周围神经源性良性肿瘤的超声特性

目的通过分析周围神经源性良性肿瘤的超声特性,评价超声在周围神经源性良性肿瘤中的诊断作用。方法采用回顾性调查方法收集2000—2011年我院收治的有完整临床资料的良性周围神经肿瘤65例患者的术前超声检查、手术图片及病理检查结果,其中58例肿瘤患者同时包含彩色多普勒超声检查结果,由2位有丰富临床经验的超声影像医师对患者的术前超声图像进行回顾分析,评估肿瘤超声特性包括肿瘤的形状、大小、边界、包膜、内部回声特性、后方回声情况与周围神经的关系以及血流情况。结果本组65例良性周围神经源性肿瘤70处病变的超声检查结果显示42处病变(60%)为内部回声均匀的实质性低回声结构;28处病变(40%)为回声不均的低回声结构,其中18处(26%)病变为低回声结构内部可见高回声区,10处(14%)病变为低回声结构内部可见液性暗区;36处病变与知名周围神经相连。58例肿瘤彩色多普勒超声检查显示24例肿瘤(41%)有丰富血流信号,22例肿瘤(38%)有少量血流信号,12例(21%)肿瘤无血流信号。65例患者70处病变均行手术切除,术中见54处病变来源于知名的周围神经,16处病变位于肌肉内,无知名神经纤维连结。超声检查显示病变与神经相连的阳性率为67%(36/54)。65例肿瘤手术切除后病理检查结果显示,62例肿瘤为神经鞘膜瘤,2例为神经纤维瘤,1例为神经纤维瘤病。结论超声检查能提供良性神经源性肿瘤较详细的形态、内部结构、边界、包膜以及肿瘤与周围组织的关系的信息,还能显示肿瘤与周围神经的联系以及血流情况等,检查方便易行,检查费用低廉,患者易于接受。     

前后路短节段固定融合治疗腰椎纵向劈裂骨折

目的：评价前后路短节段固定融合治疗腰椎纵向劈裂骨折的临床效果和安全性。方法：回顾性分析中南 大学湘雅二医院脊柱外科2005年3月至2013年5月采用的前后路短节段固定融合治疗的13例腰椎纵向劈裂骨折患者临床 资料,对所有患者的矫正情况进行随访,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指 数(Oswestry disability index,ODI)对腰椎功能进行评估。结果：随访时间为24~60个月,平均42个月;手术时间185~300 min,平均248 min;术中失血量为600~1 500 mL,平均950 mL。所有患者术后均获得功能及自我形象的改善,在Cobb 角评估方面,术后2 d,12个月和末次随访测量Cobb角较手术前均有明显改善,差异均有统计学意义(P<0.05);VAS评 分和ODI评估术后2 d,12个月和末次随访测量结果较之术前均有改善, 差异均有统计学意义(P<0.05)。术后12个月与 末次随访的评估结果相比,差异无统计学意义(P>0.05)。根据美国脊髓损伤协会(ASIA)分级标准,在末次随访时,术 前8例D级患者中6例恢复至E级,其中3例未见进一步恢复;术前2例C级中1例恢复至D级,1例恢复至E级。所有病例 骨折均获愈合,愈合时间为3~6个月,平均4.5个月;术中3例有硬膜撕裂,术中给予修补;无神经血管损伤并发症病 例。结论：短节段伤椎置钉和旋棒复位是腰椎纵向劈裂不稳定骨折较好的手术选择。     

二甲双胍治疗抗精神病药物引起的血脂异常:两项随机、安慰剂的对照研究

目的：验证二甲双胍治疗抗精神病药引起的血脂异常的疗效和安全性。方法：将两项随机、安慰剂的 对照研究纳入分析。共有201例服用抗精神病药物后出现血脂异常的首发精神分裂症患者,并将其分为1 000 mg/d 二甲双胍组(以下简称为二甲双胍组,n=103)和安慰剂组(n=98),观察24周。在基线、治疗后第12周和第24周进行 临床症状及体重、血糖、血脂等代谢指标的评估。结果：二甲双胍治疗后,二甲双胍组和安慰剂组之间低密度脂 蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)的平均差异从基线时的0.16 mmol/L,降低到第24周结束时的 –0.86 mmol/L,降低了1.02 mmol/L,差异有统计学意义(P<0.01)。而24周结束时,二甲双胍组LDL-C≥3.37 mmol/L的 患者有25.3%,显著低于安慰剂组24周结束时的64.8%(P<0.01)。与安慰剂组相比,二甲双胍组的体重、体重指数、 胰岛素、胰岛素抵抗指数、总胆固醇、三酰甘油和高密度脂蛋白胆固醇也有显著变化,差异均有统计学意义(均 P<0.05)。治疗对体重和胰岛素抵抗的影响出现在第12周,并且在第24周进一步改善,但对改善血脂异常的作用在第 24周结束时才出现。结论：二甲双胍治疗对于改善抗精神病药物引起的血脂异常和胰岛素抵抗是有效的,并且改善 抗精神病药物诱导的胰岛素抵抗出现的时间早于降低血脂异常的时间。     

Primary Cavernous Hemangioma of the Glans Penis: Rare Case Report with a Review of the Literature

Hemangiomas of the urinary tract are rare lesions, and those of the glans penis are even rarer. A 23-year-old man with a hemangioma of the glans penis treated successfully with intralesional sclerotherapy is presented. Other options for the management of this disorder are discussed.     

Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome

Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow‐up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.     

Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers.

Functional brain imaging is a powerful tool for examining the central nervous system (CNS) response to pharmacologic challenges. Amphetamine is of interest both because of its role as a stimulant of the dopaminergic system and because of its use to alter mood in mood-disordered patients, particularly in patients suffering from depression. In this study, we report the effects of oral D-amphetamine relative to placebo on regional cerebral blood flow (rCBF) measured by SPECT in healthy volunteers to characterize the normal CNS response to this primarily dopaminergic stimulant. METHODS: SPECT was used to assess changes in rCBF induced by amphetamine in 16 healthy volunteers. Subjects received placebo and then 0.4 mg/kg oral amphetamine in a fixed-order single-blind design and were imaged on a triple-head tomograph. Another six healthy volunteers received placebo at both times to assess normal rCBF variability. rCBF changes were assessed with a three-dimensional voxel-based analysis integrated into an automated coregistration system. Data were automatically normalized to whole-brain counts and coregistered. Resultant rCBF changes were evaluated parametrically through the formation of an image whose voxel values were based on the paired t statistic. RESULTS: Amphetamine increased rCBF in two mesial prefrontal zones (Brodmann's areas 8 and 10), inferior orbital frontal lobe (area 11), brain stem (ventral tegmentum), anteromesial temporal lobe (amygdala), and anterior thalamus. Amphetamine decreased rCBF to motor cortex, visual cortex, fusiform gyrus, posterolateral temporal lobe, and right lateral temporal lobe. CONCLUSION: Our data suggest that amphetamine induces focal increases and decreases in rCBF in healthy volunteers in areas primarily innervated by dopamine pathways and in areas with secondary (primarily limbic) affiliations. These data are consistent with glucose metabolic data from autoradiographic studies in animals, in which the largest increases are seen in brain stem, followed by striatum, thalamus, and frontal and sensory cortices. Frontopolar and temporal increases observed in our study appear to be unique to humans.     

Bone Mineral Density at the Hip Predicts Mortality in Elderly Men

Low bone density as assessed by calcaneal ultrasound has been associated with mortality in elderly men and women. We examined the relationship between bone density measured at the hip and all cause and cardiovascular mortality in elderly men. Men aged 65–76 years from the general community were recruited from general practices in Cambridge between 1991 and 1995. At baseline survey, data collection included health questionnaires, measures of anthropometry and cardiovascular risk factors, as well as bone mineral density (BMD) measured using dual energy X-ray absorptiometry. All men have been followed up for vital status up to December 1999. BMD was significantly inversely related to mortality from all causes and cardiovascular disease, with decreasing rates with increasing bone density quartile, and an approximate halving of risk between the bottom and top quartile (p <0.002, test for trend all causes and p <0.025, test for trend for cardiovascular deaths). In multivariate analyses using the Cox proportional hazards model, an increase of 1 standard deviation (0.144 g/cm²) in total hip bone density was significantly associated with an age-adjusted 0.77 relative risk (95% CI 0.66–0.91) for all-cause mortality and 0.76 relative risk (95% CI 0.62–0.93) for cardiovascular disease mortality. The association remained significant after adjusting for age, body mass index, cigarette smoking status, serum cholesterol, systolic blood pressure, past history of heart attack, stroke or cancer and other lifestyle factors which included use of alcohol, physical activity and general health status. Low bone density at the hip is thus a strong and independent predictor of all-cause and cardiovascular mortality in older men. Received: 16 August 2000 / Accepted: 27 October 2000     

改良性治疗法联合西地那非治疗勃起功能障碍维吾尔族患者2505例回顾性分析

目的:性治疗法目前尚未普及,本研究旨在评价性治疗法联合西地那非治疗勃起功能障碍(ED)的疗效。方法:根据治疗方法的不同将在本院治疗随访过的3130例维吾尔族ED患者分成2组。对照组625例,单纯口服西地那非3个月;试验组2505例,采用性治疗法联合西地那非治疗3个月。采用国际勃起功能问卷表(IIEF-5)在各组治疗前、后进行疗效评估,并随访12个月。结果:对照组治疗前、后及在6个月、12个月随访的IIEF-5评分分别为12.80±3.76、18.10±2.61、17.35±2.73和16.64±2.63;试验组治疗前、后及在6个月、12个月随访的IIEF-5评分分别为12.73±3.52、19.06±4.07、19.86±2.42和20.47±2.38。两组治疗前后IIEF-5评分自身对比差异均有显著性(P<0.05)。组间比较,试验组较对照组6个月和12个月随访IIEF-5评分均有显著性差异(P<0.05)。结论:性治疗法联合西地那非治疗ED的效果优于单纯西地那非治疗,并在12个月的随访中稳定性良好。