乳房下皱襞的组织学和解剖学研究及其临床应用

目的通过对乳房下皱襞相关组织结构的大体解剖和组织学研究,进一步明确乳房下皱襞的组织学和解剖结构.方法采用新鲜成年女性尸体行解剖研究,并分别于乳房上缘、乳晕上缘、乳房下皱襞及乳房下皱襞下方4 cm处取材,制作HE染色及改良Gomori′s trichrome 染色切片,并进行图像分析.结果共研究乳房20只,在乳房下皱襞组可见皮肤真皮层内红色的纤维组织排列平行于乳房下皱襞的长轴,胶原纤维的断面较少,各组的胶原纤维相对含量无明显差异.结论乳房下皱襞区域无下皱襞韧带结构,真皮内胶原纤维的密度和其他三组相比,无明显差别.     

乳房下皱襞重建术的临床研究进展

对女性乳房的形态和结构来说,乳房下皱襞是一个决定性结构[1].在青春前期该结构一般是无法觉察的, 但是从青春期开始,乳房下皱襞就开始出现并确定乳房的下界范围.从乳房发育开始, 乳房下皱襞就将乳房下极"锚定"在胸壁上[2].乳房下皱襞结构对于乳房美学及乳房重建外科都有重要价值[3].     

乳下皱襞韧带的检验

目的检验乳下皱襞韧带存在的真实性。方法对9例18侧经防腐处理的女性乳房进行了解剖及切面筋膜染色后的观察。结果否定了先前由 Bayati 和 Straalen 等提出的有独立的乳下皱襞韧带的存在。结论证明乳下皱襞的存在是基于乳房下部增厚并密集的 Cooper 韧带所致。     

乳下皱襞韧带的检验

目的　检验乳下皱襞韧带存在的真实性。方法　对９ 例１８ 侧经防腐处理的女性乳房进行了解剖及切面筋膜染色后的观察。结果　否定了先前由 Ｂａｙａｔｉ 和 Ｓｔｒａａｌｅｎ 等提出的有独立的乳下皱襞韧带的存在。结论　证明乳下皱襞的存在是基于乳房下部增厚并密集的 Ｃｏｏｐｅｒ 韧带所致。     

乳房下皱襞不对称的矫治

目的：探讨乳房下皱襞不对称的矫治方法。方法：对11例乳房下皱襞不对称患者,采用乳晕上缘半环形切口,游离乳房后间隙,根据双侧不对称的差值,将过低侧乳房的上极腺体组织弧形切除并向上与胸肌筋膜缝合固定（其中9例同期行隆乳术）,切口上缘皮肤作适当切除。结果：11例患者术后双侧乳房下皱襞基本对称,形态满意,无并发症发生。结论：本方法操作简单,疗效可靠,便于推广应用。     

乳房下皱襞超微结构的研究及临床意义

国内外很多学者对乳房下皱襞进行了大量的基础及临床方面的研究，其研究结果概括起来可大致分为两种观点：一种观点认为乳房下皱襞处存在乳房下皱襞韧带，此韧带结构是形成乳房下皱襞的原因；另一种观点认为并不存在此韧带结构，而只是一些纤维带，这些纤维带不是真正的韧带，它们属于乳腺筋膜的一部分。我们通过对新鲜女性尸体乳房行大体解剖。     

乳房下皱襞的基础研究及临床应用进展

乳房下皱襞位于乳房下缘，在内侧位于5～6肋，锁骨中线处6～7肋，腋前线处7～8肋，SirAstley Cooper最早在1845年就描述了此结构。乳房卜皱襞是乳房的一个重要结构，对于乳房美学以及乳房整形外科手术都具有重要参考价值。了解乳房下皱襞的组织解剖结构及形成机理对于指导乳房临床相关手术的设计及操作具有重要意义。     

乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

应用轮辐状模板乳房塑形悬吊术

乳房下垂一般是以乳头的位置在乳房下皱襞水平或以下,以及乳房的最低缘在乳房下皱襞以下为诊断的依据.目前,乳房下垂的手术治疗方法有多种,但对于轻、中度乳房松弛下垂或重度下垂而不希望改变乳房体积的求术者,临床较难处理,单纯去处松弛皮肤和腺体悬吊,往往很难达到满意的手术效果.自2004年以来,我们首先创用轮辐状模板乳房塑形悬吊术矫正乳房下垂患者3例,获得满意效果.     

隆乳术切口和假体置放层次及手术剥离范围探讨

目的：探讨隆乳术的切口选择、假体置放层次和腔穴剥离范围。方法：于1996例9月至2001年9月间行隆乳术537例，选择三种手术切口；乳房下皱襞切口、乳晕切口、腋窝切口；假体置放于乳腺后间隙或胸大肌后间隙；胸大肌后间隙的剥离范围以第6肋间隙为下界。术后随访半年-5年。结果：术后乳房位置、形态、手感均满意511例（占95.2%）。结论：乳房下皱襞切口适于站立时乳房下皱襞明显或者乳房轻度下垂者；对于乳晕直径≥4cm的受术者，可采用乳晕缘内上或者内下弧形切口；腋下切口最为隐蔽，适于所有的受术者。假体置放于胸大肌后间隙具有手感更真实、不易形成纤维囊性硬变、不影响哺乳等优势。在胸大肌后间隙进行剥离，顺应乳房下皱襞韧带的解剖结构，将下界定于第6肋间隙。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。