前列腺纤维化的研究进展

部分表现为下尿路症状(LUTS)的患者前列腺体积并不大,有证据支持前列腺纤维化是除BPH、平滑肌功能障碍之外,导致LUTS的原因之一。研究表明,前列腺纤维化的发生与各种原因导致的炎症、缺血缺氧、药物相关,具体机制涉及肌成纤维细胞的分化、聚集和活化。因此,抗炎、抗纤维化可能是治疗LUTS的潜在作用靶点。本文就前列腺纤维化的成因、诊断、与LUTS的关系及治疗进展作一综述。     

Results of surgical treatment of stage III lung carcinoma with carinal proximity. The role of sleeve lobectomy versus pneumonectomy and the role of sleeve pneumonectomy

Sleeve lobectomy in specific situations can be an alternative to pneumonectomy. Sleeve pneumonectomy is an aggressive resection for carcinoma involving the tracheobronchial angle, carina, or lower trachea and lung. Sleeve lobectomy is questioned because of its technical difficulties and its postoperative complications. Sleeve pneumonectomy is controversial in that its postoperative mortality and long-term survival rates are similar, it is a technically difficult procedure, and its mortality rate is greater than that of standard pneumonectomy. The indications for the procedures and patient selection are discussed.     

Neuromodulation des racines sacrées pour incontinence fécale

Sacral nerve stimulation is the best-evaluated procedure to treat today faecal incontinence. That is also the one that offers the best clear-cut clinical benefit in the management process. However its widespread is somewhat restrained, both due to its cost and its rigorous follow-up.     

Lasers in podiatry

The laser is a new therapeutic modality that is both applauded by its advocates and condemned by its critics. Its high cost is usually offset by high-volume use, leading to questions of ethics and overuse. This article addresses the controversy surrounding the laser and provides the reader with a basic understanding of its technology and its value in podiatry.     

氯胺酮炎症调节作用围术期应用进展

背景 氯胺酮是临床上常用的麻醉药物,但其除了具有传统的麻醉作用外,近年来对氯胺酮抗炎作用的研究已经取得了较大进展. 目的 综述氯胺酮抗炎作用在临床应用中的研究进展,为其在围术期应用提供参考. 内容 氯胺酮有炎症调节作用,能够及时防止局部炎症反应的恶化,又避免了过度抑制促炎反应.氯胺酮是免疫调节剂,而非免疫抑制剂. 趋向 如何优化氯胺酮的给药剂量、方式和时机,是未来的研究趋势.     

Is surgical clipping becoming underused?

Summary Coil embolization is a treatment for intracranial aneurysms with a particular appeal for posterior circulation aneurysms. However, although this procedure is effective in well-selected intracranial aneurysms, it has a series of limitations that may be overlooked as a result of its rapid technological evolution and its minimally invasive appearance. The author analyses the data that lead him to consider that since the introduction of coil embolisation in 1991 and its progressive diffusion, the technique of surgical clipping risks being underused as a therapeutic procedure for intracranial aneurysms because of the shortage of vascular neurosurgeons trained and experienced in its use.     

Schmerzchronifizierung

In its chronic form, pain has frequently lost its original physiological function of drawing attention to or giving an advance warning about tissue damage. Why pain becomes chronic beyond the acute stage is currently the subject of an intensive research effort. What is certain is that there is no single, generally applicable reason for chronification. In addition, it seems that this has its origins in various biochemical, structural, psychic and pathophysiological processes through which an independent picture of pain disease in the sense of a biopsychosocial model with typical symptoms results. It is essential that pain be treated soon after its onset if chronification is to be avoided or at least attenuated. The strategies for treatment of chronic pain are based closely on the WHO pain ladder used in the treatment of tumour pain.     

The relationship between orthopaedics and industry must be reformed

It is well-known that the long-standing relationship between orthopaedics and industry has benefited both parties. However, strong evidence indicates that the relationship is no longer a balanced one. Through a very effective stratagem, industry has used its enormous marketing power to a degree where the education of the orthopaedists now is, to a great degree, under its control and structured to satisfy its marketing needs. Orthopaedics' dependency on industry's support has resulted in our profession gradually abandoning its traditional values and ethical principles, and adopting those of the business community. This change is not in the best interest of medicine. The orthopaedic community, although striving to maintain a mutually productive relationship with industry, should forbid any intrusion into our autonomy in the areas of education and research.     

