肠系膜血管病变引起的急腹症八例报告

目的：全面认识肠系膜血管病变引起的急腹症的严重性，提高疗效。方法：对8例临床特点、治疗方法和效果进行了分析比较。结果：6例经手术病理证实，初诊多表现为急腹症，症状和体征不相符，5例误诊，1例术前确诊，2例肠系膜血管供血不足经CT及腹腔动脉造影明确诊断并经药物治疗，7例治愈，1例死亡。结论：该病较少见，症状和体征无特异性，难以做出准确的诊断，B超和CT是较敏感的检查，对诊断有积极的作用。早期切除坏死肠段，包括静脉阻塞的肠系膜部分，术中和术后抗凝治疗是预防复发、降低病死率的重要措施。     

Diagnostic and therapeutic endoscopic approaches to intraductal papillary mucinous neoplasm

Pancreatic cystic lesions are increasingly identified on routine imaging. One specific lesion, known as intraductal papillary mucinous neoplasm (IPMN), is a mucinous, pancreatic lesion characterized by papillary cells projecting from the pancreatic ductal epithelium. The finding of mucin extruding from the ampulla is essentially pathognomonic for diagnosing these lesions. IPMNs are of particular interest due to their malignant potential. Lesions range from benign, adenomatous growths to high-grade dysplasia and invasive cancer. These mucinous lesions therefore require immediate attention to determine the probability of malignancy and whether observation or resection is the best management choice. Unresected lesions need long-term surveillance monitoring for malignant transformation. The accurate diagnosis of these lesions is particularly challenging due to the substantial similarities in morphology of pancreatic cystic lesions and limitations in current imaging technologies. Endoscopic evaluation of these lesions provides additional imaging, molecular, and histologic data to aid in the identification of IPMN and to determine treatment course. The aim of this article is to focus on the diagnostic and therapeutic endoscopic approaches to IPMN.     

肝移植术后缺血型胆道病变的再移植治疗策略

目的探讨肝移植术后缺血型胆道病变的再移植的指征、手术时机的选择及免疫治疗策略。方法回顾性分析我中心自1999年7月至2007年2月10例肝移植术后缺血型胆道病变再移植治疗的病例。供肝植入均采用改良背驮式原位肝移植术,手术当天及第四天给予IL-2受体拮抗剂（舒莱）,术中不用激素冲击,术后采用他克莫司（FK506）,麦考酚酸酯（MMF）和激素（Pred）的常规三联或FK506和MMF两联免疫抑制治疗方案。结果10例病人中8例术后肝功能恢复良好,顺利痊愈出院,最长已存活42个月。2例死亡,分别于术后34、69 d死于严重的混合感染。术前MELD小于25分的7例患者无一例死亡,术前MELD大于25分的3例患者中2例死亡。结论肝移植术后发生缺血型胆道病变行再次肝移植是有效的治疗方法。术前对患者病情的准确评估,尽可能在MELD评分小于25分时进行再次肝移植治疗,有助于提高再移植的疗效。     

57例胆囊术后残留病变的防治探讨

目的研究分析胆囊术后残留病变的治疗及预防经验。方法回顾性分析我院1999年4月—2006年7月期间收治57例胆囊术后残留病变者的临床资料。结果全部病人均再次手术治疗,残余小胆囊并炎症23例,残株结石29例,残株癌变4例,1例发生残端神经瘤。其中并发胆总管结石21例,并胆内胆管结石9例。结论重视胆囊切除术,合理处理胆囊管,合理应用腹腔镜手术,正确看待小切口手术是防治胆囊术后残留病变的关键。     

The SLAP lesion as a reason for glenolabral cysts: a report of five cases and review of the literature

Introduction: Cysts in the spinoglenoidal or supraglenoidal incisura can be a cause of compression of the suprascapular nerve. There is agglomerated appearance of these cysts in combination with SLAP lesions. Hypothesis is SLAP lesions can lead to cysts in this region and should be repaired. Material and methods: MRI of five patients (all male, four 30–40 years, one 75 years) showed cysts in the supralabral region. All were in combination with lesions of the superior glenoidal labrum (Type II or more). Results: In two cases, in addition to cyst resection, the SLAP lesion was also repaired and symptoms disappeared completely and no recurrent cyst was detected in postoperative MRI. Two patients without SLAP repair showed recurrent cystic formation in MRI with similar complaints compared to their preoperative status. One patient (75 years) was treated primarily by puncture and afterwards with open resection of the cyst. His outcome was good in terms of activities of daily living without major pain. Conclusions: Our results are based on the assumption that cysts in the region of the spinoglenoidal/supraglenoidal incisura can originate from SLAP lesions. If a patient is suspected of having cysts in this region, the question of a SLAP lesion should be clarified. SLAP lesions should be repaired to avoid relapse. Arthroscopic repair of SLAP lesion can lead to the disappearance of symptoms in younger patients. In older patients puncture or resection of the ganglion alone may be an adequate therapeutic strategy.     

Do neonatal bilateral ibotenic acid lesions of the hippocampal formation or of the amygdala impair HPA axis responsiveness and regulation in infant rhesus macaques (Macaca mulatta)?

