术中超声辅助下环形减压术治疗多节段胸椎后纵韧带骨化症

目的：分析多节段胸椎后纵韧带骨化症(ossification of the posterior longitudinal ligament, OPLL)术中超声辅助下环形减压术的手术疗效和术后神经功能改善情况。方法：选择2016年1月至2021年1月北京大学第三医院多节段胸椎OPLL患者的病例资料进行回顾性分析,所有病例均完成后壁切除后行术中超声检查确定环形减压节段,并进行环形减压。纳入研究的30例患者男性14例,女性16例,平均年龄(49.3±11.4)岁。首发症状以下肢麻木无力为主(83.3%),平均症状持续时间为(33.9±42.9)个月(1～168个月)。神经功能通过术前及末次随访时改良日本骨科协会(modified Japanese Orthopedic Association, mJOA)评分(0～11分)评估,神经功能改善率根据Harabayashi法计算。根据神经功能改善率是否大于25%将患者分为较优改善组和较差改善组,收集两组患者的年龄、体重指数(body mass index, BMI)、病程时间、手术时间、出血量、mJOA评分、手术节段、脑脊液漏并进行分析比较。结...     

Morel-Lavallée损伤诊疗进展

Morel-Lavallée(MLL)损伤是由剪切力等暴力使皮肤、皮下组织与深筋膜分离而引起的复杂的软组织闭合性撕脱损伤,疾病初期具有复杂性和隐蔽性,常因延迟诊断而导致感染、截肢、多器官衰竭甚至死亡等.目前,MLL的治疗尚无统一指南,需根据损伤情况及患者意愿综合考虑.在合并开放伤、骨折、神经血管肌腱损伤时,处理的优先顺...     

CK18-M30和内毒素在大鼠非酒精性脂肪肝病中的促进作用

目的探讨细胞角蛋白18-M30片段(CK18-M30)、内毒素在大鼠非酒精性脂肪肝病(NAFLD)转化为非酒精性脂肪性肝炎(NASH)中的促进作用。方法 26只大鼠随机分为3组,对照组(NC组):普通饮食;NAFLD组:高脂饮食喂养8周;NASH组:高脂饮食喂养12周。生化仪测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST);光度法测定血清内毒素(ET);ELISA检测血清IL-18、CK18-M30,RT-PCR分析粪便肠道菌群;行苏木精伊红(HE)染色观察肝脏及末端回肠组织病理。结果 NAFLD及NASH组相比NC组,小肠黏膜结构由轻到重受到破坏。NAFLD组及NASH组大鼠血清ET、CK18-M30、肝脂肪变性程度及NAFLD活动度积分(NAS)、大肠杆菌属计数显著高于NC组,而双歧杆菌属、乳酸杆菌属计数显著低于NC组,差异有统计学意义(P<0.05);NASH组大鼠血清ET、CK18-M30、肝脂肪变性程度及NAS显著高于NAFLD组,差异有统计学意义(P<0.05);NASH组大鼠血清ALT、AST、IL-18显著高于NC组及NAFLD组,差异有统计学意义(P&l...     

梗阻性黄疸对大鼠小肠功能的影响研究

目的探讨梗阻性黄疸对大鼠小肠功能的影响。方法成年雌性SD大鼠共80只随机分为两组：模型组（40只）,对照组（40只）。模型组结扎胆总管。对照组为假手术组。每组分为三个小组,分别用作测血糖、血脂和葡聚糖蓝推进率。术后第4天开始禁食24小时,于第5天测血糖（GLU）、总胆固醇（TC）、甘油三脂（TG）、然后分别用50%的葡萄糖,30%的脂肪乳和葡聚糖蓝灌胃,并分别于半小时后测血糖和葡聚糖蓝推进率,于2小时后测总胆固醇、甘油三脂。结果模型组小肠葡聚糖蓝推进率明显低于对照组（P〈0.05）,灌胃后血糖和甘油三脂水平也明显低于对照组（P〈0.05）。结论梗阻性黄疸影响大鼠小肠的吸收能力和蠕动功能。     

