Photochemical scar ablation in chronically contused spinal cord of rat

Glial scar represents a physical and molecular barrier to axonal regeneration and has become an important target for regeneration research in chronic spinal cord injury. Although many methods have been proven useful for the prevention of scar formation in an acute injury model, to date no effective method has been described to remove an existing glial scar in a chronic injury. The chronic lesion possesses an irregular shaped scar that lines the entire perimeter of the cavity. In the present study, we used rose bengal, a molecule commonly used for biological staining, injected into the cavity at the injury site of Long-Evans rat spinal cord (5 weeks after 25-mm contusion injury). Visible light was used to illuminate the injury site. Histological observation illustrates that at least partial glial scar tissue is ablated by rose bengal/illumination. The lack of glial fibrillary acidic protein (GFAP) immunoreactivity at the glial scar coupled with the reduction of GFAP density surrounding spared tissue suggests that this photochemical scar ablation preferentially kills astrocytes at the scar tissue but also reacts, to a lesser degree, in the spared tissue. There is an observed reduction of Basso, Beattie, and Bresnahan (BBB) scale scores after scar ablation, but it is not statistically significant from stabilized behavioral scoring prior to the scar ablation treatment. Our findings indicate that the rose bengal/illumination is feasible for ablation of the glial scar which surrounds an irregular lesion cavity in shape. The scar ablation might provide a permissive environment for the regenerating axons when enriched by cellular or drug therapy.     

骶神经电刺激治疗32例继发性女性膀胱过度活动症

目的观察骶神经电刺激治疗女性膀胱过度活动症的疗效。方法采用经皮穿刺电刺激骶3神经治疗32例女性继发性膀胱过度活动症患者40周,通过排尿日记及患者症状评价疗效,并通过治疗前后抑郁与焦虑的心理评分来分析患者的生活质量有无改善。结果23例尿频尿急综合征的患者症状明显改善,日排尿次数显著减少,平均排尿量增加,尿急程度减轻;9例症状略有改善,疗效不显著。症状明显改善者治疗前后抑郁与焦虑的心理评分也明显改善。结论骶神经电刺激可明显改善女性膀胱过度活动症患者的排尿功能障碍,从而改进患者的生活质量。     

腹腔镜与开腹手术治疗子宫内膜癌的临床对比分析——前瞻性随机对照研究

目的 探讨腹腔镜手术治疗子宫内膜癌的临床效果.方法 将1998年8月～2004年12月术前确诊为子宫内膜癌的患者60例分为2组,分别施以腹腔镜下及腹式广泛子宫切除,术中根据子宫肌层受侵情况决定是否行盆腔淋巴结清扫术,前瞻性研究两组围手术期及生存情况.结果 与开腹组比较,腹腔镜组手术时间长[(247.8±77.8)min vs(196.6±63.7)min,t=2.789,P=0.007],术中出血量相近[(265.0±187.6)ml vs(350.0±210.9)ml,t=-1.649,P=0.104],切除盆腔淋巴结数量相近[(22.0±5.0)个vs(22.8±5.2)个,t=-0.607,P=0.546],术后并发症发生率差异无显著性(10/30 vs15/30,χ2=1.714,P=0.190),术后肛门排气时间早[(44.3±11.1)min vs(55.2±12.8)min,t=-3.524,P=0.000],住院时间短[(8.7±3.2)d vs(10.2±2.0)d,t=-2.177,P=0.034].腹腔镜组随访(28.6±17.4)月,均无瘤存活;开腹组随访(28.9±16.6)月,3例因转移或复发死亡.结论 腹腔镜手术可达到与开腹手术一样的效果,可以作为治疗子宫内膜癌的术式之一,但应在有条件的医院逐步开展.     

后腹腔镜肾癌根治术并发症7例总结

目的 总结后腹腔镜肾癌根治术并发症的经验. 方法 我院2002年11月～2006年5月行后腹腔镜下肾癌根治术122例,共发生并发症7例,发生率5.7%.第1例精索静脉损伤,中转开放手术止血,出血量约1000 ml,输血800 ml.第2例副肾动脉出血,术中仅用超声刀切断,术后20 h血压下降至90/60 mm Hg,再次手术,用4号线结扎副肾动脉,出血约600 ml,输血400 ml.第3例腔静脉损伤为用直线切割器切割闭合右肾静脉时误将腔静脉切割封闭一半,但未出血.第4例为直线切割器切断肾动脉后残端喷血,又上2个钛夹,出血停止.第5、6例为剪断动脉时误伤肾静脉,1例用Hem-o-lok控制近心端,另1例用10个钛夹纵行夹闭肾静脉止血.第7例为胰尾漏,术后引流液体最多时达300 ml,引流液淀粉酶26 000 U/L. 结果 腔静脉损伤者术后随访30个月,未见异常;胰尾漏者术后随访1年,肾窝无积液,无胰腺炎;其余5例随访20～40个月均未见异常. 结论 腹腔镜下并发症主要是大血管损伤,处理的原则是提高气腹压至18～20 mm Hg,镇静地钛夹夹闭出血点,必要时及时改为开放手术.保持引流管通畅可以有效地治疗胰腺损伤.     

兔膝关节持续被动活动对前交叉韧带重建术后切口局部组织血氧饱和度的影响

目的 探讨膝关节持续被动活动（continuous passive motion, CPM）对兔前交叉韧带重建术后切口局部组织血氧饱和度的影响. 方法 20 只八月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术,术后随机分为2组：自由活动组（n＝10）和CPM组（n＝10）.自由活动组笼内自由活动;CPM组应用兔膝关节持续被动活动器运动.术后第2天,近红外光技术装置ODISseyTM 局部组织血氧监护仪测量每一来回（屈曲30°～110°）不同CPM速度（分别为2.35°/s、3.2°/s 、8°/s）时的切口局部组织血氧饱和度（tissue oxygen saturation ,StO2）变化,选择最好的CPM范围和速度.分别在术前和术后第2、4、6、8、10、14天观察膝关节CPM不同角度时切口局部组织StO2的变化. 结果 与自由活动组相比,3种速度的CPM在不同屈曲角度下均保持较高的StO2,且有显著性差异（P＜0.05）,不同CPM速度之间StO2有显著性差异（P＜0.05）.每一来回（屈曲30°～110°）运动速度为3.2°/s时保持最高的StO2.在术前和术后第2、4、6、8、10、14天等各时间点,膝关节屈曲30°、60°、90°、110°时StO2均无显著性差异（P＞0.05）,不同的时间点（术前和术后第2、4、6、8、10、14天）切口的StO2差别均有显著统计学意义（P＜0.05）.术后第2～4天最低,然后逐渐上升.术后第2周拆线后,切口愈合良好,没有感染、血肿和切口裂开. 结论 兔膝前交叉韧带重建术后第2天开始进行膝关节CPM（屈曲30°～110°）,可增加切口局部组织血氧饱和度,以3.2°/s的CPM速度最佳.     

69例睾丸扭转诊断与治疗

目的提高睾丸扭转诊断及治疗水平。方法对69例睾丸扭转患者的临床资料进行回顾性分析。结果8例12h内手术者，睾丸均存活；6例12—24h手术者，3例睾丸存活；39例超过24h手术者仅7例睾丸存活。未手术者16例，随访7例扭转睾丸均发生不同程度萎缩，尚未发现生育能力受影响者。结论早期诊断、及时治疗是提高疗效的关键。睾丸移植是治疗双侧睾丸扭转后功能性无睾症的一种有效方法。     

恐惧应激对大鼠睾丸中Annexin5表达的影响

目的观察大鼠应激条件下睾丸组织中Annexin5表达的变化。方法建立SD大鼠的恐惧应激模型，分别取急性应激、急性对照、慢性应激、慢性对照SD大鼠睾丸，免疫组织化学和Western blotting分析Annexin5免疫定位和蛋白表达。结果急性应激组与对照组相比，免疫组化显示Annexin5都定位在间质细胞、支持细胞和成熟的精子头部，Western blotting分析发现Annexin5的表达降低了10．8％；慢性应激组与对照组相比，免疫组化结果显示Annexin5在精子头部的定位逐渐减少，应激1w和2w组，未见到Annexin5定位于精子头部，到了应激的3w和4w，发现Annexin5重新定位于精子的头部，而在间质细胞和支持细胞上的定位模式没有显著变化。Western blotting分析发现Annexin5的表达降低了17．4％。结论大鼠睾丸Annexin5参与了应激过程，急性应激条件下Annexin5表达降低。随着应激时间的延长，在慢性应激条件下，Annexin5的表达由减少之后而开始有缓慢增加。     

膀胱出口梗阻后逼尿肌收缩蛋白表达和膀胱重量的改变

目的探讨膀胱出口梗阻(BOO)后逼尿肌收缩蛋白表达和膀胱重量的改变及意义。方法BOO组病人16例,筛选条件为入院诊断良性前列腺增生症(BPH)并经尿动力学压力-流率检查证实为高压低流型;对照组5例,为外伤等情况入院并排除有下尿路梗阻病史者。BOO组所有病例均行耻骨上经膀胱前列腺摘除术,术前B超检查测定膀胱重量和前列腺内外径比值,术中切取膀胱上壁组织2cm×1cm×1cm大小,标本行RT-PCR反应,检测膀胱逼尿肌中肌动蛋白和肌球蛋白mRNA的表达,并比较其与膀胱重量间的线性相关性。结果BOO组与对照组膀胱重量分别为(92.15±34.89)g和(56.08±20.35)g,(P<0.05);前列腺内外径比值分别为(0.57±0.16)和(0.18±0.06),(P<0.01);与对照组相比,BOO组肌动蛋白和肌球蛋白mRNA的表达量均有显著增加,分别为(40.32±59.67)×106和(6.59±5.62)×106,(P值均<0.01);且两者表达量与膀胱重量之间均有明显线性正相关性(P<0.05)。结论逼尿肌中肌动蛋白和肌球蛋白的表达与膀胱逼尿肌的功能状态密切相关。     

无精子症精道造影209例分析

目的总结分析近6．5年来的输精管造影经验。方法对初步诊断为梗阻性无精子症的男性不育209例施行单人操作经皮穿刺输精管精道造影，对经皮穿刺失败者顿行开放穿刺。两侧穿刺成功后同时注射76％泛影葡胺一次摄片。结果209例中，异常50例（23．9％），其中输精管梗阻31例，射精管梗阻7例，其他异常12例。结论精道造影显影清晰直观，对梗阻性无精子症梗阻部位的确定和治疗方案的选择具有独特价值。     

Outcomes of Pheochromocytoma Management in the Laparoscopic Era

Background Laparoscopic adrenalectomy (LA) is the preferred surgical approach for pheochromocytomas. We have investigated the changes in diagnosis, management and outcome of pheochromocytomas treated since the widespread advent of LA. Methods Data were collected retrospectively from 96 patients with pheochromocytomas that had been surgically treated at three tertiary referral centers. Results There were 53 females. Mean age was 47 years (10–81). Tumors were found incidentally in 40% of patients. Of the 96 patients, 12 (13%) had familial syndromes. CT or MRI localized the adrenal lesion in all patients. MIBG scans obtained from 32 patients were concordant with the CT/MRI in 19, were false negative in 9 and misleading in 1, and altered management in only 3 patients. Mean tumor size was 5.6 cm (1.8–17). There were 92 adrenal pheochromocytomas and 9 paragangliomas. Laparoscopy was successful in 67 of 74 (91%) patients, with 20 of 67 (30%) having tumors of 6 cm or greater in size. Conversions to open procedures were performed in patients with 4 left, 2 right pheochromocytomas and 1 paraganglioma. Of the patients, 22 had an open procedure due to suspicion of malignancy or large tumors. Malignancy was observed in 4 of 92 (4.3%) pheochromocytomas and 4 of 9 (44%) paragangliomas. Average follow-up was 22 months (1–122). There were seven recurrences. Postoperative biochemical tests available in 64 patients were normal in 90%. Conclusions The diagnosis of pheochromocytoma was made incidentally in 40% of patients. MIBG is not necessary for unilateral non-hereditary pheochromocytomas localized by CT/MRI. LA is possible with excellent results in most patients, including for treatment of lesions 6 cm or greater in size with no signs of invasion. Laparoscopy should be used cautiously for paragangliomas because of a high rate of malignancy.