卵巢恶性生殖细胞肿瘤患者保留生理功能的治疗

卵巢恶性生殖细胞肿瘤多发于青少年,在中国和亚洲其他地区,其发病率远高于西方国家,占全部卵巢恶性肿瘤的5%～20%.卵巢恶性生殖细胞肿瘤主要包括无性细胞瘤、未成熟畸胎瘤、内胚窦瘤、胚胎癌、原发性绒癌以及混合性生殖细胞肿瘤,前三者最常见.由于该疾病大多数生长迅速、恶性程度高、预后差且多发于年轻妇女甚至是幼女而受到临床医生的高度重视.在有效的化疗方法使用前,卵巢内胚窦瘤及未成熟畸胎瘤手术治疗后的存活率仅为7.1%和27%,而且过大的手术范围不仅使患者丧失了生育功能,更因为卵巢的切除而影响第二性征的发育,严重影响患者今后的生存质量.随着联合化疗的应用和不断改进,卵巢恶性生殖细胞肿瘤的存活率逐渐提高,达到87%～97.3%.与卵巢其他恶性肿瘤有所不同的是,该病的治疗方案需根据临床期别、病理组织学特征、患者年龄及生育要求等综合考虑.     

Panfacial fractures: analysis of 33 cases treated late.

PURPOSE: The aim of this retrospective study was to analyze the characteristics of delayed panfacial fractures and evaluate treatment results. PATIENTS AND METHODS: Thirty-three patients with delayed panfacial fractures were treated in the Maxillofacial Trauma Center of Peking University, School and Hospital of Stomatology between 1998 and 2004. Each patient was examined by computed tomography (CT) scans before operation. For those who had no severe opening restriction, dental impressions were taken to fabricate dental casts. For those with severely comminuted fractures, 3-dimensional (3D) models of the facial skeleton were used. Re-establishing the continuity of the mandible was the first step and then used as a platform to reconstruct the maxillary fractures via maxillomandibular fixation after Le Fort I osteotomy. The third step was to restore the mid- and upper-facial width and projection by coronal approach to expose the zygomatic complex and frontal bone/sinus and/or naso-orbito-ethmoid (NOE) fractures. RESULTS: There were 3 types of mandibular fractures that affected the treatment plan: 1) type I, mandibular body/symphysis fracture(s) (17/33, 51.52%); 2) type II, mandibular angle and/or condylar fracture(s) (6/33, 18.18%); and 3) type III, both mandibular body/symphysis and angle/condylar fractures (10/33, 30.30%). Fourteen cases were associated with NOE fractures (42.42%) and 3 cases had frontal sinus fractures (9.1%). Twelve cases had enophthalmos (36.36%) and 3 lost 1 eyeball. The order of treatment was dependent on the mandibular fracture type. For type I fractures, reconstructing the mandibular arch was the first step. For type II fractures, repairing the angle, ascending rami, and condylar areas was the first step. For type III fractures, when both mandibular height and arch were disrupted, freeing the malunited angle or condyle was the first step before restoring the mandibular arch form. Reconstruction of the mandibular height and projection was then carried out. For all 3 types, the second step was to restore the mid- and upper facial width and projection by reducing the zygomatic complex and frontal bone/sinus or NOE fractures. Maxillary fixation across the Le Fort I level was the last step. Le Fort I osteotomy was used for all 33 cases. Bone grafts and soft tissue suspension also were used. Twenty-one cases (63.64%) had good results, 7 (21.21%) cases were acceptable, and 5 (15.15%) were not good. There were 7 cases (21.21%) that still had soft tissue problems that needed secondary operations. CONCLUSIONS: Reconstruction of the mandible first with Le Fort I osteotomy is a good way to treat delayed panfacial fractures. Computed tomography and 3D CT, model surgery, and occasionally 3D models are necessary aids for diagnosis and treatment. Soft tissue problems, including lacerations and asymmetries, were often the factors that caused an unfavorable outcome.     

超声诊断不典型胃穿孔1例

<正> 患者男性,52岁,突发上腹痛6 h来诊。疼痛呈持续性,无放射痛,无呕吐、腹泻、黄疸。既往有胃溃疡病史。查体:神清,T37.8℃,痛苦面容,平卧位,巩膜皮肤无黄染,心肺(-),上腹部压痛,轻度肌卫,无反跳痛,肝浊音界存在,移动性浊音(-),肠鸣音减弱。化验:WBC12.0×10~9/L、中性0.87。腹     

Reconstruction of distal phalanx defect with microsurgical fascia latae flaps combined with rib and skin graft]

OBJECTIVE: To evaluate the clinical application of microsurgical fascia latae flaps combined with rib and skin graft for reconstruction of the distal phalanx defect. METHODS: The phalanx wounds were sutured together like syndactyly. The autologeous rib was revised to repair the bone defect of distal phalanx. The fascia latae flap was used to cover the bone exposure with microvascular anastomoses and resurfaced by a meshed split-thickness skin graft. RESULTS: 5 cases were treated successfully. The fascia latae flaps were all survived with only skin graft necrosis at the distal end in one case. It was healed spontaneously. CONCLUSIONS: The fascia latae flap is nourished by the desending branch of the lateral circumflex femoral artery. The flaps has a good blood supply and can be easily obtained with a long vascular pedicle. The flap is ideal for the reconstruction of distal phalanx defect when combined with autologeous rib implant and skin graft.     

Announcement

The name of one of the contributing authors to this paper was omitted from the list of authors that appeared on page 373. The correct list of authors and affiliations are printed below:     

Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration.

The accuracy of myocardial perfusion SPECT improves with attenuation correction. Algorithms for attenuation correction in hybrid SPECT/CT systems have the potential for misregistration of emission and transmission scans because CT and SPECT are obtained sequentially. Misregistration will influence regional tracer distribution and may reduce diagnostic accuracy. This study focused on the role of misregistration in cardiac SPECT/CT and the performance of a software-based approach for reregistration. METHODS: We included 105 consecutive patients who underwent clinical myocardial perfusion imaging on a SPECT/CT system. Images were quantitatively assessed for misregistration using fusion software. Results were recorded in millimeters in the x-, y-, and z-axes. Regional tracer uptake in 6 segments (anterior, septal, inferior, lateral, anteroapical, and inferoapical) for noncorrected and attenuation-corrected images before and after reregistration was obtained from polar maps. To determine the relative influence of misregistration, we correlated individual differences between noncorrected and attenuation-corrected images, as well as between attenuation-corrected images before and after reregistration, with the degree of misregistration in a multivariate analysis including additional clinical variables such as sex and body weight. RESULTS: The difference in regional radiotracer uptake was significant between noncorrected and attenuation-corrected images in all 6 segments and was most pronounced in the inferior wall. On multivariate analysis, misregistration contributed significantly to changes in radiotracer distribution in the anterior (P = 0.038), septal (P = 0.011), and inferior (P = 0.006) segments. The mean misregistration was 8.6 +/- 3.8 mm (1.25 +/- 0.55 pixel). Misregistration of one or more pixels was observed in 64% of studies. Reregistration of misalignment significantly affected regional radiotracer distribution in the segments shown to be influenced by misregistration. CONCLUSION: Misregistration occurs with SPECT/CT systems and influences regional tracer distribution on attenuation-corrected myocardial images. Reregistration of misaligned studies may be a useful tool for correction. The impact of this strategy on the diagnostic and prognostic accuracy of cardiac hybrid imaging needs to be determined.     

Sudden death due to arrhythmogenic right ventricular cardiomyopathy: Two case reports

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of primary myocardial disease characterized by the regional or global replacement of right ventricular myocardium by fatty and fibrolipomatous tissues. The ARVC, usually presenting with different clinical manifestations and pathological changes, were mainly seen in young men and is one of the main causes of sudden death in the young. Here two autopsied cases of Chinese men aged 30 and 23 years old who appeared healthy but died suddenly while at work are reported respectively. One of the victims had extensive and severe pathological changes in his heart involving the left ventricular wall as well as the ventricular septum and the right atrium. Not only was there a global fatty and fibrolipomatous tissue replacement of the right ventricular myocardia, but also mild sarcoplasmic coagulation in the myocardium and focal lymphocytic infiltration in the myocardial interstitium of the right ventricular wall. In addition, slight atherosclerosis of the coronary artery and intimal thickening of the sino-atrial node were observed. It is believed that there are no marked differences in the pathological changes of ARVC between Chinese patients and patients from western countries. The etiology and pathogenesis of ARVC could not be explained by a single cause or factor and they are probably related to various congenital and acquired causes or factors.     

改良静脉穿刺方法的效果观察

在临床上静脉穿刺是最常见的护理操作之一.穿刺成功与否对治疗至关重要,并直接影响病人对护理工作的满意度.笔者经过20年临床实践,将静脉穿刺方法进行改革,取得了一定的效果.现介绍如下.……