Controversies regarding radiological changes and variables predicting amputation in a surgical series of diabetic foot osteomyelitis

BackgroundTo investigate if radiological changes have any influence on the outcomes of surgical treatment of diabetic foot osteomyelitis.MethodsData of patients included in a prospective cohort who underwent surgical treatment for definitive osteomyelitis were analyzed. Cases were classified according to radiological changes as “early osteomyelitis” when no radiological changes were found or in cases showing periosteal elevation and/or subcortical demineralization and/or cortical disruption. Cases showing sequestra and/or gross bone destruction were classified as “advanced osteomyelitis”.ResultsEarly osteomyelitis was defined according to radiological findings in 37 cases (45.7%) and advanced in 44 (54.3%). Advanced osteomyelitis was not associated with the risk of undergoing amputation.ConclusionsThe bone changes seen in simple X-rays in cases of osteomyelitis do not have any prognostic value when surgical treatment is undertaken. The outcomes are more related to soft tissue involvement than bone destruction seen in simple X-rays.     

腹膜前无张力疝修补术治疗合并肝硬化腹水的腹股沟疝患者临床体会(附11例报告)

目的 探讨局麻下腹膜前无张力疝修补术在治疗肝硬化腹水并发腹股沟疝患者的治疗效果.方法 回顾性分析我院2008年1月至2011年12月经手术治疗的合并肝硬化腹水的腹股沟疝患者11例,对其临床资料和手术效果进行分析评估.结果 患者均经腹膜前无张力疝修补术治疗,无严重并发症或术后复发;术后30 d内无患者死亡;随访患者有3例死亡,均与手术治疗无明显相关.结论 在局麻下对肝硬化腹水的患者实施腹膜前无张力疝修补术安全、有效,可明显提高此类患者的生活质量.     

单孔腹腔镜低位直肠癌保肛手术的技术要点

单孔腹腔镜技术是近年来刚刚兴起的一种微创新技术,可达到接近"无瘢痕手术"的效果,具有更好的微创和美容疗效.由于单孔的限制,手术的操作难度增加,同时在操作技巧方面也表现出一些独有的特点.单孔腹腔镜技术在结直肠手术中的应用研究相对较多,在低位直肠癌的保肛手术中可以发挥良好的微创和美容优势,但结合单孔腹腔镜技术特点及低位直肠癌的解剖结构等因素,利用单孔腹腔镜技术完成低位直肠癌的保肛手术需要充分认识和遵循其内在的规律.     

术后早期肠外联合肠内营养支持治疗对老年胃癌病人临床预后的影响

目的:观察术后早期肠外联合肠内营养支持治疗对老年胃癌病人临床预后的影响。方法:96例老年胃癌病人随机分为观察组和对照组,每组48例。术后分别行肠外营养(PN)+肠内营养(EN)和PN支持,持续7 d。测定两组病人手术前后血清C反应蛋白(CRP)、清蛋白(ALB)、转铁蛋白(TF)水平和术后疲劳指数,并观察两组病人术后肛门排气、并发症和住院时间的变化。结果:与对照组比,观察组老年胃癌病人术后第7天血清CRP水平和疲劳指数均明显下降(P<0.05),血清TF水平显著增加(P<0.05),并且术后肛门排气和术后住院时间缩短(P<0.05),术后感染发生率降低(P<0.05)。结论:PN联合EN治疗有助于调节老年胃癌病人术后机体的创伤应激,促进病人康复。     

