GS23PPAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL

Purpose To perform an audit of paediatric surgical patients in a provincial general surgical unit. Methodology Data was prospectively recorded using a standardized proforma on all children aged up to 15 yrs, seen between 11th December 2005 and 11th December 2006. Results There were 209 admissions (194 children), median age 8 yrs (6 wks–15 yrs) with 153 (73%) acutes. 37 children (18%) were under 2 yrs. Male : female ratio was 3 : 2. Procedures (n = 119) were appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy respectively. 51% of operations were acute. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusseption (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (6 wks–14 yrs). Complications were wound infection (1), post‐operative ileus (2) and infarcted ovary (1). Conclusion There are increasing moves towards centralization in paediatric surgery. 1 With only 4 paediatric tertiary centres in NZ, many general surgeons routinely perform paediatric surgery. A large number of children presented to our surgical department. Around half of these children required surgery and half of operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.     

Klippel-Feil syndrome plus atretic meningocele in one identical twin and anencephaly in the other.

Klippel-Feil syndrome (KFS) is a heterogeneous entity, characterized by specific congenital anomalies of segmentation of the cervical spine. We report a case of KFS plus atretic meningocele in one identical twin and anencephaly in the other. These identical twins were both male with no chromosome defect. One of them had anencephaly diagnosed at the gestational age of 17 weeks and died soon after birth, whereas the co-twin had KFS with multiple congenital anomalies including short neck with low hairline, occipital atretic meningocele, butterfly vertebrae, hemivertebrae, cervico-thoracic scoliosis, left thumb preaxial polydactyly, and right undescended testis. He received rehabilitation during infancy and could walk at the age of 15 months. Both of these infants had preaxial polydactyly, which is an uncommon anomaly associated with KFS. In conclusion, iniencephaly and anencephaly are probably the extreme manifestations of KFS rather than different dysraphisms. Prompt clinical suspicion with early diagnostic imaging for spine lesions and occult opening of neural tube is mandatory for further intervention and rehabilitation.     

17 β雌二醇通过丝裂原活化蛋白激酶抑制前列腺癌细胞系PC3增殖

目的探讨丝裂原活化蛋白激酶在17β雌二醇(E2)抑制前列腺癌PC3细胞生长中的作用。方法检测不同浓度E2作用不同时间后PC3细胞生长抑制率。流式细胞仪分析细胞周期分布,TUNEL染色检测凋亡。Western blot检测ERK1/2,JNK和p38活性。RT-PCR法检测雌激素受体(ER)α、ERβ、P21WAF1和cyclinD1的表达。结果E2抑制PC3细胞增殖,并且可以激活ERK1/2、JNK和p38。处理因素作用48h后,对照组、E2、E2 PD98059、E2 SP600125、E2 SB203580组细胞的凋亡率分别为(0.9±0.1)%;(23.0±1.4)%;(30.0±1.2)%;(10.6±0.8)%和(14.6±0.7)%,(P<0.05)。E2使细胞阻滞在G1期,PD98059、SP600125、SB203580分别预处理1h后细胞分别进一步阻滞在G1期;轻度阻滞在G1期和进入S期。RT-PCR发现PC3细胞表达ERα和ERβ,E2、E2 PD98059、E2 SP600125、E2 SB203580组中cyclinD1、P21WAF1基因表达分别为对照组的(0.42±0.03)、(3.13±0.02)倍;(0.21±0.03)、(3.08±0.05)倍;(0.43±0.01)、(1.31±0.04)倍;(2.81±0.02)、(3.14±0.02)倍(P<0.05)。结论E2激活JNK增加P21WAF1基因表达,并激活p38抑制cyclinD1表达,使细胞阻滞在G1期,JNK和p38通路还介导E2引起PC3细胞凋亡。同时E2又可激活ERK1/2,轻度拮抗上述作用。     

可吸收钉治疗四肢骨折18例体会

自可吸收钉发明并应用于临床以来．因该钉能在体内降解、吸收，免除了二次手术拆钉的痛苦，受到病人的普遍接受。本院自2003年6月以来应用可吸收螺钉治疗骨折18例，取得了较好的效果。报告如下。     

May钢板在治疗股骨转子间骨折中的应用

目的　探讨May钢板治疗股骨转子间骨折临床效果及治疗要点。方法　对 2 7例股骨转子间骨折用May钢板治疗 ,按Evans分型 ,Ⅰ型 2例 ,Ⅱ型 4例 ,Ⅲ型 9例 ,Ⅳ型 12例。结果　 2 7例平均随访 2 9个月 (15～ 36个月 ) ,骨折全部愈合。根据Harris髋关节评分 ,优良率达 96 %。结论　May钢板是治疗股骨转子间骨折的较好选择之一 ,可使骨折达到解剖复位和牢固的内固定 ,疗效良好。     

