调控脊柱侧弯椎体两侧的不对称应力是治疗脊柱侧弯的关键

基础研究早就发现,发生脊柱侧弯以后,在病儿的生长期和青春发育期间,都可看到脊柱的大体和镜下病理变化,如椎体楔形变、凸侧椎弓根变短、凹侧椎弓根及椎板变厚、脊椎转向凹侧,由于存在着不对称生长的结果,不对称生长发生的机制是什么? 不管何种病因,脊柱侧弯一旦形成,机械力将起着重要的作用,在侧弯脊柱凹侧产生压应力,凹侧椎间隙受压变窄,相反,凸侧产生张应力.在Hueter-Volkmann定律作用下,压应力使凹侧椎体的软骨细胞的生长、分化、成熟和退化提前和加速,从而使凹侧半的椎体生长提前终结,而凸侧则相反,造成脊柱侧弯两侧不对称生长,脊柱侧弯越来越重.     

青少年特发性脊柱侧凸患者椎体生长板中Runx2及X型胶原表达

目的：观察青少年特发性脊柱侧凸（AIS）患者上、下端椎和顶椎椎体生长板凸、凹侧软骨细胞的生物活性差异．探讨其在AIS发生和发展中的作用。方法：在对12例AIS患者行胸椎侧凸前路松解手术或前路矫形手术时获取上、下终椎和顶椎椎体生长板，分成凸、凹侧2组，共72枚标本，应用免疫组织化学方法检测Runx2和X型胶原蛋白的表达．原位杂交方法检测Runx2mRNA表达。所有染色结果通过图像分析系统进行半定量分析。结果：AIS患者顶椎椎体生长板凸、凹两侧的X型胶原、Runx2和Runx2 mRNA表达总量存在显著性差异（P〈0．05）。顶椎椎体生长板凹侧X型胶原的表达总量低于下终椎椎体生长板凹侧的表达总量（P〈0．05）。顶椎椎体生长板凹侧Runx2的表达总量低于上、下终椎椎体生长板凹侧的表达总量（P〈0．05）。顶椎椎体生长板凹侧单一软骨细胞Runx2表达量高于凸侧和上、下终椎椎体生长板凹侧单一软骨细胞的表达（P〈0.05）。顶椎椎体生长板凹侧高倍视野下平均Runx2mRNA表达总量低于上、下终椎椎体生长板的凹侧（P〈0．05）。顶椎椎体生长板凸侧单一细胞Runx2 mRNA表达量低于凹侧（P〈0.05）。顶椎椎体生长板凹侧高倍视野下平均X型胶原阳性细胞密度和Runx2阳性细胞密度低于凸侧和上、下终椎椎体生长板凹侧阳性细胞密度（P〈0．05）。结论：AIS患者上、下终椎和顶椎椎体生长板凸、凹侧软骨细胞存在不同的生物活性和细胞动力学，这可能是力学条件改变后的一种继发性改变，但其可能在AIS的进展中发挥重要作用。     

青少年特发性脊柱侧凸患者椎体生长板中Runx2及Ⅹ型胶原表达

目的:观察青少年特发性脊柱侧凸(AIS)患者上、下端椎和顶椎椎体生长板凸、凹侧软骨细胞的生物活性差异;探讨其在AIS发生和发展中的作用.方法:在对12例AIS患者行胸椎侧凸前路松解手术或前路矫形手术时获取上、下终椎和顶椎椎体生长板;分成凸、凹侧2组;共72枚标本;应用免疫组织化学方法检测Runx2和Ⅹ型胶原蛋白的表达;原位杂交方法检测Runx2 mRNA表达.所有染色结果通过图像分析系统进行半定量分析.结果:AIS患者顶椎椎体生长板凸、凹两侧的Ⅹ型胶原、Runx2和Runx2 mRNA表达总量存在显著性差异(P＜0.05).顶椎椎体生长板凹侧Ⅹ型胶原的表达总量低于下终椎椎体生长板凹侧的表达总量(P＜0.05).顶椎椎体生长板凹侧Runx2的表达总量低于上、下终椎椎体生长板凹侧的表达总量(P＜0.05).顶椎椎体生长板凹侧单一软骨细胞Runx2表达量高于凸侧和上、下终椎椎体生长板凹侧单一软骨细胞的表达(P＜0.05).顶椎椎体生长板凹侧高倍视野下平均Runx2 mRNA表达总量低于上、下终椎椎体生长板的凹侧(P＜0.05).顶椎椎体生长板凸侧单一细胞Runx2 mRNA表达量低于凹侧(P＜0.05).顶椎椎体生长板凹侧高倍视野下平均Ⅹ型胶原阳性细胞密度和Runx2阳性细胞密度低于凸侧和上、下终椎椎体生长板凹侧阳性细胞密度(P＜0.05).结论:AIS患者上、下终椎和顶椎椎体生长板凸、凹侧软骨细胞存在不同的生物活性和细胞动力学;这可能是力学条件改变后的一种继发性改变;但其可能在AIS的进展中发挥重要作用.     

青少年特发性脊柱侧凸患者凸凹侧椎体生长板组织形态学研究

[目的]探讨AIS患者椎体生长板凸、凹侧组织学及软骨细胞增殖与凋亡差异在AIS发生、发展中目的作用.[方法]本研究中取AIS患者椎体生长板,应用HE染色评估生长板凸、凹侧目的组织学分级差异,应用免疫组织化学方法及TUNEL方法评估生长板凸、凹侧软骨细胞增殖与凋亡指数,并对其进行比较.[结果]光镜下椎体生长板凸侧可见正常分层结构,生长板凹侧分层结构排列混乱.顶椎椎体牛长凸、凹侧组织学分级差异有统计学意义(＜0.05).终椎凹侧生长板和顶椎凹侧生长板组织学分级有明显差异且有统计学意义(P＜0.05).顶椎生长板凸侧软骨细胞增殖指数和凋亡指数明显高于凹侧,其差异有统计学意义(P＜0.05).在上终椎椎体牛长板凸、凹侧软骨细胞PCNA增殖指数有明显差异且有统计学意义(P＜0.05).上、下终椎椎体生长板和顶椎椎体生长板凹侧软骨细胞增殖和凋亡指数有差异且统计学意义(P＜0.05).在上、下终椎和顶椎椎体生长板凸侧软骨细胞TUNEL凋亡指数有差异且有统计学意义(P＜0.05).[结论]AIS患者上、下终椎和顶椎椎体生长板凸、凹侧组织学分级目的差异和软骨细胞目的增殖与凋亡指数差异可能表明椎体生长板凸、凹侧存在生长动力学差异,这可能影响侧凸[目的]进展.     

实验性脊柱侧凸病理变化观察

目的：利用家兔脊柱侧凸动物模型，观察椎间盘，椎骨及椎旁肌的病是变化。将２１只家兔随机分成３组，每组只。均用钢丝连接肩胛骨和股骨，制成脊柱侧模型。固定３，４，５个月后分批处死，取顶椎椎间盘，用Ｃａｒｂａｚｏｌｅ法及Ｗｏｅｓｓｎｅｒ法分别测定凸凹介己糖醛酸及羟脯氨酸含量；取顶椎椎骨，行ＨＥ染色，观察椎体骺板变化；取椎旁肌用肌球蛋白ＡＴＰ酶地染色，观察肌纤维病理变化。     

生长棒治疗生长中儿童脊柱侧弯时调控功能的X线研究

[目的]探索能反映治疗生长中儿童侧弯生长捧调控作用的X线检查方法,并验证板-棍系统(plate-rod system for scoliosis,PRSS)的调控能力。[方法]对31例置入PRSS的早发型脊柱侧弯进行至少2年的随访,收集术前、术后即刻、术后每次随访的站立位全脊柱正侧位X线片,测量其Cobb角和能反映顶椎楔形变程度的顶椎楔变角(apical vertebral wedge angle,AVWA),分析不同侧弯类型和不同手术时年龄组术后生长发育期间的顶椎椎体两侧生长速度差异、变化趋势与调控作用的关系。[结果]术前Cobb角平均63.74°±20.99°,术后矫正为25.38°±14.76°,末次随访时为31.68°±19.53°,无明显矫正丢失(P>0.05)。术后即刻AVWA平均13.74±5.88°,末次随访时平均8.74°±5.08°,平均减小5.00°±4.46°,差异有统计学意义(P<0.05)。AVWA的度数在术后总体呈下降趋势,反映侧弯椎体凹侧的生长速度超过凸侧。先天性脊柱侧弯的AVWA虽然在术后的测量起始阶段大于特发性脊柱侧弯的AVWA,但两者角度在术后的生长期间,总体都呈减小趋势,只是前者波动较明显。5岁前接受PRSS治疗的脊柱侧弯,其初始AVWA较小,且术后AVWA减小过程更平稳。[结论]测量术后生长中儿童侧弯的顶椎楔变角(AVWA),发现楔形变程度变小,是由于PRSS放置后使顶椎体两侧不对称生长发生了逆转,使凹侧生长速度超过凸侧,椎体两侧高度差减小造成的,反映了PRSS对儿童脊柱侧弯椎体两侧生长速度的调控作用。测量比较AVWA的变化是评价生长棒调控效果的一种可靠的检查方法。     

脊柱侧凸顶椎椎体及附件旋转角测量及其临床意义

[目的]评估特发性脊柱侧凸患者术前椎体、椎板、棘突旋转角及椎体相对棘突偏移的距离,为指导术中轴状面去旋转及冠状面侧凸矫形提供影像学基础.[方法]选取本院脊柱外科2008年1月～2010年1月收治的30例特发性脊柱侧凸患者,男11例,女19例;平均年龄17.0岁,Cobb角51.9°,术前皆行平卧位顶椎区域CT平扫.测量顶椎椎体、椎板及棘突的旋转角度,然后将椎体、椎板及棘突的旋转角度利用SPSS13.0进行三组定量资料的两两比较,分析三者间的旋转角差异.同时测量椎体相对椎板的偏移距离,计算出其平均值.[结果]顶椎旋转角:椎体平均为17.3°±8.67°,椎板平均为17.6°±11.14°,棘突平均为11.3°±10.51°.经统计分析椎体、椎板与棘突间的旋转角差异具有统计学意义(P=0.017,P=0.013),而椎体与椎板间的旋转角度无明显统计学差异(P =0.906).椎体相对椎板偏移的距离平均为(0.19 ±0.12) cm.[结论]测量脊柱侧凸患者术前CT顶椎椎体、椎板及棘突的旋转度和椎体相对棘突的偏移距离,对术中指导脊柱侧凸的轴状面和冠状面矫形具有一定临床意义.     

脊柱侧弯应用PRSS矫正过程中的力学性能研究

[目的]脊柱侧弯时椎体和椎间盘出现凹侧低、凸侧高的楔形变，造成两侧的不对称应力；而在应用PRSS侧推矫形后不对称应力相应减少。本实验用模型实验方法研究PRSS矫正脊柱侧弯过程中的力学行为。[方法]椎体模型选择铝材，椎间盘及韧带模型材料选择聚碳酸脂，建立5个椎体、4个椎间盘的脊柱模型并模拟轻度侧弯情况，分别取纵向载荷为0kg、5kg、10kg、15kg、20kg，横向载荷分别为0kg、3kg、6kg、9kg、12kg。按原型矫正过程的载荷，进行加载试验，利用光弹性法及应变电测法测量了模型应力。利用有限元ANSYS软件模拟并验证实验的可靠性。[结果]脊柱受矫正力后，脊柱处于纵向力和横向力的联合作用状态，界面法向应力分布明显改变，凸侧的法向压应力增加，凹侧的压应力降低并可转变为拉应力。拉应力值与矫正力成正比关系。在一定的矫正力作用下，模型凹侧压应力值逐渐减小，直至出现拉应力，而凸侧依然是压应力，并且应力值比施加矫正力前更大。[结论]脊柱侧弯应用PRSS矫正过程中，随着矫正力的增加，凸侧的压应力增大，同时凹侧的压应力迅速减小并可产生拉应力。这样可促进凹侧骨的生长，抑制凸侧骨的生长，使脊柱生长变直，从而达到矫正脊柱侧弯的目的。     

脊柱侧凸若干治疗问题的研究进展

1脊柱侧凸的椎体特征性楔形变对于制定矫形手术的计划来说,椎体楔形变是很重要的,比如对椎体截骨和对生长能力的评估。Stefan等在2004年第20期《Spine》上发表文章,对30具脊柱侧凸解剖标本椎体形变的量化分析:运用三维数字测量技术对椎体进行三维重建,对30具不同侧凸度数的标本进行测量,然后与正常标本相对照,包括胸椎和腰椎,作好记录进行差异分析和t检验,设定P=0.05。结果总共测量了471个侧凸椎体标本和510个正常椎体标本。椎体的楔形变随着接近顶椎而不断增加,其中最大的形变位于顶椎处。楔形变在冠状面较在矢状面明显。特别在上胸弯T3…     