退行性腰椎滑脱症的外科治疗

２１例老龄腰椎退行性滑脱症患者接受了腰椎后方减压术和１８个月以上的随访。以日本整形外科协会腰痛基准评分，优３８％、良１９％，中１４％和差２９％。结果提示多数病例通过简单的后方减压手术可获得较好的疗效，无需融合术。少数患椎节段不稳定的病例术后症状复发，复发与术后腰椎进一步滑脱有关，术前对腰椎的稳定性进行测评是有必要的。     

Histopathological findings in the inner ear of cats following stapes operation

Summary This paper presents the histopathological findings in the inner ear of cats following the stapes surgery. With the surgical technique modified by us, it is possible to diminish the chance of operative failures and offer more chances of success What is more, the suggested modification of making a small hole before perforating footplate seems to be favorable to preventing sudden decompression of the labyrinth and avoiding floating fragment of stapes footplate     

传统胆肠吻合与保留Oddis括约肌的胆道重建对比分析研究

目的：比较胆肠吻合和保留Oddis括约肌的胆道重建两种手术方式的优劣。方法：比较行保留Oddis括约肌胆道重建患者和同期行胆肠吻合患者的治疗效果以及术后胆红素下降情况。结果：两种手术方式胆红素下降情差异无统计学意义（P〈0.05）,腹腔出血的发生率差异无统计学意义（P〉0.05）,胆汁漏、发热伴反流以及腹腔感染的发生率差异有统计学意义（P〈0.05）。术后再狭窄1年内无明显差别（P〉0.05）,2年后发生率有明显差别（P〈0.05）。结论：保留Oddis括约肌的胆道重建术后胆肠反流明显减低,但是增加了术后再狭窄的发生率,提倡个体化治疗。     

Rapid Reversal of Parenteral-Nutrition-Associated Cirrhosis Following Isolated Intestinal Transplantation

Introduction  Liver disease and the development of hepatic fibrosis are complications associated with total parenteral nutrition (TPN). Patients developing cirrhosis and portal hypertension in the setting of intestinal failure have a high mortality and may require combined liver and intestinal transplantation which carries much higher morbidity and mortality than isolated intestinal transplantation. Discussion  Recently, regression of hepatic fibrosis in patients with TPN liver disease has been described following intestinal transplantation. To date, there has been no demonstration of the reversal of established cirrhosis due to long-term TPN injury. Herein, we describe a patient with intestinal failure who developed cirrhosis from long-standing TPN injury and underwent isolated intestinal transplantation. He had no overt clinical stigmata of portal hypertension and had preserved liver function. Serial liver biopsies were reviewed and assessed with standard histology and quantitation of fibrosis using image analysis. Dramatic regression of fibrosis and reversal of cirrhosis were observed 17 months posttransplantation. Image analysis demonstrated a 14% total decrease in the percentage area of fibrosis. Conclusions  Cirrhosis related to TPN may be rapidly reversible after isolated intestinal transplantation. Such patients may be able to undergo isolated intestinal transplantation if they do not have hepatic synthetic compromise or clinical stigmata of portal hypertension.     

Accidental ingestion of magnetic foreign body in a pediatric patient: A potentially fatal attraction

Foreign body ingestion is one of the most common pediatric emergencies. As part of their cognitive development, infants and toddlers are extremely curious and constantly explore their surroundings through their senses, namely taste. The ubiquity of toys containing magnetic elements consecutively meant an increase in the cases of children ingesting said magnets. While most ingested foreign bodies, including a single magnet, will spontaneously traverse the gastrointestinal tract without problems, some may give rise to grave and potentially life-threatening complications; the latter is often seen in the presence of 2 or more magnets or paramagnetic material. The diagnosis of ingestion of magnetic foreign bodies remains a challenge, given its often ambiguous history and presentation; nonetheless, their abundance, gravity, and preventability of their complications alone should render physicians vigilant and keep a low threshold of suspicion.