聚丙烯酰胺水凝胶隆乳后的并发症及其临床验证

目的：探讨聚丙烯酰胺水凝胶注射隆胸后并发症的临床表现和原因及处理方法。 方法：应用计算机检索1993-01/2009-10中国期刊全文数据库、万方数据库相关文章。检索有关聚丙烯酰胺水凝胶隆乳后的并发症分析及治疗研究文章，关键词为“聚丙烯酰胺水凝胶，注射隆乳，并发症”。排除重复研究、普通综述或Meta分析类文章，筛选纳入21篇文献进行评价。 结果：聚丙烯酰胺水凝胶注射隆乳并发症的种类及特点：①硬结、疼痛、肿胀、感染、发热、无菌性炎症、渗漏、移位等。②同一患者常数种并发症共存，而以其中一、二种为主。③乳房内包块为分散的，位于乳腺组织内，表现为多发的，深浅不一，表浅的可直接位于皮下。聚丙烯酰胺水凝胶注射隆乳并发症的处理方法：肿胀稀释负压吸引术，该方法一般用于凝胶集中而硬结及其他合并症较少的患者，而且不适合于硬结弥散的处理；手术切除水凝胶浸润的腺体组织，水凝胶弥散渗入到周围组织中，需彻底清除，否则就会侵及正常组织；切开引流间断灌洗术，严重感染者，建立双向引流、间断灌洗，符合外科原则。 结论：根据患者的具体情况，分别采用不同方法处理水凝胶注射隆乳术后并发症是切实有效的可行方法。 关键词：聚丙烯酰胺水凝胶；注射隆乳；并发症；生物材料；乳房 doi:10.3969/j.issn.1673-8225.2010.34.039     

乳房内少量聚丙烯酰胺凝胶残留对同期假体植入的影响

背景：目前在有关治疗注射隆乳并发症的报道中，凝胶未完全清除干净同期能否植入乳房假体目前尚无较一致意见。 目的：探讨注射隆乳术后行凝胶清除术中，因种种原因凝胶无法完全清除时，同期行假体隆乳手术的可行性及远期效果观察。 设计、时间及地点：临床病例分析，于2004-03/2008-07在南宁市第一人民医院整形美容外科完成。 对象：选择接受治疗的聚丙烯酰胺凝胶注射隆乳患者23例。年龄22~42岁。注射后至就诊时间为0.4~4.5年，聚丙烯酰胺凝胶注射量100~400 mL。 方法：术中尽量清理聚丙烯酰胺凝胶，直至抽出物肉眼看不见胶状物为止。根据凝胶清理后状况，确定无炎症反应的情况下，分别在乳腺后或胸大肌后间隙植入硅凝胶假体(200~260 mL)。 主要观察指标：术后定期随访，观察切口愈合情况、乳房硬结消退情况、乳房有无变形、乳房硬化情况、凝胶移位情况。 结果：凝胶基本干净7例、大部分干净8例、胸大肌残留部分凝胶8例，术后随访0.3~3年，所有患者乳房外观形态好，无明显硬结扪及，无感染溃疡，无凝胶移位，患者均对手术效果满意。 结论：在无炎症反应的前提下，乳房内残留少量聚丙酰胺水凝胶时，同期植入乳房假体是可行且安全的。 关键词：注射隆乳；聚丙烯酰胺水凝胶；假体置入隆乳术     

