小儿大网膜巨大囊性淋巴管瘤一例报告

一、临床资料 病例,患儿,男,3岁。因进行性腹胀、消瘦5月余入院,无腹痛及呕吐,大小便正常。在当地县医院诊断为:“肝病、腹水”,给予保肝、利尿及放腹水治疗,无好转。体检:消瘦体型,胸部呈“漏斗状”,肋间隙变窄,心肺未见异常,腹极度膨隆,肿块边缘不清,表面光滑、囊性、无压痛,肝脾触诊不满意。腹穿抽出淡黄色液体,李凡他试验(+)。腹部B超:肝胆脾未见异     

自体结膜瓣移植联合丝裂霉素C治疗翼状胬肉

翼状胬肉是局部结膜纤维血管组织呈三角形膜样增生而侵犯角膜的一种疾病，传统的翼状胬肉治疗方法是单纯芭除胬肉，手术后复发率高达24％-89％。我院眼科自2001年3月至2004年7月对59例（63眼）翼状胬肉患者采用在切除翼状胬肉的基础上联合带角膜缘上皮的结膜瓣游离植片移植以及丝裂霉素C（mitomycinC，MMC）治疗，收到良好的疗效。现报告如下。     

游离大网膜移植治疗慢性骨髓炎

目的探讨游离大网膜移植治疗慢性骨髓炎的治疗效果。方法本组8例慢性骨髓炎患者采用吻合血管的游离大网膜移植治疗。结果术后随访1月-22月,所有患者恢复正常.无复发征象。结论游离大网膜移植术既能清除慢性骨髓炎死腔,建立病灶骨及局部组织的血液循环:同时又能刺激骨区成骨细胞活跃,促进病灶的修复。游离大网膜移植术是治疗慢性骨髓炎的有效方法。     

大网膜内植入自体脾组织与原位脾组织的结构比较

目的 :为临床应用自体脾组织植入术提供实验研究资料。方法 :大鼠分为实验组和对照组 ,前者切取 1 /2脾脏去包膜后切成 1mm× 1mm× 1mm大小均匀组织块 ,植入大网膜囊袋内。饲养 6个月后取 2组脾组织制片 ,光镜和电镜定性观察组织结构变化 ,计算机图像分析系统比较血管、红髓、白髓及胶原纤维的面密度 ;免疫组化法结合计算机图像分析测定神经肽 (NPY)阳性神经纤维密度。结果 :神经和边缘窦内皮细胞结构恢复较好 ,血管 ,白髓的面密度值较对照组减少 ,红髓与对照组相当 ,胶原纤维面密度增加。结论 :大网膜内植入的自体脾组织通过再生能恢复脾脏的主要组织结构 ,但不能完全恢复正常。     

带自体角膜缘的结膜瓣移植治疗翼状胬肉

目的探讨带自体角膜缘的结膜瓣移植在翼状胬肉治疗中的效果。方法采用手术显微镜下翼状胬肉切除联合带自体角膜缘移植治疗原发性和复发性翼状胬肉50例60眼,术后随访12～24个月。结果50眼治愈,4眼翼状胬肉复发。结论带自体角膜缘的结膜瓣移植治疗原发性和复发性翼状胬肉安全有效。     

活体大网膜测量数据及其临床意义

在60例腹腔无炎症,大网膜无粘连的成人腹部手术中,对大网膜进行测量,取得了较全面的数据,供临床参考。     

大鼠大网膜表面的扫描电镜观察

大白鼠大网膜不同结构区——薄膜区、脂肪和血管区的表面均有一层间皮和散在的乳斑。同皮细胞间借突起相接。突起之间可见宽窄不一的间隙。薄膜区间隙较大,呈网络状。间皮细胞表面有疏密不均的微绒毛。微绒毛或离散分布,或连接成网。在微绒毛稀少区的细胞表面可见散在的小孔。在脂肪和血管区有丰富的乳斑,薄膜区乳斑少见且较少。乳斑的细胞多数位于间皮细胞间的间隙内或其表面。乳斑细胞的绝大部分裸露于腹膜腔。乳斑的细胞成分主要为巨噬细胞和淋巴细胞,有少数颗粒白细胞和红细胞,偶见肥大细胞。     

网膜囊计算机图像的三维重建与显示

目的：为网膜囊病变的影像学诊断和介入治疗提供其立体形态及利于网膜囊的教学。材料和方法;用上腹部薄层断层标本,在PC机上用表面重建法完成网膜囊计算机图像的三维重建和显示。结果：网膜囊的前面观,右上方为网膜囊上隐窝,围绕肝尾状叶的前、后及左侧,绿色部分为网膜囊上隐窝的肝尾状叶面,红色部分为网膜囊上隐窝的小网膜面,左上方为网膜囊脾隐窝,下方大部为网膜囊下隐窝。结论：重建出的网膜囊计算机三维图像能直观地看到网膜囊各部的空间形态和相互间的关系。特别是肝尾状叶和网膜囊上隐窝的关系。不仅有利于指导临床诊断和治疗网膜囊的病变,更有利于网囊的教学。     

