腓浅神经浅支移植修复桡神经缺损

[目的]探讨腓浅神经浅支修复桡神经缺损的临床效果。[方法]对腓浅神经浅支与桡神经形态结构进行比较，并对腓浅神经浅支移植修复桡神经缺损性损伤5例进行临床分析。[结果]腓浅神经浅支与桡神经形态结构大体一致．5例病例平均随访11(8～26)个月．按文献标准评定，优3例，良2例。[结论]腓浅神经浅支可作为修复桡神经缺损理想的供体神经。     

强脉冲光治疗浅表(皮肤)血管瘤临床观察

目的：观察强脉冲光（IPL）治疗浅表（皮肤）血管瘤的疗效。方法：选择60例浅表（皮肤）血管瘤患者,随机分为治疗组和对照组,治疗组用535nm、580nm强脉冲光治疗皮损,每三周治疗一次,三次为一个疗程;对照组采用波长为532nm的Q开关Nd：YAG激光治疗,每两周治疗一次,三次为一个疗程。观察两组皮损的治愈率、并发症等情况,并行统计学处理。结果：治疗组皮损三次治愈率明显高于对照组（P〈0.01）,患处瘢痕形成及炎症性色素沉着发生率均低于对照组。结论：强脉冲光（IPLTM）治疗浅表（皮肤）血管瘤效果满意。     

稳定表达nucleostemin—siRNA的肿瘤细胞克隆的筛选和鉴定

目的：用脂质体法建立nucleostemin（NS）基因特异性siRNA阳性细胞克隆，为深入研究NS基因在胃癌细胞增殖调控中的作用和机制提供理想的生物学模型。方法：试剂盒法将真核表达载体PCDNA4／C—NS—silencer质粒大量扩增，然后以限制性切酶PVUI酶切线性化处理，用LipofectamineTM2000Reagent将PCDNA4／C—NS—silencer及其对照空载体转染胃癌SGC-7901细胞，经Zeocin抗生素压力筛选后用PCR方法鉴定细胞克隆外源基因整合阳性。结果：经Zeocin抗生素压力筛选后两组细胞均收获多个细胞克隆；PCR结果表明两组细胞克隆外源基因整合阳性。结论：成功建立表达NS～siRNA的胃癌SGC-7901细胞克隆。     

Ⅰ期趾甲延长术9例报告

目的:总结Ⅰ期在第2足趾游离移植再造拇(手)指中行趾甲延长的临床应用经验.方法:采用趾甲延长方法对9例(男7,女2例)第2足趾移植再造拇(手)指的患者进行了趾甲延长术,其中拇指8例,食指1例.年龄18～46岁,平均25岁.在再造指距甲根皮缘5 mm处,去除1块矩形皮肤,勿损伤皮下血管网.其高度2 mm,宽度与趾甲相等,将U形皮瓣向近端柔和推剥并缝合.结果:1例术后供区发生表浅感染,经换敷料逐渐愈合.再造的拇(手)指全部成活,可延长趾甲2～3 mm,改善了再造拇(手)指的外形,无指甲生长畸形发生.随访7个月～2年(平均13个月),趾甲外形较好.结论:在第2足趾游离移植再造拇(手)指中应用Ⅰ期趾甲延长术,使趾甲从短小向纵向延长,缩小手指甲与足趾甲之间差异,能改善再造拇(手)指甲外形,且不影响再造指的活动功能,是一种简单有效的手术方法.     

Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

Anatomical Course of the Superficial Branch of the Radial Nerve and Clinical Significance for Surgical Approaches in the Distal Forearm

Abstract 10 embalmed cadaver forearms and wrists were dissected to determine the anatomical course of the superficial branch of the radial nerve in the distal forearm. The superficial radial nerve bifurcated in two branches at a mean of 54,7 mm proximal to the radial styloid. From the styloid process of the radius, the mean distance to the closest dorsal branch of the superficial radial nerve was 3,5 mm and the mean distance to the closest volar branch was 9,8 mm. The mean distance between the closest branch of the superficial radial nerve and Lister?s tubercle was 16,4 mm. The crossing point between the nerve and the cephalic vein was located at a mean of 54,3 mm proximal to the styloid process. At the level of styloid process the mean distance between the closest dorsal branch of the superficial radial nerve and the first dorsal compartment was 15,2 mm and between the closest volar branch and the first dorsal compartment 4,4 mm. Detailed knowledge of anatomic characteristics of the superficial branch of the radial nerve may help prevent injury during operations and treat traumatic lesions of the nerve. Because of great variations in the course of the superficial radial nerve we could not define an absolute safe zone for surgical procedures on the distal forearm. Iatrogenic lesions of the superficial radial nerve are described complications of percutaneous procedures. Therefore open surgical approaches are recommended. Daniela Klitscher and Lars Peter Müller contributed equally to this work.     

