Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA™ stapler for rectal cancer

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA^™ stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.     

Fever and feeding in the rat: Actions of intrahypothalamic interleukin-6 compared to macrophage inflammatory protein-1β (MIP-1β)

The chemokines, macrophage inflammatory protein-1 (MIP-1) and its subunit MIP-1β, induce an intense fever in the rat when they are injected directly into the anterior hypothalamic, pre-optic area (AH/POA), a region containing thermosensitive neurons. The purpose of this study was to compare the central action on body temperature (T_b) of MIP-1β with that of interleukin-6 (IL-6), which also has been implicated in the cerebral mechanism underlying the pathogenesis of fever. Following the stereotaxic implantation in the AH/POA of guide cannulae for repeated micro-injections, radio transmitters which monitor T_b continuously were inserted intraperitoneally in each of 15 male Sprague-Dawley rats. Each micro-injection was made in a site in the AH/POA in a volume of 1.0 μl of pyrogen-free artificial CSF, recombinant murine MIP-1β, or recombinant human IL-6. MIP-1β in a dose of 25 pg evoked an intense fever characterized by a short latency, a mean maximum rise in T_b of 2.4 ± 0.21°C reached by 3.7 ± 0.42 hr, and a duration exceeding 6.5 hr. Injected into homologous sites in the AH/POA, IL-6 induced a dose dependent fever of similar latency and a mean maximal increase in T_b of 1.2 ± 0.25°C, 1.8 ± 0.15°C, and 2.1 ± 0.22°C and duration of 6.2 ± 1.28 hr, 6.7 ± 0.49 hr, and 6.8 ± 0.65 hr when given in doses of 25, 50, and 100 ng, respectively. These results show that MIP-1β and the highest dose of IL-6 induce a fever of comparable intensity, but MIP-1β exerts its action in a much lower concentration. Thus, the de novo synthesis and subsequent action of the MIP-1 family of cytokines on neurons of the AH/POA in response to a pyrogen challenge apparently play a functional role in the pathogenesis of fever. Further, the endogenous activity of IL-6 in the hypothalamus which is enhanced in response to a lipopolysaccharide also may reflect its essential part in the acute phase response to a bacterial challenge. Copyright © 1994 Wiley-Liss, Inc.     

Examination of the dermal lymphatics in psoriasis⋆

In recent years, research on the aetiology of psoriasis has focused on immune aetiopathogenesis. However, in the last few years, research on the immunoloogical changes in psoriasis has failed to mention the lymphatics. Also, studies emphasizing the importance of the dermal lymphatics have neglected the lymphatic changes seen in psoriasis. Therefore, we decided to put this matter back on the agenda. Skin biopsies from 20 patients with psoriasis vulgaris were examined lymphatically by light microscopy using the orcein stain. We found a considerable increase in both number and dilatation in the lymphatics of psoriatic plaques, compared with both the clinically uninvolved skin of the psoriatic patients and also the skin of the control group.     

激光照射家兔眼前部组织的实验研究

用YAG、CO_2激光按不同功率照射家兔眼,观察对角膜、虹膜、晶状体的损伤和修复过程,探索两种激光对角膜的最小损伤和使其穿孔的有效功率。结果发现:YAG激光用230～250mW(1～2秒)时,可使角膜上皮呈灰白色混浊,1～2W(5～6秒)时角膜穿孔;CO_2激光用340～380mW(0.2～2秒)时,同样使角膜上皮灰白色混浊,1.3～1.4W(1秒)时角膜穿孔,在功率、照射时间、光斑相同的条件下,CO_2激光对角膜损伤重,YAG激光则对虹膜、晶状体损伤重。     

