21世纪医学发展未来

医学的诞生和发展是伴随着人类认识世界和改造世界的过程中不断前进的,在经历了长达数千年的平台期后,近两个世纪以来医学有了飞速的进步。从１９世纪中叶细胞的发现到细胞生物学、细胞生理学及细胞病理学的形成,现代医学跨过了第一个里程碑。医学深入到细胞水平,不仅使医学家对疾病本质的认识大大地提高,而且对于疾病的预防和诊疗也有了科学的依据。到２０世纪上半叶,各种病原体的发现、疫苗及生物制品的发明、维生素和激素作用的阐明、抗生素和化疗药物的研制（这些成果涵盖了该阶段诺贝尔医学奖的主要内容）、化验、X线及生物电检…     

面向21世纪的组织工程学研究趋势与策略

经过20余年的飞速发展，组织工程研究已进入一个非常关键的发展时期。当前组织工程研究的热点、重点与组织工程发展的初期有很大不同，已正在逐步走向围绕临床应用与产品开发的研究方向上来。本文结合本期骨科组织工程的专题论文，指出基础研究须与临床应用、产业化紧密结合，组织或器官的构建须由单一、简单的方式向复杂仿生化、智能化方向转变，组织工程组织的初步临床应用、安全性评价、组织工程相关产品的产业化开发等方面的研究是今后组织工程发展的趋势与方向，并对相关研究的策略进行评述。     

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回顾在 2 0世纪以前 ,人们对血管疾病总是束手无策 ,特别是在外科手术中 ,由于出血、凝血、感染等原因 ,血管被视为禁区。直到190 2年Ｃａｒｒｅｌ发明了血管三点吻合术 ,为血管重建技术开创了先河 ,为此 ,他获得了190 6年诺贝尔医学奖。同时 ,他还首次使用自体大隐静脉进行移植 ,获得成功。 192 0年 ,Ｍａｔａｓ首次施行了假性动脉瘤腔内缝补术 ,在 1940年他报道了 6 2 0例的个人经验 ,由此他享有血管外科之父的美称。 1933年 ,Ｍｕｒ ｒａｙ发现了肝素的抗凝功能 ,为血管重建术打下了扎实的基础。 192 7年 ,Ｍｏｎｉｚ首次进行动脉造影 ,…     

Paediatric surgery in the 21st century: The future is bright

The future of our society lies with our children, and they should be served best by well‐trained specialist paediatric surgeons. This is now the accepted standard of care in developed countries worldwide. In the present article, we describe the history of development of our specialty over the years, and look forward to the bright future in the coming years.     

Amish buggy injuries in the 21st century: A retrospective review from a rural level II trauma center

Horse-drawn buggies are rarely used in modern society except among certain religious groups. Northeastern Indiana has one of the largest populations of one such group: the Amish. Although there are papers written about the incidence of buggy crashes, no paper has specifically addressed the specific types of injuries sustained when buggies collide with motorized vehicles. This paper reviews the types of injuries sustained when such events occur.     

Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.

Over a 5-year period from 1985 to 1989, 2760 patients underwent open heart surgery at the University Hospital of Wales. Of these, 44 (1.6%, 35 men, mean age 61 years) developed median sternotomy dehiscence 2-40 (median 9) days after surgery. Infection was an associated factor in 18 patients (41%) and Staphylococcus aureus the predominant isolate in seven of those. Thirty-seven patients underwent rewiring of the sternotomy wound and seven patients underwent debridement, removal of wires and delayed closure. In those undergoing rewiring, sternal stability was maintained in 34 patients (92%). There were seven deaths (16%), of which two were considered to be wound-related. Median hospital stay of survivors was 34 (range 16-84) days. Comparison with 88 matched controls by univariate analysis showed preoperative chronic obstructive airways disease, reduced FEV1/FVC ratio (both P < 0.001) and smoking (P < 0.05) were all more common in the dehiscence group. In addition, reoperation for bleeding (P < 0.05), prolonged bypass time, postoperative ventilation period and length of stay in the intensive care unit (all P < 0.001) were more common in the study group.     