Bcl-2和Bax在胆管癌中的表达及意义

目的　检测 4 9例肝外胆管癌和 10例正常胆管Bcl 2和Bax的表达。方法　免疫组化ABC法。结果　Bcl 2在胆管癌中阳性表达 (48.98% )显著高于正常胆管 (10 .0 0 % ) (P <0 .0 5 ) ;高、中分化胆管癌Bcl 2阳性表达显著高于低分化癌 (P <0 .0 5 ) ;胆管癌Bax阳性表达 (5 3.0 6 % )与正常胆管 (80 .0 0 % )相比无统计学意义 (P >0 .0 5 ) ,正常胆管Bax阳性表达显著高于Bcl 2阳性表达 (P<0 .0 1) ,而胆管癌中Bcl 2与Bax阳性表达无显著性差异 (P >0 .0 5 )。结论　Bcl 2过度表达对胆管癌的发生可能起促进作用 ;胆管癌中Bcl 2低表达可能是预后不良的预测指标之一。     

胫骨干骨折带锁髓内钉固定和钢板螺钉固定的对比研究

目的：对照回顾性分析带锁髓内钉和钢板内固定两种方法治疗胫骨干骨折的效果。方法：髓内钉组32例（35处骨折）,根据AO分型,42A型11处,42B型18处,42C型6处;钢板组42例（45处骨折）,42A型10处,42B型22处,42C型13处。平均伤后手术时间在髓内钉和钢板组分别为3d和3.5d。随访评估患者手术时间,活动度,愈合时间,术后并发症之间的差别。结果：术后平均随访13个月（8～26个月）。髓内钉组平均手术时间为84min,钢板螺钉组平均为93min。髓内钉组踝关节平均背屈度为13°（0°～20°）,钢板组为11°（0°～20°）;跖屈分别为41°（30°～50°）,47°（30°～50°）。愈合时间髓内钉组平均为3.3个月,钢板螺钉平均为3.5个月。术后X线片显示髓内钉固定有1例出现旋转畸形,钢板组有3例出现成角畸形,均为胫骨远端1/3骨折。结论：在治疗胫骨骨折方面,带锁髓内钉和钢板内固定两种方法都可以取得理想的效果。     

Interleukin 17-Producing γδT Cells Increased in Patients with Active Pulmonary Tuberculosis

Although it has been known that y8 T cells may play an important role in the immune response to infection of Mycobacterium tuberculosis (M. tb), the mechanisms by which the T8 T cells participate in the innate and/or acquired immunity to tuberculosis (TB) have not been full elucidated. In the present study, 27 patients with active pulmonary TB and 16 healthy donors (HD) were performed. We found that proportion of IL-17-producing cells among lymphocyte was similar between TB patients and HD, whereas the proportions of γδ T cells in IL-17- producing cells (59.2%) and IL-17-producing cells in γδ T cells (19.4%) in peripheral blood were markedly increased in TB patients when compared to those in HD (43.9% and 7.7%, respectively). In addition, the proportions of IFN-γ-producing γδ T cells in TB patients were obviously lower than that in HD. Upon re-stimulated with M. tb heat-treated antigen (M. tb-HAg) in vitro, fewer IL-17-producing γδ T cells were generated from HD and TB patients, whereas IFN-γ-producing γδ T cells were increased in TB patients compared to that in HD. Our findings in TB patients and healthy human were consistent with other murine investigation that the IL-17- producing γδ T cells were main source of IL-17 in mouse model of BCG infection, suggesting that γδ T cells might be involved in the formation of tubercular granuloma in pulmonary TB patients, but need further identification. Cellular & Molecular Immunology. 2008;5(3):203-208.     

亚急性甲状腺炎的CT诊断

目的:探讨亚急性甲状腺炎的CT表现和特点,提高对该病影像表现的认识。材料和方法:回顾性分析10例亚急性甲状腺炎CT影像特征及临床资料,共16个病灶,其中9例经手术病理证实,1例临床证实。同时抽取局限型甲状腺癌65例,就部分征象作对照分析。结果:亚急性甲状腺炎局限性3例,弥漫性7例。CT表现分3型:①局限于甲状腺一侧叶的低密度病变,病变甲状腺肿大,峡部可受累,3例;②甲状腺两叶各有一低密度病变,呈不对称肿大,病灶之间有正常甲状腺组织,6例共12个病灶;③甲状腺两叶及岬部均匀肿大,略不对称,1例。CT平扫病变为低密度,增强扫描后呈轻到中度均匀强化(15/16),腺内更低密度结节少见(1/16)。病变处甲状腺边缘模糊(16/16),与正常甲状腺组织界限不清(15/16),而局限型甲状腺癌病灶与正常甲状腺腺组织分界清楚(62/65),两者极不一样(P<0.01)。结论:亚急性甲状腺炎CT表现有一定特点,熟悉这些特点对于诊断及鉴别诊断很有帮助。