一侧后牙缺失咀嚼肌酶组织化学定量研究

为了解一侧后牙缺失后咀嚼肌肌纤维类型构成、纤维粗细和酶活性的变化，利用图像分析仪对一侧后牙缺失后小型猪咀嚼肌酶组织化学改变进行了定量研究。结果发现两侧咀嚼肌酶组织化学均有不同程度的改变，随时间迁延，各肌变化发展趋向不同，一侧后牙缺失后１个月，失牙侧嚼肌和下颌舌骨肌以Ｉ型纤维为多，所有肌肉纤维直径均增大，翼外肌Ｉ型纤维和各肌ＩＩ型纤维酶活性均升高；至３个月时各肌均以Ｉ型纤维占优势。咬合紊乱会引起咀嚼肌酶组织化学特征的明显改变，可能与颞下颌关节紊乱综合征时肌肉的功能失调有关。     

神经损伤后NGF对骨骼肌纤维琥珀酸脱氢酶活性的影响

用持针器夹持兔右侧坐骨神经制作神经损伤动物模型。实验组动物于损伤处喷布蛇毒神经生长因子（ＮＧＦ）,对照组动物于同部位给予等量生理盐水,对胫骨前肌红肌、白肌和中间型肌纤维琥珀酸脱氢酶（ＳＤＨ）活性变化及分布进行定量、定位分析。结果显示,神经损伤１、２、３周,实验组和对照组各型肌纤维ＳＤＨ活性减弱,电镜下可见线粒体嵴断裂,酶阳性反应产物稀疏;神经损伤４周,实验组红肌、白肌和中间型肌纤维酶活性及分布恢复正常,对照组各型肌纤维酶活性仍较弱,电镜下酶阳性反应颗粒的分布也未恢复到正常水平。神经损伤３～６周,实验组各型肌纤维酶活性均强于对照组,组间差异显著（Ｐ＜００１）。本研究结果提示,坐骨神经损伤后,外源性的蛇毒ＮＧＦ对骨骼肌纤维酶活性和结构的恢复具有重要的促进作用     

一侧后牙缺失后咀嚼肌超微结构形态计量学改变

咬合紊乱会对咀嚼肌的功能和形态产生影响，本文对一侧后牙缺失后小型猪咀嚼肌超微结构的变化进行了定量研究，以探讨此类咬合紊乱状态下不同肌肉受累的差异。结果显示，一侧后牙缺失后两侧咀嚼肌超微结构均有所改变，多数表现为肌浆网和肌横管扩张，线粒体增大，数量增多。定量分析发现失牙侧咬肌线粒体体密度、数密度、表面积密度均呈下降趋势，提示可能与其在咀嚼功能中作用减弱有关，而失牙侧翼外肌上下头变化不同步则表明它们的功能出现不协调。     

下颌骨髁状突骨软骨瘤一例报告

1病例报告患者,女,44岁,因左侧耳屏前肿物伴偏颌畸形4年收入我院。患者6年前一次车祸中伤及左侧面部,无颌骨骨折,长期有下颌运动不适感。4年前发现下颌逐渐向右偏斜,致咬合关系紊乱,渐进性左侧耳前区隆起,影响咀嚼和美观,未作任何治疗。入院后常规查体,一般情况可。口腔科检查见颌面部左右不对称,下颌骨向右侧偏斜,前牙及右侧后牙反颌,上下前牙及左侧上下后牙无接触,张口度35mm,开口型右偏,左侧耳屏前隆起,可扪及被肿瘤挤压所致外突的髁突外侧极,无压痛,左侧髁状突活动度尚可,颌下及颈淋巴结未扪及。影像学检查:颞颌关节CT扫描示左侧髁状内…     

大鼠腹膜间皮瘤的酶组织化学及超微结构观察

对２２例大鼠腹膜间皮瘤进行酶组织化学和超微结构的综合研究，间皮瘤主要由ＥＣ、ＦＬＣ、ＩＣ、ＰＭＣ细胞组成，上皮瘤细胞脱氢酶活性高于纤维型，脱水酶活性低于纤维型。不同类型间皮瘤细胞酶活性特点表现各异，并与邻近组织或细胞的酶活性改变有一定的相关性。故认为间皮瘤的发生可能为多起源。同时首次报道未定型间皮瘤酶活性及超微结构的特点，这有助于进一步认识间皮瘤的组织发生及鉴别诊断。     

喉鳞状细胞癌伴扁桃体恶性淋巴瘤1例

 临床资料 患者，男，54岁，因声嘶2年余、吞咽梗阻3月入院。入院后纤维喉镜检查：右喉室声带前部新生物，触之易出血。咽喉CT：双侧口咽部实质占位，侵犯左侧颈大肌、左侧舌根、左侧喉咽部；右侧声门区实质占位，破坏右侧甲状软骨，侵犯右侧胸骨甲状肌；双侧颈动脉鞘淋巴结肿大。临床诊断：喉癌累及扁桃体。行左扁桃体摘除，左颈部淋巴结选择性清扫和全喉切除术。     

乳腺癌、乳腺良性疾病中葡萄糖—6—磷酸脱氢酶活性变化及其意义

应用酶组织化学技术,观察86例原发性乳腺癌和24例乳腺良性疾病中葡萄糖—6—磷酸脱氢酶(G6PDH)的活性和分布。结果表明:乳腺癌组织内酶活性显著高于乳腺良性疾病;乳腺癌间质酶活性与癌细胞内酶活性成正相关;乳腺增生症中终末导管上皮细胞高度增生者或纤维囊性乳腺病其细胞成分增生为主者,酶活性显著增高。文中对上述酶活性变化的临床和生物学意义进行了讨论。     

食管癌术后复发颈部淋巴结转移引起晕厥一例

患者男,45岁.2008年1月因吞咽乏力行上消化道造影发现食管上段狭窄,胃镜检查见食管入口狭窄,进镜困难.2008年2月1日在全麻下行全咽喉、全食管切除,咽-胃颈部吻合术,气管造瘘术.术后病理报告:(1)食管髓质型中分化鳞状细胞癌,肿瘤侵透肌层达纤维膜,并与气管壁纤维性粘连.肿瘤累及环后,未累及双侧声、室带、喉室、会厌、双侧梨状窝、双侧襞裂及贲门,胃切缘及气管下切缘未见癌.     

腹部纤维母细胞/肌纤维母细胞性肿瘤的PET/CT影像学特点及其应用价值

 目的 分析腹部纤维母细胞/肌纤维母细胞性肿瘤的PET/CT影像学表现,提高对该少见病的认识。方法 搜集经手术或穿刺病理证实的腹部肌纤维源性肿瘤28例,分析其PET/CT表现。统计学方法采用独立样本t检验、方差齐性检验。结果 （1）中间型组有侵袭性纤维瘤病13例、孤立性纤维性肿瘤10例、肌纤维母细胞肿瘤3例;恶性组有纤维肉瘤2例。16例位于腹腔内、12例位于腹膜后,平均直径为12.4 cm。（2）PET/CT发现病灶以局部脂肪浸润或脏器浸润为主,所有病例均无淋巴结转移,3例出现远处转移。（3）侵袭性纤维瘤病、孤立性纤维性肿瘤、肌纤维母细胞肿瘤、纤维肉瘤的SUVmax均值分别为4.9、3.6、5.6和17.9,前三组（中间型）之间差异无统计学意义,但明显低于纤维肉瘤（恶性）。结论 PET/CT有助于提示腹部纤维母细胞/肌纤维母细胞性肿瘤的术前TNM分期;SUVmax值有助于肿瘤恶性程度的判断。     

儿童肱骨内髁骨折克氏针贯穿骨折端固定九例报告

目的探讨儿童肱骨内髁骨折的诊断及治疗方法,以期提高儿童肱骨内髁骨折的诊治水平。方法回顾性分析本院2010~2015年手术治疗的9例儿童肱骨内髁骨折患儿的临床资料,其中Kilfoyle-II型3例,Kilfoyle-III型6例,2例合并肘关节脱位。术前详细体格检查了解肘关节的肿胀、压痛及畸形情况,肘后三角的改变情况,本组均行肘关节正侧位X线片及CT检查,1例5岁患儿并行肘关节MRI检查以证实诊断。手术采取切开复位2~3枚克氏针贯穿骨折端固定。术后石膏固定3周后开始肘关节功能锻炼。结果本组术后骨折均愈合良好,无肘关节畸形出现。2例术后肘关节功能活动受限,其中1例为陈旧性骨折。无伤口感染、医源性血管神经损伤、内固定松动、骨坏死、骨化性肌炎等并发症。肘关节按Dhillon评分标准,7例优,1例良,1例可。结论儿童肱骨内髁骨折容易误诊及漏诊,诊断宜体格检查与影像学相结合。小年龄患儿X线片检查时应充分考虑肱骨远端骨骺不显影,必要时行肘关节MRI检查。治疗应早期诊断及复位固定。     

