从中医角度探讨多囊卵巢综合征的发生与肺胃的相关性

对于“多囊卵巢综合征”中医病位的认识,学者们众说纷纭,主要涉及肺、肝、脾、肾、胃、冲任等。本文对其病位在“肺”“胃”这一观点提出质疑,并以多囊卵巢综合征现代文献资料为主要研究对象,确定多囊卵巢综合征的病变脏腑,提取多囊卵巢综合征的主要症状,总结多囊卵巢综合征的核心病机,从而探究多囊卵巢综合征的病位,讨论本病的发生与肺胃的相关性,加深对多囊卵巢综合征的中医认识。     

腰骶部SPR术中脊神经前后根定位的应用解剖

目的：为ＳＰＲ提供可靠的术中脊神经前、后根鉴别的解剖学依据。方法：在２０例成人脊柱标本上,去除后部结构,暴露整个马尾神经,对Ｌ１～Ｓ２节段的前后根进行形态学观察和测量。结果：脊神经后根位于马尾的后半部,前根则位于前半部。脊神经后根较相应的前根粗大,后根从Ｌ１～Ｓ１逐渐增大,以Ｓ１为最粗大;前根则以Ｌ３最粗大。相应前后根出硬脊膜前,有一段相互贴附并紧贴硬脊膜侧壁。结论：在多椎板切除ＳＰＲ术中前、后根的定位及鉴别,暴露时可根据前、后根出硬脊膜前的相互贴附;在限制性椎板切除时则可通过脊髓外侧索和Ｌ１前、后根之间的最下端的齿状韧带加以鉴别     

相关解剖定位标志在经单鼻孔-蝶窦垂体腺瘤显微外科切除术中的应用

目的：探讨相关解剖定位标志在经单鼻孔-蝶窦入路垂体腺瘤显微外科手术中的应用。方法：62例垂体腺瘤经单鼻孔-蝶窦入路显微手术，术中根据蝶嵴、蝶窦开口、蝶窦中隔、鞍底隆凸等解剖标志进行定位。结果：蝶嵴是术中确认手术入路中线的可靠标志，蝶窦开口是蝶窦前壁的重要标志，鞍底隆凸可作为蝶窦腔内鞍底定位标志。62例术中依靠相关解剖标志，均准确定位蝶窦及鞍底，未出现偏差。肿瘤全切除52例，次全切除5例，大部分切除4例。1例部分切除，无死亡病例。结论：熟悉相关解剖标志，有助于该术式的准确定位，从而安全实施手术。     

椎弓根定位方法与置钉技术探要

目的 通过Ｘ线平片分析关节突、横突及椎弓根间的相互关系,探讨上关节突作定位标志的临床价值。方法 常规Ｘ线正位片,测量Ｌ１～Ｌ５横突中轴线ＴＡ、两侧上关节突下缘连线ＡＡ与椎弓根中心点连线ＰＣ间的距离,〈１ｍｍ视为重叠。用ＡＡ组与上关节突外缘垂线的交点为进钉点,临床手术３０例。结果 ２１２例Ｘ线片共１０６０个腰椎,ＴＡ、ＡＡ与ＰＣ的重叠率分别为９２．３％和９０．２％（Ｐ〉０．０５）。男女两组间ＴＡ（Ｐ     

上颌磨牙近中颊根第二根管的定位

目的　通过对 77颗离体牙根管数目的检查 ,对近中颊根第二根管口 (MB2 )与近中颊根管口(MB)腭侧根管口 (P)的相对位置分布的规律进行观察分析 ,为临床治疗提供依据。方法　选择 77颗上颌离体牙 ,其中上颌第一磨牙 35颗 ,上颌第二磨牙 4 2颗 ,截冠后寻找近中颊根及其第二根管 ,并取得上颌恒磨牙根管口间距及根管口连线夹角等数据。结果　上颌第一、二恒磨牙近中颊根存在第二根管的有 36颗 ,占总数的 4 6 .75 % ,其中有1 5颗牙近中颊第二根管钙化不通 ,2 3颗牙近中颊根的第二根管口位于腭侧与近中颊第一根管口连线的近中处 ,近中颊根管口至近中颊第二根管口的距离为 1 .2 8± 0 .35 mm ,腭侧根管口至近中颊根管口的距离为 2 .98± 0 .4 7mm ,近中颊第二根管口至 P- MB线的垂直距离为 0 .6 3± 0 .1 2 mm,P- MB线与 MB- MB2 线的夹角为 2 5 .1 4°± 8.0 3°。结论　在上颌恒磨牙根管治疗时应注意根管系统的变异 ,改进开髓洞形 ,掌握查找近中颊根第二根管方法 ,以免遗漏根管     

