目标引导的骨性III类错多学科联合治疗一例

目标引导的正畸治疗（Objective oriented orthodontics）囊括主诉、牙面美学、动态咬合、稳定、关节健康、气道健康、牙周牙体健康、心理等八个方面。本文报道一例以正畸治疗目标为导向的严重骨性III类错患者的多学科联合治疗病例。在明确诊断的前提下,制定计划如下：牙周辅助加速成骨（Periodontally accelerated osteogenic orthodontics,PAOO）手术后进行上下颌牙列去代偿;经外科会诊后拟行Lefort I型截骨术前徙上颌骨,矢状劈开并后退及逆旋下颌骨伴颏成型术。术后颌位检查显示咬合高点与正中关系-正中颌位不调,CBCT显示左侧髁突-关节窝关系不良并发现上颌骨骨性宽度不足,稳定性板治疗后行种植钉辅助上颌快速扩弓（Maxillary skeletal expander, MSE）;下颌采用关闭曲法实现下前牙控根,继而通过短颌间牵引精调尖、磨牙关系。经由多学科联合治疗,同时依赖患者的配合与信赖,基本实现初定的治疗目标,患者及家属对治疗结果满意。     

延髓腹外侧动脉显微外科研究

目的 探讨延髓腹外侧区动脉及吻合支与脑神经根进入区的关系。方法 应用显微外科解剖学方法,观察15具血管内灌注彩色染料的成人尸头,椎基底动脉系统及分支在延髓腹外侧三角内的走行与分布,与末组脑神经的关系。结果 延髓腹外侧三角内走行椎基动脉主干,分支及动脉吻合支。吻合支在腹外侧三角,舌咽、迷走神经根处较密集,三角以外相对稀疏。动脉袢表现出不同的形态。结论 延髓腹外侧三角内吻合血管走行在舌咽、迷走神经根进入区及大动脉走行异常和动脉袢压迫,是脑神经高反应性功能障碍的解剖学基础。     

蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析

目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.

Abstract：

Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.     

延颈髓髓内室管膜瘤预后相关因素分析

目的 探讨手术治疗的延颈髓髓内室管膜瘤的预后相关因素.方法 对30例手术治疗的延颈髓髓内室管膜瘤病例进行研究并随访,采用KPS评分和改良McCormick分级对手术前后功能进行评价.结果 疼痛为最主要症状,手术可缓解大部分症状;延颈髓髓内室管膜瘤预后与病程显著相关,与年龄、术前KPS评分、肿瘤全切与否、肿瘤长度及放疗等差异无统计学意义;男性预后较差;病理Ⅱ级全切组与近全切加放疗组预后差异无统计学意义.结论 显微外科手术可有效治疗延颈髓髓内室管膜瘤;早期发现、诊断和手术是良好预后的重要因素,未全切者术后行放疗可改善预后.

Abstract：

Objective To analyze the factors affecting the operative prognosis of intramedullary ependymomas in medulla oblongata and cervical cord.Method Thirty patients harboring intramedullary ependymomas in medulla oblongata and cervical cord were operated.The preoperative and postoperative status was taken by follow - up and evaluated by Karnofsky Performance Scale (KPS) and Modified McCormick classification system.Results Pain was one of the most common symptoms which could be relieved by operation; there was no statistic significance of age, gender, preoperative status, radical resection and length of the tumor or radiotherapy, while interval was significantly associated with outcomes.The outcome of male was worse than female.There was no significant difference in postoperative status between patients of WHO Ⅱtreated by complete resection and those treated by incomplete resection and radiotherapy.Conclusions Microsurgery is an effective approach for treating intramedullary ependymomas in medulla oblongata and cervical cord.The early detection, diagnosis and radical resection are the key for good prognosis.Postoperative radiotherapy is a beneficial adjuvant treatment.     

N- cadherin, E- cadherin and β- catenin expressions in human brainstem gliomas

Objective To explore the expression and significance of N - cadherin, E - cadherin and β - catenin in human brainstem gliomas. Methods N - cadherin, E - cadherin and β - catenin proteins and mRNA were detected in 38 cases of brainstem gliomas using immunohistochemistry and RT - PCR Methods. Results There was no significant difference in the expression of N - cadherin between grades Ⅰ ～ Ⅱ and grade Ⅲ ～ Ⅳ ( P ＞ 0. 05) . The expression of N - cadherin mRNA in human brainstem gliomas of grade Ⅰ ～ Ⅱ was significantly lower than that in grade Ⅲ～ Ⅳ ( t = 2. 711, P ＜ 0. 05 ). There was no significant difference in the expression of E - cadherin and E - cadherin mRNA between grade Ⅰ ～ Ⅱ and grade Ⅲ～ Ⅳ ( P ＞ 0. 05 ). The expression of β - catenin in human brainstem gliomas of grade Ⅰ ～ Ⅱ was significantly lower than that in grade Ⅲ ～ Ⅳ ( P ＜ 0. 05 ). As regard to β -catenin mRNA, there was no significant difference between grade Ⅰ ～ Ⅱ and grade Ⅲ ～ Ⅳ ( P ＞ 0. 05 ). Conclusions The over -expressionof N - cadherin and β - catenin may play an important role in the invasion and malignant progression of human brainstem gliomas.     

加强中期汇报考核,提高医学博士研究生培养质量

医学研究生教育担负着为我国医疗事业培养创新性人才的重担,尤其博士生教育应以培养教学、科研方面的高层次创造性人才为主。很多院校都对博士研究生发表文章提出了较高的要求。结合自己的管理工作体会,从医学博士研究生论文中期汇报的内容、方式、质量控制、建立规范化的考核制度等方面进行讨论,旨在探索完善博士研究生中期考核制度,提高研究生的培养质量。     

大鼠脑干胶质瘤模型的建立

目的 建立大鼠脑干胶质瘤模型,为脑干胶质瘤的研究提供动物实验平台.方法 将1×10~6个大鼠C6胶质瘤细胞通过立体定向头架注射到大鼠脑桥,种植后2周对大鼠行磁共振扫描观察,然后行灌流固定取脑,HE染色.结果 磁共振检查均发现肿瘤生长,肿瘤为长T1和T2信号,经大鼠舌静脉注射Gd-DTPA信号明显增强.HE染色显示肿瘤为胶质母细胞瘤,呈浸润性生长,瘤内新生血管丰富,假栅栏样坏死明显.结论 大鼠C6胶质瘤细胞株可以建立脑干胶质瘤模型,成瘤率高,重复性好.     

伴有脑干胶质瘤的神经纤维瘤病1型二例并文献复习

目的 报告2例伴发脑干胶质瘤的神经纤维瘤病1型的病例并文献复习.方法 通过临床表现及手术治疗明确诊断.结果 2例均确诊神经纤维瘤病1型,脑干肿瘤手术治疗,病理为胶质母细胞瘤和星形细胞瘤.结论 神经纤维瘤病1型可伴发脑干胶质瘤,其基因型与表型的关系仍待进一步研究.     

原发延髓生殖细胞瘤二例报告及文献复习

目的 报告2例原发延髓生殖细胞瘤病例并文献复习.方法 通过手术治疗明确诊断,并进行随访.结果 2例病例均手术治疗,生殖细胞瘤诊断成立.1例术后放化疗,肿瘤完全消失.另1例未行放化疗,术后肿瘤复发,病人术后8个月死亡.结论 原发延髓生殖细胞瘤罕见,手术辅以放疗及化疗病人能取得良好预后.     

重点学科主战场

一所医院核心竞争力的标志不是其规模的大小或固定资产的多少,而是其重点学科的水平。