做好当前临床外科教学工作的思考

应从提高教师队伍素质、提倡主动式教学、专科教育、指导学生处理好医患关系、提高法律意识和自我保护意识、制定统一的教学内容和目标等方面，做好临床教学工作。     

腹腔镜辅助阴式子宫切除术与经腹子宫切除术的前瞻性随机对照研究

目的　比较评估腹腔镜辅助阴道子宫切除术与经腹子宫切除术两种手术的临床效果。方法　 12 0例妇科良性疾病患者需行子宫切除术 ,但有经阴道子宫切除术的相对禁忌证、子宫不超过孕 16周 ,随机分成两组 ,甲组 (6 0例 )行腹腔镜辅助阴式子宫切除术 ,乙组 (6 0例 )行经腹子宫切除术。结果　两组患者年龄、产次、术前血红蛋白水平、子宫平均重量、术中失血、手术时间的差异无显著性 (P >0 .0 5 )。甲组术后疼痛程度、术后住院时间明显少于乙组 (P <0 .0 1) ,两组均未出现严重手术并发症。结论　腹腔镜辅助阴式子宫切除术具有创伤小、恢复快、住院时间短等优点 ,妇科医师经过良好的腹腔镜手术操作技能培训 ,能对大部分原不宜行阴式子宫切除术而需行经腹子宫切除术的患者行腹腔镜辅助阴式子宫切除术。     

联合应用口服水剂和水灌肠肠道充盈法的MSCT研究

目的：评价口服水剂、水灌肠及两者联合应用充盈肠道后,使用MSCT显示成人正常肠道的能力。材料和方法：将43名非肠道病变志愿者分别采用口服水剂法(21例)、水灌肠法(12例)、双重法(口服水剂和水灌肠联合应用,10例)充盈肠道,然后行MSCT平扫和增强扫描并进行图像重建,对小肠和大肠各肠段充盈状态进行评价。结果：口服水剂法回肠充盈良好,水灌肠法大肠充盈良好,双重法回肠及大肠均充盈良好。口服水剂法小肠充盈优于水灌肠法,与双重法无显著差异,大肠充盈状态水灌肠法明显优于口服水剂法,与双重法无显著差异。结论：口服水剂和水灌肠联合应用可以在MSCT同时较好地充盈显示小肠和大肠,而两种方法单独使用则仅能分别充盈显示小肠和大肠,需要根据显示目的选择相应的充盈方法。     

Evaluation of peripheral blood involvement of mantle cell lymphoma by fluorescence in situ hybridization in comparison with immunophenotypic and morphologic findings.

Mantle cell lymphoma is non-Hodgkin's B-cell lymphoma characterized by the t(11;14)(q13;q32) translocation. Peripheral blood involvement of mantle cell lymphoma is usually associated with a poor prognosis and therefore, its identification is clinically important. In this study, we performed cyclin D1/IgH-probe fusion fluorescence in situ hybridization analysis on 223 peripheral blood samples: 185 from 125 mantle cell lymphoma patients, and 38 normal controls. The cutoff values for the test were established using normal controls. Flow cytometry on peripheral blood and corresponding bone marrow samples was used to evaluate this test. In all, 26% of the 185 peripheral blood samples and 27% of the 161 corresponding bone marrow samples were flow cytometry positive for mantle cell lymphoma. The mean numbers of single and- double-fusion signals and the mean number of CD5/CD19-positive cells, absolute blood lymphocyte count, and white blood cell count were significantly higher in peripheral blood and corresponding bone marrow samples with mantle cell lymphoma-positive flow cytometry. Double-fusion signals were more specific than single-fusion ones. Fluorescence in situ hybridization was far more likely to be positive for mantle cell lymphoma when the peripheral blood and the corresponding bone marrow samples had positive flow cytometry results or morphology (P<0.01). Our study indicates that cyclin D1/IgH-fusion fluorescence in situ hybridization analysis could be used to determine the presence and character of circulating mantle cell lymphoma cells in peripheral blood, thus enhancing our ability to evaluate leukemic mantle cell lymphoma and minimum residual disease.     

“鸡皮疙瘩”，非典型肌肤恐怖片

有一套系列恐怖畅销书叫做《鸡皮疙瘩丛书》，意思是故事恐怖到让看书人身上起满鸡皮疙瘩。可是，当你并不觉得寒冷或害怕时身上依然出现鸡皮疙瘩，那就代表着一种并不算恐怖却令许多女生苦恼不已的皮肤问题——毛周角化症。[编者按]     

Monitoring the protective effects of minocycline treatment with radiolabeled annexin V in an experimental model of focal cerebral ischemia.

Minocycline is an antibiotic now recognized to have antiapoptotic and antiinflammatory properties. Because of these properties, minocycline may be of benefit in reducing neuronal apoptosis from ischemia and subsequent postischemic inflammation if administered soon after a stroke. We now explore the feasibility of using (99m)Tc-annexin V, an in vivo marker of apoptosis, with SPECT to monitor the antiapoptotic effects of minocycline therapy. METHODS: CB6/F1 adult male mice underwent unilateral distal middle cerebral artery occlusion (dMCA) occlusion and were imaged and sacrificed at 1, 3, 7, or 30 d after injury. Animals were given minocycline (or vehicle) 30 min and 12 h after dMCA occlusion and then given 22.5 mg/kg twice daily for up to 7 d. Before imaging, behavioral tests were performed to evaluate the neurologic function. After imaging, brains were collected for histology and assessed for the degree of apoptosis and microglial activation. RESULTS: (99m)Tc-Annexin V uptake in injured hemispheres was significantly decreased 2- to 3-fold by minocycline at all time points. Minocyline reduced infarct size as seen histologically and improved behavioral indices as late as 30 d. Infarct volume as seen histologically correlated with radiolabeled annexin V uptake seen by SPECT. In situ fluorescent microscopy demonstrated that annexin V bound primarily to neurons at 1 and 3 d, with a shift toward microglia by 7 and 30 d. CONCLUSION: We found that minocycline significantly reduces neuronal apoptosis and infarct size and improves neurologic outcome in mice after acute focal cortical ischemia.     

A case of congenital supratentorial tumor: Atypical teratoid/rhabdoid tumor or primitive neuroectodermal tumor?

Two embryonal CNS tumors, atypical teratoid/rabdoid tumor (AT/RT) and primitive neuroectodermal tumor (PNET), may be confused with each other and misdiagnosed. Here we report an infant with a congenital supratentorial tumor, which was detected by fetal MRI at 37 weeks gestation. On routine histological examination, the tumor was composed mainly of small undifferentiated cells, among which many rhabdoid cells and occasional sickle‐shaped embracing cells were observed. No mesenchymal or epithelial areas were evident. Our impression was that the tumor was an atypical example of AT/RT. Immunohistochemically, almost all the tumor cells were strongly positive for vimentin. However, epithelial membrane antigen was notably negative, and most of the tumor cell nuclei were clearly positive for INI1. In addition, many tumor cells were positive for neurofilament protein. There were also occasional small areas containing many tumor cells positive for glial fibrillary acidic protein. Finally, a diagnosis of PNET, with a rhabdoid phenotype and expression of neuronal and glial markers, was made. In the present case, application of INI1 immunostaining was very helpful for distinguishing PNET from AT/RT.