Urodynamic studies in the rabbit under the immobility reflex

We studied some urodynamic (UD) parameters in normal rabbits under immobility reflex (IR), without anesthesia. These parameters were compared after induction of anesthesia. We found that anesthesia had a depressing effect on these UD parameters. IR is a good method for studying rabbits without the effect of anesthesia.     

The influence of aging on skin temperature and hemodynamic changes during spinal anesthesia

We investigated the influence of aging on the relationship between arterial pressure and skin temperature as a simple and indirect indicator of cutaneous blood flow. Sole and palm skin temperatures, sublingual temperature, heart rate, mean arterial blood pressure (MAP), and the anesthetic level as determined by cold discrimination, were measured before and during minor surgery under spinal anesthesia in patients aged under 65 years (young group) and above 65 years (elderly group). The sole skin temperature (T_sole) started to increase in the young group whose anesthesia level reached above L1-L2, and approached the sublingual temperature in those whose anesthesia level reached above T8-T10 after spinal injection. There was, however, no relationship between the anesthesia level and T_sole in the elderly group. There was a significant linear correlation between the decrease in MAP and the increase in T_sole in the young group. The change in T_sole was less in elderly patients than that in young patients with the same decrease in MAP. These findings suggest that a decrease in peripheral resistance may not be the main cause of hypotension during spinal anesthesia in elderly patients.     

手部不同部位的交感神经皮肤反应

目的 探讨手部不同部位交感神经皮肤反应(sympathetic skin responses,SSR)的差别和临床意义.方法 以64例健康志愿者为研究对象,采用神经肌电图电刺激方法引出SSR,分别在掌心、示指和小指指腹记录潜伏期和波幅,并进行统计学分析.结果 60例志愿者中(4例未能入选)掌心、示指和小指指腹均可记录到SSR波形,三者潜伏期分别为(1.37±O.16)s、(1.54±0.24)s和(1.60±0.25)s,三者差异有统计学意义(P<0.01);波幅分别为(3.85±2.55)mV、(2.24±1.63)mV和(2.51±2.00)mV,三者差异有统计学意义(P<0.05);但示、小指间SSR潜伏期和波幅差异无统计学意义(P>0.05).结论 SSR潜伏期稳定,是判定SSR正常与否的可靠检测指标;示、小指指腹亦可作为SSR记录部位,可能分别代表正中神经和尺神经通路上的交感神经皮肤反应.     

以因子分析方法定量评价人群手背部皮肤老化

目的：定量评价人群手背部皮肤纹理老化。方法：采用主成分因子分析方法,对测量获得的沈阳地区人群手背部皮肤纹理间距（x1）、网格数（x2）、角度最大值（x3）和角度差值（x4）进行分析,构建皮肤老化综合评分模型。结果：经求解特征根及因子旋转,提取了两个公因子,分别代表自然老化因子和光老化因子。以此为基础,构建皮肤老化综合评分计算公式为：0．6150x1＋21．7488／x2＋0．0095x30．0178x4-3．8962。该皮肤老化综合得分随着年龄、每日日光暴露时间以及皮肤老化级别的增加均呈增加趋势。结论：利用皮肤老化综合评分模型,能够获得个体皮肤老化程度,便于在不同个体间进行皮肤老化的比较。     

The effect of systemic corticosteroid therapy on the breaking strength of skin

Summary It was noted clinically that patients under long-term steroid treatment were susceptible to avulsion injuries following minor trauma. Laboratory experiment in mice revealed significant reduction in the breaking strength following steroids therapyThe authors dedicate this paper to the dear memory of Prof. Z. Neuman, M.D., F.A.C.S. former Chairman of the department of Plastic and Maxillofacial Surgery, who passed away on March 22, 1977     

Benign acquired superficial skin lesions of the hand

Numerous dermatologic conditions may be visualized by the hand surgeon during office hours, including when examining patients for an alternative chief problem. Although the primary focus of the visit may be unrelated to a skin lesion, it is important for the hand surgeon to be familiar with these lesions to address patient inquiries and determine which lesions may require some form of treatment. This article reviews some of the most common benign acquired superficial skin lesions of the hand. Particular attention will be paid to epidermal lesions, pigmented lesions, vascular lesions, dermal fibrous/fibrohistiocytic lesions, and infections that can be confused with skin neoplasms or tumor-like conditions. Diagnostic clues, including photographs, will be provided for each lesion described, as well as the recommended treatment.     

The effect of estrogen on the skin

Investigative reports describing the effect of estrogen locally applied to the skin have been examined. It is apparent that physiologic doses of estrogen in postmenopausal females improve skin elasticity and increase the thickness of skin but that very large doses induce skin atrophy. The contraindications against the use of estrogen preparations are presented.     

他汀类药物在同种异体全厚皮片移植中的作用

目的：研究他汀类药物在同种异体全厚皮片移植中作用。方法：荷兰黑兔作为供体,日本白兔作为受体。实验分为三组（n=8）：1组,空白对照组;2组,小剂量他汀类药物（术后给于2mg／kg／天）;3组,大剂量他汀类药物（术后给于4mg／kg／d）。通过临床评估和病理组织活检来计算皮片的存活时间以及他汀类药物抑制炎性细胞浸润的作用,通过免疫组织化学检测和外周血IL-2水平测定来观察他汀类药物在对抗急性炎症反应的作用。结果：全厚皮片的存活时间：1组,（7．0±1．07）天;2组,（8．13±1．13）天;3组,（13．25±0．71）天。3组的存活时间长于1组和2组,但1组和2组之间比较没有统计学差异．大剂量阿托伐他汀延长了皮片的存活时间,阻止了淋巴细胞的浸润,而且在对抗急性排斥反应中有很大的作用。结论：阿托伐他汀延长了同种异体全厚皮片移植的存活时间,抑制了炎性细胞的浸润,有效的对抗急性排斥反应。     

手背部皮肤纹理老化定量评价指标研究

目的：开展手背部皮肤老化形态学定量评价指标的研究，为客观评价皮肤老化提供手段。方法：利用图像分析软件测体手背部皮肤形态学的数字成像资料。分析各测量指标与Beagley-Gibson手部老化分级标准的一致性。结果：手部皮肤纹最大纹理间距、纹理间距均值、网格数、平均角度个数、最大角度和角度差值与年龄的相关性较强。其中网格数和平均角度随老化级别的增加而减小，其他指标随老化级别的增加而增加。结论：手部皮肤纹理的网格个数，纹理间距，角度个数及角能够较客观地应用于皮肤老化的评价。     

Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.     

两种波长的激光对不同肤色脱毛的效果分析

目的评价长脉冲激光对不同肤色脱毛的疗效和安全性。方法用波长755nm和1064nm的激光对607例不同肤色患者脱毛4次后观察疗效及出现的不良反应。结果两种激光对女性唇部体毛和男性胡须的有效率虽相差不大,但其所产生不良反应差别却很明显,还发现肤色分型为Ⅰ型、Ⅱ型和Ⅳ型、Ⅴ型两种激光所产生的有效率和不良反应也差别很明显,其差异具有统计学意义（P〈0．05）。结论波长755nm的激光对肤色越浅的患者（Ⅰ型、Ⅱ型）治疗的效果好及所产生的不良反应发生率低;而波长1064nm的激光对肤色越深的患者（Ⅲ型以上）治疗效果好,所产生的不良反应发生率低。     

手部开放性损伤皮肤缺损的早期处理

目的 报道直接缝合、游离植皮及多种皮瓣在手部开放性损伤皮肤缺损中的治疗效果.方法 1992年以来应用直接缝合、游离植皮、带蒂皮瓣移植、筋膜蒂皮瓣转移、推进皮瓣、指动脉为蒂岛状皮瓣移植及吻合血管皮瓣移植等方法对1298例手部开放性损伤的皮肤缺损进行修复.结果 本组1298例,随访976例,除126例吻合血管移植皮瓣,有9例出现水泡,远端部分皮缘坏死,经换药愈合外,其它各种方法均能一期愈合,并恢复良好的功能及皮瓣的保护性感觉.结论 根据开放性手部损伤皮肤缺损的具体情况,损伤程度类型,采取不同的处理方法,均能获良好的功能.     

手部皮肤撕脱伤的急诊手术治疗

目的探讨手部皮肤撕脱伤的急诊手术治疗效果。方法54例手部皮肤撕脱伤患者全部采用急诊手术方法治疗。其中原位缝合12例,将撕脱皮肤修剪成中厚皮片回植8例,中厚皮片游离植皮9例,腹部带蒂真皮下血管网皮瓣18例,指动脉逆行岛状皮瓣6例,筋膜蒂逆行岛状皮瓣1例。结果53例创面成功修复,1例原位缝合术后皮肤约30%坏死,经二期游离植皮修复。54例均获随访,时间6～24个月,皮肤质地柔软,外观满意,感觉、运动功能恢复较好。结论针对手部皮肤撕脱伤不同伤部情况,准确判断皮肤撕脱伤的损伤程度,应用上述方法急诊修复,能最大限度地恢复伤手的外形与功能。     