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近 2 0年来 ,我国肝癌诊断和治疗水平有了较大提高。据上海医科大学肝癌研究所 40年间 32 2 7例资料 ,小肝癌 (直径≤5ｃｍ )的比例 ,195 8～196 7年占 1 7%、196 8～ 1977年占8 1%、1978～ 1987年占 2 1 4%、1988～ 1997年占 36 3 % ,5年生存率则分别为 2 8%、7 3 %、2 7 1%、5 2 5 %。近年影像学技术有了迅速发展 ,外科技术不断提高 ,放射介入和超声介入等局部治疗和生物治疗引人注目 ,90年代开始了肝癌术后复发转移防治的研究 ,并将成为 2 1世纪肝癌研究的热点之一。我国在某些方面的研究已达到国际先进或领先水平。1　早期诊断的研究…     

Wound dehiscence in enhanced recovery after open radical cystectomy: A meta-analysis

A meta-analysis study to assess the outcome of enhanced recovery (ER) after radical cystectomy (RC) on wound dehiscence was performed. A comprehensive literature examination till January 2023 was implemented and 1457 linked studies were appraised. The picked studies contained 772 open RC subjects in the picked studies' baseline, 436 of them were enhanced recovery after RC, and 336 were open RC. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of enhanced recovery after RC on wound dehiscence after open RC by the dichotomous styles and a fixed or random model. The ER after RC caused significantly lower wound dehiscence (OR, 0.51; 95% CI, 0.30–0.89, P = .02) with low heterogeneity (I² = 46%) compared with open RC. The ER after RC caused significantly lower wound dehiscence compared with open RC. Thorough precaution should be taken when commerce with the consequences because a limited number of studies were found and selected for this meta-analysis.     

21世纪性医学发展战略与展望

性医学的概念性医学是研究人类的性心物学、性生理学及性临床学的一门学科 ,与其它许多学科有广泛的联系。性医学研究的主题是性健康 ,分为躯体健康、心理健康和社会适应健康三大部分。性医学包括 :性发育生物学与遗传和优生 ;性器官的解剖与生理 ;性化学 ;神经、激素及神经递质 ;性心理发育与性健康教育 ;儿童期及青春期与性 ;人类性反应与性行为及其年龄变化 ;性卫生与性保健 ;老年性医学 ;性取向与相关问题 :性心理障碍 ;性功能障碍 ;性传播疾病与艾滋病 ;精神疾病与人格障碍、躯体疾病与性 ;生育、不育、避孕与性 ;药物与性 (含性药学 )…     

'Skipping' is still a problem with radiofrequency ablation of small renal tumours

OBJECTIVE: To evaluate the homogeneity and extent of necrosis obtained with next-generation radiofrequency ablation (RFA) equipment and techniques, as incomplete tumour necrosis, or 'skipping', has been documented after RFA of renal tumours and subsequent partial nephrectomy, but this was assumed to result from insufficient energy deposition with first-generation low-energy generators. PATIENTS AND METHODS: In all, 17 patients with solitary renal tumours of 0.5-1.0 cm beyond the sonographically controlled tumour borders. Target temperatures of 105 degrees C were applied in three cycles for 10-30 min at up to 150 W. Tumours were then removed by laparoscopic partial nephrectomy and specimens evaluated by detailed histology. RESULTS: The mean (range) resected tumour size was 22 (11-40) mm, the mean RFA time was 39 (27-59) min and the mean surgical resection time was 25 (12-45) min. In 13 patients, haemostasis was sufficient to avoid the renal pedicle being clamped. Intraoperative repeated positive margins in one patient required a laparoscopic radical nephrectomy. Thirteen (76%) renal masses showed histologically complete ablation of the entire tumour. Of the four RFA failures, three tumours were >3 cm in diameter, two were highly vascularized and three had a very heterogeneous tissue texture. CONCLUSION: Even with state-of-the-art technology, skipping remains a problem with RFA for small renal masses and renders the technique unreliable.     

Digestive system fistula: a problem still relevant today

Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries. THE AIM OF THE STUDY was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment. MATERIAL AND METHODS. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed. RESULTS. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma). CONCLUSIONS. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.