Induction of cell-cycle arrest by all-trans retinoic acid in mouse embryonic palatal mesenchymal (MEPM) cells.

all-trans retinoic acid (atRA), the oxidative metabolite of vitamin A, is essential for normal embryonic development. Also, high levels of atRA are teratogenic in many species and can effectively induce cleft palate in the mouse. Most cleft palate resulted from the failed fusion of secondary palate shelves, and maintenance of the normal cell proliferation is important in this process of shelf growth. To clarify the mechanism by which atRA causes cleft palate, we investigated the effect of atRA on proliferation activity and cell cycle distribution in mouse embryonic palatal mesenchymal (MEPM) cells. atRA inhibited the growth of MEPM cells by inducing apoptosis in a dose-dependent manner. atRA also caused a G1 block in the cell cycle with an increase in the proportion of cells in G0/G1 and a decrease in the proportion of cells in S phase, as determined by flow cytometry. We next investigated the effects of atRA on molecules that regulate the G1 to S phase transition. These studies demonstrated that atRA inhibited expression of cyclins D and E at the protein level. Furthermore, atRA treatment reduced phosphorylated Rb and decreased cdk2 and cdk4 kinase activity. These data suggest that atRA had antiproliferative activity by modulating G1/S cell cycle regulators and by inhibition of Rb phosphorylation in MEPM cells, which might account for the pathogenesis of cleft palate induced by retinoic acid.     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

隧道式拖线加内口切挂术治疗后位马蹄型肛瘘46例

采用隧道式拖线加内口切挂术治疗后位马蹄型肛瘘 4 6例 ,4 4例为一次性治愈 ,2例经一次扩创后治愈 ,平均疗程 (2 6± 3)天。     

改良TIP尿道成形术:恢复尿道解剖结构

目的 分析尿道板背侧纵切卷管尿道成形术(TIP)基础上覆盖Buck筋膜联合尿道海绵体(BC)和背侧包皮筋膜组织(P)在无阴茎下弯或轻度阴茎下弯的小儿中远段型尿道下裂的治疗效果。 方法 回顾性分析104例中远段型尿道下裂患儿的病例资料。其中行BC-P-TIP手术72例(A组); 行传统术式TIP+背侧包皮筋膜组织(P-TIP手术)32例(B组)。术后1,3,12月进行门诊随访。术后3月参照尿道下裂客观评分系统(HOSE)对患儿进行手术效果评估,对两组病例的一般资料、HOSE评分、并发症情况进行统计学分析。 结果 A,B组术后3月HOSE评分平均分分别为15.42及13.90,差别有统计学意义(P<0.01)。A,B组的尿瘘发生率为8.3%及25%,差别有统计学意义(P<0.05)。A,B组的尿道狭窄发生率为4.2%及0%,差别无统计学意义(P>0.05)。 结论 BC-P-TIP改良术式相对于P-TIP术式能有效减少尿瘘发生,术后外观满意、排尿功能良好,手术操作简单易学,取材方便,解剖损伤小,且接近正常尿道的解剖结构,值得进一步探讨及推广。     

A Rapid Pulse After Coronary Bypass Surgery

Abstract

A secondary aortoenteric fistula is a complication of earlier aortic grafting due to an aortic abdominal aneurysm. A primary aortoduodenal fistula (ADF) is a rare clinical entity that usually causes gastrointestinal bleeding that can be occult, intermittent, or massive. This article presents the case of a 68-year-old man with acute onset of a massive hematemesis and hematochezia. Eight years earlier he had undergone the implantation of an aortobifemoral prosthesis to treat an aortic aneurysm. The patient's condition was unstable, and it was during emergency surgery that the diagnosis of an ADF was made. An infected graft was removed in its entirety, and a new prosthesis was implanted. An omentoplasty with a pedunculated flap was performed. After 8 months, the patient had a recurrent ADF. He underwent another operation, but hemorrhaging from the aortic anastomosis occurred, so he required emergency surgery. Eventration occurred on the 14th postoperative day. The resection of the transversal colon was performed with a cecostomy for the decompression of the end-to-end anastomosis. Three months later the patient suffered a recurrent ADF. An aortobifemoral stent graft was implanted. Periaortal flow-drainage was established for the irrigation of the retroperitoneal space. A microjejunostomy tube was also inserted. The patient recovered without any complications. This case represents an example of a rare serious complication of aortic abdominal aneurysm. This case report covers pathophysiology, diagnostic evaluation, and management of an aortoenteric fistula.     

外科手术与介入治疗冠状动脉瘘疗效比较

目的 探讨外科手术与介入两种方法治疗冠状动脉瘘的疗效.方法 回顾性分析25例冠状动脉瘘患者的临床资料,外科手术治疗7例,介入治疗18例.结果 7例外科手术治疗患者中6例术后复查心脏彩超无残余分流,1例术中发现冠状动脉瘤,冠状动脉与右心室间有多发瘘口,切开冠状动脉瘤,自冠状动脉瘤体内修补瘘口,术后复查心脏彩超有残余分流.18例介入治疗患者中12例术后高选择性冠状动脉造影及心脏彩超检查无残余分流,2例有残余分流,4例因冠状动脉迂曲致建立轨道困难,未能行介入治疗.结论 冠状动脉瘘外科手术与介入治疗均安全、有效,应依据具体情况决定使用不同方法.     

Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients.