保留颈外静脉同期双侧颈淋巴结清除术治疗头颈部癌

自１９８９年１月至１９９４年１２月对１９例头颈部癌并双侧颈淋巴结转移的病人采取保留颈外静脉同期双侧颈淋巴结清除术（以下简称颈清术）治疗。包括喉癌、下咽癌、舌癌、口底癌、甲状腺癌及双侧原发灶不明的颈部转移癌。本文对其手术指征及手术方法作了简单介绍，并对其意义及可行性进行了讨论。     

Medulloblastoma in an adult suggestive of external granule cells as its origin: A histological and immunohistochemical study

We describe a rare case of medulloblastoma in an adult woman with histological findings suggesting an origin for this neoplasm in the external granular layer or its remnants. The patient presented with cerebellar dysfunction, and neuroimaging revealed a right cerebellar mass lesion. Pathological examination of the operative specimen revealed a medulloblastoma with occasional areas of neuronal or glial differentiation. Zic protein was also detected immunohistochemically in the tumor cells. The tumor cells were mainly distributed in the subarachnoid space and extended to the cerebellar parenchyma through the perivascular space to form tumor nodules. A suggestive finding, as concerns the origin of this neoplasm, was that the tumor cells were also spread evenly along the subpial zone of the molecular layer, reminiscent of the cellular architecture of the fetal external granular layer.     

上海市二、三级医院品牌现状及其影响因素分析

通过对上海市二、三级医院的调查 ,分析了上海市二、三级医院的品牌现状 ,并且从医院内部因素、外部因素、医院品牌历史沉积三方面对影响医院品牌的因素进行分析总结     

外电场和电化学技术控制军团菌的实验研究

〔目的〕探索持久、有效控制军团菌繁殖、传播的技术和方法 ,为我国军团菌控制相关法规的制定提供依据。〔方法〕分别应用外电场和电化学技术对含有军团菌的空调冷却水进行杀菌消毒试验。〔结果〕外电场技术对空调冷却水军团菌的细菌减少率为 85 %左右 ;电化学技术对空调冷却水军团菌的细菌减少率可达 99.99%以上。〔结论〕电化学技术比外电场技术能更有效地控制军团菌在空调冷却水中繁殖、传播 ,而且具有方便、经济等优点。     

外固定架复位动力髁钢板固定治疗陈旧性短缩股骨髁间伴髁上骨折

目的:探讨外固定架复位动力髁钢板固定治疗陈旧性短缩股骨髁间伴髁上骨折的治疗方法。方法:自2000年2月～2005年10月采用动力髁钢板治疗陈旧性短缩股骨髁间伴髁上粉碎骨折16例,其中男13例,女3例/年龄21～59岁,平均35.4岁;骨折断端短缩3～8cm,平均5cm。伤后3～8周间手术。术中使用外固定支架牵开恢复肢体长度,复位骨折,同时植骨,动力加压螺钉钢板固定。术后膝关节应屈曲30°放置,早期进行功能锻炼,以HSS评分评价膝关节功能,以优良率表示。结果:随访14例患者,骨折全部愈合,无膝关节内、外翻现象,无断钉、断板、钢板折弯并发症,患肢短缩在0～1.5cm之内。优良率65%。结论:对陈旧性短缩股骨髁间伴髁上粉碎骨折,术中使用外固定支架复位,方法简便,效果满意,动力髁钢板固定可靠,疗效肯定。     

87例儿童四肢开放性骨折治疗分析

目的:为儿童四肢开放性骨折提供治疗依据。方法:对87例90处四肢开放性骨折患儿的临床资料进行总结分析,其中内固定组36例39处,包括髓内针8处,钢板6处,单纯螺丝钉8处,克氏针17处;牵引外固定组51例,其中牵引31例,外固定20处。结果:87例患儿90处伤口一期愈合80处,延期愈合10处。90处开放性骨折中,正常愈合77处,延迟愈合7处,骨不连3处,骨畸形愈合3处。内固定组和牵引外固定组正常愈合率分别在87.2%和84.3%,两组差异无显著性。结论:范围有限的选择性清创处理、适当的固定方法、良好的营养是儿童开放性骨折的有效治疗手段。     

腔内高剂量与低剂量近距离放射治疗中晚期肺癌疗效比较

目的探讨高剂量率后装腔内放疗结合体外放疗治疗中晚期肺癌合适剂量分割与临床疗效。方法61例中晚期肺癌随机分为A组和B组。A组腔内放疗施源器中轴外5～10mm处参考剂量10Gy/次/周×2～3次/2～3周;B组腔内放疗施源器中轴外5～10mm处参考剂量5Gy次/周×4～6次/4～6周。体外放疗两组相同。结果A组1、3、5年局控率分别为74.2%、26.7%和16.7%。B组1、3、5年生存率分别为64.5%、45.2%和20.9%。两组比较,统计学无显著意义(P>0.05)。A组1、3、5年局控率分别为60.0%、33.3%和20.0%。B组1、3、5年局控率分别为74.2%、61.3%和41.9%,两组3、5年局控率有显著意义(P<0.05)。并发症:大咯血、放射性食管炎、气管支气管炎、肺炎、气管及肺纤维化等A组明显高于B组(P<0.01)。结论192铱高剂量率后装腔内放疗低剂量放疗优于高剂量放疗,疗效高,并发症少。结合体外放射腔内放疗合适剂量应以5Gy/次周,总剂量20～30Gy为宜。     

Treatment and outcome of open dislocation of the ankle with complete talar extrusion: A case report

BackgroundOpen total talar extrusion is a severe, disabling ankle injuries. The most appropriate treatment (reimplantation versus talar body removal and tibiocalcaneal arthrodesis) is still a controversial challenge; outcomes and fearful potential complications are not predictable.ObjectiveTo report the case of an open ankle dislocation with talar extrusion, focusing on treatment modality and outcomes.MethodImmediate reduction, surgical debridement and external fixation were performed under antibiotic coverage. Wound closure was achieved with accurate debridement, postoperative strict clinical surveillance and meticulous handling of medications. The patient maintained external fixator for three weeks, then kept non-weight bearing with a cast for an additional four weeks.ResultsThe patient's wound healed with no complications. Full weight-bearing was gained at 12 weeks postoperation. At 18 months postoperatively, the patient did not develop any infection or avascularnecrosis, which are the major complications associated to talar extrusion.ConclusionsGood treatment procedure for a such severe open trauma, based on accurate debridement, wound care and stable temporary immobilization with external fixation allow reduction of infection risk and made preservation of extruded talus a successful option to preserve function and normal hindfoot anatomy at first instance. Talectomy should be considered as a salvage procedure.