四点荷包缝合圆形皮肤病灶的实验研究

目的 探讨四点荷包缝合方法修复较小圆形皮肤组织缺损的效果。方法 在3只家猪的胸背部做直径3cm的圆形皮肤软组织缺损，共18处创口，分别予以不同的缝合方法，直接关闭创口，观察创面愈合情况。结果 四点荷包缝合法和四边梭形切除加四点荷包缝合法两组缝合创面平整美观，不需要切除较多的边缘正常组织，效果优于其他方法，结论 四点荷包缝合方法是一种较好的关闭圆形病灶的缝合方法。     

Nodular Adenomyosis of the Uterus Causing Severe Groin Pain

Objectives:

To determine the cause of severe, disabling, groin pain.

Methods:

We describe in this case report 2 patients with severe groin pain. Two myoma-like masses were found on the uterus near the right round ligament. Both masses were excised via laparoscopy.

Results:

The pathology report of these 2 cases indicated adenomyosis. Both patients were asymptomatic after the procedure. Adenomyosis usually propagates in the myometrium, and the nodular shape of this pathology is rare. In patients with severe groin pain (menstrual or continuous), the gynecologist should think about both endometriosis of the round ligament and adenomyosis near the round ligament.

Conclusion:

Severe groin pain is rare but disabling. Endometriosis of the external part of the round ligament is described as a cause. In this case report, we explain that nodular adenomyosis can also be a cause.     

Clinical and radiologic analysis of 13 cases of primary neuroectodermal tumors of bone

Radiographs and clinical charts were reviewed in a series of 13 cases of primary neuroectodermal bone tumors, involving 9 males and 4 females, aged from 3 to 32 years (average: 15 years). The average delay between the onset and diagnosis was 5 months. Fever and other systemic symptoms were present in 6 cases; in 4 cases a fracture was the mode of presentation. Seven patients had metastases (4 involving bone) at the time of presentation. Only one patient is still alive after 5 years. In the 10 patients who died as a direct result of the tumor, death occured on average 8 months following diagnosis if metastases were present initially, and 36 months after the diagnosis otherwise. Tumors predominantly involved the leg (7 cases), the pelvis (2 cases), and the humerus (2 cases), the involvement being both diaphyseal and metaphyseal. The radiologic appearance is that of an aggressive, poorly demarcated tumor, with cortical destruction, periosteal reaction and soft tissue invasion. Comparison with Ewing sarcoma shows little radiologic or clinical difference, except for a poorer prognosis in neuroectodermal bone tumors. Both bone tumors may have a similar neuroectodermal origin, with Ewing sarcoma representing the undifferentiated variety.     

An inflammatory myofibroblastic tumor in liver with ALK and RANBP2 gene rearrangement: combination of distinct morphologic, immunohistochemical, and genetic features

Inflammatory myofibroblastic tumor is an intermediate-grade neoplasm with potential for recurrence and rare metastasis. Rearrangement of the anaplastic lymphoma kinase gene with variable fusion partners and anaplastic lymphoma kinase expression using immunohistochemistry are noted in about half of the tumors. We present a hepatic inflammatory myofibroblastic tumor from a 34-year–old man with an unusual rearrangement between the Ran binding protein 2 and anaplastic lymphoma kinase genes, as well as a peculiar round cell transformation of tumor cells and a unique nuclear membrane expression of anaplastic lymphoma kinase protein. As the fourth reported inflammatory myofibroblastic tumor with this fusion so far, we find that these genetic and morphologic features may be related to a poor clinical outcome. The diagnostic difficulty and other prognostic factors of inflammatory myofibroblastic tumor are also discussed.     