青少年特发性脊柱侧凸患者顶椎区脊髓位置变化及其临床意义

目的:分析青少年特发性脊柱侧凸(AIS)患者顶椎区脊髓偏移和旋转情况,并探讨其临床意义.方法:在28例AIS患者横断面MRI图像上测量顶椎区脊髓中心到椎管前、后内壁及凹、凸侧内壁的距离和脊髓、椎体的旋转角度,将脊髓旋转与椎体旋转的关系按Maruta分型分为O型、U型和R型,并分析脊髓在椎管内的位置及脊髓位置与Cobb角、脊髓旋转角度、椎体旋转角度之间的相关性.结果:顶椎区脊髓中心距脊柱凹侧、凸侧椎管内壁距离分别为7.13±1.89mm、13.68±2.93mm,距凹侧距离明显小于距凸侧距离(t=-9.56,P<0.01);距椎管内壁前、后缘距离分别为7.50±1.63mm、6.99±1.61mm,两者比较无显著性差异(t=1.22.p=0.23).椎体旋转角度为17,53°±6.70°,脊髓旋转角度为16.46°±9.16°,O型8例,U型13例,R型7例.脊髓旋转角度与椎体旋转角度、Cobb角及脊髓中心到凸凹侧椎管内壁的差值之间均呈正相关(分别为r=0.45,P=0.01;r=0.43,P=0.02;r:0.64,P<0.01),与脊髓中心列椎管内壁前后缘的差值之间无显著相关性(r=0.28,P=0.15).结论:AIS患者顶椎区脊髓向凹侧偏移,椎体与脊髓都存在旋转,脊髓的旋转方向因人而异.在行后路脊柱矫形椎弓根螺钉置入时,应特别注意凹侧脊髓及神经根,避免损伤.     

Buchbesprechungen/Book Reviews

Book reviewed in this article: Scheunert, A., und A. Trautmann: Lehrbuch der Veterinär-Physiologie . Bearbeitet von K. Bronsch, J. Brüggemann, H. Eder, H. Erbersdobler, K. Gärtner, D. Giesecke, H. Hill, G. Hofecker, V. Horn, H. HÖrnicke, A. Kment, H. Petry, H.-P. Sallmann, J. Schole, H. Spörri, J. Tiews, G. Vogel, A. Wels, G. Wittke, K. Zerobin, H. Zucker. Ueberreiter, O.: Klinische Krebsforschung bei Tieren. Meske, Christoph, Ahrensburg, und Ernst Pfeffer, GÖttingen, unter Mitwirkung von J. Matthiesen, GÖttingen; K. H. Ney, Hamburg; A. Pieper, GÖttingen; V. Potthast, GÖttingen; H. D. Pruss, Hamburg; und J. Reimers, Kiel: Ernährungsphysiologische Untersuchungen an Karpfen und Forellen. Fiedler, W.: Tiergarten Schönbrunn — Geschichte und Aufgabe. 197 Hennig, Arno, und Siegfried Poppe: Abprodukte tierischer Herkunft als Futtermittel. 232 Muller, G. H., und R. W. Kirk: Small Animal Dermatology. 809 Seiten, 2^rd edition. Verlag W. B. Saunders Company     

BOOK REVIEWS

Book Reviews in this article. GASTROINTESTINAL HAEMORRHAGE Edited by Peter W. Dykes , MD, FRCP FRACP and Michael R. B. Keighley , MS FRCS. CLINICAL AND RADIOGRAPHIC INTERPRETATION OF FACIAL FRACTURES By Amil J. Gerlock , Jr ., MD, Douglas P. Sinn , DDS, and Kevin L. Mc Bride , DDS COLOUR ATLAS OF GYNAECOLOGY By Norman A. Beischer , MD, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG and Eric V. Mac Kay , MB, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG, FACOG (Hon) ADVANCES AND TECHNICAL STANDARDS IN NEUROSURGERY Volume 8 Edited by H. Krayenbuhl DISPLACEMENT OFTHEHIP IN CHILDHOOD: AETIOLOGY, MANAGEMENT ANDSEQUELAE By Edgar W. Somerville , MA, FRCS, FRCS (Ed.) INTESTINAL FISTULAS By John Alexander -Williams , MD, ChM, FRCS, FACS and Miles Irving , MD, ChM, FRCS CLINICAL SURGERY INTERNATIONAL VOLUME 3 TISSUE TRANSPLANTATION Edited by Peter J. Morris , PhD, FRCS, FRACS DISEASES OF THE GASTROINTESTINAL TRACT AND LIVER By David J. C. Shearman , PhD, MBChB, FRCP, (Ed.), FRACP, and Niall D. C. Finlayson , PhD, MBChB, MRCP (Lond.), FRCP (Ed.)     

Unfallkrankengut Mehrfachverletzungen von 1953–1967

Ohne Zusammenfassung Unter Mitarbeit von:G. Best, E. B?ke, M. Braun, W. Brechmann, A. Encke, B. Hasper, I. Joppich, K. Junghanns, F. Kappey, H. Krebs, O. Kühn, J. Kürschner, H. Lambert, H. Leitner, P. Lichtenauer, M. L. Matthes, K. Munzinger, M. Nuri, K. Pittius, H. Rudolph, K. Schmittinger, M. Schoeyb, H. Schüler, E. v. Wedelstedt, Ch. Wehmer, St. Wysocki, D. Zeidler, H. J. Zimper Datenverarbeitung: IBM Datenverarbeitungsanlage/360 Modell 30Gerhild Braun, Claus K?hler Graphik:F. Heinrich Photo:H. Kramer, Jutta Matthes R?ntgen:W. Wenz     

同种异体椎间盘移植的实验研究

本研究是在自体椎间盘移植实验研究的基础上进一步通过Ｘ线、组织病理、生物学活性、生物化学和生物力学探索异体椎间盘移植是否可存活、功能及其归宿。１２只猴随机分为４组，移植术后３、６、９和１２个月分别处死检测。结果表明移植间盘高度术后下降，但１２个月时仍保持正常高度的６１．４％。光镜下未见明显排斥反应，终板和纤维环结构无明显改变，术后早期可见移植间盘终板软骨增生现象，髓核基质密度增大，成软骨样纤维细胞增生明显。３Ｈ－ｐｒｏｌｉｎｅ掺入较对照组明显增加。术后移植间盘的蛋白多糖和水含量降低，而胶原含量增加。生物力学动态变化表明术后早期移植间盘有失稳趋势，晚期则稳定性恢复。上述结果显示同种异体移植间盘可存活，生化代谢虽有变化但有一定的自限性，形态结构无明显改变，生物力学满足功能需要。     

Perioperative mortality and morbidity in the year 2000 in 520 certified training hospitals of Japanese Society of Anesthesiologists: with a special reference to age--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety

Perioperative mortality and morbidity in Japan for the year 2000 were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 Certified Training Hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 910,757. All cases were divided into 7 age groups; group A (< 1 months), group B (< 12 months), group C (< 5 years), group D (< 18 years), group E (< 65 years), group F (< 85 years), and group G (> 85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 70.04, 42.06, 17.79, 15.57, 21.14, 39.66, and 44.65 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rates (death during anesthesia and within 7th postoperative day) were 26.94, 5.91, 1.88, 2.57, 5.23, 11.98, and 17.50 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 28.29, 8.54, 3.56, 2.57, 5.08, 10.27, and 11.47 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 18.86, 4.60, 1.26, 1.57, 2.77, 5.50, and 6.64 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than in other groups, but much lower than those in 1999. The incidences of all critical events and the mortality rate after cardiac arrest were lowest in group C. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidences of all critical events attributable to co-existing disease were the highest in these four groups, and 32.33, 13.80, 5.86, 4.43, 7.50, 15.34, and 21.72 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 13.47, 16.43, 6.28, 3.86, 4.08, 6.87, and 6.64 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.97, 0.63, 0.29, 0.38, 0.74, and 1.81 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. Its mortality rate in each group was 0.00, 0.00, 0.21, 0.14, 0.06, 0.04, or 0.00. There were eleven cases of death or vegetative state due to anesthetic management, like improper management of airway and overdose of anesthetics. Some of them were preventable with the anesthesiologists' effort in protocol development and skilled assistance.     

