烧伤后手指瘢痕挛缩畸形综合治疗的临床研究

目的通过比较手术结合康复综合治疗方案与常规治疗方案对烧伤后手指瘢痕挛缩畸形的治疗效果,探讨综合治疗的优越性及经验。方法1999年6月~2004年6月,共56例烧伤后手指瘢痕挛缩畸形患者纳入试验。综合治疗组(A组)28例,男20例,女8例;年龄14~47岁,平均31岁;患手共47只129指,以手术结合系统康复治疗。常规治疗组(B组)28例,男17例,女11例;年龄18~51岁,平均30岁;患手共42只107指,采用常规手术,术后仅作简单的康复性锻炼指导,由患者在院外自己完成功能锻炼。采用Swanson法对患指运动功能进行评定,九孔柱试验法对患手整体运动功能进行评定,比较两组患者治疗前后手指和手整体运动功能的差异。结果A组患者术后均获随访12~19个月,B组患者均获随访13~20个月。治疗前A组患指的强直失能指数(indexofankylosis,IA)值为82%±20%,B组为78%±17%;治疗后A组为45%±13%,B组为52%±14%;治疗前后A组IA差值为37%±15%,B组为26%±15%,两组比较差异有统计学意义(P<0.05)。治疗前A组九孔柱测量值28.34±5.62s,B组为27.47±5.78s;治疗后A组为20.73±4.25s,B组为21.86±4.12s;治疗前后A组九孔柱测量差值为7.61±2.27s,B组为5.61±2.94s,两组比较差异有统计学意义(P<0.05)。结论烧伤后手指瘢痕挛缩畸形采用手术结合康复综合治疗的效果明显优于常规治疗,值得推广。     

Islet Xenotransplantation: Are We Really Ready for Clinical Trials?

Four clinical trials of porcine islet transplantation have been reported, and there are verbal reports that clinical trials on much larger scales are continuing in centers in China and Russia. The four reported trials are briefly reviewed and, in the light of the present status of experimental islet xenotransplantation, consideration is given to whether such trials are currently justified. The Ethics Committee of the International Xenotransplantation Association has (1) emphasized the need for encouraging studies in non-human primates before clinical trials should be undertaken, (2) mandatory monitoring for the transfer of porcine microorganisms, and (3) careful regulation and oversight by recognized bodies. Other aspects of the topic, such as the need for informed consent, are briefly discussed. We conclude that, at the present time, more data documenting convincing efficacy, focused on clinically applicable immunosuppressive regimens, are needed to justify the initiation of closely monitored clinical trials. A clinical trial may then be justified even though the potential risk to the patients, and possibly for society, will not be zero.     

创伤性迟发性颅内血肿的诊断和治疗

目的 探讨创伤性、迟发性颅内血肿的早期诊断和治疗的临床效果。方法 对22例病人的发病年龄、性别、伤因、早期诊断和治疗效果进行了回顾性分析。经过2—6个月，按GOS评定治疗效果。结果 良好者12例，中残者5例，重残者1例，植物生存者1例，死亡者3例，死亡率为14％。结论 早期诊断和治疗本病对于提高治愈率和降低死亡率至关重要，早期手术治疗本病，乃是多数病人首选的治疗方法。     

Primary malignant melanoma of the bladder

Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year-old man underwent trans-urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.     

KGF在乳腺癌的表达与临床意义

目的:探讨KGF蛋白在人乳腺癌的表达与意义,与临床病理因素及生物学指标的相关性。方法: 采用免疫组化方法检测KGF在63例乳腺癌组织中的表达,并与正常乳腺组织对照。结果:63例乳腺癌组织中34例肿瘤细胞表达KGF(54．0％),正常乳腺上皮细胞未表达(P<0．01),在乳腺癌间质细胞和正常乳腺组织间质细胞表达率分别为34．9％和16．7％(P>0.05)。其在肿瘤细胞中的表达与低分化相关,与ER、PR呈负相关,与Ki-67呈正相关,与Ki-67的协同表达与淋巴结转移正相关。结论: KGF在乳腺癌肿瘤细胞的表达可能促进乳腺癌的发生发展,并且与低分化、预后不良有关。     