In response to stressful events, the HPA axis is activated triggering the successive release of CRF, ACTH, and glucocorticoids. The glucocorticoids in turn provide a negative feedback signal to terminate the stress response. The amygdala and the hippocampus are involved in the regulation of the HPA axis. In rodents, their respective roles have been identified; the amygdala exerts a stimulatory effect, whereas the hippocampus provides negative feedback control. In primates, however, their regulatory roles are still not well defined. The present study compared HPA axis responsiveness and regulation in 3- to 5-month-old rhesus macaques that received neonatal (15 +/- 3 days old) bilateral ibotenic acid lesions of the hippocampus or amygdala, or sham lesions. Group differences in plasma cortisol response to separation from the mother and relocation in a novel environment were assessed as well as response to dexamethasone suppression and ACTH challenge. Results revealed that the initial cortisol levels after separation/relocation did not differ between groups. Subjects with hippocampus lesions did not show a suppression of cortisol in response to dexamethasone, suggesting a loss of negative feedback control of HPA regulation. Subjects with amygdala and sham lesions did not differ in response to dexamethasone. Indeed, bilateral neonatal lesions of the amygdala have little impact on HPA axis responsiveness and regulation in contrast to lesions in adult monkeys. Finally, females displayed higher cortisol levels than males, independently of their lesion, indicating that the development of sex differences in the regulation of the HPA axis does not involve the amygdala or hippocampus.     

神经导航系统在神经外科显微手术中的应用

目的探讨神经导航系统在神经外科显微手术中的应用价值。方法我科在2004年10月至2005年6月应用美国Stryker神经导航系统辅助进行显微神经外科手术治疗颅内病变104例。结果在85例病灶切除术中,病灶全切除71例(83．53%),次全切除13例(15．29%),部分切除1例(1．18$)；侧脑室-腹腔分流术16例,成功15例,1例改常规手术完成；3例脑脓肿穿刺成功率100%。本组术后死亡1例,其余术后恢复良好。104例平均注册误差(1．3±0．7)mm。结论神经导航系统在神经外科手术中提供术中动态跟踪、实时导航,准确、直观,有助于提高手术疗效,降低手术并发症的发生。     

立体定向开放显微手术治疗脑内致痫小病灶

目的脑内致癫痫小病灶术前、术中的精确定位和病灶切除,是手术治疗效果的关键。探讨立体定向开放微创手术,皮层电极监测下切除脑内致痫小病灶的手术方法。方法53例症状性癫痫病例,CT、MR I检查有脑内小病灶(直径在0.5~3.0 cm),24 h视频脑电图确认致痫灶为脑内单发病灶。ASA 601S型立体定向仪CT引导辅助全麻环钻开颅,导针穿刺放置导管引导,显微镜下手术分离、切除病灶,皮层脑电图确认将致痫灶切除。结果病灶全切率达96.2%,术后50例得到随访,随访时间5~12个月,平均6.3个月,癫痫消失45例,脑电图检查记录到癫痫波11例,临床癫痫发作5例。因肺癌死亡3例。结论CT立体定向引导,显微手术切除颅内致痫小病灶,术中皮层电极确认将致痫灶切除,是一种定位精确、微创、安全、有效的治疗方法。     

Computed tomographic changes of the brain and clinical outcome of patients with seizures and epilepsy after an ischaemic hemispheric stroke.

It is not well established whether seizures and epilepsy after an ischaemic stroke increase the disability of patients. Seventy-two patients with delayed seizures after a hemispheric infarct (37 with a single seizure and 35 with epilepsy) were included in the study. The modified Rankin scale was used to compare disability of the patients at 1 month after stroke and at 2 weeks after single or the last seizure, in case of epilepsy. The size of the X-ray hypoattenuation zone was compared on computed tomographic (CT) scans, performed in the weeks after the stroke and 1 week after single or repeated seizures. Lesion size was determined by superimposing the CT slices on digital cerebral vascular maps, on which the contours of the infarct area were delineated. The extent of the infarcts was expressed as the percentage fraction of the total surface area of the cerebral hemisphere. Groups with a single seizure and with epilepsy were mutually compared. Infarcts predominated in the parieto-temporal cortical regions. In the overall group the median Rankin score worsened significantly after seizures. The average size of the X-ray hypoattenuation zone was also significantly increased on the CT scans after the seizures, compared with those after stroke, without clear evidence of recent infarction. Mutual comparison of patients with a single seizure episode and of those with epilepsy showed only a trend of more severe disability and of increase in lesion size in the post-stroke epilepsy group. Delayed seizures and epilepsy after ischaemic stroke are accompanied by an increase in lesion size on CT and by worsening of the disability of the patients. This study does not allow to determine whether this is due to stroke recurrence or due to additional damage as a result of the seizures themselves.     

Differential response of arcuate proopiomelanocortin- and neuropeptide Y-containing neurons to the lesion produced by gold thioglucose administration

The effect of gold thioglucose (GTG) administration on neurons containing feeding-related peptides in the hypothalamic arcuate nucleus was examined in mice. Intraperitoneal GTG injection increased the body weight and produced a hypothalamic lesion that extended from the ventral part of the ventromedial nucleus to the dorsal part of the arcuate nucleus. Neurons containing proopiomelanocortin (POMC) and neuropeptide Y (NPY) present in the dorsal part of the arcuate nucleus were destroyed by GTG. In addition, the peptide-containing fibers that extended from the remaining arcuate neurons were degenerated at the lesion site. The number of POMC-containing fibers in the paraventricular nucleus, dorsomedial nucleus, and lateral hypothalamus was found to have decreased significantly when examined at 2 days and 2 weeks after the GTG treatment. In contrast, the number of NPY-containing fibers in the lateral hypothalamus remained unchanged after the GTG treatment, probably because of the presence of an unaffected NPY-containing fiber pathway passing through the tuberal region and projecting onto the lateral hypothalamus. The number of NPY-immunoreactive fibers in the paraventricular and dorsomedial nuclei showed a moderate but significant decrease at 2 days after the GTG treatment, but it recovered to the normal levels 2 weeks later. The NPY-containing fibers were found to have regenerated across the lesion site 2 weeks later, and this might contribute to the recovery of the NPY-immunoreactive fibers in these regions. The present results first demonstrate that POMC- and NPY-containing neurons in the arcuate nucleus respond differently to the lesion produced by the GTG treatment.