BOOK REVIEWS

CURRENT SURGERY OF THE HEART By Arthur J. Roberts and C. Richard Conti . Philadelphia: JB Lippincott, 1987. Illustrated, xx + 343 pages, includes index. Price: $120.00. TENDON TRANSFERS OF THE HAND AND FOREARM By Professor Richard J. Smith , md. Boston: Little, Brown and Company, 1987. Illustrated, 337 pages. Price: $165.00. PAEDIATRIC NUTRITION: THEORY AND PRACTICE By R. J. Grand , J. L. Sutphen and W. H. Dietz Boston: Butterworths, 1987. Illustrated, xii + 852 pages, includes index. Price: $215.00. PERCUTANEOUS RENAL SURGERY By S. R. Payne MS, FRCS and D. R. Webb MS, FRACS. Edinburgh: Churchill Livingstone, 2nd edn, 1988. Illustrated, xii + 153 pages, includes index. Price: $97.00. MUSCULOSKELETAL INFECTIONS By William Gillespie and Sydney Nade . Melbourne: Blackwell Scientific Publications, 1987. Illustrated, x + 398 pages, includes index, 25 cm × 17.5 cm. Price: $65.00. COLOUR ATLUS OF TRANSTHORACIC: REPAIR OF HIATUS HERNIA By Robert Pringle . London: Wolfe Medical Publications Ltd, Yearbook Medical Publications Inc. Illustrated, 62 pages, includes index. Price: $42.00.     

Buchbesprechungen

Book reviewed in this article: Handbuch der Tierernährung . In zwei Bänden. Herausgegeben von W. Lenkeit, Göttingen; K. Breirem, Vollebekk; E. Crasemann, Zürich. Unter Mitwirkung von D. G. Armstrong, Newcastle; C. C. Balch, Shinfield; W. Bianca, Zürich; A. L. Black, Davis; K. Breirem, Vollebekk; H. Brune, Gießen; R. C. Campling, Shinfield; E. Crasemann, Zürich; A. François, Jouy-en-Josas; K. Günther, Göttingen; H. Hill, Hannover; P. N. Hobson, Aberdeen; H. Hörnicke, Hannover; B. H. Howard, Aberdeen; P. E. Jacobsen, Kopenhagen; H. Karg, München; W. Kaufmann, Kiel; R. Müller, Bonn; L. Paloheimo, Malmi; G. Pulss, Kiel; P. M. Riis, Kopenhagen; K. Rohr, Kiel; H. H. Schlubach, Starnberg; A. Schüren, Zürich; J. Tiews, München; G. Vogel, Köln; H. Zucker, München. Band I: Allgemeine Grundlagen . Leonhardt, H.: Histologie und Zytologie des Menschen.     

Abgeschlossene und derzeit laufende adjuvante Therapieprotokolle bei Patientinnen mit operablem Mammakarzinom (II)

