避免伽玛马治疗定位误差的研究

为防止伽玛刀立体定位误差，所设研究分１人、２人、３个核组。结果表明１人核查组的误差率远高于２人核查组和３人核组。根据研究结果制订出操作常规，经复查１０８列病人，未出现定位误差的病例。     

显微镜内导航系统及观察棒辅助颅脑手术初步体会

目的：探讨显微导航系统（ＳＭＮ）及观察棒（ＳＴＮ）使用方法及辅助颅脑手术初步体会。方法：术前１天均行ＣＴ薄层扫描三维重建立体定位，先用导航仪定出切口大小和手术入路。开颅手术１４例采用直切口或弧形切口，３例采用马蹄形切口，３例经蝶窦入路，显微放大５～１５倍下切除肿瘤。结果：导航定位均准确，误差１～３ｍｍ以内，肿瘤全切除１７例，次全切除２例，１例脑积水置管准确，除多发性脑膜瘤，颅咽管瘤及巨大垂体腺瘤各１例需要输血外，其它均不必输血，无手术并发症。结论：显微导航具有定位准确、缩小骨窗、减少损伤和减少并发症等优点。     

大鼠睾丸中1，25－双羟维生素D＿3受体的免疫组织化学定位

用抗１，２５－（ＯＨ）２Ｄ３受体单克隆抗体（９Ａ７），以免疫组化法对正常大鼠睾丸行１，２５－（ＯＨ）２Ｄ３受体定位研究。成年雄性大鼠在苯巴比妥腹腔注射麻醉下，用生理盐水对心脏灌注放血致死，取睾丸置Ｂｏｕｎ＇ｓ液中固定２４小时，用振荡切片机制备５０μｍ厚切片，以ＡＢＣ法进行免疫反应，ＤＡＢ显色。在普通光镜下观察，发现睾丸曲精管内，特别是基底部的细胞有明显免疫反应。这表明雄性动物睾丸组织可能是１，２５－（ＯＨ）２Ｄ３的靶器官。     

大鼠睾丸中1，25－双羟维生素D＿3受体的免疫组织化学定位

用抗１，２５－（ＯＨ）２Ｄ３受体单克隆抗体（９Ａ７），以免疫组化法对正常大鼠睾丸行１，２５－（ＯＨ）２Ｄ３受体定位研究。成年雄性大鼠在苯巴比妥腹腔注射麻醉下，用生理盐水对心脏灌注放血致死，取睾丸置Ｂｏｕｎ＇ｓ液中固定２４小时，用振荡切片机制备５０μｍ厚切片，以ＡＢＣ法进行免疫反应，ＤＡＢ显色。在普通光镜下观察，发现睾丸曲精管内，特别是基底部的细胞有明显免疫反应。这表明雄性动物睾丸组织可能是１，２５－（ＯＨ）２Ｄ３的靶器官。     

超声测定先天性髋脱位的前倾角

超声测定先天性髋脱位的前倾角赵钟岳寇伯龙倪雷高淑华唐军从１９８８年底开始应用超声测定先天性髋关节脱位的前倾角。到１９９３年１１月已进行了１４８例，其中少于１周岁的２７人，１～２岁１０１人，２～３岁１４人，大于３岁到１０周岁６人未进行术中测量。其中２５...     

救治心脏刀穿透伤的体会

５例心脏穿透伤病人，３例急症剖胸行心脏修补术获救，２例由于失去手术机会死亡获救３例的为刀刺伤，２例为右室前壁，１例工室前壁。心脏伤口分别为２ｃｍ、０．８ｃｍ、２ｃｍ大小。均穿透心肌全层达心这内。死亡的１例是经左胸枪弹穿透左右心室，１例为由左胸刀穿透右讣和主动脉。     

1α，25双羟维生素D3对成骨样细胞增殖与分化的影响

采用同位素掺入，细胞周期、细胞化学和扫描电镜等方法观察了１α，２５双羟维生素Ｄ３［１，２５（ＯＨ）２Ｄ３］对人及大鼠成骨样细胞ＯＳ－７３２和ＲＯＳ１７／２．８增殖及分化的影响。结果表明：１，２５（ＯＨ）２Ｄ３对ＯＳ－７３２细胞增殖的抑制作用呈明显的时效和量效关系。在给１０－７ｍｏｌ／Ｌ的１，２５（ＯＨ）２Ｄ３后第４和第６天，对ＯＳ－７３２细胞生长的抑制率分别为４０％和６０％；对ＤＮＡ，ＲＮＡ和蛋白质合成的抑制作用分别为５９％，４１％和２２％。流式细胞计测定结果表明：１，２５（ＯＨ）２Ｄ３使ＤＮＡ合成受阻；扫描电镜显示：１，２５（ＯＨ）２Ｄ３有抑制ＲＯＳ１７／２．８细胞表面微绒毛的作用。此外，细胞化学染色表明：该激素有增加成骨样细胞碱性磷酸酶活性和促进骨形态形成蛋白合成的作用，即刺激骨形成的作用。     

