玉树地震致无齿状突骨折的寰椎后脱位一例

枢椎齿状突骨折脱位约占成人颈椎骨折脱位的10％～15％,而无寰枢椎骨折的寰椎相对于枢椎的后脱位极为罕见。本文介绍一例玉树地震致寰椎后脱位病例,患者枢柞齿状突完整,但枢椎齿状突完全脱出于寰椎前弓前方,并且幸存。     

截骨法高颧弓整形术

目的 探索一项新的降低颧骨颧弓突度的技术,以改善高颧患者的面容。方法 根据放射影像和数学几何原理,计算颧弓截骨量;颧骨颧弓作青枝骨折,并以此为轴向内侧旋转两断端直至两侧相接,钛板固定。结果应用该技术整复高颧患者40例,均获满意效果。结论本技术可以控制突出颧弓的矫正量,解决高颧患者颧弓弧度过大的整复问题,术后稳定性好,可作为常规手术应用。     

颌面部骨折切口设计的美容观点及其临床应用

目的以美容观点探讨外伤性颌面部骨折手术入路的切口设计。方法对14例面中部骨折及29例下颌骨骨折的患者采用经皮冠状切口或附加下睑缘切口、口内前庭沟切口、耳屏后缘切口,行骨折复位及小(微)型钛板内固定术。结果14例面中部骨折中,13例骨折及面部外形全部恢复良好。1例出现轻度睑内翻,术后一周消失。29例下颌骨骨折患者,术后面部外观对称。所有病例术后伤口一期愈合,切口隐蔽、细微,无1例感染。结论冠状切口及附加下睑缘切口、口内前庭切口治疗颌面部骨折,切口隐蔽、美观,术区暴露清楚、直视下内固定方便,术后患者反映好,在临床上广泛应用。     

颌骨骨折切复坚强内固定术后感染的回顾性分析

坚强内固定技术已经在颌面部各种骨折和骨的移动手术中广泛采用,它对颌骨骨折的治疗于提高术后颌关系和骨块的稳定性、骨折的三维解剖复位具有巨大的优越性[1]和临床应用的合理性.口腔颌面部血运丰富,组织再生修复和抗感染的能力很强[2],颌面部损伤、骨折较易愈合,发生感染的几率较少,但仍然有一些患者在颌骨骨折切复坚强内固定术后因各种原因发生感染,本文就1999年1月～2010年10月间,本科室共发生25例因颌骨骨折切复内固定术后出现感染症状而取出钛板,现就其发生感染原因作一分析.     

Occupational argyria; light and electron microscopic studies and X-ray microanalysis

Microscopic studies have been performed on skin biopsies from five patients with occupational argyria. Small brown-black granules were present in the dermis on light microscopy and were intensely refractile with dark-field illumination. Electron microscopy showed that the granules were electron-dense, round or oval in shape and varied in size from 30 nm to 100 nm. They were most numerous in relation to the basal lamina of the eccrine sweat glands, but were also present in relation to the basal lamina of the epidermis and dermal elastic fibres. X-ray microanalysis confirmed that many of the granules contained silver and sulphur. However, selenium, mercury, titanium and iron were also identified and it is probable that these elements were deposited in the skin also as a result of occupational exposure.     

Dynamic ultrastructural changes of the connective tissue sheath of human hair follicles during hair cycle

Summary Ultrastructural changes of the connective tissue sheath (CTS), including the hyaline membrane, of human hair follicles during the hair cycle, were studied in normal scalp skin specimens. In early anagen, the CTS was composed of a thin basal lamina and surrounding collagen tissue. The collagen tissue gradually thickened during the development of the hair and hair follicle. In mature anagen hair follicles, the collagen tissue was separated into three layers. The inner collagen layer, just outside the basal lamina, was thin and composed of collagen fibres running longitudinally parallel to the hair axis. The middle collagen layer was very thick with its collagen fibres running transversely against the hair axis and surrounding the inner hair tissue. Many fibroblasts were present among the collagen fibres in the middle layer, whereas the inner layer contained almost none. In the outer collagen layer, collagen fibres ran in various directions parallel to the outer surface of the outer root sheath cells. In late anagen, the basal lamina became very thick. In catagen, the basal lamine and the inner collagen layer became corrugated and showed oedematous change and degeneration. Surrounding fibroblasts showed active production of new collagen fibres, which seemed to fill the spaces left by the retraction of the hair follicle and hyaline membrane. These ultrastructural changes of the CTS show that there may be dynamic metabolic changes of the connective tissue around human hair follicles during the hair cycle.     

Surgical planes of the head and neck

The surgical plane is a plane of dissection that can be used to excise a tumor while preserving most of the neurovascular structures. The majority of skin tumors are situated on the head and neck, and dermatologic surgeons should therefore have detailed knowledge of the surgical anatomy of this region. Fear of damaging important structures may result in insufficient efficacy of the surgical treatment, with consequent risk of persistence or recurrence of the tumor. Knowledge of the superficial musculoaponeurotic system and its relationship to key neurovascular structures enables the operation to be planned and will help us to locate the appropriate plane and minimize postoperative complications. The objective of this article is to review the key anatomical features defining suitable planes of dissection in the head and neck, the use of which will ensure survival of flaps and grafts.     

Hypertext atlas of dermatopathology with expert system for epithelial tumors of the skin

Background:  Image resolution required for reference histological images is high. Obtaining high-resolution images requires a system, composing large image from individual smaller components. Such systems must thus be capable of automatically taking individual image parts, performing shading compensation and fusion of the image parts into one large image. Distribution of such images over the Internet requires developing a suitable user's interface with access to the image details.
Methods:  The ways of creating high-resolution images (virtual slides) and the interface enabling access to image details using Internet browser are described.
Results:  A collection of about 3200 dermatopathological, mostly histologic images is available at http://www.muni.cz/atlases : Hypertext atlas of dermatopathology. Methods of high-resolution image acquisition were used in digitizing the collection of skin lymphomas (Dermatology Institute, University Hospital, Zurich), which is a part of the atlas. The atlas is continuously maintained and upgraded; the number of contributors is growing.     

