Fibrous dysplasia. An analysis of options for treatment

The results of treatment of sixty-five symptomatic lesions in forty-three patients who had fibrous dysplasia were reviewed. For fourteen (93 per cent) of the fifteen times that a lesion in the upper extremity was treated non-operatively, the result was satisfactory. These results were independent of the patient's age when first seen. In contrast, in the lower extremity, the results were highly dependent on the age of the patients at the time of the initial presentation of symptoms. In patients who were eighteen years old or older, eight (88 per cent) of the nine times that a lesion involving the lower extremity had closed treatment and both times that a lesion was treated with curettage and bone-grafting, the result was satisfactory. The results of these modalities of treatment in patients who were less than eighteen years old were discouraging. Twenty-eight (88 per cent) of the thirty-two times that closed treatment was used and twenty-five (81 per cent) of the thirty-one times that curettage and bone-grafting was used, the result was unsatisfactory. However, after eighteen (86 per cent) of the twenty-one times that a lesion in the lower extremity was treated by internal fixation in a patient who was less than eighteen years old, there was a satisfactory outcome. We concluded that closed treatment of a symptomatic lesion in the upper extremity generally provides satisfactory results. In patients who are less than eighteen years old, neither closed treatment nor curettage and bone-grafting is adequate treatment for a symptomatic lesion in the lower extremity. Internal fixation should be strongly considered in these young patients.     

带血管蒂骨膜瓣移位修复肱骨不连和肱骨难愈性骨折

目的探讨带不同血管蒂骨膜瓣移位修复肱骨中、下段骨不连及难愈性骨折的应用价值。方法1995年以来,通过对肱动脉肌间隙支、桡侧副动脉和骨间返动脉的应用解剖学研究,创用了以上述血管为蒂的骨膜瓣移位术,并总结临床应用情况。结果经临床施术51例,效果满意。结论肱动脉肌间隙支肱骨中段骨膜瓣供修复肱骨中下段;桡侧副动脉肱骨下段骨膜瓣适合修复肱骨中段或中下段;骨间返动脉尺骨上段骨膜瓣逆向移位则用于修复肱骨下段髁上区。     

An unusually large asymptomatic periapical lesion that presented as a random finding on a panoramic radiograph.

OBJECTIVE: This report presents an asymptomatic case of a large mandibular periapical lesion that was discovered as a random finding on a panoramic radiograph. SUMMARY: A panoramic radiograph was asked for removal of wisdom tooth's roots. The radiograph revealed an unusually large lesion extending from lower premolar to opposite lower canine. Upon clinical examination a discolored lower central incisor and an elevation of the vestibule were visible. The discolored tooth did not respond to thermal and electrical vitality tests and was not tender to percussion. No history of trauma was recorded and all other teeth in the lower anterior area were vital. Surgical excision of the lesion was decided after denial of conservative treatment by the patient. The result was satisfactory and 6 months after the operation new bone was formed at the site of the lesion. CONCLUSIONS: Dentists should be very careful on clinical examination and should not omit any details. Before beginning any treatment a careful and complete clinical and radiographic examination is needed to supply all the required information. Small clinical signs such as a discolored tooth should alert the dentist.     

Neuropeptide Y- and vasoactive intestinal polypeptide-containing nerves in the intrinsic external urethral sphincter in the areflexic bladder compared to detrusor-sphincter dyssynergia in patients with spinal cord injury

Specimens of urethra were obtained from patients with cervical and thoracic spinal cord lesion with detrusor-sphincter dyssynergia and from patients with lower motor neurone lesion with detrusor areflexia, undergoing transurethral sphincterotomy. Neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) in nerves associated with both the smooth and striated muscle components of the urethral sphincter were studied immunohistochemically and by immunoassay. In patients with detrusor-sphincter dyssynergia following cervical and thoracic spinal cord injury, NPY- and VIP-immunoreactive varicose nerve fibres were seen in both the smooth and striated muscle components of the urethral sphincter. In the smooth muscle, NPY- and VIP-immunoreactive nerves did not appear to have any particular orientation, but in the striated muscle region they were found to run along the length of individual muscle fibres. In patients with detrusor areflexia following lower motor neurone lesion, while the pattern, density and fluorescence intensity of NPY- and VIP-immunoreactive nerves in the smooth muscle of the sphincter mechanism appeared the same as seen in patients with detrusor-sphincter dyssynergia, there was a marked increase in the density of these nerves in the striated muscle region of the sphincter mechanism. Quantitation of the peptides by immunoassay was consistent with the histochemical findings, with significantly higher levels of both NPY and VIP in the striated muscle of patients with lower motor neurone lesion, compared to those with cervical and thoracic spinal cord lesion, p = 0.04. NPY and VIP levels in urethral smooth muscle were in the same range in lower motor neurone lesion patients and cervical and thoracic spinal cord lesion patients. We conclude that there are increased NPY- and VIP-containing fibres in striated muscle of the intrinsic external urethral sphincter in patients with areflexic bladder compared with those with detrusor-sphincter dyssynergia.     

