改良去带盲结肠可控膀胱术

目的：评价改良去带盲结肠可控膀胱术的临床价值。方法：对8例膀胱癌患者施行全膀胱切除和改良去带盲结肠可控膀胱术。结果：随访3－41个月，均获得良好的疗效。贮尿囊容量为260－700ml，贮尿囊内最大压力为0.981-2.940kPa，每3－6h导尿1次，血清电解质和肾功能正常。结论：本术式可以获得大容量、低内压的贮尿囊，具有可控效果好、操作简单和并发症少等优点。     

Results of Surgical Salvage after Failed Chemoradiation Therapy for Epidermoid Carcinoma of the Anal Canal

Background The standard treatment for epidermoid carcinoma of the anal canal consists of combined radiation and chemotherapy. For patients who present with persistent or locally recurrent disease, salvage abdominoperineal resection is the treatment of choice. The purpose of this study is to review our experience with salvage surgery in this group of patients. Methods From 1990–2002, 31 patients underwent radical salvage surgery with curative intent after failure of initial sphincter-conserving therapy, and the medical records of these patients were retrospectively reviewed. Clinicopathologic variables were determined and comparisons performed with the Cox proportional hazards model. Survival was calculated by the Kaplan–Meier method. Results Eleven patients underwent radical salvage surgery for persistent disease and 20 patients for recurrent disease. The median follow-up time was 29 months. The actuarial 5-year overall survival was 64%. Twelve patients developed recurrent disease after radical salvage surgery. Patients who received an initial radiation dose of less than 55 Gy had a significantly worse survival than those who received at least 55 Gy as part of their initial treatment (5-year overall survival 37.5% vs. 75%; age-adjusted hazard ratio 8.2 [95% CI: 1.1–59.8], P = .037). The presence of positive lymph nodes at presentation also adversely affected survival (P < .05). Factors that were not found to have an impact on survival included the presence of persistent versus recurrent disease, tumor (T) stage, and margin status of resection. Conclusions Long-term survival following salvage surgery for persistent or locally recurrent epidermoid carcinoma of the anal canal can be achieved in the majority of patients. However, patients who initially present with node-positive disease and patients who receive a radiation dose of less than 55 Gy as part of their initial chemoradiation therapy regimen have a worse prognosis after radical salvage surgery.     

钢板辅助固定治疗股骨干骨折髓内钉固定术后骨不连

目的探讨断端周围植骨、钢板辅助固定治疗股骨干骨折髓内钉固定术后骨不连的临床疗效。方法采用保留原髓内固定、断端局部清理、辅助钢板固定、断端周围植骨的方法治疗股骨干骨折髓内钉固定术后骨不连的患者12例。结果12例患者经此方法治疗,随访观察8～13个月,平均11个月,10例达骨性愈合,愈合率达83．3％。结论．辅助钢板治疗股骨干骨折带锁髓内钉固定术后骨不连方法简单,疗效可靠。     

金属对金属髋关节表面置换术的短期随访研究

目的探讨金属对金属(MOM)混合固定型髋关节表面置换术(HRA)的近期疗效,分析手术技术要点。方法 2004年10月至2008年6月,对52例(58髋)股骨头缺血性坏死、骨关节炎、髋关节发育不良、强直性脊柱炎患者行MOM-HRA。其中男32例,女20例;年龄16～65岁,平均42.6岁。手术方法按照K.De.Smet标准方法进行,术后对Harris评分、关节活动度和X线片进行随访。结果失访7例(8髋),45例(50髋)获得随访,随访时间平均22个月(12～54个月)。术前平均Harris评分(37.0±1.2)分,术后22个月平均(93.0±1.0)分;术前屈髋度平均(25.3±1.6)°,术后22个月平均(105.0±1.8)°;术前外展度平均(18.8±0.8)°,术后22个月平均(40.6±1.0)°。评价:46髋优,3髋良,1髋差。无股骨颈骨折,无松动,无脱位,无感染,无翻修,1例异位骨化BrookerⅢ型。结论 HRA具有保留股骨头骨量、术后关节活动度恢复快、近期结果好等优点,对于获得优良的术后结果,严格的患者选择和精确的手术技术至关重要。     

肾上腺转移癌的诊治

目的 总结肾上腺转移癌的临床特点与诊治体会.方法 回顾性分析1996年12月至2010年4月收治47例肾上腺转移癌患者资料.男32例,女15例.平均年龄54(36～70)岁.单侧肾上腺转移42例,其中左侧25例、右侧17例,双侧5例.原发肿瘤包括肺癌24例、肾癌6例、肝癌5例、乳腺癌4例、黑色素瘤2例,其他肿瘤6例.临床表现全身乏力、消瘦、贫血或低热17例,患侧腰背部胀痛9例,高血压6例.均经B超、CT、MRI及正电子发射断层扫描(PET)检查确诊.行手术治疗36例,放弃手术11例.结果 完整切除转移癌者31例获随访,生存2～62(33.8±4.5)个月,最长存活64个月;失访5例.11例放弃手术者6例获随访,生存4～8(6.3±2.7)个月,均死于肿瘤晚期或多发转移.结论 B超及CT检查是诊断肾上腺转移癌的重要方法,PET有较高的临床诊断价值.手术完整切除肾上腺转移灶可延长患者生存期,但需严格控制适应证.     

盐酸左氧氟沙星注射液细菌内毒素检查法的研究

目的：探讨建立盐酸左氧氟沙星沙星注射液细菌内毒素检查法,方法：用不同厂家的鲎试剂对3批样品进行干扰试验,结果：盐酸左氧氟沙星注射液在6倍稀释时无干扰作用,结论：可以用鲎试验法代替家兔法检查盐酸左氧氟沙星注射液中的热原。     

血清D-二聚体测定对急性肠系膜上动脉栓塞的诊断价值

目的 评估测定血清D-二聚体（D-dimer）含量在诊断急性肠系膜上动脉（superior mesenteric artery,SMA）栓塞中的价值。方法将我院1998年6月-2006年6月入院诊断或出院诊断为急性肠系膜血管缺血性疾病的63例分为SMA栓塞（11例）和其它急腹症（52例）两组。使用ROC曲线法评价D-二聚体对SMA栓塞的诊断价值,明确D-二聚体的诊断临界点,绘制ROC曲线。结果ROC曲线下面积为0．939,并有统计学意义。通过ROC曲线确定诊断临界点为0．73mg／L,并具有较高的灵敏度和特异度。结论血清D-二聚体测定可用于急腹症中SMA栓塞的临床排除诊断。当血清D-二聚体高于0．73mg／L时,应高度怀疑为SMA栓塞。     

Are there anatomical barriers to laparoscopic donor nephrectomy?

Background: The aim of this study was to analyse the effect of the right donor kidney and multiple arteries, on donor and recipient outcomes in the era of laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analysed the 200 donors and recipients who underwent a planned laparoscopic nephrectomy at two hospitals between September 1998 and December 2006. The impact of donor right kidney and multiple donor renal arteries on operative time, hospital stay, graft function, and donor and recipient complications were analysed. Results: Of the total cohort (n = 200), 140 (70%) were classified as Simple LLDN (left live donor kidney with single renal artery). The Complex LLDN group (n = 60) contained all right‐sided kidney (n = 28) and left‐sided kidneys with multiple renal arteries (n = 32). Baseline characteristics, extraction time, conversion to open, length of admission, overall graft function and complication rates were similar between the simple and complex groups. The second warm ischaemic time in the Simple LLDN group was slightly shorter than the Complex LLDN group (32 versus 36 min P = 0.016). The 1‐month post‐operative recipient serum creatinine level was lower in the Simple LLDN group when compared with the Complex LLDN group (117 versus 125 µmol/L P = 0.025). There was no difference in post op dialysis, acute rejection within 3 months or graft survival between the Simple and Complex LLDN groups. Conclusion: Laparoscopic procurements of right kidneys and kidneys with multiple arteries were safe and yielded kidneys with excellent function comparable with those of laparoscopic left donor nephrectomy with single artery.     

