下颈椎损伤早期手术治疗55例

目的:探讨下颈椎损伤早期手术治疗的目的、时机和方法. 方法:下颈椎骨折、脱位并有不同程度脊髓损伤患者55例,早期分别施行前、后路减压固定手术. 其中前路减压43例,后路12例. 行内固定17例. 结果: 脊髓完全损伤6例,死亡3例,随访3例神经功能无恢复. 脊髓不完全损伤49例,随访46例,随访时间4～49(平均21) mo. 神经功能不同程度恢复41例. 结论:早期手术治疗有利于及早恢复椎体稳定性. 应根据具体伤情决定手术时机和方法, 采用前或后路减压均可起到良好疗效. 内固定的使用扩大了手术适应证.     

Impact of Bile Duct Tumor Thrombus on the Long-Term Surgical Outcomes of Hepatocellular Carcinoma Patients: A Propensity Score Matching Analysis

Annals of Surgical Oncology - Hepatectomy with tumor thrombectomy is the preferred treatment option for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT); however, the...     

婴儿腹部手术后并发肠外瘘6例临床分析

肠外瘘(enterocutaneous fistula)是指肠瘘穿破腹壁与外界相通,是腹部外科严重并发症之一[1].婴儿腹部手术后并发肠外瘘临床少见,病情重且病程长,临床治疗颇感棘手.笔者自1996年4月至2007年3月治疗婴儿肠外瘘6例,现分析报告如下.     

微小切口白内障超声乳化联合折叠人工晶状体植入术的临床观察

目的:观察微小切口超声乳化白内障吸除术联合推注式人工晶状体植入的临床疗效。方法:对36例(41眼)老年性白内障患者采用双手微小切口超声乳化白内障吸除联合推注式人工晶状体植入术进行治疗,观察术中超声乳化时间、手术并发症、术后矫正视力、术后散光及角膜内皮细胞密度的变化。结果:所有患者均顺利完成手术,术中超声乳化时间为0.5～4.2min,其中Ⅳ级核超声乳化时间平均为2.20±0.85min。术后1wk最佳矫正视力0.3～0.8共16眼,0.8以上25眼。术中未见明显并发症,术后5眼角膜轻度水肿,2眼术后3mo发生后发性白内障。结论:双手微小切口超声乳化白内障吸除术是一种安全、可靠、疗效好的白内障手术方式,特别是对硬核白内障,具有其他术式无法比拟的优势。     

亲水性软性角膜接触镜在眼表疾病治疗中的疗效观察

目的:探讨对大泡性角膜病变、翼状胬肉术后以及丝状角膜病变患者,通过配戴亲水性软性角膜接触镜,观察其在改善角膜刺激症状和促进角膜修复方面的治疗效果。方法:将79例90眼入选住院患者采用临床对照法,随机分为治疗组和对照组,对照组按常规给予治疗、用药和局部包眼;治疗组在按常规给予治疗、用药的同时加戴软性角膜接触镜。观察比较两组患者角膜刺激缓解症状和角膜愈合的情况。结果:治疗组患眼角膜刺激症状较对照组有明显改善,两组差异具有统计学意义(H=26.801,P<0.001),可以认为治疗组和对照组症状缓解情况的总体分布不同;在促使角膜上皮愈合方面:术后1d总体治疗组和对照组角膜创面愈合情况比较,两组差异具有统计学意义(H=7.347,P<0.05),可以认为术后1d总体治疗组和对照组角膜创面愈合情况的总体分布不同,其中翼状胬肉术后1d治疗组和对照组角膜创面愈合情况比较,差异具有统计学意义(H=13.495,P<0.001),而大泡性角膜病变术后1d治疗组和对照组角膜创面愈合情况比较,差异无统计学意义(H=0.006,P>0.05),同样丝状角膜炎术后1d治疗组和对照组角膜创面愈合情况比较,两组差异无统计学意义(H=0.245,P>0.05);术后1wk总体治疗组和对照组角膜创面愈合情况比较,差异无统计学意义(H=0.708,P>0.05),尚不能认为术后1wk总体治疗组和对照组角膜创面愈合情况总体分布不同。结论:合理使用治疗性角膜接触镜可减轻上述角膜疾病患者的痛苦,能有效的促进角膜的修复,缩短愈合时间,减轻了患者的经济负担,给临床治疗和护理带来方便等优点,但对于大泡性角膜病变,目前主要根治方法仍是穿透性角膜移植。     

中药黄白液抑制Ⅱ型单纯疱疹病毒复制的实验研究

目的 :探讨黄白液治疗预防复发性生殖器疱疹的作用。方法 :采用体外细胞培养技术观察黄白液对Ⅱ型单纯疱疹病毒 (HSV 2 )复制的抑制作用 ,并与环胞苷、阿昔洛韦作比较。结果 :黄白液对HSV 2的复制有明显抑制作用 ,其最小有效浓度为2 .5g·L- 1 ,治疗指数为 3 ,黄白液 2 .5g·L- 1 对HSV 2的抑制作用不亚于环胞苷 ,两者抑毒指数为 2 .83 ,阿昔洛韦抗HSV 2作用较强 ,抑制指数为 5 .3 1。结论 :黄白液可治疗复发性生殖器疱疹 ,与其抑制HSV 2的复制有关     

低浓度β-淀粉样蛋白抑制小鼠视网膜色素上皮细胞P-糖蛋白的功能性表达

目的　探讨低浓度β淀粉样蛋白（ａｍｙｌｏｉｄβ-ｐｒｏｔｅｉｎ,Ａβ）对原代培养小鼠视网膜色素上皮（ｒｅｔｉｎａｌｐｉｇｍｅｎｔｅｐｉｔｈｅｌｉｕｍ,ＲＰＥ）细胞Ｐ-糖蛋白（Ｐ-ｇｌｙｃｏｐｒｏｔｅｉｎ,Ｐ-ｇｐ）表达和活性的影响。方法　应用０．３μｍｏｌ?Ｌ－１Ａβ１-４２处理ＲＰＥ细胞４ｈ、８ｈ、１２ｈ和２４ｈ后,采用实时定量ｒｅａｌ-ｔｉｍｅＰＣＲ和Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ检测Ｐ-ｇｐ在基因和蛋白水平的表达;分别在细胞培养液中加入孕烯醇酮Ｘ受体原形配体１６-α-氰基孕烯诺龙（ｐｒｅｇｎｅｎｏｌｏｎｅ１６-ａｌｐｈａ-ｃａｒ-ｂｏｎｉｔｒｉｌｅ,ＰＣＮ）和Ｐ-ｇｐ特异性抑制剂ＰＳＣ８３３后,孵育罗丹明１２３,然后用流式细胞仪检测各组细胞内罗丹明１２３的荧光强度来验证Ａβ１-４２对ＲＰＥ细胞Ｐ-ｇｐ活性的影响。结果　Ａβ１-４２处理细胞４ｈ、８ｈ、１２ｈ和２４ｈ后ｍｄｒ１表达量分别减至空白对照组的（７１．２５±８．３５）％（Ｐ＞０．０５）、（６１．３８±７．３７）％（Ｐ＜０．０５）、（４７．５１±８．９７）％（Ｐ＜０．０１）和（４１．２３±９．０６）％（Ｐ＜０．０１）;Ｐ-ｇｐ表达量在４个时间点分别减至空白对照组的（８１．７１±５．２７）％（Ｐ＞０．０５）、（５３．６４±４．５８）％（Ｐ＜０．０５）、（５１．２９±６．０２）％（Ｐ＜０．０５）和（４９．８２±７．２４）％（Ｐ＜０．０５）。罗丹明１２３积蓄实验结果显示,应用ＰＣＮ后,细胞内罗丹明１２３的荧光强度随着时间延长而减少,而应用ＰＳＣ８３３后,细胞内罗丹明１２３的荧光强度随着时间延长而增加。结论　低浓度Ａβ１-４２处理小鼠ＲＰＥ细胞,可抑制Ｐ-ｇｐ的表达与活性。Ｐ-ｇｐ可能是干预早期年龄相关性黄斑变性中Ａβ清除的潜在靶点。     

Factors influencing thermal injury to skin and abdominal wall structures in HIFU ablation of uterine fibroids

Objective: To investigate the factors which may cause thermal injury of abdominal wall structures in ultrasound-guided high-intensity focussed ultrasound (USgHIFU) ablation of uterine fibroids.

Method: A total of 892 patients with uterine fibroids diagnosed on contrast-enhanced magnetic resonance imaging (MRI) scans received HIFU ablation and follow-up MRI scanning. After therapy, thermal injury to the skin was assessed via measurement of skin redness, blisters, subcutaneous nodules and to the abdominal wall structures via measurement of signal intensity on T2-weighted MRI images. A total of 151 patients were assigned to the injury group, 741 patients were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were analysed using univariate and multiple logistic regression analyses.

Results: Univariate logistic regression revealed that sonication time, sonication time per hour, total energy deposited, distance from uterine fibroid ventral side to skin, volume of uterine fibroids, abdominal wall scar, abdominal wall thickness and body mass index (BMI) all affected whether thermal injury occurred (p?p?=?0.000, OR?=?2.228, 95% CI 1.831–2.712), abdominal wall scar (p?=?0.019, OR?=?1.639, 95% CI 1.085–2.477) and abdominal wall thickness (p?=?0.000, OR?=?1.562, 95% CI 1.313–1.857) were significantly correlated with thermal injury.

Conclusion: Multiple logistic regression analysis revealed that abdominal wall thickness, total energy and abdominal wall scar were the most significant influencing factors that influenced minimal thermal injury of abdominal wall structures in USgHIFU ablation of uterine fibroids.     

Multiple littoral cell angioma of the spleen: a case report and review of the literature

BACKGROUND: Littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen with characteristic histomorphologic features. It is a unique splenic tumor which may present with abdominal pain or as an incidental finding. CASE REPORT: In this case report, we present the case of a 34-year-old woman with multiple splenic LCA. Initially, the patient presented with abdominal pain, weakness and fatigue. After a diagnostic abdominal ultrasound, multiple hemangiomas were observed in the spleen. Computed tomography scans confirmed splenomegaly with multiple round and hyperdense lesions. The patient subsequently underwent splenectomy. Postoperative histological and immunohistochemical profiles confirmed the diagnosis of LCA. CONCLUSION: LCA is a unique splenic tumor diagnosed in patients with abdominal pain or as an incidental finding. Only a few case reports of this tumor have been published, and those accounts are inconsistent. In the present paper, we report on a case and conduct a literature review.