乳管内窥镜联合高频超声定位法与传统定位法在乳头状瘤手术中的应用比较

目的研究乳管内窥镜与高频超声在乳头状瘤术前联合应用的临床意义。方法将有母乳喂养需求的73例乳腺导管内乳头状瘤患者随机分为两组,对照组33例采用传统美蓝定位法或乳管扩张器定位法手术,研究组40例采用乳管镜联合高频超声定位法进行肿瘤手术,比较乳管镜联合高频超声定位法与传统定位法的误诊率,观察和比较患者产后乳汁分泌情况。结果两组患者比较,研究组误诊率(7.50%)明显低于对照组(24.24%),术后研究组10例、对照组8例正常哺乳,乳汁分泌正常率分别为90.00%和37.50%。结论乳管内窥镜联合高频超声定位法比传统的定位法在乳腺中小导管内乳头状瘤的手术治疗中具有更优势的效果,不仅能够减少手术损伤、获得准确定位,还能最大程度地满足哺乳期妇女正常产奶的愿望,并保持乳房对称与完好曲线,适合于临床推广。     

Impact of Multifocality and Multilocation of Positive Surgical Margin After Radical Prostatectomy on Predicting Oncological Outcome

Objective

To assess the impact of focality and location of positive surgical margins (PSM) on long-term outcomes after radical prostatectomy (RP) for prostate cancer (PCa), including biochemical recurrence (BCR), metastasis and overall mortality.

Location of first attack predicts the site of subsequent relapses in multiple sclerosis

Predictors of attack location in relapsing-remitting multiple sclerosis (RRMS) are poorly known. It has been suggested that the site of the first relapse may influence the location of the subsequents. We aimed to ascertain this hypothesis in a sample of patients consecutively recruited in two Italian MS Centres, with at least two MS attacks. The following data were collected from medical records: demographic data, locations involved in the first two (or three) MS attacks (optic nerve, spinal cord, brain stem/cerebellum, cerebral hemispheres, according to symptoms presented), time elapsed between relapses and onset of disease-modifying treatment (DMT). We enrolled 199 patients (67% females; MS onset age 30.0 ± 8.69 years), in 148 of whom we could define the precise attack location. In 70/148 patients (47%) the second attack involved exactly the same location as the first. There was an increased risk of relapsing in the same location of the first attack when this involved the optic nerve (OR 4.5, 95% CI 2.2–9.2, p < 0.0001), the brainstem/cerebellum (OR 3.5, 95% CI 1.7–6.9, p < 0.0001), or the spinal cord (OR 3.0, 95% CI 1.5–5.9, p = 0.001). The location of third relapse (N = 90) was equally influenced by the site of first attack. In 24 patients with optic neuritis in both the two first attacks, the side coincided in 50% of cases. The location of first attack has a major role in influencing the site of subsequent ones in RRMS.     

Surgical margin length and location affect recurrence rates after robotic prostatectomy

BackgroundRobotic-assisted laparoscopic radical prostatectomy is a current standard treatment for localized prostate cancer, with treatment failure defined by biochemical recurrence (BCR). Open radical prostatectomy series have identified the presence of a positive surgical margin (PSM) as a predictor of long-term recurrence, a measure that is affected by the surgeon׳s skill. We evaluate the effect of PSM parameters on BCR rates from robotic-assisted laparoscopic radical prostatectomy, across 3 high-volume institutions.MethodsDe-identifiable clinicopathological and histopathological data were prospectively collected for 4,001 patients with at least 3 years of follow-up. Kaplan-Meier plots and 3 statistical models were used to evaluate the effect of margin parameters on BCR, via crude rates, traditional multivariable Cox regression, and a propensity-adjusted Cox regression model.ResultsOverall, 37% of men with a PSM developed BCR compared with 10% of men with negative margins (hazard ratio [HR] = 1.81, 95% CI: 1.47–2.22). Length ≥3 mm or a multifocal positive margin was associated with a higher risk of BCR compared with negative margin cases. On multivariable Cox regression analysis of the positive margin cohort, only apical margins significantly predicted BCR relative to basal margins (HR = 2.03, 95% CI: 1.01–4.09), whereas there was no significant difference in BCR rates for posterolateral margins relative to basal margins (HR = 1.62, 95% CI: 0.84–3.11). Propensity-adjusted modeling confirmed a greater effect of apical compared with posterolateral PSM.ConclusionsA PSM length ≥3 mm is predictive of BCR, as is to a lesser extent multiple positive margins. In contrast to open prostatectomy series, posterolateral margins carry a smaller risk of BCR compared with apical margins.     

Is proliferative colonic disease presentation changing?

AIM: To compare the site, age and gender of cases of colorectal cancer (CRC) and polyps in a single referral center in Rome, Italy, during two periods.METHODS: CRC data were collected from surgery/pathology registers, and polyp data from colonoscopy reports. Patients who met the criteria for familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study. Overlap of patients between the two groups (cancers and polyps) was carefully avoided. The χ² statistical test and a regression analysis were performed.RESULTS: Data from a total of 768 patients (352 and 416 patients, respectively, in periods A and B) who underwent surgery for cancer were collected. During the same time periods, a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies (428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B). A proximal shift in cancer occurred during the latter years for both sexes, but particularly in males. Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio (OR) 3.31, 95%CI: 2.00-5.47; P < 0.0001). A similar proximal shift was observed for polyps, particularly in males (OR 1.87, 95%CI: 1.23-2.87; P < 0.0038), but also in females (OR 1.62, 95%CI: 0.96-2.73; P < 0.07).CONCLUSION: The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade, particularly in males.