聚丙烯酰胺水凝胶注射后伴发乳房恶性肿瘤：2例报道

背景：聚丙烯酰胺水凝胶注射隆胸在中国一些医疗单位已经应用了近10年,因出现并发症而要求行注射物取出或同时进行再次隆胸的患者不在少数。在诊治过程中可能伴发乳房恶性肿瘤,临床上应给予足够的重视。 目的：回顾聚丙烯酰胺水凝胶注射填充物取出患者中确诊乳腺浸润性导管癌的2例个案,提高对于乳房恶性肿瘤检诊重要性的进一步认识。 方法：收集聚丙烯酰胺水凝胶隆乳术后发生并发症要求注射物取出的患者41例(共计82侧乳房),其中2例伴发单侧乳房恶性肿瘤,术后病理均提示：乳腺浸润性导管癌;回顾分析病史特点、物理诊断、影像学诊断、病理检查等资料。 结果与结论：因聚丙烯酰胺水凝胶注射隆胸术后就诊的患者,应提高对于乳房恶性肿瘤检诊重要性的进一步认识;诊疗过程中强调对物诊及多种影像学检查结果做综合分析,手术过程中对可疑结节多点取材,取材过程中应注意“无瘤操作”手法,及时送冰冻病理检查,一旦确诊乳房恶性肿瘤,需及时按照乳房肿瘤诊疗规范来进行相关处理,以避免医源性操作失当导致的肿瘤漏诊、加速转移和播散。 关键词：注射隆胸;并发症;乳房恶性肿瘤;浸润性导管癌;聚丙烯酰胺水凝胶;生物医用水凝胶材料 doi:10.3969/j.issn.1673-8225.2010.08.038     

颅内植物性异物肉芽肿:一例报告并文献复习

目的 颅内植物性异物肉芽肿临床十分罕见,对其临床表现和组织病理学特征进行探讨,避免误诊.方法与结果 报告l例颅内植物性异物肉芽肿患者的临床表现、组织病理学特征和免疫表型,并复习相关文献.男性患者,23岁.主要表现为发作性四肢强直性抽搐,病程7年.头部MRI检查显示,左侧侧脑室前角前下方额叶皮质内长约1.60 cm的小结节状混杂信号影,邻近额叶组织有胶质化表现.术中可见左侧额底病灶与硬脑膜粘连,大小约为3cm×2cm,呈灰褐色,质地较韧,边界不清,部分钙化,血供丰富.光学显微镜观察显示,肉芽肿伴纤维组织增生、透明变性、钙化及淋巴细胞、浆细胞浸润,未见肿瘤细胞及寄生虫病变;病变组织表达波形蛋白和CD68,不表达胶质纤维酸性蛋白、S-100蛋白和上皮膜抗原.结论 颅内植物性异物肉芽肿根据其部位不同临床表现多样,根据异物种类及存留时间的长短,其影像学也存在多样性,但是可以通过组织病理学和免疫组织化学检测明确诊断,与肿瘤、寄生虫病变相鉴别,并初步明确其植被类型.     

超声在乳房假体围置入期的评价作用

目的：总结超声评价在几种医用材料假体乳房植入中的作用。 方法：选择1998/2008-04武汉市三医院、湖北省人民医院收治正准备或已进行乳房整形美容假体置入的病例，用彩超置入前观察乳腺组织厚度、乳腺后间隙、胸大肌后间隙，置入后观察假体及周围乳腺组织的异常病理现象，对其中有明显并发症的34个病乳进行具体分析。 结果：34个病乳按置入假体材料不同可分为5组，聚丙烯酰胺水凝胶假体18个，羟基磷灰石假体1个，硅凝胶假体9个，自体脂肪材料假体1个，脱细胞真皮基质医用材料补片假体4个。通过超声检测可发现几种乳房假体都有程度不同并发症，分别为血肿、感染、纤维化粘连、硬结、假体纤维包膜挛缩、移位，切口与胸大肌粘连，以聚丙烯酰胺水凝胶假体并发症发生率最高，脱细胞真皮基质医用材料补片假体并发症发生率较少。 结论：5种材料的乳房假体中聚丙烯酰胺水凝胶假体并发症最多，脱细胞真皮基质医用材料补片假体并发症较少；彩超在乳房假体置入中可指导安置假体或探查假体异常及并发症。     

α-Sarcoglycanopathy的临床和病理学特征(附2例报告)

目的探讨α-Sarcoglycanopathy的临床和病理学特征。方法回顾性分析2例α-Sarcoglycanopathy患者的临床资料。结果本组2例患者均表现为近端肌肉无力,进行性加重。肌肉活检均可见肌间结缔组织及脂肪组织增生,肌纤维萎缩,偶见肌纤维变性、坏死和吞噬现象,未见炎细胞浸润;免疫组化染色示抗α-Sarcoglycan蛋白完全缺失,抗β、γ、δ-sacogiycan蛋白和抗dystrophin蛋白部分缺失。结论α-Sarcoglycanopathy临床表现较其他类型肌营养不良无特异性,病理学特征为免疫组化染色示抗α-Sarcoglycan蛋白完全缺失。     

皮质基底变性

由Rebeiz报道的三例神经元染色缺乏(achromasia)的皮质齿状核黑质变性是皮质基底变性(corticobasal degeneration,CBD)的最早病例,1989年Gibb等综合有关病例及三例尸解资料提出CBD的概念。 CBD的病理学改变为单侧额、顶叶皮质的明显萎缩。组织学可见皮质明显神经细胞脱落,星形胶质增生,残存的神经出现胞体肿胀,核偏移,染色不良     

人乳腺病变组织乳腺癌耐药蛋白及细胞角蛋白8和嗜铬蛋白A的表达:可能与多向分化潜能干细胞相关？

背景：多数学者认为正常乳腺组织中无神经内分泌细胞,乳腺病变后出现神经内分泌细胞是乳腺上皮干细胞分化过程中受局部微环境和激素水平影响所发生的突变、异常分化结果。 目的：通过检测人乳腺病变组织中乳腺癌耐药蛋白、细胞角蛋白8及嗜铬蛋白A的表达,从干细胞多向分化的角度探讨人乳腺病变中出现神经内分泌细胞的可能机制。 方法：用乳腺癌耐药蛋白作为SP干细胞标记物,用细胞角蛋白8作为腺上皮分化标记物,用嗜铬蛋白A作为神经内分泌分化指标标记物,采用免疫组化方法分别检测这3种蛋白在89例人乳腺组织中的表达情况,并分析3者间的相关性。 结果与结论：乳腺癌耐药蛋白与细胞角蛋白8在正常乳腺组织、乳腺增生组织、乳腺病变组织中均有表达,乳腺癌耐药蛋白在病变组织中的表达呈上升趋势,细胞角蛋白8的表达则随乳腺组织异常分化程度的降低呈逐渐减少,嗜铬蛋白A只在乳腺病变组织中有表达。在正常乳腺组织、乳腺增生组织和乳腺病变组织中,乳腺癌耐药蛋白与嗜铬蛋白A的阳性表达呈显著相关(P < 0.01),与细胞角蛋白8的阳性表达无明显相关(P=0.069)。上述结果表明正常及增生乳腺组织中未发现神经内分泌细胞,乳腺病变组织中发现神经内分泌细胞,其机制可能与多向分化潜能干细胞的分化有关。     

顽固性癫痫的神经病理学改变

目的探讨顽固性癫癎的神经病理学改变.方法对35例顽固性癫癎病人采用皮质脑电图描记下致癎灶切除,切除的组织送病理检查.结果术后病理报告肿瘤10例;血管畸形5例;颅内囊肿6例;炎性肉芽肿3例;外伤性软化灶3例.余8例为神经元变性,胶质细胞增生,含铁黄色素沉积,淋巴细胞侵润等.结论顽固性癫癎的致癎灶组织均存在着病理改变,且病理改变与临床效果密切相关.     

伴钙化与囊变的脑白质病二例临床、影像学表现及相关病理学分析

目的 探讨伴钙化与囊变的脑白质病(LCC)的临床、影像学表现以及相关病理学特点,以进一步增强对该病的认识和诊断能力.方法 2例患者均行CT和(或)MRI平扫,例2另加MRI增强扫描.2例均行实验室血清生化及钙、磷和甲状旁腺素等检查,例2行腰椎穿刺及脑脊液检查;均经手术切除相关囊性病灶并行组织病理学检查.结果 CT平扫2例均见脑内广泛钙化并伴囊性灶(例1位于右额叶、右尾状核旁;例2位于左顶叶、左丘脑).MRI增强扫描囊性灶边缘示轻度环状强化.组织病理学示囊壁小血管变形呈血管瘤样改变,伴玻璃样变性、钙化及含铁血黄素沉积;周围脑组织血管见纤维素样坏死伴腔内血栓形成,呈小动脉炎改变;脑组织部分变性伴胶质增生、Rosenthal纤维形成及出血.实验室生化检查各指标均正常.例2腰穿示颅内压增高(350 mm H_2O,1 mm H_2O=0.0098 kPa).结论 LCC的首发年龄及症状各异,其影像学上的钙化形态及分布不对称.脱髓鞘及血管源性水肿可能共同参与了脑白质异常信号的改变.     