尿路复合性恶性肿瘤（附21例报告）

报告２１例尿路复合性恶性肿瘤，位于肾盂２例，膀胱１９例。主要临床表现为血尿，绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌（ＴＣＣ）与继发性复合肿瘤有密切关系。２１例中１例为ＴＣＣ复合肉瘤，１１例为ＴＣＣ复合鳞癌，７例为ＴＣＣ复合腺癌，２例为腺癌复合鳞癌。本组２例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术，术后存活６个月和１年；膀胱肿瘤１４例行膀胱部分切除术，已生存３年４例，１年２例，未满１年２例，３例１～２年内死亡，失访３例；２例根治性膀胱全切术已生存５年和３年以上；３例行ＴＵＲＢｔ，已生存３年１例，１５年１例，未满１年１例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。     

正常成人骶1椎弓根解剖学测量与临床应用

目的：确定第一骶椎椎弓根螺钉准确的进钉点、角度和深度，探讨其临床应用意义。方法：通过对４０具成人尸体骶１椎弓根解剖测量和形态学研究，应用于Ｓｔｅｆｅｅ钢板椎弓根螺钉内固定系统治疗腰椎滑脱症２４例。结果：骶１椎弓根螺钉进钉点应在腰骶关节突中点下１０．０±２．０ｍｍ，棘突中线外３２．２±３．３ｍｍ，展角３９．６±４．７°，深度５１．８±３．０ｍｍ。随访２４例，平均滑脱纠正率７２．５％。全部骨性融合，临床疗效良好率８３．３％。结论：该定位方法能够提高骶１椎弓根螺钉的准确性，有效地增加腰骶节段固定的牢固性，有利于骨性融合     

1,25(OH)_2D_3受体与慢性肾功能衰竭的研究进展

随着慢性肾功能衰竭透析患者生存期的延长，继发性甲状旁腺功能亢进成为突出的临床问题。在其发病机制中，１ ，２５（ Ｏ Ｈ）２ Ｄ３ 受体的异常引起重视，本文从细胞分子研究水平上对１ ，２５（ Ｏ Ｈ）２ Ｄ３ 受体的细胞分布、表达调节与配体的分子作用机制及慢性肾衰１ ，２５（ Ｏ Ｈ）２ Ｄ３ 受体的异常等方面作一简要综述。     

Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication

BACKGROUND: The aim of this retrospective study was to compare the results of Nissen, Nissen-Rossetti, and Toupet laparoscopic fundoplication in terms of gastroesophageal reflux disease (GERD). METHODS: From 1992 to 1996, 1,470 laparoscopic fundoplications were performed using one of three procedures: Nissen (n = 655), Nissen-Rossetti (n = 423), and Toupet (n = 392). Preoperative checkup included esophagogastroduodenoscopy in 1,437 patients (97. 7%), esophageal manometry in 934 patients (63.5%), and 24-h pH-metry in 799 patients (54.3%). The results were estimated at 1 month, 3 months, and 2 years. Patients unable to visit the hospital center were contacted by telephone. RESULTS: The three groups were quite similar regarding demographic data such as age, gender, preoperative clinical symptoms, and duration of GERD. One death (0.07%) occurred. At 3 months, there were no differences among the three groups concerning conversion, morbidity, dysphagia, early reintervention, or postoperative length of stay. The length of surgery was more important in the Toupet procedure. In the Nissen group, there were fewer Visick grade I patients but more Visick grade III patients. At 2 years, the recurrence and reintervention rates were similar. The overall residual severe dysphagia rate was 0.35% (n = 5). In the Nissen group, there were fewer Visick grade I patients but more in Visick grade II patients. There was no difference in Visick grade III and IV among the groups. More than 90% of the patients were satisfied (Visick I + Visick II), with no significant difference among the three groups. CONCLUSIONS: The results of this study do not differ significantly from the data reported in the literature, suggesting such surgical techniques are effective and well tolerated, and that both can be properly used in the treatment of GERD.     

Long-term prognosis of incidental renal cell carcinoma--clinical analysis of renal cell carcinoma detected by our health checkup

PURPOSE: We retrospectively evaluated the characteristics and long-term prognosis of incidentally detected renal cell carcinoma by health checkup. MATERIALS AND METHODS: From January 1987 to December 2005, 556 patients were treated for renal cell carcinoma in our department. Among them, 56 patients were detected by abdominal ultrasonography in health checkup of our health care center. We reevaluated the pathological stage according to 2002 TNM classification and tumor type of renal cell carcinoma according to 2004 World Health Organization histological classification. Survival analysis was determined by Kaplan-Meier's method and log-rank test. RESULTS: Of the patients, 50 were male and 6 were female. The age of the patients ranged 37 to 68 years old at diagnosis (median 54 years). The tumors were located in the right kidney in 22 patients and in the left kidney in 34. Pathologically T1a tumors were found in 40 patients (71%), T1b in 13 (23%), T2 in 2 (4%) and T3b in 1 patients (2%). One case of T3b had N2 and M1 disease. The followup time after the operation ranged 3 to 215 months (median 121 months). Seven patients died of renal cell carcinoma. One of the 7 patients in T1a disease died at 64 months, 4 in T1b at 47, 91, 119, 163 months, 1 in T2 at 39 months and 1 in T3b at 13 months, postoperatively. The cause specific 10-year survival rate was 97% for T1a disease and 57% for T1b (p < 0.01), respectively. CONCLUSION: Most of renal cell carcinomas were T1a disease, which were detected incidentally by health checkup. The cause specific survival rate was significantly higher for T1a disease than for T1b. Our data suggested that early detection was important for good prognosis. The abdominal ultrasonography was only method for detection in routine health checkup and should be broadly implemented.     

Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective,randomized, clinical study

BACKGROUND: The aim of our prospective, randomized, clinical study was to compare two postoperative regimens after Achilles rupture repair and determine whether early functional treatment will give a better result than early immobilization in tension of the musculotendinous unit. METHODS: Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weight bearing was allowed after 3 weeks in both groups. The patients were assessed clinically at 1, 3, 6, 12, and 24 weeks, and the last control visit took place at a mean of 60 (SD 6.4) weeks postoperatively. RESULTS: The isokinetic calf muscle strength scores were excellent in 56%, good in 32%, fair in 8%, and poor in 4% of the patients in the early motion group at the last control checkup; whereas the scores in the cast group were excellent in 29%, good in 50%, and fair in 21% of the patients. The ankle performance scores were excellent or good in 88%, fair in 4%, and poor in 8% of the patients in the early motion group, whereas the scores in the cast group were excellent or good in 92% and fair in 8% of the patients. At 3 months and at the last control checkup, no significant differences were seen between the two groups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, isokinetic calf muscle strength, or overall outcome. The complications included one rerupture in the early motion group and one deep infection and two reruptures in the cast group. Deep infection and the rerupture in the cast group occurred in the same patient. The outcome of the complications was good in two cases and poor in one. CONCLUSION: The isokinetic calf muscle strength results were somewhat better in the early motion group, whereas the other outcome results obtained in the two groups of patients were very similar. We recommend early functional postoperative treatment after Achilles rupture repair for athletes and well-motivated patients and for less-motivated patients and nonathletes.     

Impact of Adenoma Weight and Ectopic Location of Parathyroid Adenoma on Localization Study Results

Although the sensitivity of preoperative localization techniques is high for solitary parathyroid adenomas, negative imaging study results are inevitable. The weight and location of the parathyroid adenoma may contribute to the negative results. We aimed to study the impact of adenoma weight and ectopic location of the parathyroid adenoma on ultrasonography and sestamibi scan results. The patients were divided into two groups according to adenoma location. Group 1 consisted of 36 patients with ectopic location, and group 2 consisted of 149 patients with normal location. Parathyroid adenoma weight and the results of imaging studies were determined in all patients. Of 185 patients operated on for hyperparathyroidism, 36 (19.4%) had ectopic parathyroid glands. There was a positive correlation between adenoma weight and positive imaging studies, whereas ectopic location did not correlate with negative imaging study results. There was no significant difference between the ectopic adenoma ratio of patients with negative and positive imaging study results. The weight of the ectopic parathyroid adenoma was significantly lower in patients with negative imaging study results than in patients with positive imaging study results (p = 0.001). According to the analysis of variance, patients with higher-weight adenomas have positive imaging study results irrespective of ectopic location. For both normal and ectopic adenoma locations, adenoma weight was found only to be a factor that positively influences imaging study results.     