甲基化CpG结合域蛋白1在胰腺癌组织中的表达和意义

目的：检测甲基化CpG结合域蛋白I（MBD1）蛋白在胰腺癌组织中的表达，并探讨其临床意义。方法：应用S-P免疫组织化学法检测38例胰腺癌、17例胰腺癌旁组织、8例胰腺良性肿瘤、3例慢性胰腺炎和6例正常胰腺组织中MBD1蛋白的表达。结果：MBD1在胰腺癌组织、正常胰腺组织、胰腺良性肿瘤、胰腺癌旁组织中的表达阳性率分别是76．32％（29/38）、16．67％（1／6）、25．0％（2／8）、29．41％（5／17），3例慢性胰腺炎标本中未见表达；胰腺癌阳性表达率明显高于正常胰腺、慢性炎症、良性肿瘤和癌旁对照组织（P〈0．05）。MBD1表达水平的高低与病人的性别、年龄、肿瘤部位、肿瘤大小、分化程度和TNM分期无显著性差异（P〉0．05）；而与淋巴结转移密切相关，有淋巴结转移者胰腺癌组织MBD1的表达阳性率为92．31％（24／26），高于无淋巴结转移者的41．67％（5／12）（P〈0．01）。结论：胰腺癌中MBD1呈高水平表达，并与胰腺癌的高转移侵袭活性有关，其机制可能与MBD1介导抑制多个甲基化相关抑癌基因的表达有关。MBD1的转录调控机制有待进一步研究。     

Toll‐like receptor 4 signaling regulates the acute local inflammatory response to injury and the fibrosis/neovascularization of sterile wounds

The role of Toll‐like receptor 4 (TLR4) in the regulation of inflammation and fibrosis in sterile wounds was investigated in TLR4 signal‐deficient (C3H/HeJ or TLR4^?/?) and control mice using the subcutaneously implanted polyvinyl alcohol sponge wound model. Total and differential wound cell counts 1, 3, and 7 days after injury did not differ between C3H/HeJ and C3H/HeOuJ animals. Blood monocytes from both strains expressed CCR2 equally. Day one wounds in C3H/HeJ mice contained fewer Gr‐1^high wound macrophages, CCL3, and CCL5, and more CCL17 than those in controls. The accumulation of CCL2, CX3CL1, tumor necrosis factor‐α, interleukin (IL)‐6, IL‐10, IL‐12, and interferon‐γ in wound fluids was not TLR4 dependent. Wound macrophages from C3H/HeJ and C3H/HeOuJ mice expressed CCR4 and CCR5, but not CCR1 or CCR3. Wound macrophage recruitment was not altered in CCR5^?/? mice or in C3H/HeOuJ animals injected with neutralizing anti‐CCL3 and anti‐CCL5 antibodies. Neutralization of the CCR4 ligand CCL17 in C3H/HeJ mice did not alter wound macrophage populations. There was a twofold increase in collagen content and number of neovessels in 21‐day‐old wounds in C3H/HeJ vs. C3H/HeOuJ mice. There were no differences between strains in the number of myofibroblasts in the wounds 7 or 21 days postwounding. The increased fibrosis and angiogenesis in wounds from /HeJ mice correlated with higher concentrations of transforming growth factor‐β and fibroblast growth factor 2 in wound fluids from these animals. Wound fluids did not contain detectable lipopolysaccharide and did not induce IκBα degradation in J774.A1 macrophages. Results support a role for endogenous ligands of TLR4 in the regulation of inflammation and repair in sterile wounds.