Facial Dystonia with Facial Grimacing and Vertical Gaze Palsy with “Round the Houses” Sign in a 29-Year-Old Woman

A 29-year-old woman developed progressive dysarthria and coordination problems from the age of 15. Examination showed dysarthria, facial dystonia, bibrachial dystonia, hyperreflexia, ataxia, and emotional incontinence. Downward supranuclear gaze palsy was prominent with a “Round the Houses” sign. Magnetic resonance imaging of the brain and medulla, electroneurography, and cerebrospinal fluid were normal. A computed tomography scan showed hepatosplenomegaly. This combination of progressive neurological symptoms together with hepatosplenomegaly was suggestive of inborn error of metabolism. A bone marrow biopsy showed an increased number of macrophages with foamy content, highly suggestive of lysosomal disease. Plasmatic chitotriosidase activity and CCL18 were increased. Genetic testing showed heterozygosis for the variation c.1070C→T (p.Ser357Leu) and c.1843→T (Arg615Cys), confirming the diagnosis of Niemann-Pick type C (NPC). The “Round the Houses” sign has only been described in patients with progressive supranuclear palsy (PSP). This sign is described as an inability to produce pure vertical saccades along the midline and instead moving the eyes in a lateral arc to accomplish the movement. The observation of this sign in a patient with NPC indicates that this bedside finding is not specific for PSP, but a sign of medial longitudinal fasciculus dysfunction. The presence of facial dystonia with facial grimacing together with supranuclear gaze palsy is highly characteristic and useful for the diagnosis of NPC. NPC is an important underdiagnosed condition, given the availability of treatment and a mean diagnostic delay of 6 years.     

内耳局部给药临床与实验研究进展

药物治疗一直是内耳病的首选方法,由于内耳与全身血液循环之间存在血 迷路屏障,药物进入内耳的剂量极为有限。内耳局部给药可以减小用药剂量与药物的不良反应,药物在内耳的作用效力也会提高。关于内耳局部给药的临床应用有鼓膜穿刺/经咽鼓管给药、经圆窗膜缓释/控释给药、内耳开窗给药,实验研究包括缓释药物制剂和控释给药装置的研究。作者对内耳局部给药的临床与实验研究进行综述,为更加微创、有效治疗疾病提供依据。     

Breast cancers with round lumps: Correlations between imaging and anatomopathology

A round lump with a well-defined outline is, in most cases, benign. However, in 10 to 20% of all cases, a round and well-defined lump may correspond to a cancer. Most often, it consists of grade III infiltrating ductal carcinoma (IDC). Other histological sub-types may provide round masses with smooth contours: colloid carcinoma (still called mucinous carcinoma), medullary carcinoma, intramammary metastases, intra-cystic papillary carcinoma, lymphoma and high-grade phyllode tumours.     

鼻窦炎手术病人抗菌药物使用分析

目的了解医院五官科围手术期抗菌药物的使用情况。方法对五官科2004年1～6月143例慢性鼻窦炎手术病人围手术期抗菌药物使用品种、用药频度、联合用药、使用方法等进行统计分析。结果 143例共用抗菌药物6类23种,单一用药40例(28.0%),二联用药100例(69.9%),三联用药3例(2.1%),三联以上用药无;围手术期合理使用抗菌药物31例(21.7%),基本合理69例(48.3%),应用不合理43例(30.1%),人均药品费用为2051.50元,人均药品费用/住院总费用0.269426。结论五官科围手术期预防应用抗菌药物存在一定的不合理性,应加强监测以提高医院合理用药水平。     

方丝弓托槽+圆丝片段在牙外伤处理中的应用

目的探讨正畸方丝弓托槽+圆丝片段在牙外伤处理中的临床应用。方法选择牙外伤致牙体松动、脱位的患者65例(共计128颗患牙),随机分为三组,分别采用不锈钢丝结扎、牙弓夹板和方丝弓托槽+圆丝片段固定。于1、3、6、12个月复诊,观察疗效。结果三种固定技术均取得了一定的效果,但方丝弓托槽+圆丝技术的成功率与其他两组相比均有明显的差异。结论方丝弓托槽+圆丝技术在牙外伤处理中疗效显著且牙周及基牙损伤较小。