用袖套式血管吻合法建立大鼠肝、肠联合移植模型

目的 建立肝、肠联合移植手术模型。方法 用Ｗｉｓｔａｒ大鼠行同种异体肝、肠联合移植。先行肝移植,再行小肠移植。肝脏为原位移植,供肠异位移植于左肾处（切除左肾）。门静脉、肝下下腔静脉和肠系膜上静脉采用袖套式吻合法分别与受者的门静脉、肝下下腔静脉和左肾静脉吻合,回肠末端在左下腹造瘘。结果 手术成功率为６２．５％,动物平均存活时间１１．２ｄ。组织学检查发现移植肝和小肠发生排斥反应。结论 用袖套式血管吻合     

广泛肝内胆管结石合并左右肝叶萎缩尾状叶明显肥大行保留尾状叶次全肝切除术1例报道

目的探讨广泛肝内胆管结石合并左右肝叶萎缩而尾状叶明显肥大的患者行保留尾状叶次全肝切除术的可行性和安全性。方法回顾性分析四川大学华西医院2020年2月收治的1例肝内胆管结石患者的临床病理资料。结果患者左右肝叶结石伴左右肝叶明显萎缩而尾状叶明显肥大。患者术前一般情况良好,心、肺和肾功能正常,肝功能Child-Pugh A级,肝脏储备功能良好。患者体表面积为1.745 m2,标准肝体积为1 235 mL,CT图像三维重建评估肝尾状叶体积为735 mL,占标准肝体积59.5%,经评估患者能耐受手术。患者成功经历保留尾状叶次全肝切除术,术后肝功能恢复良好,术后第2天拔除胃管,术后第5天拔除腹腔引流管,术后第6天出院。术后病理诊断:肝内胆管扩张伴胆管结石,胆管周围大量炎细胞浸润,门管区纤维组织增生、小胆管增生、炎细胞浸润,病变符合肝内胆管结石改变。结论通过对本病例的分析结果看,对于广泛肝内胆管结石合并左右肝明显萎缩而尾状叶明显肥大的患者,保留尾状叶次全肝切除术是安全、可行的。     

A case of interstitial cystitis that developed alternately with bronchial asthma

The patient was a 46-year-old man. His chief complaints were urinary frequency and pain on urination. They first appeared one year earlier. The patient had had a history of bronchial asthma and urticaria. Vesical capacity decreased and vesico-cutaneous developed. The urine sediment contained eosinophils and vesico ureteral reflux was observed. The bladder tissues contained a moderate amount of eosinophils, lymphocytes and plasma cells. The total IgE was 360 IU/ml. The IgE RAST score and immediate reaction to the skin tests were all negative. The Arthus and delayed-type reaction skin tests were positive to various Eumycetees and foods. Provocation tests by eating foods such as eggs, meats, and shellfish reproduced the above-mentioned bladder disorders. The patient was therefore put on a diet that restricted the amount of animal protein consumed except for white meat fishes, and a mast cell membrane stabilizer was administered. The interstitial cystitis improved but the asthma aggravated. The cystitis was found to develop alternately with asthma.     

A scanning electron microscopical and morphometrical analysis of neuromuscular junctions in different muscle fiber types in the zebra finch and rat

The differences of neuromuscular junctions (NMJs) between different muscle fibers had been examined with scanning electron microscopy and analyzed morphometrically. The anterior and posterior latissimus dorsi muscles of the zebra finch were compared. The former consisted exclusively of slow tonic fibers and the latter of fast twitch fibers. The former had numerous, small NMJs. The synaptic depressions were small in number. The latter had a large NMJ. The synaptic depressions were large in number, and subsynaptic folds were found. The extensor digitorum longus and soleus muscles in the rat were also compared. The former consisted mostly of fast twitch fibers whereas the latter consisted of slow twitch fibers (75%) and fast twitch fibers (25%). NMJ of slow twitch fiber was small and the subsynaptic folds had sparse, narrow slit-like and pit-like openings. NMJ of fast twitch fiber was large and the subsynaptic folds had numerous, wide and slit-like openings.     