Histopathological study of the "cholesterol granuloma reaction" in the sellar and juxta-sellar tumors

Specimens from operation of 211 sellar and juxta-sellar tumors were observed histopathologically, and discussed about the true form of "cholesterol granuloma reaction" in those tumors. Depending on the characteristic histological feature, "cholesterol granuloma reaction" was classified into 3 groups, each of which also represented a step of process of organization. Group I (cholesterol clefts predominates in hemorrhagic and necrotic foci), group II (foreign body giant cells, macrophages, round cell infiltrations are present other than cholesterol clefts, signifying active organization), group III (numerous cholesterol clefts predominates in fibrous scar tissue). Feature of "cholesterol granuloma reaction" were seen in 6 cases among 37 cases of craniopharyngioma with verified histology (16%), 8 among 165 in pituitary adenomas (5%) and 1 among 5 in pituitary epithelial cysts (20%). In addition, there were 4 cases in which histologic sections of the surgical specimen showed only the feature of "cholesterol granuloma reaction", in the absence of tumorous epithelial components. "Cholesterol granuloma reaction" is thought to develop as a secondary reaction to hemorrhage or tissue necrosis (pituitary adenomas), or to keratinization (craniopharyngiomas). In occasions in which surgical specimen show only a feature of "cholesterol granuloma reaction", making the final diagnosis is necessary to be careful, taking account of other lesions as well as craniopharyngiomas.     

Neurosarcoidosis following augmentation mammoplasty with silicone

Abstract

We report a patient with neurosarcoidosis, which developed 22 years after augmentation mammoplasty by the injection of silicone gel. She presented with bilateral hilar lymphadenopathy, left-sided lower cranial nerve palsies (8th, 9th, and 10th), and vestibular ataxia, which improved following the administration of prednisolone. Biopsy of the breast nodules showed granulomatous changes identical with those of sarcoidosis, while infrared spectrophotometry disclosed that the nodules contained polydimethylsiloxane, a major component of the silicone gel injection. This is the first report of neurosarcoidosis following silicone mammoplasty. [Neurol Res 1996; 18: 319-320]     

Cerebral foreign body granulomas after mechanical thrombectomy: Two case reports and a review of the literature

ObjectivesA foreign body granuloma after an endovascular intervention is a rare complication. Some cases of foreign body granulomas, especially after coil embolization, have been reported. However, only four cases of foreign body granulomas after mechanical thrombectomy (MT) have previously been reported. The current study reports two cases of post-MT foreign body granulomas, including a biopsy-proven case.Material and MethodsCase 1: A 73-year-old woman presented with complete occlusion of the right middle cerebral artery. Cerebral angiography and MT were successfully performed with improvement in clinical symptoms. Left hemiparesis and a disturbance in attention appeared after discharge and progressed slowly. She was re-admitted to our hospital 120 days after cerebral infarction owing to foreign body granulomas diagnosed on biopsy. Case 2: A 78-year-old man presented with occlusion of the left cervical internal carotid artery and the left middle cerebral artery. Cerebral angiography, percutaneous transluminal angioplasty, and MT were successfully performed. On the 34th day, he experienced progressive consciousness disorder because of foreign body granulomas. Both cases were successfully treated with steroid therapy.ResultsMRI after steroid treatment showed the disappearance of most nodular lesions and improvement of the encephalopathy.ConclusionsThe cause of the granuloma may be an allergic reaction to the hydrophilic polymers that peel from endovascular devices. Steroid therapy is an effective treatment; therefore, neurologists should consider this complication when neurological symptoms or signs on image appears or worsens. A reliable diagnosis is important for prompt treatment.     

