生肌玉红胶原海绵修复创面损伤

背景：生肌玉红胶原海绵能显著促进创面愈合。 目的：观察生肌玉红胶原海绵对兔皮肤创面愈合的影响。 方法：在新西兰白兔背部制造3处全层皮肤缺损创面,分别以生肌玉红胶原海绵、贝复剂(重组碱性成纤维细胞生长因子外用溶液)、生理盐水修复。观察各组创面愈合时间、创面愈合率,检测创面修复组织内成纤维细胞数、血红素氧化酶1、转化生长因子β1 mRNA与蛋白及增殖细胞核抗原蛋白表达。 结果与结论：与贝复剂、生理盐水比较,生肌玉红胶原海绵可显著促进成纤维细胞增殖(P < 0.05),增加创面血红素氧化酶1、转化生子因子β1及增殖细胞核抗原的表达(P < 0.05),提高创面愈合率(P < 0.05),缩短创面愈合时间(P < 0.05)。证实生肌玉红胶原海绵能够促进创面修复,其作用机制可能是通过提高创面血红素氧化酶1、转化生长因子β1表达促进细胞增殖,增加成纤维细胞等创面修复细胞。     

重组人表皮细胞生长因子对供皮区创面的修复

摘要 目的 目前,供皮区创面的修复常常被忽视。基因工程药物为供皮区创面的修复提供了新的治疗方法。本文观察重组人表皮生长因子(rhEGF)对供皮区创面的修复效果。 方法 选择2 006年2月—2008年12月泸州医学院附属医院整形烧伤科需要自体植皮修复创面的患者共32例,将32处供皮区创面随机分为两组：对照组（n＝16）,即生理盐水喷洒组;治疗组（n＝16）,即rhEGF喷洒组。观察创面愈合时间、全身和创面局部的副反应及实验室检查。结果 rhEGF喷洒组较生理盐水喷洒组明显缩短创面愈合时间,两组间比较具有显著差异(P<0.01)。rhEGF喷洒组未见明显的副反应发生。结论rhEGF能促进供皮区创面创面的愈合。关键词 重组人表皮细胞生长因子;供皮区创面;创面修复     

Reinnervation of mechanoreceptors in the human glabrous skin following peripheral nerve repair

The technique of percutaneous microneurography was used to record single unit activity from 65 reinnervated and 24 normally innervated mechanoreceptors in the glabrous skin of the human hand. The results were obtained from 20 patients and 5 control subjects. The patients had suffered complete traumatic transsection, with subsequent repair, of the median or ulnar nerves. Three types of mechanoreceptors (RA, SAI, SAII) and many unidentified units located in deep tissues were found to become reinnervated. No reinnervated PC units could be identified. Response thresholds, discharge characteristics and receptive field properties of reinnervated receptors were comparable to normal, with the exception that reinnervated SA I units had slower static discharge rates and smaller receptive fields. No evidence was found for multiple peripheral innervation by a single afferent fiber. The reinnervated mechanoreceptors were predominantly located in the palm and the proximal fingers with few in the finger tips, contrary to normal. The locations and frequency of occurrence of the different types of receptors could be correlated with the goodness of sensory recovery. It is suggested that these differences result from misguidance of regenerating fibers and from poor reinnervation, and that they account for reduced sensitivity and poor tactile discrimination in patients with peripheral nerve injuries.     

Blood-brain barrier disorders and changes in intracranial pressure in cats with surgical brain wound following sudded brain decompression

The condition of the blood-brain barrier and changes in intracranial pressure were studied in cats with surgical brain wounds and after sudded decompression. It was found that evident disturbances of the barrier function appeared only 48 hours after removal of brain tissue and were affecting mainly the white matter. Sudden decompression led to disturbances of blood-brain function when it was proceded by at least 2 hours of epidural compression. Changes developed in the cortex and basal ganglia. After 48 hours from tissue removal a significant rise of pressure was observed in the cisterna magna to a mean value of 11.5 mm Hg. Decompression caused a fall of cerebrospinal pressure, often below zero, and this was followed by a rise to values significantly exceeding the level before decompression.     