腹腔镜巨大前列腺囊腺瘤切除一例报告并文献复习

目的提高对巨大前列腺囊腺瘤的认识。方法回顾性分析收治的1例巨大前列腺囊腺瘤并成功进行腹腔镜切除的临床资料,结合文献复习进行讨论。结果本例患者成功行腹腔镜完整切除,手术时间125min,出血量60ml,术中双侧精囊输精管完整保留,术后会阴部坠胀不适消失,复查精液常规精子数目及活动度正常。已随诊12个月,肿瘤无复发。结论巨大前列腺囊腺瘤罕见,最终确诊要依靠病理诊断,其最有效的治疗是手术完整切除,而腹腔镜途径可作为完整切除的微创手段。     

5923例急性肠梗阻的病因学变迁及中西医结合诊治

目的：探讨急性肠梗阻的病因学变迁及诊治。方法：回顾性分析5923例急性肠梗阻病例的诊治经过。结果：粘连性肠梗阻始终占据病因第一位,肿瘤性肠梗阻比例明显增加,嵌顿疝比例增加。肠梗阻患者平均年龄增长,手术率、治疗有效率提高,中西医结合非手术成功率降低。结论：腹腔粘连是引起肠梗阻的首要原因;复杂性肠梗阻数量增加,肠梗阻诊断、治疗方法不断改进,提高了疗效,改善了预后。     

Prostatic tuberculosis. Two case reports

The authors report 2 cases of prostatic tuberculosis. The patients are 59 and 62-years-old respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and PSA were abnormals. The prostatic biopsy was negative. The diagnosis of prostatic tuberculosis was made by histologic analysis after transuretral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis.     

慢输送型便秘高选择性肠段切除治疗的研究

目的：介绍结肠功能性便秘患者经全结肠测压及X线对标记物定位拍片．了解便秘患者结肠受累范围、同时作高度选择性肠段切除治疗便秘．观察其疗效。方法：收集了45例健康成人及31例结肠运输功能缓慢性便秘患者，采用瑞典生产的全消化道测压仪，通过电子肠镜将测压管送人回盲部。分别测得两组人体结肠腔内的最高收缩平均压，静息压．每5min单位时间内收缩次数以及平均收缩间期持续时间。同时又分别给于作空腹结肠模拟充盈以及饮食后测压，了解其在不同状态下的结肠腔压力变化，采用“B”超手段了解测压管所在肠道位置，精确定位。对于31例结肠运输缓慢性便秘患者施行高选择性结肠段切除术，并作组织学检查。结果：正常组与患病组最高收缩压分别为58．2mmHg、40．8mmHg，静息压分别为20．8mmHg、10．4mmHg，平均每5min单位时间内收缩4．53次、3．5次，平均收缩间期21．9S、34．3S。正常组结肠模拟充盈后其压力较空腹压力有明显提高．而缓慢运输功能性便秘患者该项变化不显著；患者术后排便功能恢复正常，组织学检查均提示神经细胞结明显减少、萎缩，肌纤维变薄、变细，有中断现象。结论：正常人与便秘人群的肠道内压力有明显差异，测压对便秘患者的高选择性结肠段切除手术能起指导作用。手术治疗便秘有价值。     

Anesthesia for patients with intestinal obstruction]

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.     

磁性阿霉素维拉帕米清蛋白纳米粒的制备及性能检测

目的 制备磁性阿霉素维拉帕米清蛋白纳米粒并检测其磁性、载药量、粒径大小等物理性能,为进一步进行动物实验和临床应用奠定基础.方法 先将市售棉籽油精制,再将盐酸阿霉素、盐酸维拉帕米、人血清蛋白及Fe3O4磁粉按一定比例混合,采用加热固化法制备磁性阿霉素维拉帕米清蛋白纳米粒.用透射电子显微镜检测颗粒形态和粒径大小.倒置显微镜下观察载药纳米粒的磁响应性和结构.绘制标准曲线,高效液相色谱仪检测纳米粒中维拉帕米的载药量,荧光分光光度仪检测阿霉素的载药量.结果 纳米粒大小均一,形态规则,呈圆球形,磁响应性好.平均粒径约0.5 μm,维拉帕米载药量为0.8%,阿霉素载药量为1.25%.结论 加热固化法可以制备出同时包载两种药物的纳米粒,物理性能良好,制备方法简便,实验条件容易控制.     

