Arthroscopic internal drainage and cystectomy of popliteal cyst in knee osteoarthritis

Background

The purpose of this study was to evaluate the efficacy of arthroscopic knee cavity internal drainage and cyst cavity debridement operation of popliteal cyst in knee osteoarthritis patients.

Methods

From August 2007 to March 2013, 58 knee osteoarthritis patients with popliteal cyst were treated with arthroscopic knee cavity internal drainage through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal. In all patients, preoperative magnetic resonance imaging (MRI) was performed to detect combined intra-articular pathology and the communication between popliteal cyst and knee cavity. Clinical efficacy was evaluated through VAS score and Lysholm score.

Results

All patients had neither recurrence of popliteal cyst nor complaints of pain, swelling, or functional impairment at average 24 months follow-up after surgery. Postoperatively, VAS score was decreased significantly and Lysholm score was raised significantly comparing preoperatively.

Conclusion

Arthroscopic knee cavity internal drainage operation through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal is an effective minimally invasive surgery method for the treatment of popliteal cyst without recurrence in knee osteoarthritis patients.

     

颅脑损伤后海马区notch信号分子及其相关miRNA的表达变化

目的 观察颅脑损伤后海马区notch1相关微小RNA(miRNA)、notch1及nestin的表达变化,探讨颅脑损伤后神经干细胞增殖机制.方法 采用自由落体法复制闭合性颅脑损伤小鼠模型,于伤后4 h、1 d和3 d处死动物.(1)实时聚合酶链反应(Real-time PCR)检测伤后4 h、1 d和3d伤侧海马区mir-326、mir-34a和notch1 mRNA的表达变化.(2)免疫荧光染色检测伤后3 d伤侧海马齿状回区notch1和nestin蛋白表达变化.结果 (1)颅脑损伤后4 h、1 d和3 d组海马区mir-326和mir-34a表达水平分别为假手术组的(0.36±0.16)、(0.16±0.04)、(0.36±0.17)倍和(0.48±0.15)、(0.50±0.04)、(0.25±0.14)倍,均低于假手术组(P＜0.01);(2)颅脑损伤后4 h、1 d和3 d组海马区notch1 mRNA表达水平分别为假手术组的(1.77±0.17)、(2.55±0.48)和(2.44±0.58)倍,均高于假手术组(P＜0.05);颅脑损伤后3 d组海马齿状回区notch1阳性细胞明显多于假手术组[(18.20±3.56)个比(0.40±0.55)个,P＜0.01].(3)颅脑损伤后3 d组海马齿状回区nestin阳性细胞数明显高于假手术组[(21.80±5.07)个比(0.80±0.45)个,P＜0.01].结论 在颅脑损伤后海马区神经干细胞增殖过程中,mir-326和mir-34a表达明显降低,其靶基因notch1 mRNA和蛋白表达明显升高,提示mir-326和mir-34a可靶向抑制notch信号分子,调控伤后神经干细胞增殖过程.

Abstract：

Objective To observe the expression of notch1-related miRNA, notch1 and nestin,and explore the regulatory mechanism of neural stem cells proliferation in hippocampus of mice after traumatic brain injury (TBI). Methods Mice were suffered closed head injury, and then sacrificed at 4th h,1st day and 3rd day post-injury. Real-time polymerase chain reaction (PCR) was used to detect the expression levels of mir-326, mir-34a and notch1 mRNA in mice hippocampus at 4th h, 1st day and 3rd day post TBI. Immunofluorescence was conducted to determine protein expression levels of notch1 and nestin in mice hippocampus at 3rd day post TBI. Results ( 1 ) Relative to sham group, the levels of mir-326 and mir-34a at 4th h, 1st day and 3rd day after TBI in the hippocampus were respectively (0. 36 ± 0. 16),(0. 16±0.04), (0.36±0. 17) and (0.48±0. 15), (0.50±0.04), (0.25 ±0. 14) fold (P＜0.01);(2) Relative to sham group, the levels of notch1 mRNA at 4th h, 1st day and 3rd day post TBI injury in the hippocampus were respectively (1.77 ±0. 17), (2.55 ±0.48) and (2.44±0.58) fold (P＜0.05).Notch1 + cells in the DG at 3rd day post TBI were significantly increased compared to sham group ( 18.20± 3.56 vs 0. 40 ±0. 55 ,P ＜0. 01 ); (3) Nestin + cells in the DG at 3rd day post TBI were increased apparently compared to sham group (21.80 ± 5. 07 vs 0.80 ± 0. 45, P ＜ 0. 01 ). Conclusion mir-326 and mir-34a may play a key role in trauma-induced neural stem cells proliferation in hippocampus in vivo by targeting notch1 signaling.     

