关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

简易印模术对单个前牙烤瓷冠颈缘外观效果的作用观察

目的:观察和探讨两种印模技术对单个前牙烤瓷冠颈缘外观的改善效果。方法:40位患者用简易印模技术制取印模,制作93件镍铬合金烤瓷瓷冠,设为实验组,另35位患者以常规印模技术制取印模,制作71件镍铬合金烤瓷瓷冠,设为对照组。观察两组戴冠当时与两年后的颈缘适合性、颜色、牙龈形态与健康情况。结果:试验组有98%的合金瓷冠具有优良的边缘适合性,仅2件(2%)出现颈缘黑线,与对照组相比有显著差异(P<0.05)。结论:简易印模技术能更好的保证工作区模型的准确度,从而有效地改善了镍铬合金烤瓷冠颈缘的美观与龈组织的健康。     

负压引流在小切口根治腋臭术中的应用

目的:在众多腋臭治疗方法中,探索出一种能有效根治腋臭且并发症少的治疗方案。方法:利用小切口,肿胀麻醉,把带有汗腺及毛囊的皮肤修剪薄至全厚及中厚皮片厚度,术毕放置负压引流,使皮肤与基底贴合良好,并加压包扎。结果:本法共治疗32例腋臭患者,其中其他方法治疗复发者11例。除2例术后有轻微气味外,其余均得到根治,术后瘢痕不明显。结论:负压引流在小切口根治腋臭中可有效减少并发症,提高治愈率。     

Epidural block for obstetrics: Comparison of bolus injection of local anesthetic with gravity flow technique

Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.

Design: Prospective, randomized study.

Setting: Teaching hospital.

Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.

Interventions: After identification of the epidural space with pulsations of an air-fluid column, parturients for vaginal delivery (n = 380) were randomized to receive a test dose of 3 ml 3% 2-chloroprocaine with epinephrine 20 μg, two doses of 7 ml bupivacaine 0.03 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow (Group 1) given over 30 seconds or by bolus injection (Group 2) given over 5 seconds through the epidural needle; parturients for Cesarean delivery (n = 220) were randomized to receive a test dose and two doses of 6 ml lidocaine 2 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow or by bolus injection through the epidural needle. Changes in maternal heart rate (HR) and blood pressure, signs of intravascular injection, and adverse effects of epidural bupivacaine-sufentanil were recorded after each dose.

Measurements and Main Results: Gravity flow administration (Group 1) was associated with a smaller increase in mean maternal HR (p < 0.001), less hypotension (p < 0.01), sedation (p < 0.01), nausea (p = 0.01), and segmental spread (p < 0.0001) than were corresponding doses given by traditional bolus injection (Group 1) for vaginal or Cesarean deliveries. The incidence of systemic toxicity was zero of 300 (0%) with gravity flow and 4 of 300 (1.3%) by bolus injection, p = 0.12, Fisher's exact test. No patient in either group had an accidental intrathecal injection.

Conclusion: Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural black contributes to fewer adverse events.     

Allergic contact dermatitis from grasses

This study attempts to demonstrate the existence of allergic contact dermatitis from grass, and to develop a patch test series to screen patients with grass intolerance. 6 common grass species from lawns and military training areas were collected. Solvent extracts of polar. non-polar and volatile fractions were prepared and used for patch testing in 20 control subjects and 46 patients with a history of grass intolerance. The 20 control had negative responses to patch testing. 5 out of 46 patients had positive patch tests to Axonopus compressus (carpet grass). Ischaenmum muticum (sea-shore centipede grass). Imperata evlindrica (lalang). Panicum maximum (Guinea grass) and Pennisetum purpureum (elephant grass). Reactions to the non-polar fraction for all 5 species were noted. This study demonstrates the existence of allergic contact dermatitis from various common species of grass. In our series, this is seen in 11% of those with a history of grass intolerance.     

大鼠下丘脑弓状核的形态计量研究

为了探讨急性癫痫弓状核形态改变与可复性，我们采用光、电镜技术和形态计量方法对下丘脑弓状核进行了形态定量研究。结果显示：弓状核切面面积为317500±6460um2，神经元胞体和胞核的等效直径分别为12.94±0.34um和8.54±0.43um，暗细胞内线粒体、粗面内质网、高尔基复合体、溶酶体、游离核相体和分泌颗粒的面积分数分别是5.87±1.98％、3.53±0.25％、0.81±0.49％、2.13±0.42％、10.53±0.46％和0.86±0.35％，其面数密度（单位面积为30um2）分别为15.68±1.14um-2、21.29±3.52um-2、10.20±0.42um-2、5.62±067um-2、101.35±7.55um-2和5.22±0.77um-2.本文还对弓状核的形态结构、神经元类型及其功能进行了讨论。     

Comparative study of TRUE Test and Finn Chamber patch test techniques in Singapore

This is a report on a comparative study of the reactivity of TRUE Test and Finn Chamber patch test techniques. 413 patients attending a contact dermatitis clinic in Singapore were simultaneously patch tested with panels 1 and 2 of the TRUE Test standard series and with corresponding allergens (Hermal, Hamburg) using Finn Chambers. The left/right application of the TRUE Test and Finn Chambers was randomized. The concordance of positive patch test reactions to the 2 test techniques was studied. The number of patient with positive reactions was 38% and 42% for TRUE Test and Finn Chamber techniques, respectively (n.s.). The overall concordance of positive patch test reactions was 64% (209/328). 13% (42/328) of positive reactions appeared on TRUE Test only and 24% (77/328) on Finn Chamber only. When only relevant positive reactions were considered, the concordance rate was 67%; 11.6% of positive reactions appeared on TRUE Test only and 21% on Finn Chamber only. Positive reactions to p-phenylenediamine (PPD) and neomycin were more frequent with the Finn Chamber technique than with TRUE Test, i.e., false negative reactions to PPD and neomycin were more likely to occur with TRUE Test. It appeared that the TRUE Test and Finn Chamber techniques were comparable when used for patch testing. However false negative and false positive patch test reactions can occur when using either technique.     

Body composition in the elderly: Total body water and anthropometry

Body composition measured with isotopic dilution was compared with anthropometric measurements. The study was carried out in 47 subjects from both sexes, 65 to 92 years old. Total body water (TBW), anthropometric measurements, and dynamometry were assessed. TBW was significatively higher in men than women and decreased with age. Dynamometry and fatfree mass were well correlated (r=0.73 in males and r=0.58 in females) and significantly different between sexes. A negative correlation was found for dynamometry with age, being significant for women. Linear regression equations to predict TBW from anthropometric measurements in males and females were obtained: Males: TBW(I)=19.349+0.617 weight(kg) — 0.931 mid-arm circumference(cm)+0.122 dynamometry (kg) Females: TBW(l)=−5.531+0.343 weight(kg)-0.213 triceps skinfold (mm)+ 0.148 dynamometry(kg) + 3.424 wrist diameter (cm). This simple model is proposed for use in epidemiological and field studies where other more sophisticated methods can not be applied.     

Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures

Objective The objective of this study was to evaluate whether the rigid application of a sterile protocol for shunt placement was applicable on a routine basis and allowed the reduction of shunt infections (SI) in children. Materials and methods Since 2001, a rigid sterile protocol for shunt placement in children using neither antibiotic-impregnated catheters nor laminar airflow was prospectively applied at Erasme Hospital, Brussels, Belgium. For assessing the protocol efficacy before continuation, we preliminarily analyzed the results of the first 100 operated children (43 females, 57 males, 49 aged <12 months; 115 consecutive shunt placement/revision procedures). All procedures were performed by the same senior surgeon, one assistant, one circulating nurse, one anesthesiologist. The sterile protocol was rigidly imposed to these four staff members: uniformed surgical technique; limited implant and skin edge manipulation; minimized human circulation in the room; scheduling surgery as first morning operation; avoiding postoperative cerebrospinal fluid (CSF) leak; double gloving; procedures of less than 30-min duration; systemic antibiotics prophylaxis. We analyzed separately: (1) children carrying an increased risk of SI (n = 38) due to preoperative external ventricular drainage, CSF leak, meningitis, glucocorticoids, chemotherapy; (2) children aged <12 months; (3) procedures for shunt revision. Results Errors in protocol application were recorded in 71/115 procedures. They were mainly done by non-surgical staff, decreased with time and were medically justified in some young children. Surprisingly, no SI occurred (follow-up, 4 to 70 months). One child developed an appendicitis with peritonitis (Streptococcus faecalis) after 6 months. No SI was found. After peritonitis was cured, shunt reinsertion was uneventful. Conclusion These preliminary results suggest that a uniform and drastic sterile surgical technique for shunt placement: (1) can be rigidly applied on a routine basis; (2) can lower the early SI rate below 1%; (3) might have a stronger impact to reduce SI than using antibiotic-impregnated catheters and optimizing the operative environment such as using laminar airflow and reducing the non-surgical staff. This last issue will be evaluated further in the present ongoing protocol.     

氮芥抗药性人早幼粒白血病HL60细胞亚系的建立及其生物特性

用逐步递增药物浓度和软琼脂细胞克隆技术，药物连续作用１４个月后获得氮芥（ＨＮ２）抗药性人早幼粒白血病ＨＬ６０细胞亚系，抗件达５～７倍（ＨＬ６０／ＮＨ２６），在无ＨＮ２培养液中５倍以上抗性维持１０个月以上，抗性细胞亚系的生物学特性除倍增时间稍长和克隆形成率略低外其生长曲线，细胞周期细胞ＤＮＡ指数，形态学，组织化学和染色体分析均与亲代细胞相似。