Significado clínico de la atrofia proliferativa inflamatoria en la biopsia prostática

IntroductionProliferative inflammatory atrophy (PIA) is a frequently observed lesion in prostate biopsies and some authors have postulated its involvement in prostate carcinogenesis. However, the mechanisms that would permit its neoplastic transformation and the clinical significance of its finding in a prostate biopsy is currently not well known.ObjectiveTo analyze the characteristics of the PIA lesion, its possible role in prostate carcinogenesis and its relation with the tumor aggressiveness.Material and methodA systematic review was made of the literature in PubMed with the terms «proliferative inflammatory atrophy» or «PIA» and «prostate.» The most important findings are summarized in accordance with the study objective.ResultsPIA seems to be involved in prostate carcinogenesis. This hypothesis is based on its frequent association to cancer lesions (CaP) and on some genetic alterations that are common to the high grade prostatic intraepithelial neoplasia (HGPIN) and to the CaP, fundamentally deficit in GSTP1 expression and overexpression of AGR2. Currently, there are no epidemiological studies that evaluate the incidence of PIA or its association with HGPIN and CaP. Only one study, carried out by our group, has determined the global incidence of PIA in 30% of the prostate biopsies, a lower association to CaP than the HGPIN lesion and an association between PIA and tumors of lower and insignificant grade.ConclusionsPIA shares genetic alterations with HGPIN and CaP. Currently, there is no epidemiologic evidence to consider that the PIA is associated to a greater incidence of CaP and the genetic and epidemiological data available suggest its association to not very aggressive tumors.     

The right gastroepiploic artery in coronary artery bypass grafting

The right gastroepiploic artery (RGEA) has been used as a conduit in coronary artery bypass grafting. Although some reports presenting good results justify its use in clinical settings, there is still much concern about using the RGEA in bypass surgery. The RGEA demonstrates different behaviors from the internal thoracic artery (ITA) in bypass surgery due to its histological characteristics and anatomical difference, which might contribute to the long-term outcome. Now that left ITA (LITA) to left anterior descending artery (LAD) is the gold standard, other grafts are expected to cover the rest of the coronary arteries. It should be elucidated how we can use other grafts and what we can expect from them. RGEA, as an arterial graft, can be used as an in situ graft or a free graft. The RGEA is mainly used to graft to the right coronary artery (RCA) because of its anatomical position, and its patency is not inferior to that of the saphenous vein (SVG). The RGEA can cover the lateral walls when its length is long enough or by making a composite graft with other grafts. However, when used to graft to the LAD, its mid-term patency is not favorable.     

Computer security. An introduction for the medical practitioner

Effective security will ensure that a computer functions properly, that its information is accurate, and that its use does not subject its owners and operators to legal risk. Although problems with intentional violations of computer security have received the most press and public attention, for most computer users the greatest threat to effective and trouble-free use of their equipment can be traced to poor equipment handling and inadequate attention to the mundane tasks of computing. Proper attention to maintenance of equipment and information is as effective in ensuring the proper functioning of computers as is regular maintenance of a car, and no more complicated.     

Pendulosity in regional flaps about the head and neck

Pendulosity rarely occurs in flap transposition in the area of the head and neck. It is related to physical and physiological factors that derive from the volume of tissue transplanted, the neatness of its fit into the wound, its supportive facilities, its functional activity, its relation to gravity, and the effect of its perimeter scar tissue bed and venous drainage system. It is amazing that this condition does not appear more commonly when one considers that as much as 1,000 cc of inert tissue may be transposed as a volumetric mass, either with a singular vascular pedicle or as a singular microvascular anastomosis or a randomized soft tissue pedicle base. The difficulty is almost always compounded by the fact that the tissue does not contain a specific lymph drainage facility. The majority of these physiological handicaps, however, are accommodated by the receptiveness of the tissues of the wound and the venous drainage of the flap. If these should fail, edema and then pendulosity will occur. The condition can be improved by repositioning and a reduction in the size of the flap.     

Dimephosphon in complex therapy of acute edematous pancreatitis

Clinical investigations of 120 patients have shown that Dimephosphon included in complex treatment of acute edematous pancreatitis facilitates more rapid arrest of the symptoms. An important effect of the drug is its ability to decrease the level of endogenous intoxication by both the hydrophilic and hydrophobic components. It was established that one of the mechanisms of favorable action of the drug is its ability to inhibit LPO, to decrease activity of phospholipase A2. The drug possessing the cytoprotecting effect promotes rapid restoration of the functional state of the liver, in particular its detoxicating, albumin synthesizing ability that is not least of the factors of optimization of the complex therapy.     

Primary Osteosarcoma of the Breast- A Case Report and Review of Literature

Primary Osteosarcoma of the breast is an aggressive and relatively rare tumour whose prognosis is very poor.It is often a diagnostic dilemma to the pathologists and the surgeons are perplexed due to its aggressive behaviour as its pathology and prognostic factors are unclear. Due to its rarity we suggest pooling of tissue samples from various centres in biobanks for future studies (including molecular biological studies) so that its behaviour can be better understood.     