生物材料及封闭式负压引流技术修复潜行死腔的大面积皮肤软组织缺损

摘要 背景：大面积皮肤缺损其创面难以修复,深部死腔常合并坏死感染,修复难度大,治疗时间长,费用昂贵。目前临床已开始广泛应用封闭式负压引流技术修复各种创面。 目的：评价生物材料及封闭式负压引流技术在合并潜行死腔的大面积皮肤软组织缺损创面中的应用价值。 方法：选择广州医学院附属广州市第一人民医院创伤外科2007-01/2008-12收治的合并潜行死腔的大面积皮肤软组织缺损患者32例,全部实施封闭式负压引流术修复创面,封闭式负压引流负压引流材料为高分子泡沫材料制成,负压值维持在20~60 kPa,一次负压密封引流可维持有效引流7~14 d。观察死腔闭合时间、伤口感染消除时间、新鲜肉芽生长及并发症发生情况。 结果与结论：32例患者均获得随访。经平均2周的封闭式负压引流技术治疗后,22例死腔自行封闭,经植皮基本成活。6例合并深层死腔的病例,再次施行封闭式负压引流术后死腔完全封闭。4例皮肤软组织大面积缺损至骨外露并感染的患者多次清创,行临近肌瓣转位修复术修复创面。除1例患者小腿植皮边缘再次感染渗液外,未见骨髓炎发生,创面修复良好;无其他合并症发生,治疗后创面修复率为96.8%,人体与材料之间无组织不相容现象。 关键词：封闭式负压引流;生物材料;皮肤软组织缺损;大面积;潜行死腔;修复 doi:10.3969/j.issn.1673-8225.2010.34.040     

Beneficial effects of CHOP therapy in a case of intravascular large B-cell lymphoma diagnosed by skin biopsy]

We report a case of intravascular large B-cell lymphoma. A 52-year-old man gradually developed dementia and abnormal behaviors, which were later accompanied by spastic paraplegia and sensory disturbance in his lower limbs. MR imaging of his brain showed high signal intensity lesions on T2 imaging. IMP-SPECT images of the brain showed diffuse reduction of radioisotope uptake. Many skin rashes that looked like senile hemangioma were observed on his body. Several of those were biopsied, and the diagnosis of intravascular large B-cell lymphoma was made because of malignant B lymphocytes filling the vessel lumens in one of the seven biopsy specimens. CHOP therapy was performed and found to be effective for the neurological disorders such as dementia, paraplegia, and sensory disturbance. Our case suggests that skin biopsy for more than one sample of the skin rashes is very important for the diagnosis of intravascular large B-cell lymphoma. CHOP therapy might be effective in this case because of early diagnosis by skin biopsy.     

眶上锁孔入路显微手术切除鞍区大型和巨大型肿瘤

目的探讨经眶上锁孔显微手术切除鞍区大型、巨大型肿瘤的手术方法和技巧.方法对31例大型、巨大型鞍区肿瘤采用该法实施手术,其中垂体瘤17例,脑膜瘤5例,颅咽管瘤7例,其他2例.结果大部或部分切除5例,残余瘤体给予放疗.本组无死亡.随访4个月～2.2年,2例肿瘤复发.结论采用锁孔显微手术能够切除鞍区大型、巨大型肿瘤,效果良好,并发症少.     

Conservative treatment of paraplegia following acute trauma in a patient with tuberculous kyphosis: case report and review of the literature

This is the third known reported case in the medical literature of complete paraplegia following acute trauma in a patient with tuberculous kyphosis. Early clinical evidence of neurological recovery and the absence of a radiological fresh lesion are important indications for conservative treatment. The patient made a complete recovery. The mechanism of injury is probably both mechanical and vascular.     

Conception in an infertile patient following obliteration of a huge anterior sacral meningocele: case report

Introduction  

We present the case of a 35-year-old woman with a large anterior sacral meningocele who had been unable to conceive.     

Transient blindness following intracranial pressure changes in a hydrocephalic child with a V-P shunt

A hydrocephalic child with a V-P shunt developed transient blindness following shunt revision. A year later, visual function deteriorated when shunt malfunction occurred. Following shunt revision, the child regained sight. The effects of intracranial hypertension and hypotension on the visual pathways are discussed.     

Extracellular regulation of TGF-beta activity in wound repair: growth factor latency as a sensor mechanism for injury

The transforming growth factor-beta (TGFbeta) family of growth factors are major regulators of wound repair, scar formation, and fibrosis. One of the prominent features of TGFbeta biology is the fact that this growth factor is secreted as a latent precursor, which may be directed to and stored at specific sites in the cellular microenvironment. Targeting and mobilization, and particularly extracellular activation of latent TGF-beta control the biological action of this growth factor. This review will focus on mechanisms of extracellular TGF-beta regulation relevant to and potentially operating in wound repair and scarring.     

人工真皮复合自体薄皮移植治疗皮肤软组织缺损

背景：修复皮肤软组织缺损自体或异体植皮治疗,往往需要多次植皮。而国内临床上应用人工真皮较少,应用经验亦不足。 目的：评价人工真皮治疗皮肤软组织缺损的疗效。 方法：收集因皮肤软组织缺损,行人工真皮结合自体薄皮移植修复创面的22例患者,其中骨外露6例,肌腱外露2例,表皮肿瘤切除3例,其他11例。一期清创移植人工真皮,2~4周后局部肉芽组织生长良好,外露肌腱、骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察取皮部位、损伤部位、操作性能、密封性、不良反应情况,结合评价临床效果及综合评价。 结果与结论：20例患者人工真皮结合二期自体薄皮移植全部存活,至二期植皮所需时间(18.50±4.27) d,其中1例患者因感染再次手术,2例患者行人工真皮后未行二期植皮,而自动上皮化;随访至3个月,21例损伤部位表皮生长性、外观性均良好、无瘢痕增生,1例因感染而致瘢痕增生严重、外观不良,但生长性良好;20例患者取皮部位无明显的色素沉着及色素脱出,无严重增生性瘢痕,上皮形成时间为(15.35±4.67) d。说明人工真皮结合自体薄皮移植修复皮肤软组织缺损,操作简便,创面愈合质量高,供皮区损伤轻微,至二期植皮时间较长,总体临床效果良好。     

Effective gene therapy for an inherited CNS disease in a large animal model

Genetic diseases affecting the brain typically have widespread lesions that require global correction. Lysosomal storage diseases are good candidates for central nervous system gene therapy, because active enzyme from genetically corrected cells can be secreted and taken up by surrounding diseased cells, and only small amounts of enzyme (<5% of normal) are required to reverse storage lesions. Injection of gene transfer vectors into multiple sites in the mouse brain has been shown to mediate widespread reversal of storage lesions in several disease models. To study a brain closer in size to the human brain, we evaluated the extent of storage correction mediated by a limited number of adeno-associated virus vector injections in the cat model of human alpha-mannosidosis. The treated cats showed remarkable improvements in clinical neurological signs and in brain myelination assessed by quantitative magnetic resonance imaging. Postmortem examination showed that storage lesions were greatly reduced throughout the brain, even though gene transfer was limited to the areas surrounding the injection tracks. The data demonstrate that widespread improvement of neuropathology in a large mammalian brain can be achieved using multiple injection sites during one operation and suggest that this could be an effective treatment for the central nervous system component of human lysosomal enzyme deficiencies.     

Survival of Cajal-Retzius cells after cortical lesions in newborn mice: a possible role for Cajal-Retzius cells in brain repair

Transient Cajal-Retzius (CR) cells in layer I of the mammalian cerebral cortex are the first postmitotic neurons and they are believed to play a role in neuronal migration and lamination during cortical development. Freezing insults to the cortex of newborn mice produce cortical malformations similar to those observed in human brain disorders. Here we have used calretinin immunostaining to investigate the response of CR cells to freezing lesions of the cortical surface. Shortly after injury, CR cells disappeared from the lesioned zone. Moreover, CR cells located near the lesioned area adopted extremely fusiform shapes. At later postnatal stages (P12), CR cells were still abundant in layer I of the lesioned zone, in contrast to their almost complete loss in control animals. These results show that CR cells survive for longer developmental periods following cortical injury. Furthermore, the initial loss and later re-appearance of CR cells suggest that these neurons might migrate tangentially from the cortical areas surrounding the lesioned zone. These findings imply a role for CR cells in brain repair after cortical injury during development.     

The vibrissal motor output following severing and repair of the facial nerve in the newborn rat reorganises less than in the adult

This study examined the ability of facial motoneurons and motor cortex to reorganise their relationship with the somatic musculature following the severing and repair of the facial nerve in rats at birth. In each adult rat, the organisation of the facial nucleus and the cortical motor output corresponding to the normal side were compared with those corresponding to the reinnervated side. Labelling was used to reveal reinnervation-induced long-term changes in the motoneuron pool supplying vibrissal muscles. Cortical motor output was assessed by mapping the vibrissal movement area extension and thresholds evoked by intracortical microstimulation. After facial nerve reinnervation: (i) the proportion of labelled cell profiles decreased by 85.2% of that in the control side and cortical representation of vibrissal movement decreased by 66.3% of that in control hemispheres; (ii) the reorganised vibrissal representation was shrunken to the medialmost portion of the normal vibrissal representation and there was a medial extension of the forelimb representation, and a more modest lateral extension of eye representation, into the vibrissal territory; (iii) the normal pattern of contralateral vibrissal movement was observed in only 10% of the vibrissal sites, whereas ipsilateral vibrissal movement was found in 53% of the vibrissal sites; (iv) there was an increase in the mean threshold required to evoke contralateral vibrissal movement (32.5+/-11.1 vs. 20.5+/-6.9 microA). Thresholds to evoke other types of movement were similar to normal. These changes indicate that an incomplete motor axon regeneration at birth does not restore normal innervation and normal cortical control over the vibrissal muscles.     

Unilateral hearing loss following shunt placement for normal pressure hydrocephalus with a unilateral patent cochlear aqueduct

Hearing loss in patients who have undergone shunt placement for a hydrocephalus is perhaps an underestimated complication rather than a rare event. There appears to be a correlation between the occurrence of hearing loss and patient characteristics consistent with excessive drainage of cerebrospinal fluid (CSF) and patent cochlear aqueduct (CA). We present the case of a 77-year-old man with unilateral dominant sensorineural hearing loss after a shunt placement for normal pressure hydrocephalus (NPH) combined with a patent cochlear aqueduct. Based on our experience and a review of the literature, we suggest an early restoration of the reduced CSF pressure using a programmable valve as a treatment strategy, which might prevent the persistent hearing loss.