聚丙烯补片预防游离腹直肌皮瓣术后切口疝的作用

目的 探讨聚丙烯补片（Prolene)预防游离腹直肌皮瓣术后切口疝发生的作用。方法 1999年11月9日-2000年10月22日对26例患者行游离腹直肌皮瓣移植术时,采用聚丙烯补片作腹直肌前鞘修补,分析聚丙烯补片植入后的组织反应及创口愈合情况,以及切口疝发生的情况。结果 25例患者腹部创口均Ⅰ期愈合,1例术后腹部创口出现局部积液,经保守治疗好转,未出现排异和感染等并发症,术后随访1-12个月,全部患者聚丙烯补片愈合良好,无排出或取出,腹部不适,切口疝及腹壁膨隆。结论 聚丙烯补片具有较好的生物相容性,其植入体内后不会发生排异和增加创口感染的机会,用于腹直肌前鞘的修补安全可靠,能有效预防游离腹直肌皮瓣术后切口疝的发生,值得进一步观察和应用。     

贲门癌患者围术期肠内营养的临床研究

目的研究贲门癌患者围术期肠内营养的实施方法、效果。方法对209例贲门癌患者依据术后给予不同的营养支持方法随机分为两组,肠内营养组146例,术后施行早期肠内营养;静脉营养组63例,贲门癌术后给予全静脉营养支持;比较两组患者术后并发症发生情况,术后恢复情况,检测手术后理化指标。结果两组患者术后均未发生吻合口瘘。术后并发症发生率肠内营养组明显低于静脉营养组(P<0.01),而肠内营养组腹泻发生率高于静脉营养组(P<0.01),两组腹胀发生率差异无统计学意义(P>0.01)。术后肠鸣音恢复时间,肛门排气、排便时间和住院时间,肠内营养组较静脉营养组短(P<0.01)。术后白蛋白、球蛋白、总蛋白量肠内营养组高于静脉营养组(P<0.01),而血尿素氮、肌酐和中性粒细胞低于静脉营养组(P<0.01)。结论贲门癌患者围术期肠内营养是安全、有效、可行的,较静脉营养组有明显的优势。     

外伤性脾破裂保脾治疗的可行性及安全性分析

目的探讨外伤性脾破裂保脾治疗的可行性与安全性。方法对1998年7月至2005年7月收治的24例外伤性脾破裂患者,采用了保脾治疗:非手术保守治疗9例,保留脾手术15例,其中单纯粘合胶止血1例、单纯脾动脉结扎2例、单纯缝合修补3例、脾动脉结扎加脾修补4例、缝合修补加粘合胶止血2例、脾脏网兜捆扎术1例、脾部分切除术2例。结果在9例行非手术保守治疗中,有7例保守治疗成功,均痊愈出院,2例在保守治疗中转脾切除;15例保脾手术中2例因术后发生大出血而再次行脾切除术,其中1例抢救无效当时死亡。13例手术保脾成功,平均住院时间为13d。无其他合并症。结论外伤性脾破裂保脾治疗是可行的,但有一定风险,必须严格手术指征,手术方式依脾损伤分级或程度选择最佳术式,确保手术安全,术后应严密观察。     

经尿道前列腺汽化电切术早期并发症及防治

目的探讨经尿道前列腺汽化电切(TUEVAP)治疗良性前列腺增生(BPH)术后早期并发症发生的常见原因及相关因素,以提高手术的治疗效果,保证手术的安全性。方法回顾分析518例良性前列腺增生TUEVAP的临床资料。结果手术后早期并发症共73例,腺体残留7例(9.6%),尿路感染12例(16.4%),尿道狭窄18例(24.7%),术后出血23例(31.5%),轻度尿失禁5例(6.8%),阴茎勃起功能障碍6例(8.2%),电切综合征(TURS)2例(2.7%)。结论经尿道前列腺汽化电切除术术前预防治疗,术中熟练掌握操作技术及技巧,术后正确处理能有效减少各类并发症的发生,提高治愈率。     

Transduodenal local resection for low-risk group ampulla of vater carcinoma

BACKGROUND: Carcinoma of the ampulla of Vater has a more favorable prognosis, compared to other malignant tumors of the periampullary region, because it usually presents with symptoms in the early stage. However, treatment by local resection only of the ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of the ampulla of Vater carcinoma according to different types of operation in low-risk-group patients. METHODS: We retrospectively reviewed the medical records of 17 low-risk-group patients among a total of 102 patients with ampulla of Vater carcinoma who had underwent curative surgery from 1992 to 2002. All specimens were critically reviewed by a single expert pathologist, and the relationship between surgical outcomes and operation type was assessed. RESULTS: The low-risk group was comprised of 10 men and 7 women with a median age of 57.8 years. Thirteen of 17 patients underwent a pancreaticoduodenectomy (PD) or a pylorus preserving pancreaticoduodenectomy (PPPD), while 4 patients underwent a transduodenal local resection (TDLR). The operation time was significantly shorter in the TDLR group, compared to the PD or PPPD groups. Among the 17 patients, there was only 1 case of recurrence in the inguinal area 33 months after the pancreaticoduodenectomy. CONCLUSIONS: Transduodenal local resection is a comparable mode of operation for low-risk-group patients with Ampulla of Vater carcinoma. In particular, it is essential to evaluate the invasion depth in preoperative endoscopic ultrasonography, cell differentiation in preoperative biopsy, and positivity of resection margin accurately by using frozen section during the operation.     

Early outcomes of surgery for small bowel obstruction: analysis of risk factors

OBJECTIVES: The study aimed to review the etiologies of patients who underwent surgery for small bowel obstruction (SBO) and to evaluate the risk factors affecting the early postoperative outcomes. MATERIALS AND METHODS: A case series of 430 patients (252 men) with a mean age of 64.5 years, who underwent 437 operations for SBO, were retrospectively reviewed. RESULTS: Peritoneal adhesions and hernia were the most common causes of SBO, contributing 42.3 and 26.8% of all cases, respectively. Strangulation occurred in 27.7% and caused nonviable bowel in 13.0% of obstructing episodes. Old age (age >/= 70 years), female patient, nonadhesive obstruction, and hernia were the independent significant factors associated with bowel strangulation. The 30-day mortality was 6.5%, and the median postoperative hospital stay was 8 days. Old age, the presence of premorbid pulmonary disease, and malignant obstruction were the independent factors associated with operative mortality. The overall complication rate was 35.5%, and old age was the only significant factor associated with postoperative complications. CONCLUSIONS: Surgery for SBO is still associated with significant mortality and morbidity. As old age is significantly associated with an increased incidence of strangulation, operative mortality, and complications, this group of patients should be managed with extra cautions to avoid unfavorable outcome of surgery.     

Hypertension and albuminuria in chronic kidney disease mapped to a mouse chromosome 11 locus

Chronic kidney disease (CKD) is a key cause of hypertension and a potent independent risk for cardiovascular disease. Epidemiological studies suggest a strong genetic component determining susceptibility for renal disease and, by inference, the associated cardiovascular risk. With a subtotal nephrectomy model of kidney disease, we found the 129S6 mouse strain to be very susceptible to the development of hypertension, albuminuria, and kidney injury, whereas the C57BL/6 strain is relatively resistant. Accordingly, we set out to map quantitative trait loci conferring susceptibility to hypertension and albuminuria using this model with F2 mice. We found significant linkage of the blood pressure trait to two loci. At D11Mit143, mice homozygous for the 129S6 allele had significantly higher systolic blood pressure than mice heterozygous or homozygous for the C57BL/6 allele. Similarly, at D1Mit308, there was an excellent correlation between genotype and the blood pressure phenotype. The effect of the chromosome 11 locus was verified with a separate cohort of F2 mice. For the albuminuria trait, a significant locus was found at D11Mit143, which overlaps the blood pressure trait locus. Our studies have identified a region spanning approximately 8 cM on mouse chromosome 11 that is associated with susceptibility to hypertension and albuminuria in CKD.     

Effects of topical application of clonidine cream on pain behaviors and spinal Fos protein expression in rat models of neuropathic pain, postoperative pain, and inflammatory pain

BACKGROUND: Clonidine can effectively reduce pain and/or hypersensitivity. However, the antihypersensitivity effects of clonidine topically applied in cream (CC) have not been investigated. The authors evaluated effects of topical application of CC on pain behaviors and spinal Fos-like immunoreactivity in rats with hypersensitivity. METHODS: Clonidine (30, 100, and 300 microg/g) was prepared in a cream base. In rat models of neuropathic pain, inflammatory pain, and postoperative pain, the authors evaluated effects of CC (0.1 g), topically applied onto the plantar surface of the injured or uninjured paw, on thermal hyperalgesia and mechanical allodynia to von Frey filaments. The authors also evaluated effects of CC on lumbar spinal Fos-like immunoreactivity. RESULTS: In neuropathic rats, CC applied onto the injured paw reduced thermal hyperalgesia and mechanical allodynia dose dependently, whereas CC applied onto the uninjured paw had no effect. The antihypersensitivity effects of CC were antagonized by intraperitoneal yohimbine (10 mg/kg). Further, CC reduced Fos-like immunoreactivity in neuropathic rats. In contrast, CC in a single dose had no effects on hyperalgesia, allodynia, or Fos-like immunoreactivity in rats with inflammatory or postoperative pain. In rats with postoperative pain, CC repeatedly applied for 6 days reduced thermal hyperalgesia, but not mechanical allodynia, in the postoperative days, whereas it had no effects on hyperalgesia or allodynia in those with inflammatory pain. CONCLUSIONS: Topical CC in concentrations examined significantly reduced hypersensitivity and lumbar spinal Fos-like immunoreactivity in rats with neuropathic pain, probably through activation of peripherally located alpha2 adrenoceptors. However, CC was only partially effective and totally ineffective in rats with postoperative pain and inflammatory pain, respectively.     

Porcine PD-L1: cloning, characterization, and implications during xenotransplantation

BACKGROUND: Effective intervention achieved by manipulating cell-mediated xenogeneic immune responses would critically increase the clinical feasibility of xenotransplantation as immediate hyperacute rejections become controllable through genetic modulations of donor organs. Endogenous negative regulatory signals like the programmed death 1 (PD-1)-programmed death ligand 1 (PD-L1) system are candidate targets for the control of cell-mediated xenogeneic immune response. METHODS: A porcine PD-L1 molecule was cloned using RACE (rapid amplification of cDNA ends) technology based on the human PD-L1 sequence. The functional effects of cloned porcine PD-L1 were tested on human CD4(+) T cell activation using porcine PD-L1-transfected bystander cells. Cellular proliferation was monitored by [3H] thymidine incorporation, and human T cell apoptosis was measured by flow cytometry. RESULTS: Porcine PD-L1 (GenBank accession number AY837780) was found to have 73.8% sequence homology with human PD-L1 and to contain two immunoglobulin domains in its extracellular region. Moreover, porcine PD-L1 expressed on Chinese hamster ovary (CHO) cells inhibited human CD4(+) T cell proliferation stimulated with anti-CD3 only or anti-CD3 plus anti-CD28. Percentages of apoptotic activated human T cells increased by over 30% in the presence of porcine PD-L1/CHO cells, and the addition of recombinant human PD-1-Fc fusion proteins during human T cell activation reversed the inhibitory effects of porcine PD-L1. CONCLUSIONS: Cloned porcine PD-L1 showed high sequence homology with human PD-L1 and a similar molecular structure. Moreover, porcine PD-L1 inhibited human CD4(+) T cell activation in human PD-1-dependent manner, and this involved activated T cell apoptosis. The authors suggest that PD-1-PD-L1 might play an important endogenous immune regulatory role during xenogeneic transplantation, and that the effective application of this system would improve transplanted xenogeneic organ survival.     

Meningioma without dural attachment: case report, classification, and review of the literature

BACKGROUND: The primary occurrences of meningiomas without attachment to the dura are rare. Clinical considerations and pathophysiologic mechanisms about these tumors have not been sufficiently explored, and a complete classification has not been accomplished. CASE DESCRIPTION: A 16-year-old adolescent boy presented with epileptic seizure for 9 years. Neurologic deficits were not found on admission. Magnetic resonance imaging revealed a 25 x 23-mm mass lesion without dural attachment located in the parietooccipital region. The tumor was iso-intense on T1-weighted and hyperintense on T2-weighted images, and became clearly and heterogenously enhanced with gadolinium. During surgery, a right parietooccipital craniotomy revealed the tumor was completely buried in the sulcus occipitalis anterior. Total removal of the tumor was accomplished. Histologic examination indicated that the lesion was an atypical meningioma. CONCLUSION: According to sites of the tumor, supratentorial meningiomas without dural attachment are classified into 5 varieties, and posterior fossa meningiomas without dural attachment into 4 categories. Except for intraventricular ones, meningiomas without dural attachment predominantly occur in males. The average age is about 20 years younger than that of meningiomas in general. Fibroblastic meningiomas constitute the major subtype. Intraparenchymal or subcortical meningiomas should be considered as one type, which may arise from arachnoid cells of the pia mater within brain sulcus.