12例全头皮撕脱伤的治疗

全头皮撕脱伤采用血管吻合头皮再植术是较理想的方法，但技术难度大，成功率不高，一旦失败，不但损失了可制成皮片回植的头皮，而且使创面失去了一期修复的时机，治疗时间延长，增加病人精神和经济负担，因此应严格掌握手术指征，对不能行吻合血管再植术或技术力量不够、吻合血管成功把握不大者，应积极采取中厚皮片回植术。本组１２例中，５例吻合血管的再植术中，１例失败，４例部分成活。７例行中厚皮片回植，５例全部成活，２例７０％成活。     

Posttraumatic Pseudoaneurysm in Scalp Treated by Direct Puncture Embolization Using N-Butyl-2-Cyanoacrylate: a Case Report

Here, we report a case of scalp pseudoaneurysm which was treated by direct puncture embolization using n-butyl-2-cyanoacrylate. The patient had a history of blunt trauma in the previous two months. Ultrasound-guided manual compression was initially attempted, but the results were unsatisfactory. Direct puncture embolization was then performed, and the pseudoaneurysm was completely obliterated. Non-surgical treatment options for pseudoaneurysm are briefly discussed.     

Primary Epithelioid Sarcoma Manifesting as a Fungating Scalp Mass - Imaging Features and Treatment Options. A Case Report and Literature Review

Primary epithelioid sarcoma is an extremely rare malignancy of the scalp. To date, less than a dozen such cases have been reported in the literature. The diagnosis often is a challenge to both radiologists and clinicians. This is largely attributed to the lack of literature on the imaging features of scalp epithelioid sarcoma. In this report, we highlight the role of multimodality imaging in the diagnosis of primary scalp epithelioid sarcoma and review the epidemiology, imaging, treatment options, and prognosis of these malignant scalp tumors. Displaying a multilobulated morphology, heterogeneous enhancement, and restricted diffusion on MRI, these tumors typically show central degeneration with hemorrhage, necrosis, and calcification. Wide surgical resection and adjuvant radiotherapy are the mainstays of treatment for localized scalp tumors. Nevertheless, the prognosis of patients with distant metastases at diagnosis is extremely poor compared to those with local or regional diseases.     

1 例断指再生病例报告

医学历史记载,末节断指是不可能再生的,但自从报道MEBT/ MEBO 再生复原末节断指后,末节断指再生已成为可能.作者在临床上多次应用MEBT/ MEBO 治疗末节手指离断,均获得了与报道一致的临床效果.现报告本院治疗的1 例末节手指离断的临床结果：患者邢某,女,55 岁,门诊诊断：左食指末节损伤缺如,检查发现左食指末节已完全离断,末节指骨缺失约2/3,外露,止血后创面外涂湿润烧伤膏（MEBO）,敷料包扎,每日门诊换药2 次,15 d 后每日换药1 次,30 d 后创面愈合,继续以MEBO 作为护肤油使用,162 d 后门诊复查,断指部位完全再生复原,外观及功能均良好.     

Electromagnetically Navigated Brachytherapy as a New Treatment Option for Peripheral Pulmonary Tumors

PURPOSE: This technical note describes the principles of navigated brachytherapy for treatment of peripheral non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: In a prospective feasibility trial a first patient with medically inoperable NSCLC in the right upper lobe was treated with external-beam radiotherapy (50 Gy) and navigated endoluminal brachytherapy (15 Gy). Navigated bronchoscopy was performed with an electromagnetic navigation system for localization of a microsensor mounted on the tip of a dedicated catheter placed within the working channel of a bronchoscope. The probe can be actively guided by a steering mechanism to targeted lesions in the periphery of the lung. After successful localization of the NSCLC, endobronchial ultrasound (EBUS) was performed to confirm the exact position in the center of the lesion. A 6-F brachytherapy catheter was placed within the tumor. Primary 3-D-planned brachytherapy was performed on chest CTs acquired with the inserted catheter. High-dose-rate brachytherapy (370 GBq iridium-192) was applied as a boost three times a week (single dose 5 Gy) and provided highly conformal irradiations of the NSCLC including the draining bronchovascular bundle. RESULTS: The brachytherapy catheter was tolerated well during treatment (5 days) and alimentation was possible without any problems. Repeated CTs showed stable positioning of the catheter. During follow-up (12 months), endoluminal ultrasound and CT demonstrated a partial remission while histology showed a complete remission of the tumor. CONCLUSION: Navigated brachytherapy for peripheral pulmonary tumors not amenable to conventional bronchoscopy is feasible.     

High-Dose-Rate Interstitial Brachytherapy for the Treatment of Penile Carcinoma

BACKGROUND: Interstitial low-dose-rate (LDR) brachytherapy allows conservative treatment of T1-T2 penile carcinoma. High dose-rate (HDR) is often considered to be dangerous for interstitial implants because of a higher risk of complications, but numerous reports suggest that results may be comparable to LDR. Nevertheless, there are no data in the literature available regarding HDR interstitial brachytherapy for carcinoma of the penis. CASE REPORT: A 64-year-old man with T1 N0 M0 epidermoid carcinoma of the glans is reported. Interstitial HDR brachytherapy was performed using the stainless hollow needle technique and a breast template for fixation and good geometry. The dose delivered was 18 x 3 Gy twice daily. RESULTS: After 232 days from brachytherapy, the patient was without any evidence of the tumor, experienced no serious radiation-induced complications, and had a fully functional organ. CONCLUSION: HDR interstitial brachytherapy is feasible in selected case of penis carcinoma, when careful planning and small single fractions are used.     

Brachytherapy boost: a novel approach for epiglottic carcinoma

PURPOSE: Epiglottic (epilaryngeal) carcinoma has been treated conventionally by radical external beam radiotherapy or partial laryngectomy. The aim of this study is to evaluate the role of brachytherapy boost as a novel approach for lingual epiglottic lesions. METHODS AND MATERIALS: Twenty-three patients with T(2-3)N(0-1) lingual epiglottic carcinoma (SCC) were treated with curative intent between January 1990 and December 2001 using low dose rate interstitial (192)Ir implant boost, moderate dose of 25Gy at 0.5cm (mean dose rate, 50.5 cGy/h) 3 weeks after moderate dose of external beam radiotherapy (mEBRT) of 46Gy/23#/28-31d. RESULTS: Complete response after mEBRT was observed in 18 of the 23 patients (78%) and partial response was seen in 5 of the 23 patients (22%). After implant, all patients had complete response. Locoregional control was seen in 19 of the 23 patients (82.6%). Two patients developed distant metastases. Disease-free survival and overall survival at 5 years were 68.3% and 66.7%, respectively. Disease-free survival at 5 years showed a trend toward better outcome for biologically equivalent doses >85Gy compared with biologically equivalent doses <85Gy (80% vs. 68%) (p=0.18). All patients had minimal to acceptable xerostomia. CONCLUSIONS: Interstitial boost with mEBRT is feasible, effective, and a novel approach for lingual epiglottic lesions.     

Case Report: Intra-Abdominal Injury in a Gymnast

The ‘hip circle’ maneuver performed by female gymnasts on the uneven parallel bars may cause intra-abdominal injuries.     

Primary Pulmonary T-Cell Lymphoma: a Case Report

Primary pulmonary T-cell lymphoma is an extremely rare malady, and we diagnosed this in a 52-year-old male who was admitted to our hospital with cough for the previous two weeks. The chest CT demonstrated multiple variable sized mass-like consolidations with low density central necrosis in the peripheral portion of both the upper and lower lobes. Positron emission tomography (PET) showed multiple areas of hypermetabolic fluorodeoxyglucose (FDG) uptake in both lungs with central metabolic defects, which correlated with central necrosis seen on CT. The histological sample showed peripheral T-cell lymphoma of the not otherwise specified form. The follow-up CT scan showed an increased extent of the multifocal consolidative lesions despite that the patient had undergone chemotherapy.     

Percutaneous Transcervical Thoracic Duct Embolization for Treatment of a Cervical Lymphocele Following Anterior Spinal Fusion: A Case Report

Thoracic duct injury is an uncommon complication of neck dissection and cervical spinal surgery that is associated with significant morbidity. The authors describe an unusual case of thoracic duct injury during anterior spinal fusion resulting in a large prevertebral lymphocele presenting with dysphagia, respiratory distress, and chyloptysis. Surgical closure of the lymphocele was unsuccessful, and percutaneous drainage and sclerotherapy was performed. A large thoracic duct branch communicating with the lymphocele became evident during sclerotherapy, and embolization of the duct was performed via a percutaneous transcervical approach. Symptoms immediately resolved, and the patient remained asymptomatic at 6-month follow-up.