Formation of malonaldehyde and focal brain edema induced by subpial injection of FeCl2 into rat isocortex

Subpial injection of iron salts or iron-containing blood products into rat isocortex induces recurrent epileptiform discharges coupled with cavitary necrosis and gliosis. Since aqueous iron or heme compounds cause formation of superoxide radicals and peroxidation of membrane lipids, we studied the rat of formation of malonaldehyde (MDA) after subpial injection of 5 μl of various concentrations of FeCl₂ and CoCl₂.Injection of CoCl₂ failed to alter isocortical MDA levels. However, significant formation of MDA occurred after injection of 25, 50 and 100 mM FeCl₂ into rat isocortex. Formation of peak MDA levels of13.4 ± 1.0nmol·mg protein⁻¹ occurred at 15 min to 1 h after 100 mM FeCl₂ injection; levels returned to equal control by 12 h. Tissue fluid accumulation occurred by 2 h after FeCl₂ injection and persisted for 48 h. Histopathologic assessment using Nissl staining of tissue from the injection site showed loss of cellular staining, coagulation necrosis, and accumulation of macrophages and glial cells.Although these experiments showed the initiation of lipid peroxidation and formation of focal isocortical edema by injection of aqueous solutions of iron salts, we speculate that decompartmentalization of iron from red blood cells after trauma, cerebral hemorrhage or infarction may be important in the propagation of tissue damage from such injuries.     

心肌梗死局部注射壳聚糖水凝胶材料的存留和降解

摘要 背景：研究发现壳聚糖水凝胶可促进受损组织新生血管生成,修复损伤细胞和组织。 目的：观察心肌梗死部位局部注射壳聚糖水凝胶材料的存留和降解及其对心脏功能的保护作用。 方法：结扎Wistar大鼠冠状动脉左前降支致心肌梗死30 min 后,随机抽签法分为壳聚糖水凝胶注射组、心肌梗死模型组、PBS注射组。术后1,2,4 周使大鼠心脏停留在舒张期行心肌组织学检查,术后4周进行心电图、心脏超声检测,并进行大鼠颈动脉插管,检测心脏功能和心室内压。 结果与结论：壳聚糖水凝胶注射1,2 周后在心肌组织中有明显存留,4 周后已降解吸收,无明显残留。注射4周后心脏超声、心室血流动力学及心室内压检测结果表明,壳聚糖水凝胶注射组心脏功能明显好于心肌梗死模型组、PBS 注射组,而心肌梗死模型组和PBS 注射组之间没有明显的区别。说明以壳聚糖为支架材料,应用配制的可注射性液态支架进行心肌梗死局部注射治疗,注射4周后无明显残留,保护和改善了心脏功能,适宜作为可注射性组织工程化心肌的支架材料。 关键词：壳聚糖水凝胶;心肌梗死;组织相容性;心脏功能;生物材料 doi:10.3969/j.issn.1673-8225.2011.12.017     

Brucellar spondylodiscitis: A case series with focus on histopathological features

Brucellar spondylodiscitis (BS) is the most common form of musculoskeletal brucellosis. The isolation of Brucella spp from blood, other body fluids or tissue cultures is the gold standard for definitive diagnosis of BS. BS shows a large histopathological spectrum of lesions with non-specific and granulomatous forms, and its histopathological features are not widely reported. This case series study reported the histopathological features of a series of 21 BS. Ten cases revealed nonspecific forms of BS. Lymphocytes were the predominant inflammatory cells in this group. In one case neutrophils were predominant. The eleven remaining were granulomatous. The 11 exhibited histiocytic type granulomas. Ten were non-necrotizing. One case, taken from abscess wall, contained minimal deposition of caseous like necrotic material. This case and 2 others corresponding to abscess wall biopsies, showed histiocytic granulomas mixed with small aggregates of epithelioid cells without well-formed epithelioid granuloma nor giant cell.The histopathological diagnosis of BS is challenging. Nonspecific forms of BS, mimiking pyogenic spondylodiscitis, are observed in about half of the cases. Although nonspecific forms of BS are characterized by the predominance of lymphocytes and plasmocytes, BS forms with predominant neutrophil cell infiltration do exist. Histiocytic granuloma is highly suggestive of BS. Purely epithelioid forms of BS were not observed in the present series. Caseous like necrosis suggestive of tuberculosis is a possible feature of BS.     