内上腺体蒂乳房缩小成形术

目的 探讨一种能够保持乳房功能和形成良好外观的乳房缩小成形术。方法 根据乳房肥大的程度设计不同类型的皮肤切口，采用内上腺体蒂技术，切除外上方和下方过多的乳腺组织，将保留的乳腺组织重新塑形，切除多余的皮肤后缝合切口。结果 本组36例72侧乳房术后形态良好，无并发症，乳头乳晕感觉良好，效果满意。结论 内上腺体蒂技术是一种安全、有效的手术方法，能获得持久的塑形效果，通过选择不同类型的皮肤切口可以适用于各种程度乳房肥大的矫治。     

Clinical studies on tosufloxacin (TFLX) in urology]

We clinically evaluated the usefulness of a new oral antimicrobial agent, TFLX, in the field of urology. The dose administered was 150 mg t.i.d and the duration of administration was 3 days. The clinical effect was evaluated according to the criteria of the Japanese UTI committee. The clinical response obtained on 164 female patients with acute simple cystitis was excellent in 118, moderate in 44 and poor in 2 patients. The efficacy rate was 98.78%. The clinical response obtained on 4 male patients with acute simple cystitis was excellent in 2 and moderate in 2 patients. The efficacy rate was 100%. The clinical response obtained on 3 female patients with simple pyelonephritis was excellent in 2 and moderate in 1 patient. The efficacy rate was 100%. The clinical response obtained on one patient with non-gonococcal urethritis was excellent by doctor's evaluation. The clinical response obtained on 7 patients with complicated UTI was excellent in 3 and moderate in 4 patients. The efficacy rate was 100%. Three patients complained of stomach distress or malaise and 2 patients developed rash. No abnormal laboratory data were observed. Thus, TFLX appears to be safe and suitable for use in the field of urology.     

Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect

Reconstruction of maxillectomy with extensive orbital rim and floor excision defects is a challenging problem. The goal of reconstruction here is to provide adequate orbital support to prevent enophthalmos and diplopia as well as obturation of the palatal defect. The existing methods of the reconstruction fail to simultaneously address these 2 goals of reconstruction. A new method of reconstruction of these defects using tensor fascia lata-iliac crest flap was used in 7 cases of cancers of the maxilla, which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in 5 cases and in 2, a skin paddle was included. The immediate and delayed outcome at 6-month follow-up was analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech, and swallowing were recorded. The bone viability at 6 months was assessed by computed tomography scan. The flap was successful in all the 7 cases. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be covered successfully in all the cases, resulting in normal speech and swallowing. The computed tomography scan showed excellent integration of the bone. The free tensor fascia lata-iliac crest flap is a reliable and safe method of reconstruction of the orbitomaxillary defects, addressing the issues of both orbital support and palatal obturation.     

bFGF和硫糖铝在组织扩张术中的应用

目的：探索碱性居纤维细胞生长因子（bFGF）和硫糖铝在扩张术中的临床应用方法与效果。方法：皮肤瘢痕及鼻尖缺损患者共12例，经病变外边缘垂直切口埋置扩张器23个，持续恒免疫组化检测。结果：术后1－3d即可开始持续扩张，平均扩张时间为8．9d；第一、二期手术间隔平均13．5d，平均住院时间为28．4d。扩张后皮肤软组织即时回缩率平均25．7％，皮瓣全部皮活。组织学、PCNA检测显示表皮层明显增厚、细胞层数增加，胶原纤维排列较密，弹力纤维、成纤维细胞、毛细血管密度增高；增生期基底细胞增多，分布广泛。结论：采用此法扩张速度快，能明显缩知疗程，提高皮瓣质量，改善治疗效果。     

Descriptive anatomy and biodynamic study of the medial collateral ligament of the trapezio-metacarpal articulation of the thumb

The trapezoid articular surface is classically compared to a saddle. The movements of the thumb obey to two centers of rotation. The one is proximal and determined by the convexity of the saddle; the other is distal and determined by its convexity. The authors have realised 15 dissections and 20 cinematic studies; they bring precision to the collateral medial trapeziometacarpal ligament and show the fundamental role of its anchorage point on the medial metacarpal tubercle: the distal center of rotation and the anchorage point are practically superimposed. The movements from this center are realised in indifferent pronosupination. The proximal center of rotation and the anchorage point are distant. The movements from this center are necessarily accompanied by pronation or supination. Statement report of the mechanism of this double rotation.     