间断纵行缝扎硬化注射治疗直肠黏膜内脱垂68例临床分析

目的:观察和评价间断纵行缝扎硬化注射治疗直肠黏膜内脱垂的临床疗效。方法:将68例直肠黏膜内脱垂患者随机分成两组,治疗组(36例)采用经间断纵行缝扎硬化注射治疗,对照组(32例)采用单纯硬化注射治疗。并对临床资料进行分析总结。结果:术后3个月随访,治疗组与对照组的症状、体征总得分比较,治疗组均优于对照组。结论:纵行缝扎硬化注射治疗后症状消除快,近远期疗效佳。     

Comparison of diagnostic usefulness of predictive models in preliminary differentiation of adnexal masses

The purpose of this study was to compare prognostic models evaluating the probability of an ovarian cancer occurrence based on a number of clinical and ultrasonographic data in women with adnexal masses. A total of 686 women with adnexal masses underwent the examinations between 1994 and 2002. The recorded parameters included: age, menopausal status, body mass index, the grayscale and Doppler ultrasonographic examination, and selected markers concentration levels. In order to find the best combination of features, which significantly influences the probability of malignancy, stepwise logistic regression analysis, as well as artificial neural network, was used. The diagnostic efficiency of received models was estimated and compared using receiver-operating characteristics (ROC) curve. The results indicate that 431 and 255 patients had a benign and malignant ovarian tumor, respectively. Application of stepwise logistic regression analysis revealed statistically significant importance of eight features. The sensitivity and specificity for the received model were 65.71% and 77.59%, respectively. Three-layer perceptron network shows 13 features as significant predictors of malignancy. The network gave a sensitivity of 85.7% and specificity of 93.1%. Comparison of area under ROC curve for received models was 0.9679 vs 0.9716. Prognostic values of the analyzed neural model are not optimal but seem to surpass logistic regression model in terms of the predictive possibilities.     

Female pelvic floor. Descriptive anatomy and clinical exploration by transvaginal ultrasound

In order to assess the state and pathology of the woman's pelvis minor, a number of methods are commonly used among practitioners, encompassing clinical exploration, radiology, MRN, urodynamics, endoscopy and echography.

Echography has been poorly used in clinical pelvic exploration and its reliability is actually a matter of controversy 1. However, echographic surveys can provide us with valuable gynecological data on the state and pathologies of the soft pelvis, within the genital regions or even going beyond them, i.e. the rectal channel, bladder, urethra, anus, vascular plexuses, and all of their supporting tissues.

At our research unit, we have been employing Transvaginal Ultrasound echography (TVU) for a long time in conjunction with other pelvis-focused methods in order to study different kinds of pelvic alterations. TVU has proven to be friendly to use, fast, harmless and inexpensive, allowing serial explorations and producing high-quality dynamic images (loop-cinema, video-tape). Furthermore, this method is fairly aseptic in that the occurrence of faeces in the rectal ampolla is not a nuisance but a bonus in tracking the contours of the rectum walls and other topographical features which would be otherwise difficult to survey.

A complete pelvic floor TVU may add no longer than 5-8 minutes to a routine gynecological examination, can be implemented by the general gynecologist and generates data that can be further studied by the appropriate specialist for a more insightful evaluation 2.     

Prenatal screening and diagnosis of handicaps: Current state of the art

Current medical procedures used in prenatal screening and diagnosis of handicapping conditions are reviewed. These strategies include ultrasound, amniocentesis, chorionic villus biopsy, restriction enzyme analysis, maternal serum analysis, fetoscopy, and fetal serum analysis. Along with an explanation of each method, advantages, disadvantages, and risks involved with each are provided. An understanding of these procedures by medical and educational personnel is encouraged, and the potential benefits of prenatal identification of handicapping conditions are emphasized.     

CT对肝外胆管梗阻性质的鉴别诊断

目的：探讨良恶性肝外胆管梗阻病变的CT表现及其诊断意义。方法：回顾经手术病理证实的肝外胆管梗阻病变76例(良性34例，恶性42例)。结果：肝内胆管呈枯枝状轻中度扩张，肝内外胆管不一致扩张(内轻外重)，肝外胆管远段梗阻，梗阻部胆管呈削尖状狭窄，肝外胆管壁呈弥漫环形增厚，对良性梗阻的诊断有重要意义。肝内胆管呈软藤状重度扩张，肝外胆管中段梗阻，梗阻部胆管呈伴或不伴肿块的截断型或突然狭窄型，肝外胆管壁局限不规则增厚，高度揭示恶性梗阻。结论：良恶性肝外胆管梗阻病变均有特征性CT表现，通过分析胆管形态和临床资料基本能判断梗阻的性质。