Polyacrylamide as an infiltrating and embedding medium for vibratome sectioning of human fetal cerebellum containing DiI-filled axons.

Polyacrylamide is widely used for the separation of proteins by electrophoresis. Here the usage of polyacrylamide as an infiltrating and embedding medium for vibratome sectioning of human fetal cerebellum containing DiI-filled axons is reported. The procedure is simple to implement and has several advantages: it does not require prior dehydration and clearing of tissue; it can be carried out at a low temperature of 4 degrees C; and the polyacrylamide neither dissolves the DiI nor does it interfere with the visualizing of DiI-filled profiles under fluorescence microscope.     

Immunohistochemical localization of tissue factor pathway inhibitor-2 in human tumor tissue

The progression of neoplasms is frequently associated with thromboembolic complications. Coagulation proteins, particularly tissue factor (TF), have been shown to play a role in tumor growth and metastatic dissemination. TFPI is the principal inhibitor of TF-dependent pathway of blood coagulation, but previous studies failed to detect antigenic TFPI in cancer tissue. Recently, a second inhibitor of tissue factor dependent pathway, TFPI-2 (also known as placental protein 5 [PP5] or matrix-associated serine protease inhibitor [MSPI]), has been described. Information on the presence of TFPI-2 within the malignant tumor tissue still remains obscure, and thus the aim of this study was to evaluate the expression of TFPI-2 in loco in several different neoplasms. TFPI-2 expression was demonstrated by immunohistochemical procedures in neoplastic cells of laryngeal, breast, gastric, colon, pancreatic, renal and endometrial cancer, as well as glial neoplasms. The intensity of staining was not uniform, with higher intensity in more differentiated tumors. G3 breast, gastric, endometrial and colon cancer cells revealed populations of cells that were either TFPI-2 positive or negative. Gastric and renal cancer tissue exhibited the presence of TFPI-2 in tumor infiltrating macrophages. TFPI-2 was also observed in normal tissue of the breast, stomach, colon and pancreas. These data demonstrate that the expression of TFPI-2 diminishes with an increasing degree of malignancy, which may suggest a role for TFPI-2 in the maintenance of tumor stability and inhibition of the growth of neoplasms.     

纳米羟基磷灰石/聚酰胺66人工椎体置入与椎体重建

摘要 背景：发生于胸腰椎的骨嗜酸性肉芽肿临床较少见,对于病灶切除后的椎体缺损,已有不同生物材料的椎体替代物用于临床,但是纳米羟基磷灰石/聚酰胺66人工椎体在此病的临床应用还鲜有报道。 目的：观察纳米羟基磷灰石/聚酰胺66人工椎体在脊椎嗜酸性肉芽肿病椎切除术后椎体重建的效果。 方法：回顾性分析2005-01/2009-12重庆医科大学附属第一医院骨科收治的经病理证实的胸腰椎嗜酸性肉芽肿患者15例,全部行前路病灶切除、椎体间行纳米羟基磷灰石/聚酰胺66人工椎体置入、前路钉板系统内固定治疗。观察切口愈合情况、伤口并发症及脊髓功能恢复情况。 结果与结论：15例患者全部获得随访,平均随访2.1年。全部痊愈,脊髓功能得到恢复,无复发及并发症发生。提示脊椎嗜酸性肉芽肿病椎切除后椎体间纳米羟基磷灰石/聚酰胺66人工椎体置入、前路钉板系统内固定可以获得良好的椎体重建效果。 关键词：纳米羟基磷灰石/聚酰胺66;人工椎体;胸腰椎;嗜酸性肉芽肿;椎体重建 doi:10.3969/j.issn.1673-8225.2010.47.037