Summary Background: Between 1984 and 1996 4336 patients with operated breast cancer were included in trials of the Austrian breast cancer study group. Methods: Based on prognostic factors patients were randomised with 2 different treatment groups. Results: The largest ever performed oncological trial (study VI) in postmenopausal breast cancer patients is already finished. 5 other trials are open for randomisation. Conclusions: It is the intention of the Austrian breast cancer study group to accrue patients for ongoing trials in whole Austria and to increase the number of randomised patients. K. Abbrederis, Ch. Armbruster, Gabriele Barbieri, Doris Bauer, Th. Bauernhofer, S. Beller, J. Berger, O. B?ckl, A. Brunhofer, F. Burger, Ursula Denison, Elke Derstvenscheg, Ch. Dittrich, Manuela Djavanmard, W. D?ller, Daniela Eckhoff, H. Eidtmann, R. Fegerl, J. Fellinger, F. Friedrich, Sabine Fuchs, Barbara Gebhart, Friederike Gieseking, Ch. Gr?ger, Karin Haider, D. Haidinger, E. Hanzal, E. Hell, C. Hinterbuchinger, W. Horvath, W. Jonat, Daniela Kandioler, Anna-Katrin Kasparek, M. Kern, R. Kocher, Veronika Kohlmayer, R. Kolb, Ch. Kopf, S. Kriwanek, Irene Kührer, Christine Kurz, Iris Kuss, W. Kwasny, Caroline Lackner, M. Lang, O. Langer, J. Lenz, S. Leodolter, A. Lepsinger, P. Lisborg, G. Lokker, H. Ludwig, G. Luschin-Ebengreuth, H. Maass, M. Markovic, P. Mayer, M. Medl, Elisabeth Melbinger, R. Menzel, Brigitte Mlineritsch, Elke Moosbrugger, E. Moritz, Renate Moser, W. Neunteufel, A. Obermair, J. Omann, P. Oppitz, M. Pecherstorfer, A. Pertl, Catharina Pietrzak, F. Ploner, M. Pober, R. P?hnl, R. Punzengruber, Friederike Püribauer, Ch. Rass, J. Ritschl, H. Rosen, Christine Sam, L. Schiller, W. Schippinger, J. Schüller, M. Seifert, M. Smola, P. Speiser, H. Spoula, G. Steger, Birgit Steiner, H. St?ger, G. Tatzer, Susanne Taucher, J. Tschmelitsch, P. Uher, A. Unger, M. Van Trotsenburg, N. Vavra, Sonja Vogl, B. Wenky, V. Wette, A. Wiegele, G. Winter, Monika Wirth, B. Zeh, G. Zimmermann.     

General rules for recording endoscopic findings of esophagogastric varices (1991)

The general rules made in 1980 for recording endoscopic findings of esophageal varices have widely been used in Japan and in other countries. However, since the development of endoscopic sclerotherapy and other modalities of endoscopic treatment, these 1980 rules were found to be insufficient for recording mucosal changes after treatment. The general rules as revised in 1991 recognize mucosal changes such as erosion, ulcer, scar, thrombosed varices, and bleeding signs. These new 1991 rules, which seem useful for recording initial evaluation of gastroesophageal varices and for describing mucosal changes after sclerotherapy as well, are described here.Michio Kobayashi, M.D., Masahiro Arakawa, M.D., Katsutoshi Obara, M.D., Hiroyuki Kato, M.D., Seigo Kitano, M.D., Yoshiya Kumagai, M.D., Kensho Sanjo, M.D., Hiroaki Suzuki, M.D., Jun Toyonaga, M.D., Yasuhiro Takase, M.D., Masayuki Fujino, M.D., Hiroyasu Makuuchi, M.D., Shunji Futagawa, M.D., Yoshinobu Mitarai, M.D., Yasuyuki Yazaki, M.D.     

引导性骨再生中内源性BMP的作用

为探讨引导性骨再生中，内源性ＢＭＰ对骨再生过程的作用而进行以下研究。手术的方法造成兔桡骨中段１０ｍｍ缺损。实验侧用硅胶膜管连结骨缺损，作为引导性骨再生模型。另一侧作为对照。１５只新西兰兔分为三组，分别于术后３，７及１４日处死，标本行组织学及ＢＭＰ免疫组化检查。切片上，距骨端１，２，５ｍｍ处设置ａ，ｂ，ｃ线。利用真彩色计算机图像分析系统在三条线上选点测量ＢＭＰ值。实验侧骨缺损区内有一个完整的血肿结构，其ＢＭＰ染色阳性，膜管外组织ＢＭＰ染色几乎完全阴性。对照侧ＢＭＰ弥散于骨缺损周围的肌肉组织中。１周时，实验侧及对照侧均可见新骨形成。２周时，对照侧已停止，实验侧仍可见持续骨再生。ＢＭＰ定量分析中，实验侧三条带的ＢＭＰ值大部分高于对照侧。实验侧和对照侧ｂ，ｃ带之间存在梯度差，但实验侧的差值小于对照侧。这不仅证明了Ｈｕｌｔｈ关于骨折间隙存在ＢＭＰ浓度梯度的假说，也显示膜在引导性骨再生中可将内源性ＢＭＰ局限于骨缺损区内，提高内源性ＢＭＰ浓度并改善其分布的作用。这有利于骨再生，可能是引导性骨再生机理之一。对照侧ＢＭＰ值１周时最高，而实验侧在２周时仍呈持续升高。这说明，内源性ＢＭＰ有两个来源：骨端吸收释放及骨形成细胞合成。