灯盏花素干预体外培养大鼠脑皮质神经元的存活与生长

背景：神经生长因子在维持中枢神经系统神经细胞的存活、分化,促进其生长、发育,维持其功能方面具有不可替代的作用。 目的：观察灯盏花素对SD大鼠大脑皮质体外培养神经元生长的影响,并初步探讨其机制。 方法：取新生SD大鼠胚胎,取其大脑皮质后,对神经元进行原代培养,随机分为3组,其中灯盏花素组加入10 g/L灯盏花素,对照组加入等量生理盐水,正常组不作任何处理,各组又分为24 h、48 h亚组。对24孔板中各组细胞各时间点采集图像,之后采用RT-PCR技术检测神经生长因子、酪氨酸激酶A mRNA的表达变化。对96孔板中各组细胞不同时间点采用MTT检测神经元生长活力。 结果与结论：正常组和对照组在各时间点细胞数、胞体面积、突起长度及细胞活力无明显差异（P〉0.05）,但正常组及对照组均有随时间点延长,3个指标均上调（P0.05）,灯盏花素组各时间点较正常组和对照组上调（P〈0.05）。提示灯盏花素促进SD大鼠脑源性神经元的存活、生长,其机制可能是通过上调神经生长因子及其受体TrkA的表达发挥作用。     

Prevention of grafted liver from reperfusive injury

INTRODUCTIONThe incidence of primary non-function(PNF)of grafted liver in the early postoperative stage is 2%-23%[1-4],its main cause is the ischemic-rechemic injure[5,6].In this experiment,anisodamine was added into the preserving fluid and the grafted liver was rewarmed at different temperatures to protect the cell membranc and prevent ischemic-reperfusive injury.     

维生素E琥珀酸酯联合化疗药物对胰腺癌细胞的体外抑制作用

目的检测维生素E琥珀酸酯(VES)联合化疗药物对胰腺癌细胞的体外抑制作用,并初步分析其机制。方法人胰腺癌细胞BxPc-3以VES联合化疗药物处理24h,VES浓度为5μg/ml、10μg/ml和20μg/ml。化疗药物的浓度分别为5-FU:100μmol/L,130μmol/L,260μmol/L和400μmol/L;丝裂霉素(MMC):0.5μmol/L,1μmol/L,3μmol/L和10μmol/L以及顺铂:5μmol/L,10μmol/L和20μmol/L,以及不同VES浓度分别与不同浓度不同化疗药物联合应用。以MTT法测定对细胞增殖的抑制作用,以流式细胞仪分析细胞凋亡率和细胞表面Fas表达。结果(1)单用不同浓度的VES和化疗药物均可显著抑制胰腺癌细胞的生长,并表现出剂量依赖关系(P<0.05)。二者合用时产生协同效应,抑制作用较单用相应浓度的药物显著增强,并且随相应药物浓度的增加而增强(P<0.05)。(2)BxPc-3细胞的自然凋亡率为0.4%,20μg/mlVES作用24h后凋亡率为21.0%,3种化疗药物最高浓度作用后的凋亡率分别为17.5%,12.4%和18.8%。VES与3种化疗药物最高浓度联合应用后的凋亡率分别为37.5%,30.6%和51.4%。(3)VES联合化疗药物作用后胰腺癌细胞表面Fas表达增强。结论VES联合化疗药物对胰腺癌细胞具有显著的凋亡诱导作用,其机制可能与细胞表面Fas表达上调有关。     

Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus

In general, focal nodular hyperplasia lesions of the liver have a benign natural course; the majority of cases remain asymptomatic and complications are rare. We report a case of spontaneous rupture and hemorrhage of focal nodular hyperplasia, which is extremely rare in the literature. A 35-year-old woman was admitted with severe upper abdominal pain and unstable hemodynamic status. No major abdominal trauma was noted. Radiology findings suggested a diffuse hemoperitoneum. Emergent surgical exploration showed a hemoperitoneum due to the rupture of a hepatic mass lesion in segment I. Suture of the rupture was undertaken with success. After this lifesaving emergent surgery, further investigations, including ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging, were undertaken, and a 5.7 × 9.8 × 6.4-cm focal nodular hyperplasia lesion was identified in segment I. Two weeks after the first surgical hemostasis, surgical removal of segment I, including the mass, was performed. The postoperative course was uneventful. Pathological evaluation confirmed the nature of focal nodular hyperplasia. The patient remains asymptomatic without evidence of recurrence 3 years and 6 months after surgery. To our knowledge, this is the firstcase of spontaneous rupture and hemorrhage of focal nodular hyperplasia that needed two consecutive surgical operations.