Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery.

BACKGROUND: Concept of the 'super-thin perforator flap' was introduced in 1994 by authors. Since then, various types of 'super-thin perforator flaps' were applied successfully especially for contour sensitive reconstruction such as face and neck. METHODS: Eleven patients requiring large flaps who presented with extensive disfiguring facial scar (male: seven cases, female: four cases). On the consideration of flaps' colour, texture and thickness requirements, the authors selected 'super-thin' anterior intercostal perforator flaps (AICP, range from 4 x 14 cm to 25 cm x 9 cm) for reconstruction purpose. First, tissue expanders (volume range from 800 cc to 1200 cc) were carefully inserted under the AICP. After the flaps were expanded for 2 months, distant scars were removed and the covering super-thinned flaps were transferred into recipient site. Two weeks later, pedicles in the anterior chest were cut down and flaps were transferred to replace all the left scars. RESULTS: Flap were survived without any complications. The colour, texture and thickness of the transferred flap were satisfactory, shrink of flaps were not observed after long term follow-up. The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good colour and texture, without the need of microsurgery and few disadvantages of donor-site morbidity. The disadvantages are three-staged procedures, complications of tissue expansion and uncomfortable compulsory posture for patients. In our opinion, this is an alternative method of choice for reconstructing all large defects in the lower two-thirds of the face.     

路志正教授"知常达变"辨治妇科病经验撷萃

路志正教授从事中医临床多年,不仅对内科杂病有丰富的临床经验,对妇科疾病的诊疗,亦很有特色。笔者于2003年有幸侍诊左右,耳濡目染,略有所得,不揣浅陋,举述验案二则。健脾祛湿行水治疗闭经、不孕患者某,女,32岁,已婚,2003年10月9日初诊。主诉:月经稀少10余年,闭经2年。患者15岁     

界定需要急诊入院的高危人群单纯依据既往的入院率会造成误导

预测哪些人可能因急性发病而需要急诊入院，已成为英国国家医疗卫生服务体系（NHS）的一个重要话题。卫生部门将那些患有复杂的慢性疾病，经常不定期地去二级医疗机构就医的人们视为高危人群。确定这些人之后，社区护理员或其他卫生人员将通过“个案管理”的方法照顾他们。“个案管理”此前被定义为“对疾病尚未控制或所需费用昂贵的患者进行加强医疗计划”。社区护理人员可来自任何护理部门，但一般认为社区护士更能胜任这一角色。此方法能够减少可避免的急诊入院患者数量，并有助于实现到2008年3月减少5％急诊住院床位日的公共医疗服务目标。但是，如何才能界定需要急诊入院的高危人群呢？     

Factors associated with work-related injury among hospital employees: a case-control study.

The Central Arkansas Veterans Healthcare System (CAVHS) spends $1 million annually on occupational illnesses and injuries. To address the problem of injuries among hospital employees, a retrospective case-control study was conducted to examine select risk factors for work-related injuries (WRI) among CAVHS employees. Study methods included a review of employee health charts and computer and manual databases from 1997 to 2002 (N = 2,050). The researchers found that WRI increased with age; WRI occurred more often in women than in men; WRI was greater among maintenance and custodial staff compared to direct caregivers, and less among clerical staff; WRI occurred less often in part-time than full-time staff; and WRI increased with increasing body mass index. Developing standards, guidelines, and policies for preplacement screening, preventive measures, training, and education may help to minimize WRI and associated costs.     

Immunohistochemical differentiation of atypical hyperplasia vs. carcinoma in situ of the breast.

The distinction between atypical hyperplasia and carcinoma in situ in breast lesions can be difficult. The identification of myoepithelial cell layers may be helpful in establishing a diagnosis of proliferative breast disease vs. intraepithelial neoplasia. We reviewed pathologic material on 20 cases of atypical hyperplasia and 29 cases of carcinoma in situ. Immunohistochemical stains were employed against muscle-specific actin, S-100 protein, and cytokeratin to identify myoepithelial cells and to recognize different staining patterns. In atypical hyperplasia, muscle-specific actin staining identified myoepithelial cells in fine branching fibrovascular layers or as scattered cells between other proliferating cells. This pattern was absent in carcinoma in situ. S-100 protein showed more positive staining in atypical hyperplasia than in carcinoma in situ with patterns distinct from muscle-specific actin. Immunostaining for cytokeratin demonstrated distinctly different patterns between the two lesions. This study suggests that muscle-specific actin, S-100 protein, and cytokeratin in combination may assist in distinguishing proliferative breast disease with atypia from carcinoma in situ.     

Secretion of human hepatitis B virus is inhibited by the imino sugar N-butyldeoxynojirimycin.

The imino sugar N-butyldeoxynojirimycin (NBDNJ) is a potent inhibitor of the oligosaccharide-trimming enzyme alpha-glucosidase I. Hepatitis B virus (HBV) contains three surface proteins (HBs proteins) of different sizes that are singly or doubly N-glycosylated and are essential for the formation of infectious virus. Therefore, the replication and secretion of HBV in the human hepatoma cell line HepG2 were studied in the presence of NBDNJ. In the stably HBV-transfected HepG 2.2.15 cells and in HBV-infected HepG2 cells, NBDNJ suppressed secretion of HBV particles and caused intracellular retention of HBV DNA. The secretion of subviral particles was less affected. These data suggest that inhibitors of oligosaccharide trimming may be useful for antiviral therapy of hepatitis B and for the study of the intracellular transport of the viral glycoproteins.     

结直肠癌中雄激素受体及其与临床病理学特征关系的研究

应用放射性配基结合分析法，检测了４０例结直肠癌及部分癌旁正常粘膜组织中的雄激素受体（ＡｎｄｒｏｇｅｎＲｅｃｅｐｔｏｒ，ＡＲ），同时分析了ＡＲ水平与临床病理学变化的关系。证实结直肠癌ＡＲ数目（３３．７±２３．３ｆｍｏｌ／ｍｇ蛋白）明显低于癌旁５ｃｍ以外粘膜（５３．９±３２．４ｆｍｏｌ／ｍｇ蛋白），Ｐ＜０．０１，而其亲和力则无变化；结直肠癌时ＡＲ数目变化与女性、直肠癌、高分化癌及早期癌关系密切。提示ＡＲ与结直肠癌关系密切，本实验为临床上结直肠癌的诊断及内分泌治疗提供了初步资料。     

癌胚抗原及粘液组织化学在胃癌中表达的研究

对60例胃癌进行了粘液组织化学和癌胚抗原免疫组织化学研究。结果表明:胃癌发病率肠型和胃肠混合型占多数。60例胃癌中含大肠型粘液者占50例,而单纯含胃型粘液为极少数。癌胚抗原分布方式,肠型胃癌与胃肠混合型胃癌比较无显著差异性(P>0.05)。癌胚抗原的阳性率,胃肠混合型胃癌高于肠型胃癌,两者之间有非常显著差别(P<0.01)。认为选用能显示硫粘蛋白和氧乙酰基唾液酸粘蛋白的粘液组织化学方法,作为胃癌组织分型和确定胃粘膜肠化性质,对癌前病变诊断有一定价值。