关节镜下肱二头肌长头肌腱转位治疗不可修复巨大肩袖撕裂的研究进展

目的综述关节镜下肱二头肌长头肌腱(long head of biceps tendon,LHBT)转位治疗不可修复巨大肩袖撕裂的研究进展。方法查阅近年来国内外关节镜下不同方式LHBT转位治疗不可修复巨大肩袖撕裂的相关文献,并进行总结分析。结果关节镜下LHBT转位是一种治疗不可修复巨大肩袖撕裂的有效方法,目前主要采用断近端、两头断、断远端及不切断4种方式。临床研究表明上述方式均能取得良好疗效,但远期疗效有待进一步随访明确。结论关节镜下LHBT转位治疗不可修复巨大肩袖撕裂手术简便、有效,患者损伤小、术后恢复快,但对术者技术要求较高,需严格把握手术适应证。     

Dural-based Rosai–Dorfman disease: Differential diagnostic considerations

Extranodal sinus histiocytosis with massive lymphadenopathy (Rosai–Dorfman disease) is a non-neoplastic condition that has rarely been reported to involve the central nervous system. This report documents a 28-year-old man with Rosai–Dorfman disease who presented with a seizure and a dural-based mass that was thought to represent a meningioma. Resection showed a lesion marked by large, S-100 protein immunoreactive histiocytic cells with intermixed benign lymphocytes and plasma cells. Emperipolesis with intracytoplasmic lymphocytes and plasma cells was present. Differential diagnostic considerations will be discussed.     

Primary aortoduodenal fistula caused by duodenal tuberculosis without an abdominal aortic aneurysm: Report of a case

A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature.     

Fascia lata allograft bridging of a rotator cuff tear in a rabbit animal model

Purpose:

Despite advances in surgical treatment options, large rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. The purpose of this study was to evaluate the temporary and spatial histological incorporation of fascia lata allografts, used for bridging artificially created defects of the r-c.

Materials and Methods:

Seventy-two rabbits were divided into two groups and a supraspinatus tendinous defect was created. Half of the rabbit population underwent repair only, while in the other half, the defect was bridged utilizing fascia lata allograft. The animals were euthanized at 2, 4, and 6 weeks postoperative. Half of the specimens were evaluated histologically and the other half underwent mechanical testing.

Results:

There was an increased remodeling activity, fibroblastic in growth and strong presence of collagen fibers observed at 6 weeks on both groups. A gradually increasing mechanical strength was noticed by week 6 and increased toughness was also found at the same time period. There was no significant difference observed between the two groups regarding their histological and mechanical properties.

Conclusions:

In the difficult scenario of a large irreparable tear where the simple suture of the remaining r-c is impossible, allograft bridging, could be used with satisfactory results.

Clinical Relevance:

Treatment Study, Level 1.     

首发于头颈部的Rosai-Dorfman病临床分析

目的探讨首发于头颈部的Rosai Dorfman病（Rosai Dorfman disease,RDD）临床表现、治疗方法及预后。方法回顾性分析1986~2017年收治的首发于头颈部的RDD患者10例,分析其一般情况、临床表现、病理特征、治疗经过及预后。结果10例首发于头颈部的RDD患者中男6例,女4例,确诊RDD时中位数年龄为36.5岁（22~77岁）。病变累及最多的部位为鼻部（8例）、喉部（6例）,其中8例为≥2个部位受累。RDD临床表现与病变累及的部位及范围有关。治疗多采用激素+手术切除。中位数随访时间89个月（3~384个月）,1例失访,1例治愈,其余8例带病生存。结论确诊RDD的患者需进行耳鼻咽喉科详尽的检查。患者的临床表现及影像学检查缺乏特异性。病理及免疫组织化学检查可确诊。采用激素+手术治疗的方式患者全身情况及头颈部病变可基本稳定,但仍需长期随诊。一般预后良好.     

Successful treatment with low-dose splenic irradiation for massive splenomegaly in an elderly patient with hairy-cell leukemia

The therapeutic approach to hairy-cell leukemia (HCL) is in some instances still debated. Although management with alpha-interferon and purine analogues is well established, there is an alternative role for therapeutic splenectomy in patients with massive splenomegaly who have failed to respond to systemic therapy. Most patients with HCL will not be suitable for treatment with splenectomy as their ages at diagnosis are high. Here, we report an elderly Japanese HCL patient whose refractory massive splenomegaly responded well to low-dose splenic irradiation.     

Splenomegaly, hypersplenism and coagulation abnormalities in liver disease

Splenomegaly is a frequent finding in patients with liver disease. It is usually asymptomatic but may cause hypersplenism. Thrombocytopenia is the most frequent manifestation of hypersplenism and may contribute to portal hypertension related bleeding. A number of therapies are available for treating thrombocytopenia due to hypersplenism including splenectomy, partial splenectomy, partial splenic embolization, TIPS etc. None is entirely satisfactory. Hypersplenism usually improves following liver transplantation. Therapy with cytokines such as thrombopoietin may offer hope for the future. Patients with liver disease also have abnormalities in coagulation. This is not surprising as all coagulation proteins (except for von willebrand factor vWF) and most inhibitors of coagulation are synthesized in the liver. Genetic or acquired abnormalities of coagulation may predispose to thrombosis of the hepatic or portal veins with significant clinical sequelae. An understanding of the mechanisms involved in coagulation and thrombosis is valuable in choosing from the increasing treatment options available. These include clotting factors, haemeostatic drugs and newer therapies such as recombinant factor VIIa. Splenic artery aneurysms are the most common visceral artery aneurysms in man. Rupture is frequently catastrophic. These aneurysms are being increasingly recognized in liver transplant patients and require treatment before or during transplant surgery.