术前静脉造影对静脉管壁及其吻合效应的实验研究

以动物实验模拟行静脉造影后,肉眼观察,并以透射电镜和扫描电镜动态观察经灌注固定的局部静脉管壁和内皮细胞的改变,发现造影剂回流的静脉管壁在较长的时间内处于扩张状态,同时穿刺注射造影剂的部位出现较严重的淤血和血栓形成。内皮细胞连接有较广泛裂开、剥离及内皮下组织暴露。在受损严重的区域还可见有微血栓形成。造影1天后内皮细胞受损最为严重,至第3天基本恢复。血管吻合实验表明,术前3天静脉造影不影响直径为2.5mm静脉的吻合通畅率。     

青光眼小梁切除术后浅前房临床分析

目的 探讨青光眼小梁切除术后浅前房的原因及发生情况。方法 回顾总结我院1997年1月至2001年12月连续92例104只眼小梁切除术后发生浅前房的程度及原因。结果 本组发生术后浅前房16眼；占15.4％，其中结膜漏1眼(6．25％)，滤过过强11眼(68．75％)，脉络膜睫状体脱离4眼(25％)。结论 青光眼小梁切除术后浅前房原因复杂，与术前眼压关系密切，与患者年龄及青光眼类型无关，最常见的原因是房水滤过过强。     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

桡骨头切除对肘关节稳定性影响的生物力学研究

目的：探讨桡骨头粉碎性骨折不同治疗方法对肘关节稳定性的影响。方法：将10个尸体标本，分别测定在其它组织无损伤时，肘内侧副韧带切断时，肘内侧副韧带和前臂骨间膜均切断时的力－位移曲线（纵向位移）及肘外翻角。结果：肘内侧副韧带切断时的纵向位移及肘外翻角均大于其它组织无损伤时；肘内侧副韧带和前臂骨间膜均切断时的纵向位移及肘外翻角均大于其它组织无损伤时和肘内侧副韧带切断时，两两间比较均有显著性差异（P＜0．001）。结论：在其它组织无损伤时，单纯桡骨头切除是安全的；合并肘内侧副韧带损伤时，可在有效修补韧带的同时作单纯头切除，必要时行假体置换；合并肘内侧副韧带和前臂骨间膜均损伤时，最好作假体置换。     

The need for future surgical low rectal cancer studies

Optimal surgery remains the mainstay of best outcome for rectal cancer. The demonstration, during the 3rd Annual Pelican Surgical Workshop Symposium, of an abdomino‐perineal excision (APE) performed in the ‘Berlin position’, further added to the debate on optimal surgical technique. Much interest was created at the 1st Pelican symposium with the demonstration, by the Swedish surgeon Dr Torbjorn Holm, of a prone APE and the delivery of a ‘cylindrical’ specimen and the potential to reduce local recurrence using this approach. The high rates of local recurrence following APE and the discussions as to optimal technique have led to the development of a proposed MERCURY Study Group study to assess the benefit of a radical APE, with careful assessment of the impact that this operation may have on morbidity. A German study has also been proposed adopting the UK's multidisciplinary team approach. It aims at targeting preoperative chemoradiotherapy at those patients in whom a radical APE or total mesorectal excision is likely to result in an involved surgical resection margin. In this article we review the evidence for improving the surgical technique for low rectal cancer. We believe improvements may be best achieved through continued European prospective, multi‐centre, multidisciplinary studies.     

颈椎椎体次全切除钛网钉板系统的临床应用

目的探讨颈椎前路椎体次全切除钛网钉板植骨融合的临床效果。方法自2001年3月～2003年3月间应用颈前路椎体次全切除钛网植骨融合及钉板固定治疗颈椎管狭窄性疾病22例，其中4例患者行2椎体次全切除3节椎间隙减压手术。术后观察减压、固定、融合及神经功能恢复情况，并行X线摄片或CT扫描检查。结果患者获6～12个月随访，神经功能得到不同程度改善，无加重情况。椎间隙高度无丢失、无成角，均获得骨性融合。术后3d在颈围领固定下下床活动，4周后可恢复较轻工作。结论此术式可避免传统手术方法的缺点，即不取自体髂骨，融合率高，稳定性好，并减压彻底，疗效好，是一种值得推广的新技术。