Necrotizing soft tissue infections

Necrotizing soft tissue infections (NSTI) represent a spectrum of diseases characterized by extensive rapidly progressive necrosis that may involve the skin, subcutaneous tissues, fascia or muscle. Their progress is extremely fast, leading often to sepsis and septic shock that ends up in multiple organ failure with abrupt and high mortality. A variety of classification systems have been developed based on parameters such as anatomic location of the disease or microbiology. There are a number of factors that predispose to the spread of these soft tissue infections, such as delays in recognition, immune suppression, diabetes mellitus and advanced age. The use of broad‐spectrum antibiotics tends to mask the severity of the underlying infection, modulates the clinical presentation, and even delays hospital admission. The most important factor affecting outcome in NSTI is early diagnosis and aggressive radical surgical treatment. The medical records of 13 patients who had been treated for NSTI from 1996 to 2005 were reviewed, retrospectively. There were eight men (61.5%) and five (38.5%) women. Mean age was 56 years (range 27–73). Seven cases of infection involved the perineal region (54%), two the lower limb, one the upper limb and three the abdominal wall/trunk. The most common associated comorbidity was diabetes mellitus in five patients (38.5%). A single organism was identified in two (15%) and multiple organisms in 11 (85%) patients. Necrotizing aponeurositis Type I was the most common of the polymicrobial necrotizing infections. Overall survival was 85%, and the mean hospital stay for survivors was 35 days (range 17–92).     

Sutureless bowel anastomosis using Nd:YAG laser

Small bowel anastomoses were performed without sutures by using the Nd:YAG laser to produce welded enterotomies. Optimal energy levels for contact and noncontact laser were determined. Anastomoses produced using five target energy levels between 100 and 500 J were examined. Short-term anastomotic strength of these enterotomies was measured 1 min after the welding. Bursting pressure of the laser welded enterotomies was compared to the bursting pressure of traditional two-layer, inverting, interrupted sutured bowel anastomoses. The overall mean bursting pressure of non-contact-welded enterotomies was 50.6 mmHg. Optimal laser settings determined in this initial phase were then used to produce anastomoses in rabbits which are recovered postoperatively for 1 or 2 weeks in order to examine long-term viability and integrity of the anastomoses. All chronic rabbit preparations recovered without complication. The mean bursting pressure was 200 mmHg, not significantly different from that of uncut bowel or two-layer sutured anastomosis.     

Improved haemorheology associated with a reduction in plasma fibrinogen and LDL in patients being treated by heparin-induced extracorporeal LDL precipitation (HELP)

Heparin-induced Extracorporeal LDL-Precipitation (HELP) is an effective procedure for the elimination of both plasma LDL and fibrinogen. In 10 adult patients with severe type II hyperlipoproteinemia, a single HELP treatment of 3 1 plasma led to an acute decrease in the average plasma viscosity (PV) from 1.30 to 1.1 mPas. At the same time, an even more marked decrease in the mean erythrocyte aggregation rate from a pathological value of 7.9% to a value of 3.7% (normal range less than 5%) was observed. Long-term studies on five patients demonstrated a lasting improvement in these two haemorheological variables. The acute rheological changes were also accompanied by an improvement in polarographically determined muscle oxygen tension. Mean oxygen tension values measured in both the m.biceps brachii and the m.tibialis anterior in five patients before and after a single HELP treatment increased from 30 +/- 4 to 37 +/- 7 mmHg and from 27 +/- 2 to 31 +/- 3 mmHg respectively. These results may provide an explanation for the rapid improvement in patients' clinical symptoms such as angina pectoris and in stress electrocardiogram which have been observed during HELP therapy.     

神经内结缔组织增生与三叉神经脱髓鞘的关系

目的探讨三叉神经痛（trigeminal neuralgia，TN）患者三叉神经患支内结缔组织改变与神经脱髓鞘的关系。方法对手术切取的TN患者三又神经患支标本及对照标本行髓鞘染色，在光镜及电镜下观察神经横截面形态改变，并采用图像分析仪进行半定量测量。结果形态观察及图像分析结果都显示TN患者三叉神经患支明显脱髓鞘，神经内结缔组织显著增生，F检验证实二者存在显著线性正相关。结论TN患者三叉神经惠支内神经内结缔组织增生，可能是TN发生的重要机制之一。     

脂肪来源间充质干细胞对大鼠肝移植的免疫调节作用

目的探讨大鼠脂肪来源间充质干细胞(MSC)对大鼠肝移植术后急性排斥反应的作用。方法分离、培养SD大鼠MSC,体外混合淋巴细胞培养(MLC)体系中,研究MSC对Wistar大鼠T细胞增殖的抑制作用。以SD与Wistar大鼠为供受体建立肝移植模型。随机分为MSC处理组与空白对照组,术后第7天检测肝功能、血清白细胞介素(IL)-2和白细胞介素(IL)-10水平、肝组织病理形态及肝细胞凋亡。结果体外MLC中,Wistar大鼠T细胞增殖明显受抑,抑制率为48.44%。实验组血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、IL-2、IL-10分别为(134.2±45.0)、(162.5±30.5)U/L、(30.6±5.4)μmol/L、(187.35±18.26)、(193.95±37.62)μg/L;对照组上述指标分别为(355.6±54.3)、(296.4±71.2)U/L、(145.7±28.6)μmoL/L、(295.73±57.15)、(75.12±11.23)μg/L,两组差异有统计学意义(P<0.05);病检提示实验组排斥反应较对照组明显减轻;脱氧脲核苷酸缺口末端标记(TUNEL)检测提示实验组肝细胞凋亡程度明显低于对照组(P<0.05)。结论供体来源MSC能明显抑制MLC体系中受体源T细胞的增殖,并能显著减轻大鼠肝移植术后急性排斥反应。     

足底深支或(和)第一跖背动脉逆行足背岛状皮瓣的临床应用

目的探索足部远端软组织缺损修复的较佳方法。方法采用足底深支或(和)第1跖背动脉逆行足背岛状皮瓣对6例足部远端软组织缺损创面进行修复。结果6例患者均一次性修复,软组织缺损最大面积8cm×6cm,术后随访1~4年,足部功能与外观均较满意。结论足底深支或(和)第1跖背动脉逆行足背岛状皮瓣血管解剖比较恒定,操作简单,是修复足远端软组织缺损的较好方法。     

皮肤定量扩张法在耳廓再造中的应用及并发症的处理

目的 探讨皮肤扩张器的定量扩张法在在耳廓再造中的应用,并对所发生的并发症进行处理.方法 选择50 ml肾形扩张器埋置于残耳后乳突区无毛发皮下,术后3 d拔除引流管,10d拆除缝线.术后7 d进行常规注水,每周3次,每次注水约5 ml,注水总量为60 ml左右.注水完毕后维持扩张1个月.结果 1992年1月至2006年12月共收治先天性小耳畸形患者5 248例,完成50ml肾形扩张器埋置6 252只.扩张器维持扩张完毕后可见扩张皮肤质薄、血管丰富.并发症有血肿、扩张器外露、创口裂开、感染等,发生率较低,约为7.79%.结论 皮肤定量扩张法操作简单、并发症较少,为耳廓再造提供了良好的无毛发、质薄、血供丰富可靠的皮肤.     

胸大肌肌皮瓣脂肪液化的相关危险因素探讨

目的探讨胸大肌肌皮瓣术后发生脂肪液化的相关危险因素。方法对1998年5月至2005年12月采用胸大肌肌皮瓣修复口腔癌术后组织缺损的82例中10例术后发生不同程度脂肪液化的病例,进行Logistic回归分析。结果Logistic单因素回归分析结果表明：肥胖、电刀切开皮下组织、皮岛设计低于第7肋、吸烟等因素与胸大肌肌皮瓣术后发生脂肪液化有关;Logistic多因素回归分析结果表明：胸大肌肌皮瓣术后发生脂肪液化与肥胖、电刀切开皮下组织、皮岛设计低于第7肋等因素有关,而与吸烟无关。结论肥胖、电刀切开皮下组织、皮岛设计低于第7肋等因素是胸大肌肌皮瓣术后发生脂肪液化的危险因素。