局部手法按摩用于扩张皮瓣的初步探讨

目的总结局部手法按摩用于扩张皮瓣的初步经验。方法自2006年至2007年，我们将手法按摩用于扩张器置入预扩张皮瓣患者21例（35个扩张器）。采用预定的按摩手法，对置入扩张器的皮瓣进行适当按摩。结果本组21例患者，1例因感染取出扩张器，余20例效果满意。与以往未经手法按摩扩张器置入术比较，注水速度明显增快，扩张周期明显缩短。结论局部手法按摩用于扩张皮瓣，安全可靠，效果明显，值得推广。     

地塞米松对扩张皮瓣血运障碍的救治

目的寻求扩张皮肤Ⅱ期手术形成皮瓣时出现血运障碍及防止坏死的有效治疗方法。方法皮瓣出现血运障碍时，立即静脉给予地塞米松0．4mg／kg，然后逐渐减量，术后6d停药。10d时观察判断皮瓣成活情况。结果35例出现血运障碍的皮瓣，经救治完全成活33例，大部分成活2例。成活后皮瓣色泽、弹性均好。结论及时用地塞米松是防止扩张皮瓣出现血运障碍及坏死的良好方法。     

经鼻蝶向鞍底两侧扩大切除侵入海绵窦的垂体腺瘤20例报告

目的探讨采用经鼻蝶向鞍底两侧扩大切除侵入海绵窦的垂体腺瘤的可行性。方法经单鼻孔显露蝶窦腹侧壁,蝶窦腹侧壁充分咬除,进入蝶窦,去除蝶窦黏膜和蝶窦隔,显露鞍底,鞍底开窗,放射状切开鞍底硬膜,切除鞍内肿瘤组织后,将牵开器的中心部分指向所侵入的海绵窦方向,咬骨钳咬除或磨钻磨除海绵窦腹侧骨质,显露海绵窦腹侧硬脑膜,自鞍底硬膜切开部分向外侧切开海绵窦腹侧硬脑膜,显露并切除海绵窦内部分肿瘤。结果肿瘤全部切除18例,次全切除2例。术中出现2例脑脊液漏,应用明胶海绵鞍内及蝶窦内填塞,术后无脑脊液漏。术后出现一过性动眼神经麻痹1例,术后3个月恢复正常。术后出现一过性尿崩12例,一过性电解质紊乱6例,均在1周内恢复正常。术后出院半个月后出现2例脑脊液鼻漏,行腰穿置管引流1周治愈。18例随访3～36个月,平均20个月,肿瘤无复发。结论采用经鼻蝶向鞍底两侧扩大切除侵入海绵窦的垂体腺瘤显露满意,切除彻底,无明显手术并发症。     

预扩张的跨越人体中线肩胛皮瓣治疗儿童项背部巨痣(附7例报告)

采用预扩张的跨越人体中线肩胛皮瓣治疗儿童项背部巨痣7例，将儿童颈部和背部巨痣切除后，用扩张的肩胛皮瓣带蒂转移覆盖创面，供瓣区直接拉拢缝合，皮瓣均成活良好。此方法可最大程度地减少损伤和供区瘢痕，并获得良好的美容效果。     

一种可防止扩张期切口裂开的皮肤软组织扩张器植入术

目的探讨防止扩张期切口裂开的扩张器植入方法。方法在切口部位,沿扩张区域局部轮廓切线的垂直方向切开,植入扩张器。结果注水时间早,手术周期短,无切口裂开,无其他严重并发症。结论此种扩张器植入术可有效防止扩张期切口裂开,防止包膜挛缩,明显缩短手术时间。     

