兔眼视网膜下注射N-甲基右旋天冬氨酸诱导视网膜变性的组织病理学研究

目的研究视网膜下注射兴奋性氨基酸N-甲基右旋天冬氨酸（NMDA）对神经细胞变性的作用。方法取12只1个月龄有色家兔,视网膜下注射10μl（30mmol／L）NMDA（溶剂为DMEM-F12）,形成视网膜隆起,在注射12、24、48h及1周后分别处死家兔,取其视网膜组织进行免疫组织化学检测和电镜观察。应用抗Calretinin、Calbindin、PKCα抗体,分别标记视网膜无长突细胞、水平细胞及视杆双极细胞;采用原位缺口末端标记技术（TUNEL）技术标记凋亡细胞。结果损伤早期（12～24h）,实验组视网膜可见散在细胞核固缩浓染的光感受器细胞,并有无长突细胞和神经节细胞的早期严重变性;中期（48h）视网膜各层神经元均出现病理性改变;损伤晚期（1周）视网膜各层细胞数目明显减少。损伤早期,TUNEL技术标记的阳性细胞位于视网膜各层。免疫组织化学和形态学计量资料显示视网膜下注射NMDA后,水平细胞、无长突细胞及神经节细胞数目明显减少,视杆双极细胞数目基本无变化。超微结构观察显示有凋亡、坏死、水肿变性及混合型细胞死亡等多种变性形式。结论视网膜下聚集NMDA时,光感受器细胞、水平细胞、视杆双极细胞、无长突细胞及神经节细胞均表现为视网膜兴奋性毒性反应,与以往体内及体外研究结果显示的仅有内核层神经元死亡情况不同。     

综合疗法联合关节镜清理术治疗膝关节骨性关节炎的近期疗效

目的探讨综合疗法联合关节镜清理术治疗膝关节骨性关节炎（KOA）的近期效果。方法选择2012年10月至2014年3月江苏省邳州市人民医院收治的50例KOA患者,随机分为观察组和对照组,每组各25例。对照组采用单纯关节镜清理术,观察组在对照组基础上实施综合疗法（痛点阻滞、关节腔注射玻璃酸钠＋曲安奈德和推拿按摩）。比较术后3、6个月两组Lysholm膝关节功能评分和视觉模拟量表（VAS）评分,同时记录两组股四头肌、股二头肌肌力峰力矩（PT）。结果术后3、6个月观察组Lysholm评分以及股四头肌、股二头肌肌力PT高于对照组,VAS评分低于对照组,两组比较,差异均有统计学意义（P〈0.05）。两组术后均无严重不良反应。结论与单纯关节镜清理术相比,联用综合疗法能够更好地改善患膝关节功能,缓解疼痛症状,提高股四头肌、股二头肌肌力,近期疗效更为理想。     

Decreased recurrence of symptoms in oral lichen planus with intralesional injection of hyaluronic acid and triamcinolone

Oral lichen planus (OLP) is a chronic non-infectious, inflammatory, immunological disease. In contrast to skin lesions, which are often self-limiting, oral lesions rarely heal on their own and can be resistant to local and systemic treatments. In this clinical trial, hyaluronic acid (HA) was mixed with triamcinolone for intralesional injection to reduce side effects in the treatment of OLP. This randomized clinical trial with a split-mouth design was performed on 28 patients with OLP. The mouth was divided randomly into two sides: a test side, which received HA combined with triamcinolone, and a control side, which received triamcinolone alone. The rate of symptom recurrence was 74.1% on the control side and 11.1% on the test side (significant difference, P < 0.01). Pain scores did not differ between the two groups when assessed after 2 weeks. The group treated with a combination of HA and triamcinolone experienced a significantly better resolution of lesions and symptoms. Considering the role of HA in tissue healing and in regulating inflammatory responses, as well as its antioxidant and hydration properties, it appears that HA could be effective in improving of OLP and decreasing the rate of symptom recurrence.     

利美达松局部注射辅助治疗桥本甲状腺炎的效果

①目的　了解利美达松局部注射辅助治疗桥本甲状腺炎 (HT)的效果。②方法　选择 6 0例HT病人 ,随机分为两组 ,各 30例 ,对照组只应用纠正甲状腺功能紊乱药物治疗 ;治疗组在此治疗基础上 ,甲状腺局部注射利美达松 1～ 2mL ,每 2周注射 1次 ,6～ 8次为 1疗程。治疗结束后观察甲状腺质地、体积以及病理变化 ,并与对照组比较。③结果　治疗组甲状腺质地均较对照组明显变软 ,体积缩小 (t=1 2 .83、2 1 .2 6 ,χ2 =7.94 ,P <0 .0 5 )。病理检查示淋巴细胞浸润减少 ,甲状腺局部免疫反应减轻。且无明显激素素副作用出现。④结论　利美达松局部注射治疗可减轻HT的甲状腺肿大并软化结节     

Inadvertent tumor violation during musculoskeletal sarcoma surgery and risk of recurrence.

