多种带蒂皮瓣治疗颈部中重度瘢痕挛缩畸形的比较研究

目的：比较颈胸前薄皮瓣、颔肩胛皮瓣、背阔肌肌皮瓣及颈部扩张皮瓣整复颈部挛缩瘢痕畸形的效果。方法：共治疗颈部挛缩瘢痕畸形104例，其中应用颈胸前薄皮瓣26例，颈肩胛皮瓣11例，背阔肌肌皮瓣8例，颈部扩张皮瓣59例。结果：所有手术均得到良好的远期效果。5例颈部扩张皮瓣术后出现血肿，3例出现皮瓣远端坏死；颈胸前皮瓣未出现血供障碍；早期有3例颈肩胛皮瓣术后出现远端部分坏死，在对皮瓣长宽比〉3．5：1者实施延迟手术后未再出现远端坏死；1例背阔肌肌皮瓣术后出现肌肉部分坏死。结论：颈部扩张皮瓣质地及色泽与受瓣区皮肤匹配，为修复颈部瘢痕挛缩畸形的首选；颈胸前皮瓣和颈肩胛皮瓣血供可靠，肤色与颈部相近，供瓣区面积大，能直接拉拢缝合，修复效果也比较满意；背阔肌肌皮瓣术后外形明显臃肿，应避免选用。     

Norepinephrine‐induced diastolic dysfunction with aortic valve opening under calcium‐loading in rats

Heart failure associated with a high plasma level of norepinephrine (NE) has an extremely poor prognosis with NE being the most powerful predictor of all‐cause mortality. An increase in the diastolic intracellular calcium level (Ca²⁺) occurs in left ventricular dysfunction; however, the cause‐and‐effect relationships among Ca²⁺loading, high plasma NE, and an increase in diastolic ventricular pressure is unclear. Here, we examined the relationship between diastolic dysfunction and NE with and without Ca²⁺loading in rats. Animals were studied in four groups: Ca²⁺loading for 45 min (Ca²⁺group), NE alone for 25 min (30 µg/kg/min NE for 25 min; NE group), Ca²⁺loading and NE for 25 min after Ca²⁺loading (Ca²⁺‐NE group), and a vehicle group. Hemodynamics were examined using a micromanometer‐tipped pressure catheter, and diastolic function was studied using Doppler echocardiography. Significantly increased left ventricular end‐diastolic pressure (LVEDP) and decreased E and Ea waves and deceleration time (DCT) were found in the Ca²⁺‐NE group, compared with the Ca²⁺and NE groups. There were no changes in left ventricular pressure (LVP) and LV ejection fraction (EF) among the four groups. NE‐induced diastolic contracture (NEIDC) with aortic valve opening occurred in the diastole when LVP overshot the aortic pressure after co‐administration of NE and Ca²⁺after Ca²⁺loading, and pulmonary hemorrhage was observed in all animals of the Ca²⁺‐NE group. The results support the suggestion that NE may be an important factor in the development of diastolic dysfunction in ischemic heart disease. Drug Dev. Res. 67:511–518, 2006. © 2006 Wiley‐Liss, Inc.     

小儿臀肌挛缩症的成因分析与预防

目的:解除臀肌挛缩,改善双下肢功能.方法:手术治疗,并提出相应的预防措施.结果:有效率达98.5%.结论:认为反复的臀肌注射史是臀肌挛缩症的主要成因.     

C群脑膜炎球菌多糖蛋白结合疫苗衍化工艺研究

目的筛选和优化C群脑膜炎多糖的衍化工艺。方法将C群奈瑟脑膜炎球菌多糖经溴化氰活化后通过己二酰肼衍生后制备出适宜的多糖衍生物。对衍化条件进行摸索和优化后通过衍化率及衍生物的可溶性来考察衍化效果,同时通过生化指标来考察该衍生工艺制备的结合疫苗的质量和收率。结果在pH11.0±0.2、活化30min以及溴化氰与多糖比值(W/W)=0.5时,所获衍生物制备的结合疫苗各项生化指标在所筛选的条件中最优。结论经过筛选优化的衍生工艺提高了多糖的衍化率,适于结合疫苗的研制,保证了结合疫苗的免疫原性。     

Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation

PURPOSE: Concurrent incontinence and severe recurrent bladder neck contracture following radical prostatectomy are difficult to manage. Recurrent anastomotic strictures following repeat transurethral incisions and resections, and the need for frequent instrumentation are contraindications for artificial urinary sphincter placement. Usually treatment alternatives for these patients consist of some form of urinary diversion or chronic catheter drainage. We evaluated our results using a UroLume stent across the bladder neck contracture followed by placement of an artificial urinary sphincter. MATERIALS AND METHODS: After failed multiple (mean incisions 4.4) attempts at conservative management of anastomotic stricture 9 men were treated with a UroLume urethral stent across the contracture followed by artificial urinary sphincter placement after appropriate epithelialization of the stent was confirmed. RESULTS: All patients were followed for a mean of 17.5 months. Mean pad use per day decreased from 6.5 to 0.7 before and after artificial urinary sphincter placement, respectively. Two patients reported mild persistent perineal discomfort and 1 had a recurrent contracture after stent placement, which was successfully managed with placement of a second overlapping stent. Overall, 89% of the patients were satisfied with the results. CONCLUSIONS: UroLume stent placement followed by artificial urinary sphincter can be a successful method for treating recurrent severe bladder neck contracture and incontinence. There is minimal morbidity with the procedures, and the combination offers a much more attractive treatment alternative compared to urinary diversion or chronic catheter drainage.     

儿童间隔综合征的早期诊断与治疗

通过对患间隔综合征的３１例患儿复查，总结如何正确作出早期诊断和治疗的经验。３１例患儿中，上肢病变１６例，其中９例为肱骨髁上骨折（５６％），下肢病变１５例，其中７例为胫腓骨骨折（４０％）。２５例行筋膜减张术，１７例获得随访，平均随访时间为２８个月，１４例肢体功能恢复（８２％）。治疗成功的关键在于早期诊断和治疗，彻底的筋膜减张是预防神经、肌肉坏死唯一有效的方法。临床诊断间隔综合征的五大要点：疼痛是最早最常见的症状，感觉障碍是很早出现而易被忽视的体征，疼痛消失和麻痹是晚期标志，被动牵拉试验阳性是手术适应证，但不能作为唯一的确诊指标。     

关节囊髋臼成形术治疗大龄儿童Legg-Perthes病

目的 :定期随访评价关节囊髋臼成形术治疗Legg Perthes病。方法 :2 5例 (平均 8.4岁 )Legg Perthes病中 ,CatterallⅠ型 1例 ,Ⅱ型 9例 ,Ⅲ型 7例 ,Ⅳ型 8例。采取临床和X线片测定 ,记录髋关节功能以及手术前后股骨头外移半脱位指数 ,髋臼覆盖百分比 ,股骨头宽指数和髋臼指数。结果 :术后平均随访 2 4(8～ 5 2 )个月。全部2 5例均获得优良临床结果。股骨头外移半脱位指数 ,术前为 1.3 83 8,术后为 1.3 2 0 0 (P >0 .0 5 ) ;髋臼覆盖百分比 :术前为 0 .785 0 ,术后为 1.10 0 0 (P <0 .0 1) ;股骨头宽指数 ,术前为 1.0 879,术后为 1.14 3 3 (P >0 .0 5 ) ;髋臼指数 ,术前为 2 0 .9167,术后为 7.0 83 3 (P <0 .0 1)。结论 :关节囊髋臼成形术是治疗大龄儿童Legg Perthes病手术方法之一 ,其效果确实 ,无需特殊器械 ,费用相对较低 ,并发症少。     

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren's contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren's disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.     

Flexion contracture after total knee arthroplasty in a patient with Parkinson's disease: successful treatment with botulinum toxin type A

The few reports in the orthopedic literature that discuss outcomes after total knee arthroplasty in patients with Parkinson's disease cite mixed results. These patients are at increased risk for the development of flexion contracture, which has been shown to significantly worsen functional scores. The present report describes the development of a flexion contracture in a patient with Parkinson's disease after total knee arthroplasty. This contracture was successfully treated with manipulation under anesthesia and injections of botulinum toxin type A into the hamstring and gastrocnemius muscles, in conjunction with a static progressive extension orthosis and rigorous physical therapy.