自体结膜在翼状胬肉手术治疗中的美容效果观察

目的观察自体结膜在翼状胬肉手术治疗中的美容效果。方法翼状胬肉患者94例102眼，初发翼状胬肉患者采取胬肉切除保留结膜组织手术。复发性胬肉切除全部病灶组织，取术眼颞侧结膜移植。术后观察6～18月个。结果正常外观，无明显手术痕迹达到美观效果的83例，占81．37％。结论自体结膜治疗翼状胬肉能达到恢复自然外观，满足患者美观要求的手术效果，是目前治疗翼状胬肉的主流。     

Malignant melanoma of the conjunctiva

The clinicopathological features of 37 patients with invasive melanoma of the conjunctiva have been studied. Prognosis was closely related to the subsite and size of the primary tumour. Twenty of 21 patients with small localized bulbar neoplasms (95%) and four of six patients with diffuse bulbar melanomas (67%) have survived with no evidence of secondary spread. By contrast, only one of six patients with neoplasms involving the fornix (17%) and two of four (50%) with caruncular melanomas have survived. Metastatic spread was very uncommon in patients with melanomas less than 1.5 mm in maximum thickness, but the outcome of the disease in patients with tumours greater than 1.5 mm was not always bad. Treatment by local excision biopsy was followed by a high rate of conjunctival recurrence (59%). Exenteration of the affected eye guarded against the development of further orbital disease, but was not infrequently followed by the appearance of metastases. Many (62%) of the tumours appeared to have arisen in a pre-existing melanotic lesion or pigmented naevus of long-standing. Histologically, the tumours could be divided into those with an adjacent intra-epithelial component, manifest as atypical melanocytic hyperplasia in the conjunctival epithelium adjacent to the invasive melanoma, and those without (nodular melanoma). However, clear separation of the former group into the subtypes described for cutaneous melanomas proved impossible. Prognosis was not related to the type of melanoma, mitotic rate, cell type or degree of pigmentation.     

Differential immunoreactivity of melanocytic lesions of the conjunctiva

AIMS: To evaluate the expression of S100NKI/C3 and HMB45 antigens in melanocytic lesions of the conjunctiva and the ability of HMB45 to aid assessment of neoplasia. METHODS AND RESULTS: Stored formalin-fixed specimens of conjunctival melanomas and primary acquired melanosis were considered as participants and conjunctival naevi and racial melanosis as controls. Ninety-seven conjunctival melanocytic lesions were analysed using formalin-fixed paraffin-embedded material. These included 20 melanomas arising in the context of primary acquired melanosis (PAM), 22 melanomas arising without evidence of pre-existing PAM, seven cases of PAM with atypia, nine cases of PAM with no atypia, 35 conjunctival naevi and four cases of racial melanosis. S100 and NKI/C3 were similarly expressed in all lesions, with at least one of these markers positive in 100% of the lesions examined. HMB45 was expressed in 72.7% of primary melanomas and 85% of melanomas in the context of PAM; 42.8% of PAM with atypia expressed HMB45 while it was expressed in 11.1% of PAM without atypia and 8.5% of naevi. Racial melanosis cases did not express HMB45. S100 and NKI/C3 were expressed to a similar extent in all groups. CONCLUSIONS: S100 and NKI/C3 are useful markers to assess the extent of melanocytic lesions in the conjunctiva. HMB45 immunoreactivity can act as a useful aid to histopathology for the distinction of benign from malignant conjunctival lesions, particularly in the context of primary acquired melanosis.     

Cultures of bovine cornea and conjunctiva epithelial cells for use in a bacterial adherence assay

Summary Methods to culture bovine cornea and conjunctiva epithelial cells in suspension are described. Fetal, newborn, and adult corneas and conjunctivas are obtained from animals killed just before culture, or from packing-plant sources. Excised corneas are dissected mid-stroma, and the anterior stroma and attached epithelial layer are affixed onto plastic flasks. Dissected conjunctival mucosa fragments are likewise attached. Growth medium containing fetal bovine serum and supplemented with cholera toxin, epidermal growth factor, insulin, transferrin, selenium, triiodothyronine, and hydrocortisone is added to cover the explants. Epithelial cells grow in suspension and can be recovered for use in bacterial adherence assays. For this purpose, radiolabeled bacteria are incubated with epithelial cells in suspension, and the mixture is subjected to a discontinuous gradient using Percoll. Nonadherent bacteria can be separated from bacteria attached to epithelial cells, and estimates of the number of bacteria attached per epithelial cell can be made.     