Quality of life after laparoscopy-assisted pylorus-preserving gastrectomy: an evaluation using a questionnaire mailed to the patients

Purpose

This study investigated the postoperative quality of life (QOL) after laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) in comparison to laparoscopy-assisted distal gastrectomy (LADG).

Methods

Twenty-one patients with early-stage gastric cancer underwent minimally invasive LADG (n?=?12) or LAPPG (n?=?9). Demographic and cancer-related data were obtained retrospectively from medical records. QOL was assessed using a 13-item questionnaire and the Japanese edition of the Gastrointestinal Symptom Rating Scale, which were mailed to patients twice postoperatively. Body weight and hemoglobin levels were measured at the same time.

Results

Early upper abdominal pain was rated as significantly worse with LAPPG than with LADG at the first checkup (1.4 vs. 1.0, P?=?0.02) but not at the second checkup (1.3 vs. 1.0, P?=?0.07). There was a trend toward less body weight loss in the LAPPG patients in comparison to the LADG patients. The serum hemoglobin levels of LAPPG patients at the second checkup showed significantly higher than LADG patients (13.3 vs. 11.6?g/dL, P?Conclusions LAPPG and LADG produce similar QOL in patients. Trends toward less body weight loss and improved anemia in LAPPG patients may therefore become more pronounced in future studies that have adequate number of the patients and longer follow-up periods.     

髌腱及股四头肌腱断裂的诊断与治疗

目的：探讨髌腱及股四头肌腱断裂的诊断与治疗问题。方法：23例髌腱及股四头肌腱断裂的患者。股四头肌或股四头肌腱断裂12例（急性股四头肌或股四头肌腱损伤7例,陈旧性股四头肌或股四头肌腱损伤5例）。髌腱断裂11例（急性髌腱损伤共8例,陈旧性髌腱损伤共3例）。回顾性统计患者的年龄、致伤原因、损伤性质、症状、体征、辅助检查、受伤至手术时间间隔、手术治疗方式、制动情况、膝关节活动度、功能恢复情况（采用Lysholm评分。积分达95分以上者为优秀,94-85分为良好,84-65分为尚可,小于65分为差）、髌骨位置高低（Insall方法）及满意程度。结果：23例髌腱及股四头肌腱断裂患者平均随访期为6年（4个月-11年6个月）。3例因联系方式失效而失访。急性股四头肌或肌腱断裂急诊修复者5例优秀,2例良可。急性髌腱断裂急诊修复8例均为优秀。陈旧性股四头肌及股四头肌腱损伤5例,2例为优秀（3例失访）。陈旧性髌腱断裂重建结果为优秀1例,优良2例。结论：手术治疗髌腱及股四头肌腱断裂,急性髌腱及股四头肌腱断裂早期修复有很好的预后。陈旧性损伤的预后劣于急性髌腱及股四头肌腱断裂早期修复,但经过治疗亦可取得较为满意的结果。     

Facial electroneurography: clinical and experimental investigations

Facial electroneurography (ENoG) appears to be a reliable prognostic test for intratemporal facial nerve paralysis. ENoG is objective and allows a permanent record to be maintained. Nonetheless, occasional inconsistencies in clinical correlation may diminish the utility of ENoG. A qualitative study was undertaken to identify the possible reasons for the inaccuracy of ENoG in some patients. Four clinical groups and one experimental group were studied: (1) normal subjects, (2) patients with acute facial palsy, (3) patients with progressive facial palsy, (4) patients with temporal bone tumors and normal facial function, and (5) animals in which one facial nerve was crushed and repaired. The reliability of ENoG is dependent on careful interpretation of data obtained by optimal electrode placement and stimulus duration.     

Predictors of the accuracy of quotation of references in peer-reviewed orthopaedic literature in relation to publications on the scaphoid

Using inaccurate quotations can propagate misleading information, which might affect the management of patients. The aim of this study was to determine the predictors of quotation inaccuracy in the peer-reviewed orthopaedic literature related to the scaphoid. We randomly selected 100 papers from ten orthopaedic journals. All references were retrieved in full text when available or otherwise excluded. Two observers independently rated all quotations from the selected papers by comparing the claims made by the authors with the data and expressed opinions of the reference source. A statistical analysis determined which article-related factors were predictors of quotation inaccuracy. The mean total inaccuracy rate of the 3840 verified quotes was 7.6%. There was no correlation between the rate of inaccuracy and the impact factor of the journal. Multivariable analysis identified the journal and the type of study (clinical, biomechanical, methodological, case report or review) as important predictors of the total quotation inaccuracy rate. We concluded that inaccurate quotations in the peer-reviewed orthopaedic literature related to the scaphoid were common and slightly more so for certain journals and certain study types. Authors, reviewers and editorial staff play an important role in reducing this inaccuracy.     