葛根素注射液对骨质疏松性大鼠下颌骨骨折愈合的影响

目的研究葛根素注射液对骨质疏松性大鼠下颌骨骨折愈合的影响。方法建立WIST-AR大鼠骨质疏松模型后再在大鼠右侧下颌骨体部造成颊舌侧贯通的不完全性骨折模型,随机分为假手术+下颌骨骨折组(A),去势+下颌骨骨折+葛根素治疗组(B)和去势+下颌骨骨折+盐水对照组(C),骨折后B、C两组分别于腹腔注射葛根素注射液和盐水。于术后第1周、2周、3周和4周将每组大鼠分别随机抽取5只处死,并取右侧下颌骨,用X线片检查骨折愈合情况并测量骨折愈合处骨密度值和进行组织学观察。结果在第3周后平均骨密度分析显示B组骨折愈合处平均骨密度值均高于C组(P<0.05);差异随着愈合时间的延长而显著;组织学观察结果显示C组骨折愈合明显延迟于B组。A组和B组差别不明显。结论葛根素注射液可加快骨生长,促进骨密度增加和骨质疏松性大鼠下颌骨骨折愈合。     

胫骨骨巨细胞瘤自体骨移植单髁置换中短期疗效观察

目的探讨胫骨单髁骨巨细胞瘤行肿瘤切除,应用自体髂骨移植、单髁置换重建膝关节功能的临床应用,提出手术步骤及方法,观察其疗效。方法2008年7月至2012年6月,我院收治胫骨近端单髁骨巨细胞瘤患者6例,男4例,女2例;内侧髁3例,外侧髁3例,年龄22～45岁,平均38岁,均为初次发病,病史3～10个月。按照CT横截面,肿瘤破坏最大横轴线≤1／2,关节软骨面明显受侵,2例有周围软组织受侵,3例有病理骨折;采用肿瘤整块切除,行自体髂骨移植、单髁表面置换术重建膝关节功能。结果经6个月至4年随访,肿瘤无复发,根据国际保肢学会功能评分标准,术后依疼痛程度、功能活动、心理接受程度、是否需用外部支持、行走能力及步态6个指标来评价效果。本组优5例,良1例。患膝关节活动范围均在0°～120°之间,关节稳定性好,效果满意。结论胫骨单髁骨巨细胞瘤,行肿瘤骨单髁切除、自体骨移植加单髁表面置换术,重建膝关节功能,经中短期观察疗效满意,膝关节功能恢复良好。     

Pathologic fracture after radiation therapy for primary non-Hodgkin's malignant lymphoma of bone

Between 1963 and 1981, 32 patients with biopsy proven non-Hodgkin's lymphoma involving bone were treated at the Mallinckrodt Institute of Radiology either with radiation alone or in conjunction with chemotherapy. An unexpectedly high rate of fracture at the site of the tumor was observed. Six patients were excluded because they survived less than six months after the completion of radiotherapy or were lost to follow-up within six months. There were 15 appendicular and 17 axial sites treated. Local control was achieved in 30 of 32. There were 10 patients with appendicular lesions of which seven suffered a fracture. Of the seven patients with lesions in a weight bearing bone, six suffered fractures. Twenty-six sites of involvement received less than 5000 rad. Five sites of involvement with diffuse histiocytic lymphoma (DHL) involving the appendicular skeleton received 5000 to 6000 rad. One site with DHL involving the axial skeleton received 5000 rad. Of the six patients receiving high dose, two presented with pathologic fractures of the femur requiring surgical stabilization and the remaining four patients suffered subsequent fractures 7 to 30 months after completion of therapy. Two of these six had local recurrence of disease. It appears that involvement of the appendicular skeleton by lymphoma frequently results in fracture. Doses of 5000 rad or greater do not increase the probability of local control but may contribute to the risk of fracture following radiotherapy.     

Prospective analysis of masticatory function following lateral mandibulotomy

Based on clinical impressions and subjective reports by patients, it is generally accepted that a loss of mandibular continuity will result in decreased masticatory function while preserving continuity will result in maintenance of masticatory function. Surprisingly, there is a paucity of well controlled studies objectively evaluating masticatory function to support these statements. The purpose of this study was to objectively evaluate masticatory function in a patient who underwent surgical resection for cure of a tonsillar carcinoma where a lateral mandibulotomy was used. Masticatory performance and swallowing threshold were assessed using a 0.5 gm frito as the test food substance and a sieve analysis. The subject was evaluated pre and post surgery and post prosthetic rehabilitation. When compared with pre surgery function, masticatory function and swallowing threshold were maintained and enhanced with prosthetic treatment 1 year post surgery. Maintenance of mandibular continuity did have functional merit for the subject studied.     

逆行腓骨短肌肌瓣修复跟骨骨折术后骨外露临床体会

目的探讨逆行腓骨短肌肌瓣在修复跟骨骨折术后骨外露的可行性.方法自2007年1月至2010年2月收治跟骨骨折内固定术后所致骨外露病例11例,其中男7例,女4例,年龄18～50岁,平均35.2岁;开放性骨折3例,闭合性骨折8例,手术原切口均为跟骨外侧"L"形切口,跟骨解剖型钢板内固定.创面缺损范围1.5cm×2.3cm～3.0cm×4.0cm,病程为2-4个月;所有病例均进行多次换药不见好转.手术时首先给予原切口扩创,清除坏死组织和炎性肉芽组织,取出内固定物.设计并切取同侧腓骨短肌逆行肌瓣充填缺损区,观察血运良好后,表面予以中厚游离皮片覆盖,打包加压,石膏托固定2周,供区均直接缝合.结果所有病例术后转移肌瓣及植皮完全成活,仅1例伴肌瓣下感染,换药后愈合.11例患者随访时间为2-20个月,平均4.5个月;术后皮瓣质地、外形良好,足踝活动稳定,无并发症发生,均可正常行走,无疼痛.结论逆行腓骨短肌肌瓣修复跟骨骨折术后骨外露,操作简单、成功率高、并发症少,可获得满意临床疗效.     

骨肿瘤术后缺损即刻修复重建的临床研究

目的　探讨下颌骨肿瘤切除后即刻修复重建的方法。方法　对28例下颌骨肿瘤切除后致下颌骨部分缺损,用不同方法一期修复。结果　3例局部感染, 1例钛支架松动, 1例骨折, 23例获得较好的外形及功能恢复。结论　下颌骨肿瘤切除后缺损行一期修复,获得较好效果。血管化游离骨移植+钛板修复为较理想的修复方法。     

Heating characteristics of a 430 MHz microwave heating system with a lens applicator in phantoms and miniature pigs

Heating experiments on phantoms and miniature pigs were performed using two types of lens applicator and a conventional waveguide applicator fed by a 430 MHz microwave heating system (HTS-100, manufactured by Tokyo Keiki Co., Ltd). Temperature distributions in agar phantoms and miniature pigs were measured at regular intervals during heating. The following results were thus obtained: (1) The effective heating depth varied with the focal length, showing the lens effect. (2) Using a four-aperture lens applicator in miniature pigs, a heating depth of 6 cm was obtained. This almost doubles the depth of conventional waveguide applicator. The heating area was 12 X 6 cm at the depth of 4 cm. (3) Dielectric properties of the buttocks of the miniature pig were virtually identical to those of the agar phantom containing 0.35% NaCl and 0.05% NaN3.     

Chronic neuroblastoma

BACKGROUND: An indolent course is associated with neuroblastoma (NB) in adolescents and adults. In the current study, the authors analyzed this phenomenon in a large series of children with metastatic NB. METHODS: The authors studied 38 patients who were diagnosed with NB in the first decade of life and had metastatic disease 5 years or more from diagnosis. RESULTS: The median age at diagnosis was 3 years 10 months. MYCN was amplified in 2 of 28 patients tested. Of 30 patients with classic Stage 4 NB, 9 had a late first recurrence of disease (4.3-13 years from diagnosis). Of eight patients who had atypical cases at diagnosis (one isolated mandibular lesion, two Stage 4-N, five non-Stage 4), six had a late first distant recurrence of disease (4 years 11 months-38 years 8 months). Nineteen patients were off therapy continuously for 3 years or more before disease recurred a first or second time. Myeloablative therapy was used to consolidate a first or second response in 27 patients. High-dose conventional therapy helped to achieve a second remission of disease in 9 of 20 patients assessable for response of first recurrence but achieved no major responses of second or third relapse in 10 of 11 patients. The combination of anti-G(D2) immunotherapy and/or cis-retinoic acid, targeted radiotherapy, and multiple cycles of chemotherapy with modest toxicity helped prolong survival. Twelve patients survive at 5 years 6 months+ to 19 years 4 months+ from diagnosis (median, 6 years 10 months+), including four with complete remission of disease; 10 received anti-G(D2) immunotherapy after recurrence. The other 26 patients died of disease (n = 22) or toxicity (n = 4) at 5 years-41 years 5 months from diagnosis (median, 6 years 5 months). CONCLUSIONS: The concept of indolent or smoldering NB should not be limited to adolescents/adults. The expanding repertoire of anti-NB treatments, including biologic therapies and chemotherapy regimens of modest toxicity, can convert childhood NB into a chronic disease with prolonged survival after recurrence.     

局部切除治疗壶腹部肿瘤

 报告经局部切除治疗的乏特氏壶腹部肿瘤5例。平均年龄61.4岁，所有病例均合并有严重疾病。肿瘤直径0.5～3.0cm，病理诊断：良性腺瘤2例，腺癌3例。并发症发生率为20%，无手术死亡率。腺癌病人中1例术后存活19个月，1例失访。1例良性肿瘤病人术后6年无瘤健在。另2例为手术后的近期随访中。我们认为对于瘤体较小的壶腹部肿瘤，特别是良性肿瘤和不能耐受根治性手术的高危病人，可考虑施行局部切除手术。本文对肿瘤切除及胆、胰管重建的手术操作进行了讨论。