Benign anatomical mistakes: the correct anatomical term for the recurrent laryngeal nerve

The term recurrent laryngeal nerve has been adopted by Nomina Anatomica (1989) and Terminologia Anatomica (1998) to describe this vagus branch from its origin, its turn dorsally around the subclavian artery and the aortic arch, and its cranial pathway until it reaches its terminal organs in the neck. However, there is still much confusion, and either the terms inferior and recurrent laryngeal nerve are used interchangeably or inferior laryngeal nerve is considered the terminal branch of the recurrent laryngeal nerve. We hereby feel that it is necessary to reassess the term and we propose the term inferior laryngeal nerve for the entire nerve under consideration, from its origin from the vagus nerve to its destinations, including tracheal, esophageal, and pharyngeal branches. If the term superior laryngeal nerve is a given, standard and accepted term in the anatomical terminology, then logically the term inferior laryngeal nerve should also be accepted, as opposed to it. Of course the upward travel of the inferior laryngeal nerve is "recurrent". When nonrecurrence is encountered together with an arteria lusoria, a retroesophageal right subclavian artery or a right aortic arch, we consider that the term nonrecurrent inferior laryngeal nerve should be used to describe the deviation from the normal.     

Clavicular function.

This is a survey of the functional variation of the clavicle, in particular with regard to its adaptability, the bone being an essential link in the shoulder girdle. The presence of a clavicle, and its shape, size and position are discussed from the point of view of stability and mobility, and the role of the bone regarding circulation, pulmonary ventilation and muscular tension is pointed out. It is stated that the clavicle contributes significantly to the stability of the shoulder girdle, and that in man the presence of this bone represents an increase in the degree of freedom of the upper extremity mobility pattern, dependent on the transversal shape of the thoracic diameter. The precondition for the clavicle to function appropriately is that its curvature fits in with the ligamentous pull.     

The Infectious Hypodermal and Haematopoietic Necrosis Virus: A Brief Review of What We Do and Do Not Know

Given its high prevalence, its wide distribution and its remarkable capacity to cause severe mortality in shrimp, the infectious hypodermal and haematopoietic necrosis virus (IHHNV) may deserve far more attention than it has received, as it remains considered as one of the most serious problems plaguing the global shrimp farming industry. Furthermore, its real measurable impact over wild shrimp populations remains unknown. Undeniably, the progress that we have reached today on the knowledge of its geographical distribution, clinical signs, genetic diversity, transmission and virulence may help to identify and understand important aspects of its biology and pathogenesis. However, the information regarding the molecular events that occur during the infection process is scarce. Thus, it may not be surprising to find that there are no therapeutic options available for the prophylaxis or treatments to reduce the deleterious impact of this viral pathogen to date. The aim of this review is to integrate and discuss the current state of knowledge concerning several aspects of the biology of IHHNV and to highlight potential future directions for this area of research.     

Glottis and subglottis: a thoracic surgeon's perspective

Anatomically, the larynx presents several unique features that account for the difficulties in the surgical management of pathologies, such as benign strictures located in the area. These features include its unique cartilaginous support, its short length, its intrinsic and extrinsic musculatures, and its innervation, all of which are fundamental for the function of breathing, phonation, and swallowing. It is important that the thoracic surgeon operating on the larynx understand this particular anatomy, the limits of surgery, and most importantly the steps to be taken to avoid catastrophic complications.     

湿润烧伤膏对烧伤大鼠IL－2的影响与临床存在的问题

湿润烧伤膏在临床应用以来，对其疗效评价不一。为此我们对其临床治疗效果、抑菌作用及对烫伤后大鼠产生ＩＬ－２能力的影响等方面进行了研究。结果表明：①应用湿润膏治疗烧伤创面，局部感染重，愈合时间延长，愈合后瘢痕增生，造成功能障碍及外观毁损；②治疗费用昂贵，无改善伤后机体免疫功能的作用，亦无抗菌作用。     

Results of behavioral treatment for urinary incontinence in women

Recent research on pelvic muscle exercises, which are known to be effective in stress and mixed urinary incontinence, has demonstrated that this therapy has a durable effect. However, the mechanism that creates its efficacy remains unclear. Transvaginal electrical stimulation has been used to manage stress, urge and mixed urinary incontinence. Conflicting evidence exists concerning its efficacy in stress urinary incontinence, but its benefit to women with mixed and urge incontinence is well established.