and was simultaneously treated with oral glutamine. Group 4 underwent CBD ligation and was simultaneously treated with oral bile acid replacement. After 3 days (n = 5) and 7 days (n = 5), liver tissues were harvested for histopathologic analysis and apoptosis measurements. When compared with the sham operation group, significantly increased hepatocyte apoptosis and ductular proliferation occurred after CBD ligation for either 3 or 7 days. After administration of either glutamine or bile acid, the increased hepatocyte apoptosis and ductular proliferation after CBD ligation for 3 days were significantly diminished. However, both failed to diminish the changes after CBD ligation for 7 days. Significantly increased hepatocyte apoptosis and ductular proliferation occurred after CBD ligation. The administration of either glutamine or bile acid effectively diminished the hepatocyte apoptosis and ductular proliferation after CBD ligation for 3 days, whereas both failed to show the same effect after CBD ligation for 7 days.     

The Effects of Nitric Oxide Supplementation and Inhibition on Bacterial Translocation in Bile Duct Ligated Rats

Obstructive jaundice promotes bacterial translocation from the gut, but the role of nitric oxide is controversial in this process. We studied the effects of nitric oxide synthase substrate, L-arginine, and nitric oxide synthase inhibitor, NG-nitro-¿-arginine methyl ester, on bacterial translocation in bile duct ligated rats. The animals were randomized into five groups; control, sham, common bile duct ligation alone, nitric oxide inhibition, and nitric oxide supplementation. Obstructive jaundice was performed with common bile duct ligation. ¿-arginine or NG-nitro-¿-arginine methyl ester was injected once daily for 14 days. Blood bilirubin level, liver histology, and bacterial translocation to the mesenteric lymph nodes as well as to the liver were assessed. The ¿-arginine supplemented group had the lowest bacterial translocation rate, but the most prominent hepatic fibrosis. Nitric oxide inhibition increased bacterial translocation to the mesenteric lymph nodes. Therefore, the administration of nitric oxide donor or inhibitor acts as a significant regulatory factor for bacterial translocation in obstructive jaundice.     

A Retrospective Study on the Efficacy and Complications of Q-Switched Alexandrite Laser in the Treatment of Acquired Bilateral Nevus of Ota-Like Macules

BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori's macules, is a common Asian condition that is characterized by bluish hyperpigmentation in the bilateral malar regions. Unlike nevus of Ota, ABNOM is an acquired condition that often develops after 20 years of age and involves both sides of the face, but there is no mucosal involvement. Recently Q-switched (QS) 1064 nm Nd:YAG lasers have been effective in clearing this condition. The effectiveness of QS alexandrite lasers has not yet been studied. OBJECTIVE: To retrospectively assess the efficacy and complications of QS alexandrite lasers in the treatment of ABNOM. METHODS: Thirty-two Chinese women with ABNOM ranging in age from 28 to 66 years were involved in the study. All underwent QS alexandrite laser treatment (755 nm, spot size 3 mm, 8 J/cm(2)). Topical hydroquinone and tretinoin cream were given to those with hyperpigmentation after the laser surgery. Clinical photographs were taken before and after laser surgery and assessed by two independent observers. The degree of clearing was scored and complications, including hypopigmentation, hyperpigmentation, scarring, and erythema, were assessed. RESULTS: The mean number of treatment sessions was 7 (range 2-11) and the mean treatment interval was 33 days. Both observers identified more than 80% of the patients as having more than a 50% degree of clearing, and complete clearance was seen in more than 28% of patients. Although most patients had postlaser hyperpigmentation and were on depigmentary regimes, the hyperpigmentation was seen in only 12.5% of the patients during photographic evaluation. Hypopigmentation was seen in 50% of patients and erythema in 41%. CONCLUSION: QS alexandrite appears to be effective in the treatment of ABNOM. Postoperative pigmentary changes were frequent and the use of topical depigmentary agents was necessary to achieve a satisfactory result. Transient hypopigmentation risk was high, affecting up to 50% of the patients. Further study is warranted to compare the efficacy and complications of different laser systems in the treatment of this condition.