肾小球上皮细胞增生病变在局灶节段性肾小球硬化症中的临床意义及其组织来源探讨

目的 探讨特发性局灶节段性肾小球硬化症（FSGS）的肾小球上皮细胞增生病变（glomerular epithelial proliferative lesion,GEPL）的临床意义及其组织学来源。 方法 2000年1月至2005年12月间在本研究所接受治疗的特发性FSGS患者共74例,按照是否存在GEPL病变分为两组：GEPL组31例,非GEPL组43例。分析两组患者的临床病理特点,对其活动性及慢性化病理改变进行半定量评估,并对患者的治疗和预后进行随访。通过免疫组化方法分析肾小球增生上皮细胞的细胞表型表达情况。 结果 与非GEPL组相比,GEPL组的病程显著较短（P < 0.05）;肾病综合征（NS）患者比例显著较高（P < 0.05）;节段性硬化的肾小球比例显著较高（P < 0.05）;病理活动性评分显著较高（P < 0.05）;慢性化评分显著较低（P < 0.05）。29例随访患者中,GEPL组（16例）的肾脏存活率明显降低（P ＝ 0.049）。COX回归分析发现GEPL和Scr水平是导致肾衰竭的危险因素（OR值分别为1.204和1.008）。免疫组化结果显示肾小球增生上皮细胞WT-1及Pcx表达缺失;细胞增殖核抗原（PCNA）、Pax-2和CK-8表达阳性。 结论 特发性FSGS的肾小球上皮细胞增生病变是急性期、活动性病变的病理表现,也可能为临床病情较重和肾脏存活预后不良的病理学指征。增生的肾小球上皮细胞缺乏足细胞表型,说明可能源于壁层上皮细胞,但不排除损伤的足细胞去分化、增生并表达壁层上皮细胞标记的可能。     

Using the C7-T3 spinous processes as landmarks for the localization of thoracic spinal lesions: technique notes

The authors describe a method of using the C7-T3 spinous processes visualized on MRI as landmarks for localizing thoracic spinal lesions in 19 cases. This method included six steps. First, the “spinous process nearest to the lesion that was visible on the MRI image” was identified. Second, a dashed line was drawn on the image through the tip of the identified spinous process perpendicular to the skin surface. Third, two additional dashed lines parallel to the first dashed line were drawn from the upper and lower margins of the lesion. Fourth, the distances between the identified process and the two additional dashed lines were measured. Fifth, the same “spinous process nearest to the lesion” was identified by palpation and marked on the patient’s skin. Sixth, the upper and lower margins of the lesion were marked on the skin according to the two distances measured in step 4. After the lesion was exposed, the deviations of the lesion margins were measured. All 19 cases of the thoracic spinal lesions were localized correctly using the C7-T3 spinous processes visualized on the MRI images as landmarks without any other evaluation methods. The deviation value for the localization of the tumor margin was 4.1?±?1.47 mm. Using the C7-T3 spinous processes as landmarks is an accurate, simple, and economic method for lesion localization during thoracic spinal surgery.     

Bilateral multiple sclerosing hemangiomas of the lung

This report presents a case of bilateral multiple sclerosing hemangiomas of the lung in a 73-year-old woman. A computed tomography (CT) scan of the chest showed a total of three well-defined small nodules in the right and left lower lobes of the lung. Because malignant metastatic lung tumors were highly suspected, a wedge resection of the left lower lobe was performed to obtain a definitive diagnosis. Histopathologically, two tumors of the left lower lobe were composed of epithelial-like cuboidal cells covering the surface of papillary protrusions and sheets of round to polygonal cells underneath the epithelial-like cells. The final diagnosis was that both tumors were sclerosing hemangiomas. After surgery the residual lesion of the right lower lobe was carefully followed by chest CT. The size of the right lung nodule did not change over the course of 9 years, and no new lesion has emerged.     

Pathogenesis of lumbo-sacral nerve root lesion: from the view point of thermographic findings of the lower limbs

Pathogenesis of the lumbo-sacral nerve roots lesion is discussed especially on the role of the sympathetic nerve using thermographic investigation of the lower limbs. 50 persons without any lumbar symptom were selected as control, and 97 patients with lumbo-sacral nerve roots lesion, including 64 with lumbar disc herniation (LDH) and 33 with lumbar canal stenosis (LCS), were the subjects of this study. In 33 patients group thermography was taken before and after selective nerve root block. The thermograms of the control group showed almost symmetrical thermatome. 49 (76.6%) of LDH group had hypothermal area on the affected limb, however, particularity of the hypothermal area did not define between L5 and S1 nerve root lesion. The patients with hypothermal area of the lower limb were characterised as having apparent neurological deficits and longer duration of the history from the onset, compared with the group without hypothermal area. 25 (75.8%) of LCS group showed not only hypothermal but also complicated thermographic findings. The patients with the complicated findings tended to have severer neurological deficits. Through thermographic findings after nerve root block, it is suggested that skin distribution of the particular nerve root, for example L5 or S1 nerve root distribution, exists in the lower limbs probably related to sympathetic nerve. This study concludes that thermograms of the lower limbs reflect pathogenesis of lumbo-sacral nerve root lesion in some extent, and probably indicate the prognosis of the lesion.     

Clinical and pathological features of idiopathic membranous nephropathy with focal segmental lesion

Objective To investigate the clinical-pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesion. Methods Two hundred and ninety-eight patients with biopsy-proven IMN in our hospital were retrospectively analyzed. The patients were divided into three groups: without focal segmental lesion group (FSL-), with focal segmental glomerulosclerosis group (FSGS) and with early focal segmental lesion group (EFSL). The differences of clinical and pathological features and prognosis in the 3 groups were studied. Results There were later pathological stage, higher ratio of chronic renal tubulointerstitial damage and global glomerular sclerosis in FSGS group than those in the other two groups (all P＜0.05). The male ratio in EFSL group was higher than that inFSL- group (P＜0.01), while the level of serum albumin was lower (P＜0.05). Compared withFSL- group, there was longer average course before renal biopsy, higher blood pressure and levels of Scr in FSGS group (all P＜0.05)．Furthermore, the remission rate in EFSL group was lower than that in FSGS group andFSL- group. Survival analysis showed that FSGS group had worse prognosis (FSGS toFSL-, P=0.005, FSGS to EFSL, P=0.008). The analysis of risk factors suggested that triacylglycerol (OR=1.519, P=0.017), glomerulosclerosis (OR=1.073, P=0.041) and FSGS lesion (OR=5.960, P=0.009) were independent risk factors for renal death. Conclusions There were some differences between EFSL and FSGS lesion, both in clinical manifestations and pathology. FSGS lesion was independent predictive factor for progression to renal death. And the lowest remission rate was in EFSL group.     

Eccrine Porocarcinoma of the Eyelid Treated With Mohs Micrographic Surgery

Background. Eccrine porocarcinoma (EPC) is a rare malignant tumor of the eccrine sweat glands. The lesions are reported to occur most commonly on the lower extremity with variable prognosis.
Objective. To discuss the clinical and histologic features and the prognosis of EPC.
Methods. We report a 71-year-old man who presented with an asymptomatic lesion on his lower eyelid that had been present for 6 weeks.
Results. The 4×4-mm lesion was removed in two stages using the Mohs micrographic surgery fresh-tissue technique. The histopathologic diagnosis was primary EPC.
Conclusion. EPCs most commonly occur on the lower extremity. This case is interesting because the lesion was located on the lower eyelid.     

Patients with lower motor spinal cord lesion: a decrease of vasoactive intestinal polypeptide, calcitonin gene-related peptide and substance P, but not neuropeptide Y and somatostatin-immunoreactive nerves in the detrusor muscle of the bladder.

Specimens of the detrusor muscle of the bladder from four patients with lower motor neurone lesion and three patients with carcinoma of the bladder used as "controls", were studied immunohistochemically for vasoactive intestinal polypeptide, neuropeptide Y, calcitonin-gene related peptide, substance P and somatostatin. The greatest density of nerves in the bladder from "control" patients contained neuropeptide Y, followed in a decreasing order by vasoactive intestinal polypeptide, calcitonin gene-related peptide, substance P and somatostatin. Neuropeptide Y- and vasoactive intestinal polypeptide-immunoreactive nerves were found throughout the smooth muscle and the base of the mucosa, while calcitonin gene-related peptide-, substance P- and somatostatin-immunoreactive nerves were found predominantly in nerve bundles with a few single fibres at the base of the mucosa. Vasoactive intestinal polypeptide-, neuropeptide Y- and calcitonin gene-related peptide-immunoreactive nerves were also located around blood vessels. In patients with lower motor neurone lesion, there was a decrease in the density of vasoactive intestinal polypeptide-, calcitonin gene-related peptide- and substance P-immunoreactive nerves, but there was little change in neuropeptide Y- or somatostatin-immunoreactive nerves. Urinary retention, bladder areflexia and deficient sensation may be directly linked to neuropeptide neuropathy in patients with lower motor neurone lesion.     

