盆腔肿物切除术后发现肺淋巴管肌瘤病1例报告

淋巴管肌瘤病(LAM)是一种主要发生在育龄女性的全身性疾病,以肺部受累最为常见,其次可累及肾脏、淋巴系统和肝脏等。尽管目前对该病的认识不断提高,但对以肺外表现首次就诊者,经常忽略肺高分辨CT(HRCT)等检查而失去对肺部受累的判断,丧失治疗时机。此例患者即     

Expression of vesicular glutamate transporters type 1 and 2 in sensory and autonomic neurons innervating the mouse colorectum

Vesicular glutamate transporters (VGLUTs) have been extensively studied in various neuronal systems, but their expression in visceral sensory and autonomic neurons remains to be analyzed in detail. Here we studied VGLUTs type 1 and 2 (VGLUT₁ and VGLUT₂, respectively) in neurons innervating the mouse colorectum. Lumbosacral and thoracolumbar dorsal root ganglion (DRG), lumbar sympathetic chain (LSC), and major pelvic ganglion (MPG) neurons innervating the colorectum of BALB/C mice were retrogradely traced with Fast Blue, dissected, and processed for immunohistochemistry. Tissue from additional naïve mice was included. Previously characterized antibodies against VGLUT₁, VGLUT₂, and calcitonin gene‐related peptide (CGRP) were used. Riboprobe in situ hybridization, using probes against VGLUT₁ and VGLUT₂, was also performed. Most colorectal DRG neurons expressed VGLUT₂ and often colocalized with CGRP. A smaller percentage of neurons expressed VGLUT₁. VGLUT₂‐immunoreactive (IR) neurons in the MPG were rare. Abundant VGLUT₂‐IR nerves were detected in all layers of the colorectum; VGLUT₁‐IR nerves were sparse. A subpopulation of myenteric plexus neurons expressed VGLUT2 protein and mRNA, but VGLUT1 mRNA was undetectable. In conclusion, we show 1) that most colorectal DRG neurons express VGLUT₂, and to a lesser extent, VGLUT₁; 2) abundance of VGLUT2‐IR fibers innervating colorectum; and 3) a subpopulation of myenteric plexus neurons expressing VGLUT₂. Altogether, our data suggests a role for VGLUT₂ in colorectal glutamatergic neurotransmission, potentially influencing colorectal sensitivity and motility. J. Comp. Neurol. 519:3346–3366, 2011. © 2011 Wiley‐Liss, Inc.     

Ultrasound imaging of the pelvic floor: Where are we going?

We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the outcome of conservative treatment and reconstructive surgery. Published papers fall into the remits of diagnostic studies but often fail to comply with the recommendations of the STARD initiative. Most published evidence remains the product of a single institution effort and confirmatory studies are rarely found. Imaging studies in patients with UI did not provide evidence of any clinical benefit in the management of patients. In patients with POP, interesting correlations have been identified such as between childbirth, dimension of levator hiatus, avulsion of levator ani and risk of prolapse, but the non clinical benefit of pelvic floor imaging could still not be identified. Research on pelvic floor imaging requires a coordinated, international, multicentre effort to improve internal and external validity of imaging techniques, confirm observations published by single institutions and provide health technology assessment of imaging in the management of UI or POP patients.     

游离前臂皮瓣联合髂骨同期修复重建口底及面下部的复合性组织缺损

目的 探讨游离前臂皮瓣联合游离髂骨进行口底及面下部复合型组织缺损同期修复重建的临床疗效。 方法 术前对11例口底及面下部复合型组织缺损的范围及外形进行认真的评估,设计出与缺损区相匹配的个体化前臂皮瓣。术中先行成型钛板恢复缺损下颌骨基本的外形及咬合关系,然后用来复锯切取设计塑型的游离髂骨并移植固定于钛板的内侧,从而恢复缺损下颌骨的连续性。 结果 11例前臂皮瓣及髂骨全部成活,成功率100％。本组患者经随访6～ 12个月,修复区外形虽显不同程度的臃肿,但饮食、吞咽等口腔功能得到了改善,有7例可进普食,有4例可进流质饮食,同时可参与社会活动中日常的语言交流,皮瓣的感觉功能及外形恢复满意。 结论 适形游离前臂皮瓣联合游离髂骨对口底及面下部复合型组织缺损同期修复重建,是修复口底及面下部复合型组织缺损较为理想的方法之一,既达到安全、实用的预后效果,又可明显提高患者的生存质量,值得临床借鉴并使用。