胶原酶溶解术治疗腰椎间盘突出症疗效与影像表现的关系

目的 评价胶原酶溶解术治疗腰椎间盘突出症后l、2、3年的疗效，分析疗效与影像学表现的关系，为该方法筛选适应证的影像学表现。方法 按统一的诊断标准、治疗方法，对1996年1月至1999年1月在我科行胶原酶溶解术的、资料完整的腰椎间盘突出症患者l254例进行随访观察(复诊、书信、电话等方式)，按统一的疗效标准评价胶原酶溶解术的l、2、3年的疗效。结果 单纯性椎间盘突出症，1年优良率为93．1％，2年优良率为90.3％，3年优良率为90．9％。结论 单纯性椎间盘突出症是胶原酶溶解术的绝对适应证，合并有其他影响因素的椎间盘突出症应慎重选择胶原酶溶解术。     

Clinical outcomes following collagenase injections compared to fasciectomy in the treatment of Dupuytren’s contracture

IntroductionThe aim of this study is to compare the efficacy of collagenase injections with that of fasciectomy in the treatment of Dupuytren’s contracture.MethodsThis is a case–control retrospective study. We reviewed the electronic medical records from January 2009 through January 2013, identifying 142 consecutive patients who underwent either fasciectomy or collagenase injection. Exclusion criteria for both groups were age <18 years, pregnant women, and arthroplasty or arthrodesis of the treated joint. Follow-up data beyond 1-year duration was available for 117 of the patients: 44 patients who had undergone fasciectomy, and 73 patients who had received collagenase injection. The primary outcome measure in this study was resolution of joint contracture to 0–5° deficit of full extension. Data was analyzed using two-sample t tests for continuous data and chi-square test for categorical data. A significant P value was set at <0.05.ResultsAt the latest follow-up, significantly more joints treated with fasciectomy met the primary outcome measure. Metacarpophalangeal (MP) joints responded better than the proximal interphalangeal (PIP) joints for both treatments. At the latest follow-up (14.2 months for collagenase, 16.3 months for fasciectomy), 46 % of MP joints treated with collagenase and 68 % of MP joints treated with fasciectomy maintained resolution of joint contracture. Sub-analysis of the affected joints based on the severity of initial contracture demonstrated that MP and PIP joints with contractures <45° responded better than more severely contracted joints (>45°).ConclusionsFasciectomy yields a greater mean magnitude of correction for digital contractures at the latest follow-up when compared to collagenase. Both treatments were more effective for treatment of MP joint contracture compared to PIP joint contracture.

Level of Evidence

Level III, therapeutic.     

Recurring episodes of spreading depression are spontaneously elicited by an intracerebral hemorrhage in the swine

Intracranial bleeding damages the surrounding tissue in a complex fashion that involves contamination by blood-borne products and loss of ionic homeostasis. We used electrophysiological techniques to examine the functional changes in the developing intracerebral bleed and in surrounding regions using an in vivo swine model. Intracerebral hemorrhage (ICH) was induced by collagenase injection into the primary somatosensory cortex (SI). Somatic evoked potential (SEP) elicited by electrical stimulation of the contralateral snout as well as changes in DC-coupled potential were monitored in the SI from the time of collagenase injection in order to measure the effects of ICH. The SEP decreased in amplitude within minutes of the intracerebral injection. Its short-latency component was abolished within the first hour after collagenase injection without any sign of recovery for the duration of the experiment. As the SEP started decreasing in amplitude, we observed spontaneous, recurring episodes of cortical spreading depression (SD) as early as 20 min post-injection. The timing of SDs in SI is consistent with our interpretation that SDs were initially generated at multiple sites adjacent to the lesion core and propagated into the surrounding area. With time, SD became less frequent near the injection site, shifting to more distant electrodes in the surrounding area. Our results indicate that ICH leads to the reduction in SEP amplitude and induces spontaneous episodes of SD. Loss of ionic homeostasis is most likely the physiological basis for the SEP change and for the induction of SD. Recurring SD spontaneously generated in experimental ICH needs further study in humans with ICH.     

介入注射胶原酶配合三维牵引治疗腰椎间盘突出症

我院2000年12月-2003年3月，运用介入注射胶原酶配合三维牵引治疗腰椎间盘突出症50例，取得了满意效果，现报告如下。     

Urinary trypsin inhibitor suppresses premature cervical ripening

Unknown signals from the fetus are thought to be involved in the onset of parturition. We recently discovered that urinary trypsin inhibitor (UTI) from fetal urine inhibits uterine muscle contraction. Objectives: The aim of this research was to elucidate the mechanism of action of UTI in suppressing cervical maturation. Study design: Non-pregnant and pregnant rabbits pretreated with and without UTI suppositories containing 1000 U (400 μg) for 3 days were treated for 2 days with vaginal suppositories containing 100 ng of interleukin-8 (IL-8). Results: IL-8 induced softening and dilatation of the rabbit cervices. In contrast UTI inhibited IL-8 induced cervical softening and dilatation. Water content, collagen content, neutrophil counts, elastase activity and collagenase activity of the cervix were increased by IL-8, but they did not increase by IL-8 with UTI. Conclusion: These results suggest that UTI inhibits cervical maturation induced by IL-8.     

Type II Collagen induced bone resorption in the temporal bone of rats: Histological and immunohistochemical studies

Summary Bone resorption in the temporal bone of rats was induced by peripheral immunizations of heterogeneous type II collagen. Bone resorption was found at both the tympanic bone and the petrous bone of the otic capsule. Macrophages, fibroblasts and osteoclasts were found in the enlarged spaces of bone. Immunohistochemical studies demonstrated that macrophages, fibroblasts and osteoclasts produced collagenase and prostaglandins in the bone resorption processes, suggesting that these cells are responsible for the resorption observed.     

Technical aspects of islet preparation and transplantation

The introduction of insulin therapy for the management of diabetes mellitus is arguably the greatest milestone in the history of modern medicine. -cell replacement therapy is the only treatment that reestablishes and maintains long-term physiological normoglycemia. Until recently, successful clinical outcomes of pancreas transplantation for patients with long-standing diabetes were much superior to that of islet transplantation. Significant advances in islet isolation and purification technology, the development of more specific and less diabetogenic immunosuppressants and the prophylactic administration of antiviral agents have rekindled a worldwide interest in islet transplantation. This chapter will review the rationale of islet transplantation and the development of islet isolation and purification. The challenges facing clinical islet transplantation in the twenty-first century will also be introduced.     

臭氧与胶原酶联合应用治疗腰椎间盘突出症

目的：研究臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症的临床疗效。方法：对45例腰椎间盘突出症患者进行臭氧结合胶原酶盘内、外注射治疗。术后随访6-12个月,按照Macnab评定标准进行疗效评定。结果：45例患者,优32例,良8例,可2例,差3例;优良率为88.9%,有效率为93.3%。结论：臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症集合了两者的优点,疗效好,是腰椎间盘突出症首选的微创治疗方法。