Virtual pointer projection of the central sulcus to the outside of the skull using frameless neuronavigation -- accuracy and applications

BACKGROUND:The purpose of this prospective study was to localize the central sulcus by frameless neuronavigation and to project this anatomical structure to the outside of the skull on the skin. This method was analyzed in respect to its practicability, accuracy, and potential applications. METHOD: In 27 patients investigated (28 unaffected hemispheres), the central sulcus was virtually projected to the outside of the skull using frameless neuronavigation and a virtual pointer elongation of 15 or 20 mm. The following parameters were measured on the scalp: 1. the distance between the bregma and the midline junction of the central sulcus, and 2. the angle between the central sulcus and the midline. These dada were compared with measurements based on the original axial MR images of these patients. Finally, a laboratory phantom study was designed in analogy to a patient's examination for estimation of the overall accuracy of the neuronavigation system in the experimental setup used in this study. FINDINGS: Virtual pointer projection of the central sulcus to the outside of the skull using frameless neuronavigation was found to be easily possible. The distance between the bregma and the midline junction of the central sulcus amounted to a mean of 55 mm on the left and 56 mm on the right. The angle between the central sulcus and the midline reached a mean of 63 degrees on the left and 60 degrees on the right. These data confirmed results of other studies with no frameless neuronavigation devices. The phantom study revealed a mean overall inaccuracy of 0.9 mm at a virtual pointer elongation of 15 mm. At a virtual pointer elongation of 20 mm, the mean overall inaccuracy of our study was 1.1 mm. These results correspond to the inaccuracy of frame based stereotaxy. INTERPRETATION: It is easily possible, valid, and reliable to virtually project the central sulcus to the outside of the skull with an acceptably low inaccuracy using frameless neuronavigation. This is important for research studies that correlate and integrate different functional imaging methods with the aid of frameless neuronavigation.     

Accuracy of 16-channel multi-detector row chest computed tomography with thin sections in the detection of metastatic pulmonary nodules.

OBJECTIVES: The inaccuracy of conventional CT makes open thoracotomy and manual palpation inevitable in pulmonary metastasectomy. However, the introduction of multi-detector row CT technology made it possible to detect pulmonary nodules with a diameter of 1mm. The purpose of this study was to investigate the accuracy of 1mm thin-section 16-channel multi-detector row CT (TSMDCT) in the detection of metastatic pulmonary nodules. METHODS: Twenty-seven patients who underwent pulmonary metastasectomy between November 2005 and September 2006 were included in the study. The primary tumors were colorectal cancer (n=11), renal cell carcinoma (n=5), osteosarcoma (n=3), hepatocellular carcinoma (n=3), thymic tumor (n=2), bladder cancer (n=1), thyroid cancer (n=1), and primitive neuroectodermal tumor (n=1). TSMDCT was performed in all patients in order to evaluate the location and number of metastatic nodules. The patients were divided into osteosarcoma and non-osteosarcoma groups, and the accuracy of TSMDCT was evaluated by comparison with the pathologic diagnosis of metastatic nodules. RESULTS: A total of 117 nodules were detected preoperatively by TSMDCT scanning, and 198 nodules were resected during the operation. A total of 101 nodules were pathologically confirmed to be metastatic nodules. In the osteosarcoma group, the sensitivity, specificity, positive predictive value, and negative predictive value were 34%, 93%, 92%, and 38%, respectively. In the non-osteosarcoma group, the sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 54%, 64%, and 96%, respectively. Subgroup analysis in the non-osteosarcoma group revealed that nodule size over 5mm, number of metastatic nodules less than five, and disease-free interval over 24 months showed 100% sensitivity by preoperative TSMDCT. CONCLUSIONS: TSMDCT with 1mm thickness image reconstruction showed high detection rate of metastatic pulmonary nodules in the patients with non-osteosarcoma. In highly selected subgroups, TSMDCT detected all the metastatic nodules which manual palpation could detect. Further study on the application of TSMDCT in thoracoscopic metastasectomy should be performed.