The immediate impact of opening an adult high dependency unit on intensive care unit occupancy

We assessed the hourly occupancy of our intensive care and high dependency units over an 8-week period commencing on the day our high dependency unit opened. Using criteria established by the working group on 'Guidelines on Admission to and Discharge from Intensive Care and High Dependency Units' published by the National Health Service Executive, we defined each patient daily as intensive care or high dependency status. Compared with hourly occupancy figures obtained before the high dependency unit opened, occupancy of the intensive care unit by high dependency patients has been shown to decrease significantly from 21.6% to 11.2%. Use of intensive care beds became more appropriate, their occupancy increasing significantly from 63.7% to 73.4%. A significant decrease in readmissions occurred, supporting the hypothesis that having high dependency beds reduces the number of patients discharged prematurely to the wards.     

辐照猪皮与金因肽联合在儿童烧伤创面治疗中的应用

目的：观察辐照猪皮与金因肽在儿童Ⅱ度烧伤治疗中的作用。方法：治疗组清创后应用辐照猪皮与金因肽覆盖创面;对照组应用磺胺嘧啶银锌霜＋金因肽覆盖创面。临床选择65例患者（总共127个创面）,包括浅、深Ⅱ度烧伤,临床观察创面愈合时间、应用辐照猪皮与金因肽对全身情况的影响,后期瘢痕增生情况。结果：治疗组比对照组创面愈合时间明显缩短,治疗组明显优于对照组（P〈0.05）;患者未出现过敏反应和其他不良反应,后期随访瘢痕增生少。结论：辐照猪皮与金因肽联合治疗儿童Ⅱ度烧伤创面,可促进创面上皮化,明显缩短创面愈合时间,瘢痕增生少,疗效可靠。     

The effect of temperature on hand function in patients with tremor.

Hand therapists may notice a patient's tremor when treating another diagnostic problem, such as arthritis or a fracture. In these instances, the tremor may become apparent as the patient attempts to don or doff a splint or to practice a home exercise program, or it may be reported in terms of difficulty with dressing or eating. The authors hypothesized that limb cooling would temporarily improve hand function among patients with essential tremor (ET) and that limb warming would temporarily improve hand function among patients with resting tremor secondary to Parkinson disease (PD). Twenty patients with ET and 20 patients with PD completed this single-blind randomized crossover study. Scores following exposure to cold water were compared with scores following exposure to warm water. For patients with ET, subtest scores for the Archimedes spiral, simulated feeding, and checkers were, statistically, significantly lower (i.e., improved) following exposure to cold water than following exposure to warm water; scores for Archimedes spiral card turning, simulated feeding, and checkers were significantly lower following exposure to cold water than at baseline. Scores for Archimedes spiral and card turning were also significantly lower following exposure to warm water than at baseline. For patients with PD, no statistically significant differences were noted between treatments or from baseline except the score for small common objects, which was lower (improved) following exposure to warm water than at baseline. The significant findings from this study support the therapeutic use of cooling to temporarily decrease tremor, thereby improving hand function among patients with ET.     

Assessment of skin temperature during regional anaesthesia—What the anaesthesiologist should know

Body temperature homeostasis is accurately regulated by complex feedback‐driven neuronal mechanisms, which involve a multitude of thermoregulatory pathways. Thus, core temperature is constantly maintained within a narrow range. As one of the most effective regulatory systems skin temperature is dependent on skin blood flow. Skin blood flow in turn is highly dependent on sympathetic activity. Regional anaesthesia leads to blockade not only of somatosensory and motor nerve fibres but also of sympathetic fibres. As a consequence, vasoconstrictor tonic activity is abrogated and a vasodilation leads to an increase in skin blood flow and temperature. The aim of this review was to summarize the general physiology of thermoregulation and skin temperature as well as the alterations during regional anaesthesia. The main focus was the usefulness of measuring skin temperature as an indicator of regional anaesthesia success. According to the available literature, assessment of skin temperature can indeed serve to predict success of regional anaesthesia. Hence, it is important to realize that relevant and reliable temperature increase is only seen in the most distal body parts, ie fingers and toes. More proximally, temperature changes are frequently small and inconsistent, which means that assessment of block levels is not possible by temperature measurement. Furthermore, relevant skin temperature increases will only be observed in patients, which are initially vasoconstricted. In conclusion, measurement of skin temperature represents a reliable and feasible diagnostic tool to assess and predict the success or failure of regional anaesthesia procedures, especially in patients in which sensory testing is impossible.