内淋巴囊的应用解剖学

本文观察了60侧(左36,右24)正常成人的内淋巴囊,位于颞骨岩部后面的内淋巴囊压迹处,大小约9.2×10.0mm;另外还注意了内淋巴囊与周围结构(特别是乙状)的毗邻关系,从而提出手术入路的新设想,供临床应用作参考。     

Microcirculation of a bulbar conjunctiva in calves with the total artificial heart: results of a long-term study

The aim of this work was to study the microcirculation in calves with total artificial heart (TAH) using the observation of the microcirculatory bed of bulbar conjunctiva. The examination were performed on 21 calves with total artificial heart and 8 controls. The microcirculatory bed was registered using the flash photographic method. In experimental calves after artificial heart implantation the microvasculature was studied two times in a week, to follow the pathophysiological changes in longitudinal periods until 100 days, between 100 and 200 days and after 200 days. For the evaluation we used the correlation analysis between arteriovenous diameter ratio (A/V ratio) and the values of central venous pressure (CVP). On the basis of our results we can conclude that during the survival period with TAH the morphological changes of conjunctival microvasculature occur. Our results showed the varicosities, serpentine-like forms and typical congestive changes of small vessels in bulbar conjunctiva. The correlation analysis showed the positive correlation between arteriovenous diameter ratio (A/V ratio) and central venous pressure (CVP) in the late phase of survival period between 100 to 200 days and over 200 days. The number of pathological changes of calves with artificial heart implantation.     

内淋巴囊的显微外科解剖

目的 :为后颅窝手术保护听力提供解剖学基础。方法 :2 0例甲醛固定后的成人头颅 (4 0侧 ) ,游标卡尺和量规测量内淋巴囊壁与表面标志的距离。结果 :内淋巴囊与内听道口后缘的平均距离为 1 1 6± 0 .1 4cm ,与XI神经后缘的距离 1 3 8± 0 .1 7cm ,岩嵴与乙状窦前缘相交点的平均距离为 1 67± 0 .3 5cm ,与岩嵴平均距离为 0 1 6± 0 .2 8cm。结论 :本文结果有助于后颅窝手术定位内淋巴囊 ,保留听力     

Well-differentiated papillary mesothelioma manifesting in a hernia sac

Well-differentiated papillary mesothelioma (WDPM) is a tumor of uncertain malignant potential that usually occurs as a multifocal lesion of the female peritoneum, and is incidentally found at the time of surgery. We present here a multifocal case that had arisen from the lining of a hernia sac. To our knowledge, only four cases of this event have been previously described. A review of the five cases reported, including our case, revealed that the mean age of the patients was 56.6 ± 8.35 years. There was predominance in men (4:1). In four cases, the lesion was incidental. Most tumors were found in inguinal hernias. Four cases presented with gross abnormalities in the hernia sac. All the five patients were alive with no evidence of WDPM after a mean follow-up of 38.6 months. Extensive sampling of this rare lesion helps to rule out an epithelial malignant mesothelioma and prevents overtreatment.     

关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带临床疗效比较的meta分析

目的:系统评价关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带在疼痛的控制和膝关节功能恢复等方面的有效性和安全性.方法:采用计算机和手工检索PubMed,The Cochrane Library,EMBASE,中国知网(CNKI),维普数据库(VIP)和万方数据库,搜集关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带临床疗效比较的前瞻性临床对照研究文献,检索时限均为从建库至2016年8月.根据渥太华纽卡斯尔标准(Newcastle-Ottawa Scale,NOS)评估纳入的研究方法学质量,采用RevMan S.3软件进行meta分析.结果:共纳入8项前瞻性临床对照研究,371例前交叉韧带损伤患者.meta分析结果显示:LARS人工韧带移植组与自体肌腱移植组术后6个月Lysholm评分,MD=12.46,95％CI:12.46～15.74,差异有统计学意义(P＜0.001);术后6个月滕纳尔(Tegner)评分,MD=1.72,95％CI:1.45～1.99,P＜0.001,差异有统计学意义;术后12个月Lysholm评分,MD=4.31,95％CI:-0.70～9.32,差异无统计学意义(P=0.09);术后12个月Tegner评分,MD=0.52,95％CI:-0.21～1.24,差异无统计学意义(P=0.16).结论:在术后6个月时LARS人工韧带移植较自体腘绳肌腱移植进行前交叉韧带重建的效果更好;在术后12个月时,LARS人工韧带移植与自体腘绳肌腱移植进行前交叉韧带重建的疗效相当.