Neurogenetic diseases: molecular diagnosis and therapeutic approaches

A neurogenetic disorder is defined as a clinical disease caused by a defect in one or more genes which affect the differentiation and function of the neuroectoderm and its derivatives. Genetic findings in various neurogenetic disorders are discussed. Huntington disease, spinobulbar muscular atrophy, and the autosomal dominant cerebellar ataxias are examples of autosomal dominant disorders caused by the expansion of trinucleotides (CAG) within disease genes. The CAG expansions appear to result in a gain of gene function. Prenatal, presymptomatic, and differential diagnostic tests are based on the detection of the repeat expansions. Point mutations within disease genes result in many additional neurogenetic disorders. An autosomal dominant form of amyotrophic lateral sclerosis and various types of craniosynostotic syndromes are described. The mutations in the disease genes also appear to result in a gain of gene function. Molecular diagnosis in these disorders is based on the direct examination of the mutated gene by methods such as single-strand conformation polymorphism analysis, denaturing gradient gel electrophoresis, and direct DNA sequencing. In many neurogenetic disorders the disease gene has not yet been identified. Here molecular diagnosis relies on indirect approaches based on methods such as the analysis of linkage and of allelic association. Hereditary forms of dystonia are presented as examples. Common sporadic neurological disorders such as Alzheimer and Parkinson diseases frequently have multifactorial causes. Investigations into the molecular basis and the development of diagnostic tests in these two important diseases are discussed. At present no curative therapies exist in neurogenetic disorders. Gene therapeutic approaches, however, provide promise for a cure in at least some of these diseases. Basic principles of gene therapy are explained and attempts at gene therapy in Alzheimer and Parkinson diseases are described. Finally, some of the many obstacles are summarized that must be overcome before gene therapy becomes feasible in most monogenic neurological diseases.Abbreviations AD Alzheimer disease - ALS Amyotrophic lateral sclerosis - apoE Apolipoprotein E - APP Amyloid precursor protein - AR Androgen receptor - DGGE Denaturing gradient gel electrophoresis - DRPLA Dentatorubral pallidoluysian atrophy - HD Huntington disease - MJD Machado-Joseph diseas - NGF Nerve growth factor - PCR Polymerase chain reaction - PD Parkinson disease - SBMA Spinobulbar muscular atrophy - SCA Spinocerebellar ataxias - SSCP Single-strand conformation polymorphism     

Expanding laminoplasty for cervical myelopathy-spinous process roofing technique

Summary We have carried out expanding laminoplasty using spinous process roofing technique for patients presenting with cervical myelopathy. The technique is a modified Kurokawa's method. The result shows that laminoplasty with this technique provides better postoperative neck movement with a simpler surgical procedure. The clinical material consists of 54 cases with more than 3 years follow-up. Long-term investigation was performed focusing on the following three points, (1) bony fusion rates, (2) radiographic neck movement, (3) neurological improvement. The results indicate good postoperative bony fusion in all cases. Postoperative neck movement was also well preserved in the majority of cases.     

Modeling human calcium tracer kinetics using a minimum of assumptions

Summary A conceptually simple model of human calcium kinetics, based on the Bauer-Carlsson-Linquist (B.C.L.) [1, 2] expression, is presented. The B.C.L. model assumes tracer retention in the body, occurs either in an exchangeable pool or in the skeleton, and the rate of calcium transfer from pool to bone (mineralization) is constant. As a modification, it is demonstrated that the existence of an expanding calcium pool and its rate of expansion may be directly determined from the raw data, without a priori assumptions. If data on whole body retention are unavailable, the concept of dermal tracer loss [3] as the difference between tracer excretion and whole body retention may be used to estimate whole body retention. It has been possible to compare the modified B.C.L. expression with various multicompartmental kinetic models by analyzing raw data supplied by other workers and making comparisons with their published results [4–6]. As methodologies are very different, the two sets of estimates of bone mineralization rate and exchangeable pool size have been ranked within individual groups. In five of six comparisons, the results indicate a rank correlation coefficient with a p-value better than 0.05 occurred. In all cases of data analysis from “normal” subjects, the calcium pool was found to be expanding. The existence of an expanding pool renders the model similar to a previous one [7], but the present one is conceptually and mathematically simpler in achieving equivalent results.     

拓展护理在海洛因依赖者美沙酮维持治疗中的作用探讨

目的 探讨拓展护理对海洛因依赖者美沙酮维持治疗(MMT)受治者脱失率和尿吗啡阳性率的作用.方法 将100例受治者随机分为干预组50例,对照组50例,通过对干预组开展拓展护理服务,对照组仅开展健康宣教;对比两组偷吸海洛因和受治者脱失率.结果 干预组2年脱失率16％(8/50),对照组2年脱失率50％(25/50),干预组尿吗啡阳性率半年为26％(13/50),1年38％(19/50);对照组尿吗啡阳性率半年为64％(32/50),1年为78％( 39/50).结论 实施拓展护理干预能增强受治者的治疗依从性,明显减少尿吗啡阳性率,明显降低受治者的脱失率.     

边缘供肝应用于肝脏移植的研究进展

目的 探讨边缘供肝的种类及其在肝移植中的应用前景。方法 复习国外有关边缘供肝应用于临床肝移植的最新进展。结果 高龄供体、缺血时限较长供体、脑死亡供体和脂肪肝供体是几种临床意义较大的边缘供肝。结论 虽然边缘供肝的使用给肝脏移植带来负面效应，然而其能扩大供肝来源且疗效确切。