Cervical Occult Spinal Dysraphism: MRI Findings and the Value of a Vascular Birthmark

Abstract: Spinal dysraphism is easily recognized in the overt form as a meningocele or myetomeningocele. The closed form or occult spinal dysraphism (OSD) can be overlooked. It occurs predominantly at the lumbosacral level, but OSD at the cervical level, although very rare, also occurs. The value of magnetic resonance imaging investigations in preparation for surgical treatment is emphasized. We discuss the value of various midline posterior skin anomalies as Indicators of an underlying developmental defect in the neural axis. Hallmarks for OSD in the inferior third of the back are well known. They can also occur at the cervical level. Among these warning cutaneous midline changes, a vascular stain alone is rarely a clue for OSD whatever the spinal level involved, and specifically In the nuchal area.     

Increased soft tissue in the posterior cervical and upper back area of patients on HIV-1 protease inhibitors.

BACKGROUND: Corticosteroids as well as sex hormones affect the redistribution of subcutaneous fat and the percentage of lean body mass. In addition, some stromal cells express steroid receptors, and the quantity and distribution of these receptors vary at different body sites and between sexes. Inhibitors of HIV-1 protease may affect steroid hormone metabolism through their effect on cytochrome P450. OBJECTIVES: To determine the changes in the tissue of the back in three HIV-1+ patients who developed increased soft tissue in posterior cervical and upper back areas while on HIV-1 protease inhibitors. METHODS: Punch biopsies of the involved posterior cervical and upper back areas were done. These included subcutaneous adipose tissue. Routine hematoxylin and eosin-stained sections, along with special stains for elastic and stromal mucin, and immunohistochemical stains for CD34 (HPCA-1 and Factor XIIIa) were evaluated. RESULTS: Histologically all three patients showed identical features. There was expansion of the dermis with decreased periadnexal fat and marked widening of the fibrous septa within the expanded subcutaneous fat. CONCLUSIONS: The posterior cervical and upper back area appears to be a common site for localization of mesenchymal tumours that show some fat differentiation and produce an increase in stromal matrix material. Mesenchymal cell populations within this area are also affected by systemic diseases. A male predominance pattern occurs with these conditions, and steroid receptors are expressed on some mesenchymal cells, that vary with the body location. Thus, this observation may be related to the effects of protease inhibitors on steroid hormone metabolism through their inhibition of cytochrome P-450.     

《皮肤性病学-电子图片示教教程》的编写及在临床见习中的应用

皮肤性病学为一门形态学科,临床见习过程中认识皮损非常重要。但由于学生课时有限、患者不配合等诸多因素,典型病例的数量及质量难以保证。因此在多年的积累基础上,笔者制作出版了《皮肤性病学-电子图片示教教程》。在滨州医学院附属医院2010级的附院见习带教应用过程中,调查结果显示,配合应用《教程》组与配合应用教材配套光盘图片组教学效果差异有统计学意义(χ~2=7.014,P0.05),配合应用《教程》组教学效果更佳。《教程》在临床见习中值得推广应用。     

Role of UV Light in Photodamage,Skin Aging,and Skin Cancer

Solar, and particularly UV, radiation causes molecular and cellular damage with resultant histopathologic and clinical degenerative changes, leading in turn to photosensitivity, photo-aging, and skin cancer. While our bodies have some natural UV defenses, additional protection from the sun is essential, including sun avoidance, physical protection, and sunscreen use. Sun avoidance includes limiting exposure during peak UV times (10am–4pm), avoiding UV-reflective surfaces such as sand, snow and water, and eliminating photosensitizing drugs. Physical protection includes wearing photoprotective clothing such as a broad-brimmed hat and long sleeves and use of UV-blocking films on windows. Sunscreen containing avobenzone, titanium dioxide, zinc oxide or encamsule should be used daily and frequently reapplied. To guard against the UVB spectrum, zinc oxide and titanium dioxide are particularly recommended. Sunscreen is generally under-applied at only 25% of the recommended dose, seriously compromising photoprotection. Dosage guidelines recommend using more than half a teaspoon each on head and neck area and each arm, and more than a teaspoon each on anterior torso, posterior torso, and each leg (approximately 2 mg/cm²).     

Digital Images in Dermatology and the Dermatology Online Atlas on the World Wide Web

The digital revolution opens new ways of storing, retrieving and distributing images. The informativeness of digital images of dermatological conditions as compared to conventional photographs and slides has proven to be statistically similar; in many cases, digital images may even substitute for dermatologic physical examination. Current developments in high-speed, high-capacity international networks and the growing popularity of the World Wide Web are converging in ways that have great potential for enhancing access to biomedical information, including medical images. However, lack of metainformation and indexing services specialised in retrieving images makes finding images—as opposed to textual information—on the Web difficult. To provide an image collection and entry point into dermatological resources on the World Wide Web, we have developed an image database (Dermatological Online Atlas—DOIA). The database, which is freely available on the Internet at http://dermis.net , contains about 3,000 clinical images covering more than 600 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. It serves as a teaching tool for medical students, doctors and patients, assists professional users by being an easy gateway to other databases such as MEDLINE, PDQ, and OMIM and serves as a platform for conducting research by means of administering Internet surveys to users. We conclude that an online image atlas has multiple educational, clinical, and research applications.