逍遥散加减配合七白散治疗女性肝郁气滞型黄褐斑的临床效果

目的 探讨逍遥散加减配合七白散治疗女性肝郁气滞型黄褐斑临床效果。方法 选择2021年 1月-2023年1月我院收治的肝郁气滞型黄褐斑女性患者60例为研究对象,随机分为对照组和观察组,每 组30例。对照组实施逍遥散加减治疗,观察组在对照组基础上配合七白散治疗。比较两组中医症候积分、皮 损面积、色斑颜色,血清MDA、LPO、SOD水平改善情况以及并发症发生率。结果 两组治疗后中医症候积 分、皮损面积、色斑颜色各项评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P ＜0.05）; 两组治疗后血清MDA、LPO水平低于治疗前,血清SOD水平高于治疗前,且观察组MDA、LPO水平低于 对照组,SOD水平高于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率低于对照组,差异有 统计学意义（P ＜0.05）。结论 逍遥散加减配合七白散治疗女性肝郁气滞型黄褐斑临床效果确切,可有效 改善患者皮损面积、色斑颜色,调节血清水平,降低并发症发生几率。     

糖尿病并发下肢血管病变的发病机理及治疗进展

目的介绍糖尿病合并下肢血管病变的发病机理及治疗进展。方法复习近几年的相关文献，进行综述。结果糖尿病为周围动脉病变的主要危险因素之一，糖尿病血管病变包括大血管病变和微血管病变两种，动脉硬化和微循环的血流减少是下肢缺血的重要因素。下肢的缺血性病变是糖尿病的常见并发症，内科治疗及外科治疗均可改善其症状。结论外科治疗是治疗糖尿病合并下肢血管病变的有效方法。     

糠酸莫米松乳膏治疗皮炎湿疹的临床效果

目的 探究糠酸莫米松乳膏治疗皮炎湿疹的有效性及安全性。方法 选取镇江市第一人民医院2022年 1月-2023年12月收治的80例皮炎湿疹患者为研究对象,根据治疗方式不同分为参照组和研究组,各40例。 参照组给予丁酸氢化可的松乳膏治疗,研究组给予糠酸莫米松乳膏治疗,比较两组临床疗效、疾病复发 率、不良反应发生率、靶皮损面积、皮损面积评分及皮肤屏障功能指标。结果 研究组治疗总有效率为 95.00%,高于参照组的75.00%（P ＜0.05）;研究组复发率为0,低于参照组的10.00%（P ＜0.05）;研究组 不良反应发生率为2.50%,低于参照组的15.00%（P ＜0.05）;研究组治疗后靶皮损面积小于参照组,皮损 面积评分低于参照组（P＜0.05）;研究组治疗后皮肤油脂、皮肤湿度、角质层含水量均高于参照组,经皮 肤水分丢失低于参照组（P ＜0.05）。结论 糠酸莫米松乳膏治疗皮炎湿疹的效果良好,可有效缩小靶皮损 面积及改善皮损症状,治疗后复发率和不良反应发生率均较低,有利于改善患者的皮肤屏障功能,值得临 床应用。     

595 nm脉冲染料激光联合0.5%马来酸噻吗洛尔滴眼液治疗 浅表性血管瘤的临床效果

目的 探讨595 nm脉冲染料激光联合0.5%马来酸噻吗洛尔滴眼液对浅表性血管瘤的临床治疗效 果。方法 选取2020年3月-2023年3月青羊西婵光华医疗美容门诊部收治的140例浅表性血管瘤患者为研究 对象，随机分为观察组和对照组，各70例。对照组采用595 nm脉冲染料激光法进行治疗，观察组在对照 组的基础上联合0.5%马来酸噻吗洛尔滴眼液进行治疗，比较两组临床疗效、病灶厚度变化情况及不良反 应发生情况。结果 观察组临床治疗总有效率为97.14%，高于对照组的74.29%（P＜0.05）；两组治疗后 病灶厚度低于治疗前，且观察组低于对照组（P＜0.05）；观察组不良反应发生率为5.72%，低于对照组的 21.43%（P＜0.05）。结论 595 nm脉冲染料激光联合0.5%马来酸噻吗洛尔滴眼液对浅表性血管瘤的临床治 疗效果确切，可降低患者病灶厚度，安全性良好。     

Prolonged endarterectomy in distal forms of arterial diseases of the lower extremities

Six-year experience of surgical treatment of patients with critical lower limb ischemia due to a distal form of arterial lesion is presented. Surgical treatment was performed in extended occlusive lesion from inguinal fold to arteries of the calf and foot, and inadequate "ways of outflow". The king of arterial lesion did not permit the surgeon to perform typical bypass surgery or arterialisation of venous system with a traditional scheme. All the patients were candidates for amputation. For salvage of extremity 36 patients underwent prolonged semi-closed endarterectomy using special instrument which was supplemented with temporary arterio-venous fistula or popliteal-distal auto-venous bypass. In short-term period after surgery critical ischemia was eliminated in 25 (69%) patients. The rest of the patients underwent amputations. 5 years later cumulative safety of the extremities was 95% among patients with good short-term results. These variants of revascularizing surgery may be regarded as alternative to amputations in patients with critical limb ischemia due to distal lesions of lower limbs arteries.     

Comparison of tacrolimus and cyclosporin in renal transplantation by the protocol biopsies

Acute and chronic lesion scores on renal allograft protocol biopsies may predict long-term graft function. The aim of this study was to compare the effects of tacrolimus (Tac) and cyclosporine microemulsion (CsA) based immunosuppressive protocols using protocol biopsies from well-functioning renal allografts. 35 consecutive renal transplant patients were randomized to Tac (n: 17) versus CsA (n: 18) treatment arms. Patient age and sex, donor type and age, histocompatibility, cold ischemia time and prior delayed graft function were similar between the two groups. Treatment protocol consisted of prednisolone, azathioprine and Tac or CsA. Biopsies performed on the third, sixth and twelfth months were blindly evaluated by the same pathologist. The incidences of acute rejection (AR) episodes among CsA vs Tac groups were 33% vs 29%, respectively (NS). The Creatinine level was lower in Tac than CsA, although it was not significant (Table). Subclinical AR and subclinical chronic allograft nephropathy were detected on protocol biopsies in 3 (2 CsA, 1 Tac) and 12 (7 CsA, 5 Tac) patients, respectively. Acute lesion score at the third month PBx was significantly lower in the Tac group (p < 0.05). Chronic lesion scores in all biopsies were lower in the Tac group, although not significantly. The protocol biopsy findings suggest that graft injury may be less pronounced among the Tac group.     

Methylene blue guidance for simplified resection of a lung lesion.

A 60-year-old patient returned 1 year after right pneumonectomy with a new primary squamous cell carcinoma of the left lower lobe. Using fluoroscopic guidance, the lesion and the shortest track to the surface were marked by methylene blue preoperatively. The lesion was easily excised by wedge resection without the need for manipulation or deflation of the lung.     

Percutaneous management of perinatal spontaneous rupture of a calyceal diverticulum

We report a case of spontaneous rupture of a calyceal diverticulum in a perinatal woman who was treated with percutaneous procedure. A 28-year-old woman, who delivered a full-term healthy male infant 13 days prior to hospitalization, was admitted complaining of left progressive severe flank pain. Kidney-urethra-bladder X-ray showed a space-occupying lesion in the lower pole of the left kidney. Drip intravenous pyelography revealed the left renal pelvis and calyx to be pushed up. Renal computed tomographic scan demonstrated a cystic lesion in the lower pole of the left kidney with a perirenal hematoma. After percutaneous puncture followed by indwelling of 8 Fr. balloon catheter within the cystic lesion for drainage, the patient recovered dramatically. Retrograde and antegrade pyelography showed the cystic lesion communicating with an adjacent calyx in the lower pole of the left kidney. The physiological relationship to pregnancy is discussed as a possible etiological factor in the unique occurrence of this rare rupture, and the literature is reviewed.     

Anterior shoulder instability with humeral avulsion of the glenohumeral ligament lesion

Humeral avulsion of the glenohumeral ligament (HAGL) is a rare lesion. The purpose of this study was to analyze the clinical manifestations of HAGL lesions in patients who underwent operative treatment for anterior shoulder instability. Six patients with HAGL lesions were studied. Four patients had an HAGL lesion associated with a Bankart lesion, and two had an isolated HAGL lesion. The range of motion at final follow-up showed a loss of 1 degree in forward flexion and of 15 degrees in external rotation. During an operation to treat anterior shoulder instability, a thorough examination for not only Bankart lesions but also other associated lesions, including an HAGL lesion, should be considered to lower the risk of redislocation. In repairing an HAGL lesion, the surgeon should keep in mind the possibility of a postoperative loss of external rotation and follow an active rehabilitation protocol to obtain successful results.