During the limb preserving procedure for musculoskeletal sarcoma, the course of action that should be taken when a tumor or tumor-cell-contaminated adjacent tissue is violated remains controversial. From January, 1973, to July, 1989, 120 patients with musculoskeletal sarcoma were treated by limb salvage surgery and, in 40 of them, such violations inadvertently occurred during surgery. Follow-up studies on the patients have been conducted for at least one year after the violation. Soft tissue sarcoma was noted in 24 cases (low grade, 4; high grade, 20) and bone sarcoma in 16 (low grade, 6; high grade, 10). To treat the violation, re-excision with a clean margin and copious lavage was generally conducted after careful closure of the violated site. Sixteen cases in the soft tissue sarcoma group and eight in the bone sarcoma group were treated in this way. Local recurrences were found in 13 of the 40 cases (33%), but the percentage was reduced to 13 in cases treated by re-excision with a clean margin. In the present study, there was no significant effect of adjuvant therapy after violation. The survival rate in cases of local recurrence was very low, and not at all improved by adjuvant therapy.     

利美达松治疗突眼性甲状腺肿的疗效

目的：观察甲状腺局部注射利美达松治疗突眼性甲状腺肿（ＧＤ）的疗效。方法：ＧＤ病人４２例（男性４例，女性３８例，年龄３６±ｓ１１ａ）为治疗组，另４５例为对照组（男性５例，女性４０例，年龄３４±１０ａ），前者在抗甲状腺药物治疗基础上，行利美达松甲状腺局部注射，２．５～５ｍｇ／次，１次／２ｗｋ，４次为一个疗程，治疗１～２个疗程。对照组仅行抗甲状腺药物治疗。结果：治疗组与对照组比较：前者甲状腺体积明显缩小，且质地变软；Ｔ３，Ｔ４，及ＴＳＨ复原时间缩短；病理显示甲状腺内淋巴细胞浸润明显减少，均Ｐ＜０．０１。无明显激素样副作用。结论：利美达松可作为治疗ＧＤ良好的辅助用药     

Alopecia Areata in Korea (1982–1994)

I clinically studied 905 patients with alopecia areata (AA) who visited the Department of Dermatology, College of Medicine, Chung Ang University, from January of 1982 to February of 1994. The purpose of the study was to evaluate the clinical manifestations and compare the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with dinitrochlorobenzene (DNCB) or diphenylcyclopropenone (DPCP). The results were as follows: 1) The incidence of AA among all out-patients (59,970) was 1.5% (905 cases), and the ratio of males to females was 1.3:1 (512:393). 2) The age distribution showed high incidences in the third (41.8%) and fourth decades (20.0%). 3) The family history was contributory in 104 cases (11.5%). 4) The relapse rate was 17.5% (158 cases). 5) Almost half of the patients had a solitary lesion (408 cases, 46.7%). 6) The most common site of predilection was the occipital region of the scalp in both male and female patients. 7) Associated diseases were seborrheic dermatitis, atopic dermatitis, hepatitis, hypertension, open heart surgery, thyroid disease, pulmonary disease, and vitiligo in order of frequency. 8) The effect of treatment on the patients who had bald patches less than 50 cm² was not significantly statistically different between intralesional injection of triamcinolone acetonide and immunotherapy with DNCB or DPCP. 9) In cases with bald areas more than 50 cm², including alopecia totalis and universalis, DNCB or DPCP immunotherapy showed better therapeutic effects than did intralesional injection of triamcinolone acetonide.     

Short-term clinical evaluation of intralesional triamcinolone acetonide injection for ulcerative oral lichen planus

BACKGROUND: Efforts are made in a continued searching for novel therapies for symptomatic oral lichen planus (OLP). This study aimed to evaluate the efficacy and safety of intralesional triamcinolone acetonide (TA) injection for ulcerative OLP. METHODS: Forty-five patients with clinical and histologically confirmed ulcerative OLP on bilateral buccal mucosa, one for treatment and the other for control, were studied. All participants received 0.5 ml TA (40 mg/ml) on experimental sites. Visual analogue scale score and lesion areas were recorded at the time of injection and 1-week interval. After 2 weeks, if the treated ulceration reduced < 81% in size, a second injection was given. RESULTS: The treated group gave rapid relief of signs and symptoms, while the control group showed minimal decrease. 38 (84.4%) patients demonstrated complete response in ulceration size. No complications were noted with TA injections. CONCLUSIONS: Intralesional TA injection in ulcerative OLP is effective and safe in achieving lesion and pain regression.     

Bone primary sarcomas undergone unplanned intralesional procedures - the possibility of limb salvage and their oncologic results

BACKGROUND: It is quite rare but some primary sarcomas of the bone can be misdiagnosed as benign and be treated using intralesional procedures. An unplanned surgical excision occurs when tumors are removed without the appropriate preoperative evaluation and consideration for the need to obtain tumor-free margins. Residual tumor tissue as a result of unplanned excision of soft tissue sarcoma is a risk factor for local recurrence. METHODS: Twenty-five patients, undergone unplanned intralesional procedures of lower extremities, were enrolled in this study. There were 22 (88%) cases of osteosarcomas, 2 (8%) MFH of bone and 1 (4%) adamantinoma. Twenty-two (88%) cases had a limb salvage and among them, 4 (18%) cases had local recurrences. Three cases (12%) had amputation without any local event. RESULTS: Lung metastasis developed in 6 (24%) cases. The CDF 5 year survival for 22 osteosarcoma cases was 65%(confidence interval: 52-82%). DISCUSSION: Despite the high recurrence rate, the CDF survival of osteosarcoma cases was comparable to the primary one. Limb salvage procedures are worthwhile in cases whose initial radiographic findings simulate benign lesions, showing favorable response to neoadjuvant chemotherapy. The relative contraindication to the limb salvage is cases with a history of a pathologic fracture and extensive operative fixation.