Massive Immune Hemolysis Caused by Anti-D After Dual Kidney Transplantation

Massive immune hemolysis due to passenger lymphocyte-derived anti-D has not been reported in renal transplantation. A 50-year-old (B-positive) male received a dual deceased-donor kidney transplant (B-negative) for diabetic renal failure. Two weeks post-transplant, the patient developed severe hemolytic anemia. The donor anti-D titer was 1:8. The recipient anti-D titer (zero pre-transplant) increased from 1:4 to 1:16 over 4 days. Rapid hemolysis caused severe anemia, minimum Hb = 4.2 g/dL, while selectively lysing the patient's autologous red cells during this time. The hemolytic anemia did not impair the allografts and subsided without monoclonal B-cell pharmacotherapy or apheresis. The anti-D titer decreased to barely detectable levels at four months and had cleared when checked 2 years post-transplant. Transfusion support subsided after two months. If complications of anemia can be avoided, the deleterious effects of hemolysis may be well tolerated by renal allografts using antigen negative transfusion alone.     

Comparative genomic hybridization (CGH) of augmentation cystoplasties

OBJECTIVE: Tumors arising within augmentation cystoplasties are aggressive, have poor prognosis and the majority are not detected at follow-up cystoscopy. Genetic changes in tumors precede morphological abnormalities. Therefore, the aim of this study was to investigate whether genetic abnormalities detected by comparative genomic hybridization (CGH) could be used to identify those patients with augmentation cystoplasties at increased risk of tumorigenesis. METHODS: Bladder biopsy samples were obtained from 16 augmentation cystoplasty patients both distant from and near to the enterovesical anastomosis. CGH was used to detect genetic abnormalities in DNA extracted from the biopsies, archival specimens of two augmentation cystoplasties and two de novo bladder adenocarcinomas. RESULTS: A greater number of amplifications on 2p, 3q, 8q, 9p, 17p, 18pq and 20pq, were observed in bladder biopsies obtained near to the enterovesical anastomosis compared to those taken distant to the suture line. CGH of archival augmentation cystoplasty tumor DNA indicated abnormalities at several loci with amplifications at 2q, 5q, 10p and 21pq, while deletions occurred at 5p and 16p. CONCLUSIONS: The results of this study suggest that the urothelium adjacent to the bladder and/or bowel anastomosis in augmentation cystoplasties is genetically unstable. Furthermore, longitudinal studies are required to establish whether or not patients exhibiting genetic instability following augmentation cystoplasty are at greater risk of developing tumors than those with genetically stable epithelia.     

Urological emergency in neonates with congenital hydronephrosis

OBJECTIVE: It is well described that unilateral pelviureteric junction obstruction (PUJO) is a benign condition, because the dilatation resolves spontaneously and the function does not decrease in most of the kidneys. However, there is exceptional PUJO that requires emergent treatment in neonatal periods. The aim of this article is to report the urological emergency and management in neonates with PUJO. MATERIALS AND METHODS: Nine children (seven boys and two girls) with PUJO who underwent neonatal emergent treatment during the last 13 years were reviewed. Renal function was evaluated according to decay curve of serum creatinine (SCr) levels corresponding to gestational age (GA) at delivery. Physical examination, ultrasonographic monitoring, and chest and abdominal plain radiographs were repeated in each neonate. RESULTS: Eight patients were detected prenatally. In five patients, multicystic dysplastic kidney (MCDK) was demonstrated on the contralateral side. Three patients underwent percutaneous puncture of fetal hydronephrosis. Decrease of amniotic fluid was evident in three fetuses. Indications for emergent treatment included mass effect from hydronephrosis in three patients, renal dysfunction in five, and severe urinary tract infection in one. During neonatal periods, a percutaneous nephrostomy tube was placed in seven, and open nephrostomy in one with anorectal malformation. Repeated punctures of the dilated renal pelvis were done in one patient. Renal function after pyeloplasty was stable in eight patients, while it was moderately decreased in one who was associated with oligohydramnios in utero. CONCLUSION: Indications for emergent treatment in neonates with PUJO included mass effect from giant hydronephrosis, renal dysfunction and severe urinary tract infection. At birth, respiratory and circulatory conditions must first be stabilized. In neonates with hydronephrosis of the solitary kidney or severe bilateral PUJO, serial SCr should be monitored to evaluate renal function. Decrease of amniotic fluid suggested renal functional compromise that would not recover after urological management.