复发性静脉性溃疡的原因分析及再处理方法

目的 分析复发性静脉溃疡的原因及再次手术策略.方法 回顾性分析2000年1月至2010年6月收治的复发性静脉性溃疡患者的临床资料.共73例患者81条肢体入组,男性55例(60条肢体),女性18例(21条肢体),平均年龄52.6岁(31～73岁).所有患者入院前均因下肢静脉溃疡接受过一次或数次手术.溃疡复发距上次手术8～37个月,平均10.6个月;溃疡直径1.3～6.5 cm,平均3.7 cm.再次手术前多普勒超声发现小腿交通静脉反流57条肢体(70.4%),原发性深静脉瓣膜功能不全38条肢体(46.9%),DVT后遗症16条肢体(19.8%),大隐静脉属支残留11条肢体(13.6%),大隐静脉主干再通或残留8例(9.9%).针对存在的病因采取大隐静脉高位结扎抽剥及属支结扎、内镜深筋膜下交通静脉结扎、溃疡周边环形缝扎、曲张静脉环形缝扎加切除、深静脉瓣膜修复术以及穿着弹力袜等治疗措施.结果 随访3～60个月,平均37.3个月.3个月时溃疡平均直径明显缩小,6个月时溃疡完全愈合,血流动力学指标明显改善.1年后3条肢体(3.7%)溃疡再次复发.结论 小腿交通静脉功能不全、深静脉瓣膜功能不全以及大隐静脉再通或属支残留是静脉性溃疡术后复发的主要原因,针对性的冉次手术仍然可以达到满意疗效.

Abstract：

Objective To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation. Methods Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52. 6 years(ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months ( ranging from 5 to 37 months). Average diameter of ulcers was 3. 7 cm ( ranging from 1. 3 to 6. 5 cm) . Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70. 4% ) , primary deep vein insufficiency in 38 limbs (46. 9% ) ,post-DVT syndrome in 16 limbs (19. 8% ) , reflux of accessory saphenous veins in 11 limbs (13. 6% ) and residual/re-opened great saphenous vein in 8 limbs ( 9. 9% ) . Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality. Results All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation.Only 3 limbs (3.7% ) suffered again from recurrence 1 year after re-operation. Conclusions Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.     

磁共振化学位移成像对肾上腺肿瘤的诊断（附18例报告）

目的：评价磁共振（magnetic resonance,MR）化学位移成像（chemical shift imaging,CSI）对肾上腺腺瘤的诊断价值。方法：回顾分析我院18例肾上腺肿瘤患者,术前均进行了MR-CSI检查,对其病历资料及MR图象进行分析。结果：12例肾上腺腺瘤在MR—CSI同相位、反相位序列的检查中,均表现为反相位不同程度的信号减低,6例非腺瘤性病变反相位上不表现为明显的信号降低。结论：MR—CSI对肾上腺腺瘤与非腺瘤性病变的诊断与鉴别诊断具有重要价值。     

膀胱内翻性乳头状瘤36例报告

目的 提高对膀胱内翻性乳头状瘤(inverted papilloma of the bladder,IPB)的诊治水平.方法 回顾分析我科1995年1月至2010年5月收治的具有完整临床和随访结果的36例IPB患者的资料.结果 36例患者均接受手术治疗,其中1例患者同时合并有膀胱尿路上皮细胞癌,1例在内翻性乳头状瘤中合并有尿路上皮细胞癌成分,术后27例行定期膀胱内灌注化疗,9例仅作定期随访,其中1例同时合并有膀胱尿路上皮细胞癌者术后3年复发.结论 IPB是一种预后良好的良性肿瘤,诊断有赖于病理检查,TURBT是治疗该病的标准方法,术后应行膀胱内灌注化疗及定期随访.     

3012例泌尿系结石成分分析

目的初步探讨烟台、威海地区泌尿系结石的成分组成,为临床防治提供依据。方法采用LIIR型结石红外光谱自动分析系统分析,分析烟台、威海地区3012例泌尿系结石标本。结果结石总体构成,一水草酸钙为主要成分的结石1601例(53.15%),碳酸磷灰石为主要成分的结石316例(10.49%),无水尿酸为主要成分的结石870例(28.89%)。结论烟台、威海地区尿酸结石相对较多,借鉴并结合结石的成分分析结果,对患者进行有针对性的健康教育。     

促排卵药物使用规范(2016)

随着生育政策调整,越来越多女性采用促排卵技术提高受孕几率。为进一步规范我国促排卵药物及方法的应用,合理、适度使用促排卵药物,有效地控制促排卵并发症,保障医疗质量和医疗安全,中华医学会生殖医学分会编撰本规范。     

伤口呈色显影用于预测重症肢体缺血患者血管腔内治疗后溃疡愈合的价值初探

目的 探讨伤口呈色显影预测重症肢体缺血患者血运重建术后溃疡愈合的价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2011年6月1日-2014年6月30日收治成功实施Angiosome概念指导腔内血运重建的重症肢体缺血的缺血性溃疡患者临床资料.根据血管腔内血运重建术后伤口呈色显影情况分组,其中伤口呈色(+)组109例,伤口呈色(-)组64例,分别比较患者保肢率,溃疡愈合时间的差异,试分析其作为重症肢体缺血的缺血性溃疡愈合预测因子的价值.采用SPSS 19.0软件进行统计学分析.正态分布计量资料以均数±标准差(x±s)表示,两组比较采用t检验.计数资料以频数和百分比表示,两组比较采用Pearson x2检验或Fisher确切概率法.结果 纳入研究患者共173例(173条患肢),两组患者年龄、性别比例、吸烟史、冠心病、糖尿病、慢性肾功能不全、术前踝肱指数、术后踝肱指数差异均无统计学意义,溃疡愈合时间:伤口呈色(+)组(3.9±1.9)个月低于伤口呈色(-)组(7.9±2.6)个月,差异有统计学意义(P＜0.05).累积保肢率:伤口呈色(+)组(90.2％)高于伤口呈色(-)组(78.0％),差异有统计学意义(P＜0.05).通过Logistic回归分析,校正年龄、性别、吸烟史、高血压异常等因素后,伤口呈色(-)(OR=4.5,P＜0.05)、IRc(间接血供有侧支)血运重建(OR =2.6,P＜0.05)均是溃疡难愈合的独立危险因素.结论 伤口呈色显影阳性显示足部循环较好,可以作为重症肢体缺血的缺血性溃疡愈合的预测因子,而伤口呈色显影阴性是溃疡难愈合的独立危险因素.     

TightRope与金属螺钉内固定治疗下胫腓联合分离的临床疗效对比

目的探讨锁扣带袢钛板(Tight Rope)内固定与金属螺钉内固定2种术式治疗下胫腓联合分离的临床疗效。方法笔者自2012-01—2016-03采用Tight Rope(Tight Rope组)与金属螺钉(金属螺钉组)2种内固定术式治疗46例下胫腓联合分离伴或不伴踝关节骨折。分别记录2组术前、术后即刻、术后3个月、末次随访时后前位X线片上下胫腓间隙(TBCS)、下胫腓重叠距离(TBOL),观察比较2组术后VAS评分、部分负重时间、完全负重时间、AOFAS踝与后足功能评分。结果 2组手术均顺利完成,术后切口均一期愈合,均获得平均14(11~18)个月随访。2组术前、术后即刻、术后3个月、末次随访时TBCS、TBOL差异无统计学意义(P0.05);2组术后3 d VAS评分差异无统计学意义(P0.05);Tight Rope组术后部分负重时间及完全负重时间均少于金属螺钉组,差异有统计学意义(P0.05);Tight Rope组术后3个月及6个月的AOFAS踝与后足评分高于金属螺钉组,差异有统计学意义(P0.05),2组末次随访时AOFAS踝与后足功能评分差异无统计学意义(P0.05)。金属螺钉组出现1例螺钉弯曲、1例螺钉断裂,Tight Rope组无内固定松动、断裂等并发症。2组均无下胫腓联合再次分离、踝关节再次骨折等并发症。结论 Tight Rope内固定与螺钉内固定均为治疗下胫腓联合分离的可靠性方法;Tight Rope组可早期功能锻炼及下地负重,踝关节功能恢复较金属螺钉组更有优势。     

全麻术后患者应用泻黄散加味行口腔护理研究

目的研制全麻术后患者优效口腔护理含漱液,提高口腔护理效果。方法将105例全麻术后脾胃伏火证患者随机分为三组各35例,均于术后开始口腔护理及用生理盐水进行预处理;之后生理盐水组用生理盐水含漱清洗及喷雾;银尔通组用银尔通含漱清洗及喷雾;泻黄散加味组制备泻黄散加味含漱液并用于含漱清洗及喷雾。2次/d,连续3d后评价效果。结果泻黄散加味组口臭发生率及菌落计数显著低于和少于生理盐水组,pH值显著高于另两组(P0.0125,P0.05);咽部不适防治效果及口腔黏膜炎发生率三组比较,差异无统计学意义(均P0.05)。结论泻黄散加味佩兰及薄荷,用于全麻术后患者口腔护理,可有效维持口腔正常pH值,有良好的抑菌效果,从而降低口臭发生率;预处理、含漱清洗及口腔喷雾干预模式有利于保持口腔持续湿润状态,缓解不适感。