Videothoracoscopic approach in the treatment of intralobar pulmonary sequestration. Report of a case

The Authors report on the use of a videothorascopic approach in the treatment of a patient with intralobar bronchopulmonary sequestration. The latter is a rare malformation which more often than not manifests itself in young patients with hemophthisis, recurrent infection and cough. The condition is difficult to diagnose and is often diagnosed intraoperatively. The treatment is surgical resection. The videothorascopic approach was used in a young patient presenting a lesion of the left inferior lobe with polycyclic contours suspected of being an intralobar bronchopulmonary sequestration, along with medical history findings of cough and hyperpyrexia. The approach permitted identification of the lesion in the context of the left inferior lobe, safe identification and section of the abnormal systemic vessel supplying the lesion and subsequent inferior lobectomy. The postoperative course was uneventful and the patient was discharged on postoperative day 5 with an excellent esthetic and functional outcome. The videothorascopic approach should be taken into consideration for the diagnosis and treatment of intralobar bronchopulmonary sequestrations.     

克罗恩病外科治疗85例分析

目的总结分析肠道克罗恩病（CD）的外科治疗策略。方法对1980—2005年收治的85例CD病人资料进行回顾性分析。结果近年来CD病人呈增多趋势，术前确诊率为23．53％。肠梗阻（25．88％）、右下腹包块（回盲部肿物，10．59％）、盲肠癌（12．94％）、急性阑尾炎（4．71％）是术前误诊的几大主要原因。手术方式以右半结肠切除术（37．65％），小肠部分切除（21．18％）为主，内、外瘘及肛周CD行外科处理预后良好。结论手术仍是目前肠道CD的重要治疗手段；手术方式依病变部位和并发症类型不同而有差异，术式选择和规范化手术操作是亟待解决的问题。     

Geometry of the proximal humerus and implications for prosthetic design

The purpose of this study was to add critical information to the data already available on anthropometry of the proximal humerus. Two hundred macerated humeri were examined. Measurements were taken either directly on the bones or on standardized radiographic projections. The methodology was validated and showed a mean interobserver correlation of 0.94 +/- 0.067. Results were expressed in mean values, first SD, and minimum and maximum values, as well as the 10th and 90th percentiles. The frontal radius of the head ranged between 21 and 26.5 mm (10th respectively 90th percentile). The frontal diameter of the base of the head ranged between 39.4 and 50 mm. The head height ranged between 14.4 and 18.8 mm. The frontal radius-head height ratio ranged between 0.64 and 0.77. The inclination of the head ranged between 132 degrees and 142 degrees. The medial offset ranged between 3.9 and 8.6 mm. The posterior offset ranged between -0.4 and 3.2 mm. The greater tuberosity offset (distance between the axis of the proximal humerus and the most medial insertion point of the supraspinatus tendon) ranged between 2.5 and 9.2 mm. Retrotorsion ranged between 7 degrees and 38.5 degrees. The distance from the bicipital groove to the head equator ranged between 6 and 10.5 mm. The anatomy of the proximal humerus showed a wide range for variables such as the medial offset and the greater tuberosity offset but was surprisingly constant for the inclination and relative dimensions of the head. The implications for prosthetic design are as follows: stem design and insertion should respect the insertion facet of the supraspinatus, a constant head inclination is an adequate approximation, only one head height per radius is required, and the capability for adjustment of medial offset is mandatory.     

Patellofemoral contact zones in knee endoprostheses

Failures after total knee arthroplasty often are caused by problems of the patellofemoral articulation. We investigated 10 different femoral components and 12 different patellar implants. The size of the patellofemoral contact areas was evaluated by pressure sensitive films every 10 degrees up to 90 degrees of flexion. The forces of the quadriceps muscle and the patella ligament were measured by force transducers. The compressive forces acting between patella and gliding grove were calculated. The geometry of the components and forces was documented. The retropatellar contact areas are specific for each prosthesis. The patterns of displacement are similar for some groups of prostheses. The absolute size of the contact areas and their size relative total surface of the patellar implant is very small. This induces high local pressure of the polyethylene.     

犬胰和十二指肠的血供

通过动脉灌注，在４１例标本上研究犬胰和十二指肠的血供。犬胰的血供分为四组：胰械叶由胃十二指肠动脉、脾动脉主干及其尾侧干的胰支供应；胰角由胃十二指肠动脉和胃网膜右动脉的胰支供应；胰右叶头侧头由胰十二指肠头侧动脉的胰支供应；胰右叶属侧部由胰十二指肠头，尾侧动脉的胰动供应。十二指肠主要由十二指肠上动脉和胰十二指肠头，尾侧动脉的十二指肠支供应。本研究对犬的胰腺切除术及胰腺移植术提供了解剖学资料。