上睑下垂的术前评估及改良提上睑肌缩短术矫治的疗效评价

目的评价改良提上睑肌缩短术矫治上睑下垂的效果。方法采用改良提上睑肌缩短术[此改良术式与常规术式不同之处在于增加分离提上睑肌腱膜的长度(22mm)和宽度(16mm),腱膜在睑板上固4对缝线,以增加其牢固度],共治疗上睑下垂57例68眼,其中轻度13例13眼,中度38例47眼,重度6例8眼。结果术后4～36个月随访,治愈48例59眼,欠矫9例9眼,无过矫病例。结论该提上睑肌缩短术与常规手术比较有改进,术后的睑缘高度易保持在上方角膜缘,弧度与健侧对称,不易形成眼角畸形,能较好提高矫治效果。     

FK506-壳聚糖膜与体外培养雪旺细胞生物相容性的研究

目的 探讨FK506-壳聚糖膜片与培养的雪旺细胞生物相容性.方法 将生长状况和纯度较好的第3代雪旺细胞,分别传代接种于含有FK506-壳聚糖膜片、单纯壳聚糖膜片的培养皿中培养,以盖玻片作为对照组.计算3组雪旺细胞倍增时间、雪旺细胞纯度;用MTT法比较不同膜片上雪旺细胞的生长活力,绘制生长曲线;S-100免疫荧光染色.结果 雪旺细胞倍增时间对照组为5.9 d,单纯壳聚糖膜片及FK506-壳聚糖膜片组均为4.0 d;雪旺细胞纯度分别为80%、89%,93%;雪旺细胞增殖情况以FK506-壳聚糖组最佳,单纯壳聚糖组次之,对照组最差;各组雪旺细胞均呈S-100阳性,FK506-壳聚糖组与单纯壳聚糖组雪旺细胞排列呈典型的漩涡状或栅栏状.结论 FK506-壳聚糖膜片具有更显著的组织相容性与生物功能性,并保持了雪旺细胞的生物学特性.     

Le Fort型骨折的CT表现和分型

目的探讨Le Fort型骨折的CT表现及其分型。方法对62例Le Fort型骨折患者进行薄层螺旋CT扫描和三维重组分析。结果在62例中，Le FortⅠ型10例，Ⅱ型9例，Ⅲ型8例，复合型35例（其中Ⅰ＋Ⅱ型18例，I＋Ⅱ＋Ⅲ型7例，Ⅱ＋Ⅲ型10例）；55例同时伴发颌面部其他骨折。Le Fort型骨折在二维CT上表现为颌面部多发且杂乱的骨折，虽然在发现细小和深部结构的骨折方面优于三维CT成像，但难以作出Le Fort型骨折的诊断；三维CT成像能清晰立体地显示Le Fort型骨折的整体形状及走向，并可明确作出分型。结论三维CT成像是Le Fort型骨折最有效的诊断方法，对临床制定治疗方案具有指导意义，但是对细小骨折诊断不如二维CT。     

急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

COPD机械通气病人下呼吸道感染致病菌分布特点

①目的 探讨慢性阻塞性肺病(COPD)病人机械通气后下呼吸道感染致病菌的特点。②方法 取32例COPD并发呼吸衰竭行机械通气病人下呼吸道分泌物做痰细菌学培养，同时做药物敏感试验。③结果 32例病人共分离出菌株76株，阳性率71．7％，其中混合感染10例次。其中革兰阴性杆菌(GNB)58株，占76．3％；阳性球菌10株，占13．2％；真菌8株，占10．5％。常见致病菌以铜绿假单胞菌、鲍曼不动杆菌和肺炎杆菌为主，GNB中铜绿假单胞菌和不动杆菌的耐药率高。④结论 COPD应用机械通气病人下呼吸道感染以革兰阴性杆菌为主，耐药性高。     

CT、MRI对肾上腺病变的诊断分析

目的:分析探讨CT、MRI诊断对肾上腺病变的作用与价值。方法:MarconiMX8000 4层螺旋CT机,增强造影剂使用非离子型制剂,常规扫描及增强。应用西门子MAGNETOM1.5T磁共振机,增强造影剂使用Gd-DTPA制剂,常规T1WI、T2WI、脂肪抑制、化学位移同反相位及增强。对25例经手术及病理资料诊断证实的肾上腺病变进行CT、MRI诊断回顾性分析。结果:可清楚显示肾上腺病变的侧别、数目、大小、范围及可能的性质。结论:CT是肾上腺病变最佳影像检查方法,MRI具有重要辅助及补充诊断价值。     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

In vivo Regulation of Prolactin Gene Expression in the Male Rat: Role of Sex Steroids and Dopamine

The influence of sex steroids and the dopaminergic system on the in vivo modulation of prolactin (PRL) mRNA levels was investigated by quantitative in situ hybridization in the male rat anterior pituitary gland. In situ hybridization was performed using a [³⁵S]-labeled cDNA probe encoding PRL. Orchiectomy performed 14 days earlier did not modify PRL mRNA levels. In orchiectomized rats treatment with the dopaminergic agonist bromocriptine for 14 days decreased PRL mRNA levels by 30%, while in intact animals the same treatment did not induce any changes in PRL mRNA levels. Administration of the dopamine D₂ receptor antagonist haloperidol in both intact and orchiectomized rats induced a 4-fold increase in mRNA levels. Administration of dihydrotestosterone to orchiectomized animals which had been treated or not with haloperidol or bromocriptine did not modify PRL mRNA levels. In orchiectomized animals administration of 17ß-estradiol (0.25 μg twice daily) for 14 days caused a 4-fold increase in amounts of PRL mRNA. Administration of bromocriptine to 17ß-estradiol-treated animals induced a 15% decrease of PRL mRNA levels compared to those obtained by 17ß-estradiol administered alone. The concomitant administration of 17ß-estradiol and haloperidol resulted in a 50% increase in PRL mRNA levels compared to those measured in animals treated with haloperidol alone. The present results clearly demonstrate that in vivo estrogen as well as dopamine-mediated mechanisms play a regulatory role in PRL mRNA levels in the male rat.     

获得性骨肥大综合征1例

获得性骨肥大综合征,即滑膜炎、痤疮、脓包疮、骨肥厚、骨炎综合征(synovitis,acne,pustulosis,hyperostosis,osteitis,SAPHO),包括骨关节病变和皮肤病变,是一种少见的原因未明的慢性进行性骨病,笔者遇到1例,现报告如下。患者男,50岁。因右胸锁关节处隆起、压痛、翻身疼痛难忍逐渐加重2年而来就诊。自述两年前曾因此处疼痛在当地医院就诊,诊为“畸形性骨炎”,用抗炎药物治疗后,症状有缓解。但近年来上述症状逐渐加重遂来本院就诊。检查:前上胸、双侧锁骨区及胸锁关节处隆起,以右胸锁关节隆起明显,局部皮肤无红、热,触诊质地硬,有压痛,无波…     

Liver and lung resection for colorectal metastasis

Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival.